“Do you analyze everyone you meet?”

People sometimes wonder whether I “analyze” everyone I meet. This is usually asked with some fear that as a psychiatrist I can “see right through them” and instantly know things about their innermost thoughts they’d prefer to keep hidden.  Although this is true (just kidding), I try to reassure them with the following analogy.

Imagine an architect whose business and personal life includes walking into and out of buildings all day. Does the architect “analyze” every building —  home, coffee shop, office, gym — all day long? I doubt it. Perhaps if a particular construction is especially creative, or unusual, or singularly beautiful or ugly.  But most of the time an architect relates to buildings the same way everyone else does: for the personal reasons he or she visited there.  (If there are any architects out there, please confirm!)

In my experience the same is true of psychiatrists and other mental health practitioners. We deal with people all day, both professionally and personally.  When working, our attention is directed in a certain way, toward understanding the person in front of us.  After all, this person paid good money for us to focus our attention exactly this way.  Other than this, though, we deal with loved ones as loved ones, colleagues as colleagues, store clerks as store clerks, and so forth.  It is only when someone’s personality or behavior is noteworthy and unusual that we may find ourselves viewing them momentarily through our “psychiatrist glasses.”

I’ve heard it works similarly for doctors and medical diseases.  Occasionally a case of acromegaly, cerebral palsy, rheumatoid arthritis, or psoriasis can be diagnosed in a stranger on the street, or in a crowded elevator.  Most of the time, though, people are just people.

The question about analyzing everyone often seems to harbor some anxiety.  It feels threatening to have possessors of mystical and limitless insight lurking among us, wantonly tearing holes through the public persona and self-image of each innocent bystander.

Fortunately, this is a fantasy.  Being a psychiatrist doesn’t make me a mind-reader.  It usually takes an hour of formal intake interviewing before I begin to have a sense of a person’s personality.  Often it takes more than one session. While it’s true that people, not just psychiatrists, can pick up clues to personality early in a conversation, psychiatrists aim more for accuracy than speed.   Instant on-the-fly psychiatric diagnosis or case formulation is fraught with uncertainty and error because it is based on insufficient data.  As professionals, we are trained not to shoot from the hip, and for good reason: because our opinion should mean something.  If the considered views of psychiatrists are to matter more than the hunches of untrained persons, we must refrain from offering half-baked, “cocktail party” assessments.  I cringe when I hear a colleague spouting off about a politician or celebrity known only through the media.  A detailed study of someone not personally interviewed, e.g., a psychohistory, may be defensible; an off the cuff opinion cloaked in psychological jargon is not.

“Analyzing everyone we meet” is literally impossible, and as in the case of the architect, would be a huge distraction from everyday life.  Moreover, even attempting it is unprofessional.  We should reserve any such analysis for the clinical office, where the setting is conducive, and the data sufficient, to make a meaningful assessment.

7 comments to “Do you analyze everyone you meet?”

  • The same thing can be said about priests. For a short time, my major in college was religion. Just because I was enrolled in religious courses didn’t mean that I “analyzed” people as sinners, pointing out what each person did wrong in my mind. The goal of religious counseling is not to beat people down for their shortcomings, but to help them become better people and to become more conscientious in doing good things for other people. Religion helps to bring out the mercy in people, but if it isn’t practiced in a sense of love for oneself, others, and God, can also breed a lot of hatred. Overall, assumptions that one analyzes someone all day are often unwarranted and may even be a hindrance to the relationship that one would share with their therapist.

    Thanks for sharing and I wish you the best!

    Alison

  • Sharon

    Shooting from the hip can result is fixing something that is not really broken. I understand and agree. If your so inclined could you share your thoughts on grief and loss.

  • Don

    Couldnt have said it any better myself! Can’t tell you how many times I’ve encountered that reaction, and been asked that same question… Not to mention the number of potential dates I’ve frightened away!
    I enjoyed coming across your blog…
    Don….UCSF psychiatry class of ’89

  • Penny

    Here is the thinking from the other side. I lived with a “psychotherapist” for over 25 years. He analyzed my every move, yet he never had any counseling. He said things like “you would just trash me” He constantly used psychiatric terms in his interactions with me, calling me every psychiatric term possible. He told me things like “You have repressed memory syndrome” Your mother gave you PTSD”
    It eventually ruined our relationship. I can tell you how harmful this is. I have come across a web site that suggested that therapists can do this without even thinking about the ramification on the “other” person.

