Tuesday, September 18, 2018

Goodbye New York

As my current patients know, I'm relocating to California next month.

New York has been good to me in many ways, but I've developed a chronic knee condition that makes taking the subway impossible. I've always loved Northern California, and I have family there. I've been thinking about moving there for several years, and now is the time.

I'm in the process of obtaining the California LCSW license and will be looking for a job. I'm not sure when I'll try to start a private practice, as I want to get some exposure to other professionals and general practice in California first.

Sunday, May 27, 2018

Is Marijuana Safe?

I've long been suspicious about claims that marijuana is harmless. I was interested in this article in the Washington Post, by a neuroscientist. Any drug changes the body's chemistry.

Tuesday, May 15, 2018

College Students and Suicide

Recently The New York Times published an article about a growing controversy: As more college students commit suicide, parents are frustrated by medical and academic confidentiality laws that seemingly have prevented the colleges from contacting them about their children who are having mental health problems. What should be done about these situations?

When new patients come to my practice, I have them fill out a form that includes space to list an emergency contact. So far, no one has refused to name an emergency contact. I've only called an emergency contact once or twice in 16 years, but it is necessary for me to have this information, because someone's life could be at stake.  Why don't colleges and universities do the same? I don't know. Perhaps their administrators believe psychiatric emergencies aren't their purview.

Of course, it's possible that a student would list someone other than his or her parents as emergency contacts, in a university setting. But that's not the point. The point is that there should be someone who can be called who can assist the student in accessing resources--that could include calling the parents, as laypeople aren't bound by confidentiality laws.

An emergency contact person is ideally someone who is willing to escort the person to an Emergency Room or stay with the person until the crisis is over.

In a genuine emergency, confidentiality laws don't apply. If someone in my practice tells me that he or she is planning on committing suicide, I ask to escort them to the Emergency Room, and if they refuse I would call 911. I do not need a confidentiality waiver to call 911, but, I have in fact never needed to call 911, because every time, the person has agreed to go to the hospital. A college counseling center should be staffed by licensed clinicians who are obligated to work with their patients the same way that I am.

What about situations in which a college student is deteriorating, but it's not clear if it's an emergency? The student should be asked to take a leave of absence for a semester and engage in mental health treatment. Then the treating clinician should be asked to sign off on a form stating that the patient is not at risk, before the student can resume classes. Of course, it's possible for someone to relapse--but at that point the parents could not reasonably claim they didn't know anything was wrong. If they are in contact with their child at all, in most cases they would at least  know that their  child was not attending school that semester.

Thursday, January 4, 2018

Some Important Tips About Being in Psychotherapy

Over the past 30 years, the general public's understanding of psychotherapy has declined. This is because of the growing influence of health insurance companies and pharmaceutical companies, which prefer that people take psychiatric medications rather than going to psychotherapy. It's not uncommon for me to hear patients use the verbiage of pharmaceutical companies without realizing they are doing so. This societal change has caused problems for me and other therapists.

Here is a brief summary of some aspects of being in psychotherapy and how therapy works, that used to be common knowledge but are now mostly unknown among persons under 45:

1. You do not have to use normal social rituals with your therapist. You do not have to shake your therapist's hand, ask them "how are you?" or inquire whether they had a good time on their vacation. It's the one type of  relationship that's about you and not the other person, and this is part of why and how psychotherapy cures.

2 Your therapist wants to hear everything. I discussed this in a previous post. Your history of sexual abuse, your porn habit, your poor money management and bad credit--people go to therapy to talk about the things they can't talk about elsewhere--that's one of the reasons why therapists exist. If you tell lies to your therapist or avoid mentioning important information, your therapy will not be effective.

3. If your therapist confronts you on something you did or are doing in therapy, such as repeatedly showing up late, or behavior in the session, such as sexual provocativeness, the purpose is for the both of you to explore what the behavior means. You do not have to say "I'm sorry." Instead, you should ponder the meaning of your behavior and work with the therapist to understand it. Things that other people say that are meant as criticisms are meant by your therapist to prompt self-exploration. (On the other hand, if the dysfunctional behavior continues, the therapist has a right to stop working with you).

4. The reason for #3 above is that an important part of what's called "insight-oriented therapy" (also known as psychodynamic therapy or psychoanalytically-oriented therapy) is a discussion of the dynamic between the therapist and the patient. In longer-term therapy, particularly therapy that lasts more than two years, patients often undergo a regression and start re-enacting childhood behaviors with the therapist. This is a phenomenon known as "transference." In some cases it is very important for the therapist and patient to discuss the interaction between them and what it means, as behavior in the session may reflect long-standing behavioral patterns or relationships in early childhood.

Psychotherapy is about more than learning "coping strategies." A patient could research coping strategies on the internet. Ultimately psychotherapy is about personal growth through a specific type of dyadic relationship. Psychotherapy harnesses the human tendency to grow and develop through interaction with another person. When psychotherapy is effective it is a permanent cure--perhaps not a 100 percent cure, but a cure that does not go away when the therapy ends--unlike medication.

Your Privacy

This morning I read this story in The New York Times. Not to worry--because I'm old-fashioned (as well as verging on old) I don't keep patient records in a "cloud" or even on my computer. My records are written in pen-and-ink and are stored in a locked file cabinet in my apartment in a doorman building.