![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 18 to 42 of 42. Go back in thread:
Posted by terrics on February 1, 2004, at 21:51:14
In reply to Rant in Response to All (very long), posted by Racer on February 1, 2004, at 15:32:35
Hi Racer, Your ranting was very interesting. I enjoyed it. I do have opinions on this stuff, but am usually to lazy to post them. p.s. I know my therapist breaks all the rules, but I like her. She is hetero and I am not so we won't have that problem. Well thanks for the ramble. terrics
Posted by DaisyM on February 2, 2004, at 0:32:18
In reply to Re: Therapist honesty » Dinah, posted by fallsfall on February 1, 2004, at 13:22:32
I've read through this twice, trying to put into words what I feel. I'm not sure if my Therapist holds "tight" boundaries...he is not a blank slate and does answer questions like: yes, he has kids, he told me his sign (we were talking about my birthday) he told about an author he met that we both have read, etc. He has refused to answer questions though, but we explored why I asked and he tells me why he won't answer. We start and stop on time, but he encourages calls in-between as needed and extra sessions (these are paid for, of course.) But it feels to me like he knows how to be personable without being too personal -- does that make sense?
I also appreciate his humor and wit - and the fact that he appreciates my intelligence. I don't want someone who treats me either as immature or as unobservant. (He told me once that he was aware that I missed NOTHING.) But he doesn't tell me his problems, ever, and I wouldn't engage in "his sexual fantasy" conversation with him for a number of reasons but mostly because I want to keep him in the role of someone I respect professionally. Otherwise I would quickly move into the authority role, taking over as the one in charge, as the one teaching and leading and remove any vulnerability that might be present. Maybe the best way to put it is that he seems very mature and secure with himself so we can focus on me.
So, I guess I think that while each Therapist should be flexible about disclosure, they should know themselves and their personally selected boundaries very well and be consistant about adhering to them. I think a lot of the pain and confusion I've seen posted has to do with boundaries that move-- either suddenly tighten up or get too loose.
Dinah's right -- Disclosure should be done when it is either inconsequential or theraputic to do so -- but never lightly and without fore-thought. And it might be that we don't like it, it might be painful (Racer's analogy of hand-therapy - painful but necessary to get better) but ultimately it is what we need.
It makes me think, in some ways, of being the boss. You want everyone to like you, you'd like to be their friend but most of the time you can't be. You have to "enforce" the rules. This doesn't mean that we don't apply the rules individually but most of the time the rules were created to protect both of you. Ignoring the rules in favor of "being nice" usually backfires...lessons learned the hard way.
Posted by Racer on February 2, 2004, at 14:44:58
In reply to Re: Therapist honesty, posted by DaisyM on February 2, 2004, at 0:32:18
That was so well stated and clear, and I agree absolutely. This is something that I struggle with a lot: I'm the trainer, I'm the one with the answers, I'm the one in charge, I'm the one who can't delegate because it wouldn't be done right if I didn't do it myself. In order for the therapy to be successful, I have to be willing to accept my vulnerability to the therapist, thus allowing her to play her role in the process. And that's damned hard for me to do, because I am The Boss and In Charge.
Ironically, that's what my last session was about: being able to cede control, and the fears involved.
So, here's my developing theory on this matter:
Ethical standards mostly fall into a sort of bell curve, where many things are appropriate under many circumstances, and a few things are always appropriate or inappropriate no matter what the circumstance. That means that for some of us, the PowerChargers amongst us, the therapist might be most effective by enforcing the boundaries quite strongly. For someone more inclined to be passive, stretching the boundaries might be more productive.
I liken it to child rearing. A child who is given strictly enforced boundaries, with immediate and substantive consequences for crossing them, will learn to feel secure. That's because the parent is acting as a sort of external conscience, exerting control in order to help the child learn to control himself or herself. Not control in the micromanaging sense, but control in the good sense -- like having working brakes in a car. A good parent gradually widens the boundaries as the child grows, so that the security the child has learned can grow into self confidence and an ability to adapt to new circumstances, out of which process comes autonomy, and a healthy adult.
