{"id":1083,"date":"2015-08-29T16:27:42","date_gmt":"2015-08-29T23:27:42","guid":{"rendered":"http:\/\/blog.stevenreidbordmd.com\/?p=1083"},"modified":"2015-08-29T16:54:58","modified_gmt":"2015-08-29T23:54:58","slug":"hiring-the-one-armed-surgeon","status":"publish","type":"post","link":"http:\/\/blog.stevenreidbordmd.com\/?p=1083","title":{"rendered":"Hiring the one-armed surgeon"},"content":{"rendered":"

\"surgical_glove\"<\/a>Two of the most commented posts on my blog are about\u00a0charging patients for missed sessions<\/a> and how psychotherapies end<\/a>. \u00a0As there is no single\u00a0correct approach to either of these, there’s\u00a0plenty of room for practices legitimately to vary, and plenty of room for patients, i.e., most of my\u00a0commenters, to express their likes and dislikes. \u00a0By my reading, many commenters\u00a0assume that cancellation and termination policies mainly feed\u00a0their therapists’ wallets; they tend to dismiss clinical rationales that are not obvious common sense. \u00a0I’m often drawn to defend the field\u00a0and\u00a0their therapists, and to point out\u00a0that insight doesn’t always come painlessly.<\/p>\n

Other times, though, I’m just dumbfounded (or the more hip\u00a0term, gobsmacked). \u00a0One therapist reportedly<\/a> starts sessions ten minutes late on a regular basis, and repeatedly cancels\u00a0with less than a day’s notice for home\u00a0furniture deliveries and the like. \u00a0Another conducted<\/a> a therapy session “lying half dead on the couch. Her eyes were literally half closed \u2013 she was sick but didn\u2019t call ahead of time to reschedule.” Yet another disappeared<\/a> in mid-treatment and was later found\u00a0to be practicing without a valid license. \u00a0Another psychotherapist left\u00a0a voicemail<\/a> at 6 pm to cancel a\u00a07 pm appointment\u00a0because her\u00a06 pm cancelled and she\u00a0wanted to go home. \u00a0And most recently, a patient wrote that her therapist revealed\u00a0her own diagnosis of borderline personality disorder\u00a0“with narcissistic overlay,”\u00a0then\u00a0went on to cancel<\/a>\u00a0the writer’s regular weekly therapy appointment, without advance discussion or notice, following an apparent misunderstanding.<\/p>\n

It’s important to consider that these reports may be\u00a0distorted. \u00a0That is the nature of transference. \u00a0For example, patients have accused me of “yelling” at them when I clearly had not; some are\u00a0certain that\u00a0I\u00a0want them to\u00a0end treatment when that isn’t true. \u00a0It’s possible<\/em> that these therapeutic missteps\u00a0are fantasies or\u00a0exaggerations of the truth. \u00a0But I have no reason to think so. \u00a0The reported behavior sounds all too human.<\/p>\n

Why do therapists\u00a0\u2014\u00a0my colleagues\u00a0\u2014\u00a0act like this?\u00a0 \u00a0We all have momentary lapses due to fatigue or\u00a0personal\u00a0crises. \u00a0These are unfortunate but usually rare and short-term. \u00a0A\u00a0good therapist gets back on track quickly, acknowledges (and apologizes for) any hurt feelings, and repairs\u00a0the damage done. \u00a0Sometimes a particular patient really “pushes our buttons,” i.e., stirs up strong countertransference<\/a>, and we lose our composure as we are swept up in the patient’s narrative. \u00a0Ideally, these enactments are also\u00a0brief, lasting only until we step back and gain perspective. \u00a0According to some schools\u00a0of psychotherapy, they may even be helpful. \u00a0However, since countertransference can be\u00a0partially or wholly unconscious, they may unfortunately go on\u00a0much longer than ideal. \u00a0The therapist’s own therapy<\/a> may mitigate, if not eliminate, these reactions.<\/p>\n

Beyond this, however, some therapists seem impaired<\/em>. \u00a0A psychotherapist who has little tolerance\u00a0for strong emotion, who routinely engages in power struggles, who can’t stand rejection, who is excessively self-interested (or self-sacrificing!), or who has outsized needs for adoration or deference \u2014 well, that’s like hiring a one-armed surgeon. \u00a0(Not to denigrate any actual<\/a> one-armed surgeons out there, but you have to admit it’s a disadvantage.) \u00a0Certainly in traditional dynamic psychotherapy, and to some extent in any professional helping relationship, our own personalities and social skills are part of what we offer. \u00a0We need to be healthy enough to “be there” for patients, and not add to their problems. \u00a0Surely it’s possible\u00a0to pursue a career as a psychotherapist\u00a0even if one suffers “borderline personality disorder with narcissistic overlay.” But it’s a significant handicap, much like the challenges facing\u00a0a surgeon who is\u00a0missing an arm.<\/p>\n

Don’t get me wrong. \u00a0Overcoming such challenges is courageous and noble. \u00a0I’d have great respect for a one-armed surgeon if I ever met one.\u00a0 I have similar respect for those who overcome debilitating psychiatric conditions to pursue their dreams. \u00a0But from the patient’s point of view, the idea is not to give the underdog a chance. \u00a0The idea is to get help. \u00a0Given the choice, most patients would not opt for a one-armed surgeon. \u00a0Most would not opt for a psychotherapist who acts in erratic or traumatizing ways. \u00a0The difference is that the surgeon’s impairment is obvious and the therapist’s is not.<\/p>\n

There’s a cliche that\u00a0mental health professionals (MHPs) enter the field to figure ourselves out, or to deal with our own inner demons. \u00a0Like most stereotypes, it contains\u00a0a kernel of truth. \u00a0What’s important is the degree to which\u00a0we’ve succeeded in gaining that insight and conquering those demons. \u00a0What’s even more important is how our personality affects our patients \u2014 however far we’ve traveled and whatever we’ve overcome.<\/p>\n","protected":false},"excerpt":{"rendered":"

Two of the most commented posts on my blog are about charging patients for missed sessions and how psychotherapies end. As there is no single correct approach to either of these, there’s plenty of room for practices legitimately to vary, and plenty of room for patients, i.e., most of my commenters, to express their likes […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[8],"tags":[22,37,24],"class_list":["post-1083","post","type-post","status-publish","format-standard","hentry","category-psychotherapy","tag-borderline-personality","tag-countertransference","tag-transference","odd"],"aioseo_notices":[],"_links":{"self":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/1083","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1083"}],"version-history":[{"count":4,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/1083\/revisions"}],"predecessor-version":[{"id":1088,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/1083\/revisions\/1088"}],"wp:attachment":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1083"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1083"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1083"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}