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Thursday, December 18. 2008
I feel badly for this young Psychiatric resident at Baylor, who discussed a mutual romantic attraction to a patient with a supervisor (my bolds):
Well, I am glad she finally got to Dr. Gabbard, because he is one smart guy. Still, I found her supervisor's reponse deeply disheartening and soulless - if not neutered.
Fact is, as everybody knows, humans are prone to affection, attraction and attachment and there is nothing necessarily different about whether that occurs in a shrink's office, or between a businessman and his secretary, teacher and student, clergyman and congregant, trainer and client, doctor and nurse, lawyer and client, classmates, or business associates and office colleagues. Romantic feelings in offices (like many other emotions) are ubiquitous. Sometimes it's mutual. The proximity and intimacy of some associations naturally builds more closeness than the usual and more contentless (but sometimes powerful) chemistry of strangers in bars.
When you put people together, things of all sorts happen. Analysts and psychotherapists have the peculiar and challenging task of figuring those things out rather than acting on them.
So rather than viewing this resident's issue as a "problem," I see it as a healthy sign of vitality. Humans are, among many other things, relentlessly sexual machines and attachment machines, and no PC baloney, laws, psychoanalytic exploration, or rules could or should ever change that.
Obviously, acting on such feelings can destroy the doctor's role, potentially ruin a doctor's life, and end a patient's hope for real internal improvement. That's why analytically-oriented therapists maintain various sorts of rules and boundaries. The doc's gratification is meant to come from doing a job and from getting paid for it, but it's impossible and undesirable to remove the human elements - emotions, fantasies, etc. People fall for each other all the time: it's basic biology.
Mr. Spock would not make a good shrink.
I would go so far as to say that a shrink who never has such emotional experiences with patients is too robotic to practice in the field of intense and confusing human emotion. Of course, one must ask oneself about transference and countertransference and transference resistance and acting out and patient seductive manipulations and the state of one's own psychology and all that stuff we analytically-oriented shrinks get paid the big bucks to think about - but sometimes a cigar is just a cigar. The world is full of charming and appealing people.
Can a shrink effectively treat a patient they have lasting romantic feelings about, whether it's mutual or not? Probably not, if a chat with a colleague and a little introspection can't deal with it. Refer them out, same as one would with a patient you strongly disliked or distrusted so you can get back to doing your job.
(If any resourceful reader can figure out how to forward this post to the honest Baylor Psychiatry resident, Dr. Raymer, who wrote the linked piece, I think she might appreciate it.)
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Ah, yes, more shrink nonsense. Yes, all people (including shrinks and even lawyers, I'm told) are human, but that doesn't mean they are excused from telling right from wrong. Forgive me if I get the facts wrong here (too much "text posted on the screen of my latest piece of mobile communications technology" instead of "got a text message" and "presented for evaluation" and "countertransference" wordy crap tries my patience...is this parenthetical thought too long? Bah!) but I think the principle still appiles. I think the "therapist" indicates that knew she was attracted to the patient before the therapy started. She should have referred elsewhere right then and there. And while I sympathise with the "I would not have come for therapy if it had been anyone else but you" position, either that itself is an endictment of the profession or it's a come-on.
I'm sure someone will straighten me out for not reading the whole 2 pages of self-centered shrink crap. It's just that I get really annoyed with people who are supposedly trying to get a point across and then take advantage of our collective attention span to navel-gazing. And a shrink, no less.
Don't be silly, KRW. "...collective attention spans... navel-gazing.." haha. This is what it's about:
"I diagnosed an adjustment disorder with anxious features. We agreed that he start with an antianxiety agent and expressive-supportive dynamic therapy."
The features of his disorder were anxious. Just the features, not the patient. The 'expressive-supportive-dynamic' part is shrinkspeak for "I really want to have unbridled sex with this man. Whatever shall I do?"
I'm wondering if behaviorally oriented shrinks go through setting up boundaries and rules.
I had a crush on one of my students once. I dreamed we walked out of school together under an umbrella and that he closed the umbrella over our heads and kissed me. I woke up and my bed was on fire with lust. I blushed the next day when he came to class. shew!
Alas, Meta, where were you when I was in school? You know teachers these days just go ahead and follow through on their impulses. Then they get sent to shrinks, who...ah, fuhgetabowdeht...
haha. Maybe you have a point. But I think it's more complicated than that.
OK, so my initial read was during my lunch hour when I haven't the time to bother with shrink bs. But now that I'm home, have had my requisite martini, both olives, and dinner, the other posts here have prompted me to take the time to read the whole thing. I now understand (of course you have to read to the whole damn article to the end to understand this) that the therapist developed these feelings over the time of the sessions and did not know the patient beforehand. Sigh...
I'm sure this thread is dead but such is my contempt for the shrink profession that I feel I must post my little rant. The resident doctors are invited to express their contempt for the ramblings of this ignorant bastard, as has been done in the past, sans invitation, so here goes...
Full disclosure, I am thrilled to hear, despite what my cynical persona believes to be true, that our therapist, with proper and adequate counseling, has chosen the proper path. Granted, she still does not seem to see through to the more likely reality of the situation, but we must take what we can get. But my God, what drama. I mean really, "the tools of my trade"…”safe and effective medication with minimal adverse effects”, or so says the doctor. Hell, I don't think my blood pressure medication has "minimal adverse effects", I don't care what the label says. Every human is different and will react differently to different drugs. They're overwhelmingly fire-aim-fire tools and I doubt that the ones that act on the human brain, possibly to most complex organism known to, well, the human brain are any better. Ahh, next point...
