Ending therapy

Two events prompt me to write about therapy endings. In the more abrupt and traumatic of the two, a local psychiatrist died last month in a tragic accident, leaving many patients suddenly without their doctor. The other event, far more commonplace, was the decision of one of my own patients to stop therapy. These events […]

“I don’t want to be in therapy forever!”

In this age of managed care it may seem surprising, perhaps even suspicious, that traditional psychodynamic therapy is designed to be open-ended, with no fixed number of sessions or duration. This can be anxiety-provoking both to third-party payers, e.g., insurance companies, who prefer to know from the start how much a treatment will […]

Healthcare reform & psychiatry

The recent debates over U.S. healthcare reform are long overdue, yet still sadly inadequate. (The discussion is about health insurance, actually, not the care itself. But I titled this post “healthcare reform” since that is what everyone is calling it.) There is no need to rehash the plentiful evidence that the current system is broken: […]

Borderline personality disorder: parasuicide

In my last post, I highlighted diagnostic challenges related to borderline personality disorder (BPD): Sometimes dramatic, self-destructive behavior leads to reflexive, inaccurate use of this label, while other times eagerness to diagnose a medication-responsive illness such as bipolar disorder can lead to overlooking BPD. Naturally, this barely scratches the surface. Thousands of books have been […]

Charging patients for missed sessions

When Sigmund Freud originally developed psychoanalysis (the precursor to dynamic psychotherapy), he likened treatment fees to those for music lessons:

“As to time, I follow the principle of payment for a fixed hour exclusively. A given hour is assigned to each patient, and that hour is his and he is responsible for it even if […]

Therapist disclosure: why all the secrecy?

Happy Chinese New Year (Gung Hay Fat Choy!). As you can see from the photo, I attended the New Year’s parade in San Francisco’s Chinatown this year. This disclosure introduces my topic for today, directed toward patients and would-be patients: Why do therapists disclose so little about ourselves? Why all the secrecy?

The standard answer […]

Online anonymity and transference

I’ve been online quite a few years now. Actually, I first used the internet in college in the late 1970s. There were only a handful of non-governmental university sites back then, and I happened to be an undergraduate at one of them. A decade later, in the late 1980s, I was a member of the […]