A good therapist, in a sense, is being a Good Parent. For the individual who is locked in the helpless stage, the therapist helps define boundaries and assists the patient in learning to live within them comfortably; moving towards reassuring the patient when the time comes to start getting more independant. For another individual, someone who's learned not to trust anyone else, and that our needs can only be met by our own actions, the same Good Therapist might be more inclined to act as a safe depository for our trust, while strictly enforcing the boundaries in order to minimize our instinct to push on every potential weak spot.
OK, that got longer than I intended, and much more convoluted than I had intended. Boiled down, I agree with what you said, and see in it a starting point for defining a good therapeutic relationship.
Phew, I'm out of breath...
Posted by terrics on February 2, 2004, at 16:06:16
In reply to Excellent! » DaisyM, posted by Racer on February 2, 2004, at 14:44:58
Daisy and Racer seem to have rapped up what a good therapeutic relationship should be like. Yet in a strange and very loose-boundry way I think my therapist is good at what she does, but she sure as heck does it differently. terrics
Posted by DaisyM on February 2, 2004, at 16:19:49
In reply to Re: Excellent!, posted by terrics on February 2, 2004, at 16:06:16
And, we are back to Fallsfall's point of something for everyone is what we need, not the "one-size fits all."
I'm glad she is good for you. That is what counts.
Posted by fallsfall on February 3, 2004, at 17:31:36
In reply to Excellent! » DaisyM, posted by Racer on February 2, 2004, at 14:44:58
A very wise friend told me the other day:
"Please don't take this amiss, as it is meant in all kindness, but I do think you have a strong tendency to want to "fix the therapist" -- ultimately un-useful, except as it provides clues about you. Who you really want to fix is your parents and the trauma from way back then -- that's the core work. Turns out only thr trauma from way back then can be fixed. Very harsh reality."
Maybe we should start a "Fix The Therapist Club" - the FTTC!
Posted by Dinah on February 3, 2004, at 17:48:56
In reply to Who is in charge? » Racer, posted by fallsfall on February 3, 2004, at 17:31:36
I dunno. My therapist has improved immensely under my tutelage. (grin) Even he admits it, though in slightly different terms.
Posted by Karen_kay on February 3, 2004, at 19:59:03
In reply to Re: Who is in charge? » fallsfall, posted by Dinah on February 3, 2004, at 17:48:56
Weeelll. not to brag or anything but if anyone's taking home an award for helping improve their therapist... Well... I WIN... Gimme gimme gimme... He was expaining something to me today and I grunted and he said, "Well, you sound displeased." I said, "Heck yeah I do. You make me sound so clinical. Like you just read 'my case' straight from a text book." He never before realized that he did it. Hello, pin a bow on my head.. I'm going to the county fair..... I've helped future clients today to not feel like some clinical case when he later refers to how they aren't &^^*& able to form emotional attachments... And yes I'm still a bit upset about this... :) (But, to make matters worse, after I pointed it out he tried to retell me in a different way so it didn't sound quite so clinical. Well, I already understood it the first time he said it. He didn't have to tell me a second time... I was just upset that he told me in such a way that I was rather "removed" from the situation, as if we were talking about someone else. But, to retell me again! Oh, the nerve!!! Hello, I understood the first time. I'm not so dense that I can't understand you when you say it in a removed fashion.... Don't give me bad news twice!)
Posted by Dinah on February 3, 2004, at 20:27:12
In reply to Re: Who is in charge? » Dinah, posted by Karen_kay on February 3, 2004, at 19:59:03
Ahhh, but I taught mine how to handle clients when they quit so that they feel free to come back.
