Sunday, July 22, 2018

Comments by Jspsych

Showing 8 of 8 comments.

  • I see delusions as a form of reification – a psychological defense in which some complex and messy is made literal. Reifcations are usually rigid, because they are protecting against complexity or depth of feeling or experience that cannot be named. A delusion is a literal and rigid belief about something that makes a feeling make sense to the person. Hence, overwhelming feelings of dread may become a “them.” Or to compensate for chronically feeling less-than, the person literally becomes a God, or has a “special relationship” to a movie star, etc.

  • This should be called “What I want in a therapist.” – not so general. This article is full of many generalizations and misunderstandings, though there is a lot of truth in it. Others have hopefully created some discussion around the blanket statement about therapists who are also parents (Parenting a special needs child was essential for me opening up as a person and made me a MUCH better therapist).

    Regarding fees: The only therapists I know who routinely slide are ones that already have money. Either they married into money, or came from money, so they do not have massive student loans and bills to pay. The other therapists who slide even if they cannot afford it are often very needy – they are needy for clients, and they are needy for the interpersonal interactions with clients. As a result, they are subtly using their clients and are more prone to act unethically or in a way that creates dependence. Almost all therapists I know who don’t slide, do have “slots” for pro-bono or low paying clients. But they do not automatically slide. It is not to “get rich” – although there are some who really are into it for that and charge accordingly. Often it is about making sure one is secure enough in a practice to do good work. If one is not secure, anxiety takes over and bad practice is inevitable. Private practice is VERY inconsistent work.

    I agree with many of your statements, especially if working with people who have sustained quite a lot of psychological damage and their suffering is immense. But we know the number 1 predictor of success in therapy is the ability to form a collaborative relationship. One does not have to be deep or radical to do this – and many great therapists get great outcomes for less serious problems.

    So again, I think you are talking about what YOU need – but your generalizations are so broad and dismissive, my hope is it does not deter others from seeking treatment.

  • It seems to me that there is a place for genetic, biological marker research, as long as it does not fall into the overly simplistic “gene for” type of thinking. As an assessment psychologist, I am well versed in unstructured methods such as the Rorschach and TAT, and have done many assessments on young children. I can tell you that the children of those who experience bipolar and psychotic states show up on these tests as having latent propensities for these states. Although they may not be actively manic or psychotic, the way they process information and deal with stress is much different than norms. That being said, the propensity does not mean one has a disorder, that these states will manifest, or one should be treated with some medication as a result of an assessment. However, psych testing, and perhaps this genetic research, can help identify those with the proclivity, and therefore can tailor interventions toward this means. For example, I was able to convince a psychiatrist to discontinue stimulant meds and convince the child to avoid marijuana due to a very psychotic testing profile with an absence of overt psychosis. I also suggested family therapy in lieu of her individual therapy to work on family communication. I could not diagnose her with a psychotic disorder, but I could clearly see the beginnings of psychotic processes in her mind. Perhaps the “biotypes” can offer us the same insight. However, I suspect you are correct in that it will become a simplistic manner of diagnosing with pharmaceutical, not therapeutic solutions.

  • Thank you for this. I, too, do evaluations for ASD, but in teens and adults. Those I work with had their diagnoses missed and had been given a multitude of other labels. The autistic women, in particular, are often missed because they learn to mask their symptoms. Invariably in these cases, receiving the label of Autism reduces the stigma. It provides community, understanding, and a new sense of self that defeats the shame of having been blamed for being different for, for some, a lifetime.

  • I wanted to share a few of stories. When I was in college, I took an internship at a VA and worked in a lab doing clinical trials on the cognitive affects of Risperidone. I was one of two employees running some of the computerized psychological tests. Before testing, I always asked the participants about themselves, their families, etc. A couple of weeks later I was removed from the tests because all of my results were coming in less disordered than that my coworker who didn’t build rapport.

    Later in life, just before graduating from grad school, I was on the subway. There was a woman with some kind of schizophrenia next to me, and across from us, two teenaged girls. The girls were laughing at the woman’s behavior, which was becoming more and more disorganized. I glared at the girls and said, “Shame on you for laughing at someone going through a pain you cannot even imagine.” I then took the woman’s hand and said, “I know it is hard when others laugh at you. It is so hurtful. Is there anything you need?” The change was instant. Her behavior stopped, she looked in my eyes, and cried. She expressed how difficult her life is, and was afraid she could not find the hospital to which she was traveling. I made sure she existed on the correct stop…by then I could not tell, aside from her appearance, that she was mentally ill.

    One last one: Again on the subway, a clearly psychotic man engaged me in conversation. He had written a detailed circuit diagram. Aspects of the circuit represented all types of government and power institutions. There were three primary batteries…The two main ones were pumping too much power, and the third was damaged. I asked if that was his family. He looked at me with glee and said, “Yes! You get it!” He was whistling when he existed the train.