    I have since learned that their were other people in his life who ended up avoiding him due to his analyzing them. I wonder does the use of therapeutic terms become second nature to them. Let’s face it if I am a teacher I can assist my children more than someone who is not. Sometimes “psychotherapists” and I think this term is overused and too vague, use therapy at least in their intimate relationships harming people.

    I also hold a counseling degree, but I actually work in education. This made our relationship interesting because I knew when he was using “therapeutic principles” I knew when he was using CBT, or rational therapy, or psychoanalysis etc., but other people don’t necessarily know and that is potentially an issue.

    I advocate that ALL therapy training school at least require courses that address the issue of abusive therapy unethical therapy and call it that. Therapists need to learn that intentionally, or unintentionally the use of therapy outside the office harms others. If I want counseling I choose my therapist and I pay for it. I call this type of “forced therapy” intrusive and unwanted.

    Food for thought…..

    • You raise an important issue, although it’s a different one than I raised in the original post. I was writing about “analyzing” casual acquaintances or even total strangers. Instead, your comment is about someone who uses psych jargon in a hostile and highly defensive way. This type of verbal abuse isn’t necessarily limited to trained mental health professionals. I’ve run into untrained people who do this too. I would say the main problem is their underlying hostility and lack of insight, not the specific tools they use against others.

      The use of psych jargon to avoid insight and psychological change is a related matter that I sometime discuss with psychiatry trainees. A long-time patient — or a patient who is a mental health professional himself — may know all the lingo, but may use it to fend off actual introspection. The words can be hollow and without real feeling, a type of sophisticated defense. I sometimes have trainees read this technical paper. Thanks for writing.

  • Penny

    Thank-you for the response. I read the link and will read the entire article. This being the case, I wonder if it points to the absolute need for practitioners or students who pursue this field need to undergo therapy, and maybe even psychological testing as a condition of their education?

    If their are in fact practitioners who use psychological jargon in a hostile and defensive way, and they themselves are avoiding introspection and change should they in fact being practicing therapists? Are they able to truly assist their clients?

    In your opinion what steps might schools and oversight agencies tske to prevent this from happening to people? I would really like to see that no one in the future can be harmed by pursuing therapy with such an individual.

    • It’s not an easy problem. Professional training programs interview their applicants, and reputable ones try to weed out those with obvious personality issues. Maybe psychological testing would assist in this, although such testing is rarely definitive. Less reputable programs probably don’t even try, yet the licenses of their graduates are just as valid. Forced psychotherapy is almost a contradiction in terms, as a person who sees no need for treatment or introspection can attend psychotherapy for years without ever truly engaging in it.

      Practitioners who are hostile and defensive (whether or not they use psych jargon to that end), and who avoid introspection and change are unlikely to be helpful as practicing psychotherapists. This may be especially true for psychodynamic therapists, where one’s own emotional reactions (countertransference) are an essential tool for treatment. Yet I’m hesitant to make a blanket statement: I’ve run across a therapist or two over the years who struck me as quite impaired themselves, yet certain patients loved them. Such therapists can’t help (or connect with) most people, but there are always exceptions.

      Which brings me to your question about what schools and oversight agencies can do. As I see it, not much. There is a fairly wide range of “normal” when it comes to personality. Some people are pleasant, others more grouchy or irritable. Some have a personal ax to grind, a chip on their shoulder, a prejudice. Schools for mental health professionals point out clinical errors in their trainees, and connect these errors to the trainees’ personality when appropriate. But the point of doing this is to help the trainee do the right thing, not be the right person. Many training programs encourage, and some demand, that their students be in therapy themselves. But this is rarely to treat a personality disorder, and more to “tune” a functioning personality to be even better. Ultimately it comes down to breaking the rules or hurting someone, at which point a school or oversight agency intervenes. To that end, it can be very helpful to report a harmful therapist to their state licensing authority, bearing in mind that such complaints are usually subjective and open to different interpretations. There is also “word of mouth advertising”, both positive and negative, although these are unusual in mental health treatment. Wish I had better news or ideas for you.

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