And patience. Lots of patience. :D
Posted by Racer on February 4, 2004, at 9:31:31
In reply to Re: Who is in charge? » Karen_kay, posted by Dinah on February 3, 2004, at 20:27:12
OK, obviously not a T here, but one of my clients "fixed" me once, and I'm forever grateful to her. As a riding teacher, I'm pretty tough. I will tell you you're not working hard enough, and I will tell you that the horse is not a sofa you get to lounge on. Oh, and some days I get so frustrated at getting students who've been allowed to move ahead faster than they should simply because their old teachers never took the trouble to ask them to work harder.
So, one day, one of my students said to me, "You know, you're a really good riding instructor. Just try to remember to tell us what we're doing right..."
That was like the 2x4 to get my attention. It made me a better teacher, and I've been profoundly grateful to her ever since. I'd bet we do the same to our Ts more often than we think, and I'd bet they're grateful for it, too.
(Acting on that theory, I always tell my T when she says something that really resonates for me. Maybe it doesn't help, maybe it does, but at least she gets more clues to working with me from what I point out.)
Posted by Dr. Bob on February 11, 2004, at 2:39:04
In reply to Re: Dr. Bob, A special request?, posted by Dinah on February 1, 2004, at 12:47:38
> Do you know of a guest expert who might be able to throw more light on this subject and might be willing to make himself available?
FWIW, I've been working on this, and there's someone who's willing to give it a try, but we haven't yet worked out exactly when it would be...
Bob
Posted by Parisss on February 11, 2004, at 22:44:57
In reply to Re: Dr. Bob, A special request?, posted by Dinah on February 1, 2004, at 12:47:38
As sure as we are all different, so are our Docs and therapists. I find it takes a long time to really tell if your therapist is the right one.
I have had good ones, bad ones. The worst one was one that I made the mistake of sharing some very deeep dark secret that was used to blackmail me into following paths in my therapy that I was NOT AT ALL IN AGREEMENT with. Directions that almost ruined my health physically and emotionally. If I did not cooperate, this therapist reminded me of how damaging this information could be.
I am finally free of this one. I lived in fear for too long though and what I thought was so terrible I see now was not at all what I should have feared so much. I have learned however, don't tell your therapist EVERYTHING.
Posted by fallsfall on February 12, 2004, at 10:50:15
In reply to Re: Dr. Bob, A special request?, posted by Parisss on February 11, 2004, at 22:44:57
There are evil people in the world, and some of them are therapists. It really stinks when the people we trust the most (therapists, parents...) let us down so hard. I'm truly sorry that you were hurt.
But, at some point, I think we have to make a decision of whether we will protect ourselves from every possible danger. I think that if we do that, we won't be able to live. Sort of like the only way to be absolutely sure you won't get a virus on your computer is to disconnect it from the internet. I think we do need to be wary, but I think that we will only truly live if we take some risks.
I hope that your experiences in the future are more positive.
Posted by Parisss on February 12, 2004, at 14:55:52
In reply to Re: Dr. Bob, A special request? » Parisss, posted by fallsfall on February 12, 2004, at 10:50:15
Thank you for your thoughts. I actually wish I could have hit an undo button on that last post. It was very bad advice for most people. You need to reach a point where you can trust your therapist and if you are to be helped, probably the deepist darkest area is what SHOULD be told.
My situation was unique and I should not have used it to tell others to keep secrets.
Posted by Dinah on February 12, 2004, at 17:04:18
In reply to Re: guest expert, posted by Dr. Bob on February 11, 2004, at 2:39:04
We'll try to treat them gently. :)
Posted by Dr. Bob on February 22, 2004, at 2:44:56
Hi, everyone,
I'm pleased to announce that Ms. Schmidt, a faculty member at the Institute for Clinical Social Work and the Child and Adolescent Psychotherapy Training Program at the Institute for Psychoanalysis, both here in Chicago, has agreed to be our guest expert here for the next week.
If you have any questions for her, post them here. Just put "Schmidt: " at the beginning of the subject line to let me know it's for her. I'll be the intermediary.
