Tuesday, December 8, 2015

Holiday Cheer?

It's the time of year when many employers hold holiday parties for their employees. Some of these parties will be held in venues that serve alcohol, despite the fact that approximately 10 percent of people are alcoholics or have the disposition to become alcoholic.

I've had at least one patient who was fired from a job due to alcohol-related behavior at an office party. Why would employers create situations that facilitate problematic behavior and raise liability risk for the company? Because often managers are people without common sense.

Even without alcohol, office parties may be problematic, because co-workers aren't necessarily friends. People choose their friends, but they rarely choose their co-workers.

The office party may be an attempt by the management to create an image of bonhomie among workers, an image that may  not correspond to reality.

If employers choose to hold holiday parties, they should be optional events and in no circumstance should alcohol be served.

 Increased diversity in the workplace in recent decades has not always meant increased harmony in the workplace. Many male or white employees have not made the mental transition to a diverse workplace.

Free-form banter among persons who have nothing in common except their place of employment is likely to lead to disharmony. In what may go down in history as the worst possible outcome of this type of disharmony, the recent San Bernardino shooter may have been involved in a heated  conversation with co-workers prior to the attack. (Although the couple was planning a terrorist attack for some time, it's not clear that the office party was the original intended target). One newspaper report I read indicated the conversation may have been about "Israel." Why on earth would someone initiate or continue a conversation about a controversial foreign policy subject with a co-worker he or she isn't friends with and especially, if it's likely the co-worker will disagree? In fact it looks like a deliberate attempt at provocation. I've observed, over the course of my life, that many people enjoy provoking others with whom they disagree. This isn't smart behavior, but many people do not use good judgment in social situations.

Having lived and traveled around the world, I've observed that many issues that are life-or-death to persons in foreign countries are viewed as abstractions and appropriate topics for social conversations among Americans. There used to be a commonly-repeated dictum in American social etiquette,  "don't discuss religion or politics," but this dictum has fallen by the wayside.

If you don't know your co-workers well, it's best to avoid any controversial topics of conversation.

Friday, December 4, 2015

What Questions Should You Ask A Prospective Therapist?

The most common question people ask when they contact me is "Are you taking new patients?" In most cases, the person is seeking to make an appointment, so it  would save time if the person just said 'I'd like to make an appointment."  This would result in my saying "do you need an evening slot or can you come during the day?" or "I have a time available at 6 p.m. Monday" or "I'm not taking new patients right now." All of those responses answer the question of whether I am taking new patients or not, as I would never enter a conversation about scheduling unless I was taking new patients. If I am taking new patients, we can get right down to the details of scheduling.

What type of questions should people ask when they contact a therapist? First of all, people should ask whether I take their insurance or what type of fees I charge. I am often surprised how many people ask for an appointment without asking first for this information. When I tell some people that I don't take their insurance, they are surprised. I'm often not sure where the misinformation has come from. I am on some HMO panels and not on others. Many times people have found me through their insurance directory, but sometimes people find me through the internet or personal referrals.

 A few people pay cash for their sessions. I have a sliding scale fee based on income/net worth. On a few (thankfully rare) occasions, a patient who reports a high income has tried to "negotiate" a lower fee. I offer lower fees for people with low incomes, not for people with high incomes.

I sometimes I get a question along the lines of: "What is your orientation?" People aren't asking about my sexual orientation. They're asking about my theoretical orientation. I'm never sure how to answer this question. If I gave a complete answer, it would sound like gibberish to most people. It would sound something like this: "I believe Object Relations Theory, Self Psychology and Ego Psychology are all important. I sometimes use DBT techniques for anxiety disorders and borderline personality disorder. I've been trained in Family Systems Therapy, but when I do couples counseling I mostly just take a problem-solving approach." (that isn't even a totally complete answer).  If you understood all of that, you are probably a therapist yourself.

What I usually say instead is "I'm mostly an insight-oriented therapist, but I sometimes use DBT and other techniques as appropriate." But I don't think most people understand that either. 

There are some questions on subjects other than payment and scheduling that someone might want to ask a prospective therapist:

1. Do you have experience treating (name of problem)?
2. What are the typical types of patients you work with?
3. Are there any types of patients you don't work with? 
4. How many years have you been practicing psychotherapy?

 The answers to these questions are more important than the theoretical orientation to which a therapist subscribes. 

 Newspapers, TV and the internet are full of articles about new types of therapy, often accompanied by claims that the new treatment works miracles. Never forget that today's miracle cure is tomorrow's debunked failure. Almost all of these articles are written by people who aren't mental health professionals. Some of these articles may give a false impression that one can understand different types of therapy by reading articles in the media.

 All types of psychotherapy adhere to some basic principles and most therapists today use a variety of techniques. In fact, if you come across a therapist who is wedded to a particular theory or technique,  you should be suspicious. That type of specialization only works if the therapist is willing to refer out all patients who need a different type of therapy, and in today's economy, most therapists need more patients, not fewer patients. I do refer out people who need a type of therapy I don't do. But mostly I have a general practice that allows me to see a wide variety of patients. Most of them get better.