"Birds and bees discussion with our parents when we were growing up. Mixed emotions surface when forced to discuss something so personal with an authority". An authority? Methinks she thinks a bit highly of herself. The guy’s a “neuroscience researcher” which means he’s either one step shy of a brain surgeon or…some dipshit psych major who’s uncle/father-in-law/both-at-the-same-time got him a marketing job that he’s inflated as such on his resume…on second thought, maybe she’s right. So she experienced physical attraction and he starts asking leading questions and says he thinks she's cute. Did she maybe consider dressing down a bit? Skip the makeup for a day/hour. I recommend something with a high collar and a more-gray-than-blue hue, maybe some clunky middle-age Balkan peasant shoes, but then I'm no fashion (anti-fashion?) expert.
And again there’s the phrase “He was also curious about my countertransference”…is this what “bi-curious” means? I don’t think that’s what they imply on South Park. And finally, "Was I rebelling against social norms by desiring my patient?" Yes, and I’m rebelling against social norms by posting a response to this drivel…really, I am….
And lastly, yes I lied when I said "finally", is "discombobulating" in the Shrink Thesaurus? If not I wonder where she's been slumming.
As always, you may fire when ready, Gridley.
Well aimed. No dissent here.
It was both olives that did it for me... you are obviously a person of a serious nature.
Not that I try to take myself too seriously, however...a dangerous temptation in itself.
Agreed, of course. But it at times seems to be a prerequisite here.
Roy: Well, I'm stuck, and I'm buried. I need help, and I need advice. I need counseling, I need a... I need a shrink.
Romeo: You don't know no shrinks.
Roy: I know one!
Romeo: No-ooo, no no no. Not the doctor lady.
Roy: Why not?
Romeo: You can't ask for advice about the woman you're trying to hose FROM the woman you're trying to hose!
Roy: Why not?!
the exchange is hilarious. it's from Tin Cup. one of those golfer movies ;)
I found Dr. Raymer's dilemma very moving, and even more so the admirable advice she got from Dr. Gabbard. It's rare to find a mentor so unshakeable in his ethical advice while at the same time so alive to emotional realities. Just imagine: someone who still knows how to advise feeling one thing and yet doing another. Most people would go for the easier choice of advocating either a surrender to impulse (mustn't repress!) or a denial of feeling (mustn't transgress even mentally!).
Texas!? Why I thought only steers and...never mind...I see the Dr. has given you a gold star and your point is well stated, but there's something between "surrender to impulse" and "denial of feeling" aren't one's only options. There's also "grow up". The therapist implies that she herself has a marriage and children no less. There's a lot of fish in the sea and once you've chosen and made commitments, a grown up realizes that no matter how tempting the fruit (pardon the disparaging double entente) there are other people who need to be considered. In this regard she's no different from anyone else. Ah, but except that she's a shrink and shares intimate personal details...which are the kind of things women attach themselves to. Of course this differs only slightly from the physical attractions that most men deal with every stinkin' day. But of course it's different...either because she's a woman or a shrink, not sure which, but surely someone can tell me.
I think it is different, because she's a shrink. She doesn't have the option of going cold and formal, as the rest of us would if an inappropriate but very strong sexual reaction cropped up. The relationship can't be sexual, but it has to remain both genuine and very closely engaged. It's a difficult tightrope.
What Dr. Gabbard said was, in essence, to "grow up," but instead of saying it in anger and disgust, he broke it down into elements that she could hear in her distress and confusion. In other words, concentrate more on what you're actually doing than on your secret transgressive thoughts, and pay attention to how unreal a fantasy this is. That kind of advice helps her to get a grip and act like the responsible adult she ought to be, without becoming cold or false.
I found it moving, too that the young Dr worked so hard on resisting her impulses. Opened herself up to her supervisor and tried to do a good job with her patient. I have seen other cases of analysts not controlling themselves. One example, a famous shrink with a beautiful patient. When she wanted to stop analysis because she could no longer afford it, he analysed her free for over a year. Eventually, she felt she had to move away to break free--I can't get too specific--and when he heard she was going he said "I didn't know my love was so hard to bear." My new novel Vienna Triangle is filled with examples of transference and counter-transference leading to a tragic result.
Dr. B -
Dr. Raymer works out of the Baylor College of Medicine in the Psych Dept. While I can't find her personal contact info, your best bet would probably be to send the link to the contact info for that department and ask them to bring it to her attention:
Hope that helps.
BD pointed out to me that Doc Raymer is a psychiatrist, not a psychologist, so she would be in the Medical Dept, not the Psych Dept.
And ale is very, very different from beer.
So, pulling the brim of my Investigative Reporter cap down low, I proceeded to dig into the very bowels of the Internet and came up with this plum:
I've sent her the link and invited her to respond, either as a guest post by way of me or here in the comments. Did you make it, Dr. R?
Cool. I'd love to tell her about how my wife just doesn't understand me. Did you find her phone number there also?
Wow, Texan 99 ... you gots dem words really working for you. As another Texan, I'm reely impressed!
Also, Dr. Merc, you're right about ale, "brown October" or not. And Guinness is the king of heavy beers or ales or what-have-you.
P.S. My computer has been in hospital for 2 1/2 days, and I just got it back, so I'm a little silly.
Marianne, I have always enjoyed your comments, but didn't know until just now that you were a fellow Texan. I live in Rockport, myself.
So it's OK to get all confused over my woodworking tools, but it's not a good idea to seek therapy from them?
i wonder if Dr. Raymer knows Dr. Golonzo-Perez...he "kicked me off" his blog a couple of years ago, for unknown reasons (i wasn't horrible, mean or anything) and it still hurts... :(