Discussion about the how this works -- or doesn't -- is welcome, but should take place at Psycho-Babble Administration.
OK, any questions? :-)
Bob
PS: The participation of a guest expert is intended to provide information and not advice. Her responses should not be considered diagnosis or treatment. She may suggest an option to consider, but do not infer that her professional opinion is that you personally should choose that option. What specifically to do for yourself or a loved one you should discuss with a knowledgeable professional in person.
Posted by Lyrical13 on February 22, 2004, at 16:22:59
In reply to PBP Guest Expert: Erika Schmidt, LCSW, posted by Dr. Bob on February 22, 2004, at 2:44:56
I have concerns about my younger sister who is 15. I am 34. (we're technically half sisters... same dad, different mom). Within the past year or so she has been dx'ed with a mood disorder. The first symptoms were panic/anxiety but she has since experienced severe depression. The doc has also mentioned bipolar. (MHx note: Several members of our dad's family have battled with depression/anxiety. After 13 yrs of thinking I was depressed w/ GAD I have recently been dx'ed BPII)
Back in Nov. she was talking/writing about suicide and she showed me her arms... there were scars all the way up to her shoulder where she had cut herself. They looked pretty old. I asked her how long she had been doing it and she said for 2 or 3 years. We have a very good relationship and have "sister night" every week. She is on Prozac and Trileptal. The day she showed me her arms I urged her to call her doctor. I also told her mom that she needed to see the doc immediately. They contacted her doc and he raised the Trileptal.
My concern is that she is still struggling. Falling apart during the week that her best friend was out of town. Still seems down but says she's "OK". She quit going to counseling because the counselor made her mad. She isn't seeing a psychiatrist. Her pediatrician prescribes her meds but she doesn't see him for regular visits. I have expressed my concern about this to her and to my parents. I have urged her to talk to someone else (new counselor) and to think about finding an adolescent psychiatrist. I even researched docs/counselors in the area that specialize in her type of problems. I gave the info to both parents (for some reason my step-mom thought we should keep this all secret from my dad.... I finally told him what was going on b/c a few months had gone by and my s-mom hadn't followed through on anything....she is basically trying to be the "cool mom" and not make her daughter mad. Anyway, I told my dad what was happened with HIS daughter and he thanked me and asked for more info. I gave it to him and haven't heard anything else yet.)
I guess what I want to know is if you have any other advice for getting sis some help. I am afraid she will do something to seriously hurt herself. I think I have done all I can do. I think it is in my parents' hands...and God's hands. I am so frustrated though that they aren't taking this more seriously.
Thanks for any insight or advice you might be able to give.
Lyrical
Posted by Dr. Bob on February 25, 2004, at 2:21:01
In reply to Schmidt re: sister concerns, posted by Lyrical13 on February 22, 2004, at 16:22:59
There are few things more painful than seeing someone you care deeply about suffering in that way and not be able to help effectively. You have certainly done the things I would recommend in such situations. You may want to talk further with your sister, just to say that you remain concerned about her and also talk again with your father about the situation. I'm wondering what it meant that she gave up on the therapist because she got mad -- ideally those kinds of difficulties in therapy can often be repaired and learned from and she might be encouraged to do that. I suspect that her parents are frightened by her symptoms and that sometimes leads people to minimize their concern. Don't underestimate the usefulness of your support in the long run, even if it feels like no one is paying attention to your advice.
Erika Schmidt, LCSW
Posted by ramsea on February 25, 2004, at 4:07:58
In reply to Re: guest expert, posted by Dr. Bob on February 11, 2004, at 2:39:04
I have what is considered to be a very chronic, rapid cycling bipolar 1 disorder. As a UK resident reeceiving NHS psychotherapy is possible, but one does have to wait a long time and it is not on offer indefinitely. In fact I saw a clinical psychologist for almost a year, and she terminated the relationship. She does not like working with people who are very ill, so I was out. She actually said to me, "I think we both know you come here and just sort of ramble." That hurt a lot. For several reasons.
