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Understanding The Subtext Of The Therapeutic Relationship

When we talk about psychotherapy, one aspect of what we look at is the process of what occurs in the therapeutic relationship.  This is an important part of psychodynamic-based psychotherapy, meaning psychotherapy that is derived from the theories put forth by Freud.  Psychoanalysis (the purest form of psychodynamic psychotherapy) includes an emphasis on events that occurred during childhood, and a focus on understanding what goes on in the relationship between the therapist and the patient, including the transference and counter-transference.

In some of our posts, our friend Jesse has commented about how it’s important to understand what transpires in the mind of the patient when certain things are said and done.  Let me tell you that Jesse is a wonderful psychiatrist, he is warm and caring and attentive and gentle, and he’s had extensive training in the analytic method, he’s on my list of who I go to when I need help, so while I want to discuss this concept, I don’t want anyone, especially Jesse, to think I don’t respect him.  With that disclaimer…..

On my tongue-in-cheek post on What to Get Your Psychiatrist for the Holidays, Jesse wrote: Read more »

*This blog post was originally published at Shrink Rap*

The Stigma Of Psychiatric Treatment And Its Inclusion In The EMR

For a while now we’ve been talking about issues related to psychiatry and electronic medical records.  Roy is very interested in the evolution of EHR’s.

I don’t like them.  I think they have too many problems still, both in terms of issues of efficiency and time, and how they divert the physician’s attention away from the patient, and they focus medical appointments on the collection of data– data that is used in a checkbox form: patient is not suicidal and I asked, whether it was clinically relevant or not– and will therefore serve as protection in a lawsuit, or demographic information used by insurers, the government, who knows.

From a privacy standpoint, I think they are appalling.   If you are a patient in the hospital where I work, you get Read more »

*This blog post was originally published at Shrink Rap*

Research Suggests Certain Professions Are More Associated With Schizophrenia

People with schizophrenia or bipolar disorder and their first-degree relatives more frequently work in creative professions, suggesting some truth to the long-mythologized link between artists and madness. The way the link plays out along family lines suggests a genetic cause, researchers reported.

While smaller studies have looked specifically at small groups of creative populations such as artist’s workshops and their rates of mental illness, researchers in Sweden conducted a population-based study of how often mental illness occurs among people and their relatives, and its association with creative and non-creative professions.

The researchers performed a nested, case- control study using longitudinal Swedish total population registers and compared it with occupational census data. Creative professions included visual artists such as photographers and non-visual artists such as performers and writers, as well as members of the scientific professions among university academics. Accountants and auditors acted as a control group.

Results appeared in The British Journal of Psychiatry. Overall, Read more »

*This blog post was originally published at ACP Internist*

Conference Covers Topics About Psychiatry And Law

Regular readers know that every year I tweet and blog from the conference of the American Academy of Psychiatry and Law. This group of forensic psychiatrists consists of about 1800 of the country’s practitioners. Topics are quite diverse and sometimes rather unusual. It’s a lot of fun. Here’s just a small smattering of factoids I picked up last week:

  • The “sovereign citizen” defense can prompt a competency eval, but is not a delusion. The sovereign citizen movement is a recognized subculture of people who believe the government has no jurisdiction over them.
  • Of 200 defendants cleared by DNA, one-fourth had confessed to the crime.
  • According to FBI uniform crime reports, Read more »

*This blog post was originally published at Shrink Rap*

New York Times Reports On Very Atypical Case Of Schizophrenia

Benedict Carey is a New York Times mental health reporter.  In last Sunday’s Times, he wrote about Joe Holt, a man with a diagnosis of schizophrenia.  Mr. Holt was dealt a particularly tough deck of cards: in addition to a diagnosis of schizophrenia, he had a horrible and traumatic childhood with much loss, placement in a facility where he was physically abused, and periods of homelessness as a teenager.  He now has a stable marriage, has adopted children and keeps numerous foster children, and holds two jobs, one as a computer consultant and another as a therapist (if I read that correctly).  He struggles with his emotional life, but my take on this was that this is one extremely resilient man who has waged a successful battle against many demons and his story is inspirational.

So Benedict Carey often writes stories that are skeptical, if not outright critical, of the mental health field.  This story did not have that tone.  I found it interesting, though, that he chose a person with a diagnosis of schizophrenia who’s life was not “typical.”  What did I find not typical? Read more »

*This blog post was originally published at Shrink Rap*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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