1)I think it is HER job to ensure that our time together is fruitful. She let an entire year pass before blowing me off with that, not even giving an opportunity to change focus and work more actively on something. I thought I was doing what I was meant to do--talk about stuff. Was it really my fault that she seemingly took a whole year to tekll me I ramble too much, goodbye???? Doyou see a problem in this?
2) I am very psychological, have even been trained to be a counselor, and have studied psychology at post-grad level, though I make no claims to be a therapist. However, I do feel that with this background I should have/could have handled therapy that required the more reflective, educated sort of client who likes to write and do assignments. She never seemed to see this side of me or take advantage of these personal qualities---
3) I felt and still feel very let down by this experience. I can't afford private therapy. It looks like I am going to have to keep playing therapist for myself. I sometimes long for one of these therapists people write about, this person who isn't down on bipolar, or anti-meds (as was the psychologist I saw--she didn't believe bipolar was real and she thought most psychiatric medicines are placebos for people too lazy to take care of themselves. She helped one chronic schizophrenic I was friends with come off ALL medicines within a month's time, and he was all triumphant, even got featured in a major national mental health magazine as a real success story. Within six months he was in hospital, worse than anyone had ever seen him, and he still isn't back to his previous level of functioning.)
By the way, this psychologist is no longer working for the local NHS.
Do you have any thoughts about how a person who needs therapy, but can't afford it, can help themselves? Is there therapy on-line that works???
Thanks for your time.
Posted by Lyrical13 on February 25, 2004, at 4:15:41
In reply to Re:Schmidt re: no therapy, posted by ramsea on February 25, 2004, at 4:07:58
Sounds like your therapist was in the wrong profession. The things that were said to you were very unprofessional and IMO broke the hippocratic oath..."first of all, do no harm..." The statements made seem very hurtful to me. You are better off without this therapist. Removing a schizophrenic from all meds? Believing bipolar is all is your head and you could get better if you tried hard enough? What century is this therapist from?
I hope you are able to find a compassionate skilled therapist. In my area, Catholic Social Services provides low to no cost therapy. You don't have to be Catholic or any denomination. They accept most insurances and if you don't have insurance they have a sliding scale based on your ability to pay. If you can't pay, that's where the United Way money comes into play. I paid $10 per session when I was a broke college student.
Good luck
Lyrical13
Posted by Lyrical13 on February 25, 2004, at 4:19:42
In reply to from Ms. Schmidt: sister concerns, posted by Dr. Bob on February 25, 2004, at 2:21:01
Thank you for your help. I continue to revisit the therapy topic. I asked my dad last week if he had a chance to read any of the material and he said he hadn't yet. My sister got mad because her therapist tried to insist on my sister giving her the razor blade she carried in her pocket that she used to SI. She got mad. I think maybe it wasn't a good fit. In my mind, even though giving up the blade could be more symbolic than anything, what was the point? If she was going to SI she'd find something else to do it with. I don't know how much experience this clinician has with adolescents who SI. The clinicians and doctors I found had a lot of experience in adolescent psych and this issue specifically.
Thanks for your encouragement and support.
L13
Posted by phazedout on February 25, 2004, at 12:50:04
In reply to Re:Schmidt re: no therapy, posted by ramsea on February 25, 2004, at 4:07:58
It is really unfortunate to find another Brit in the same situation - but at least now I am beginning to realise it isn't ME! Therapy on the NHS is the pits, its short, sharp and definitely a shock. I have had 5 therapists ranging from CBT to CAT and with the exception of one (who happens to be UK's leading specialist on PTSD and I only got her by my original therapist dying) they have been totally 'untrustworthy' and IMHO unethical in their approach. I would honestly advise anyone in the UK to approach specialist counselling organisations which often offer free treatment rather than risk your long-term health with the NHS!
I was actually told by my last T that she was seeing me as and I quote "I'm not as good as the others" rofl rofl rofl (eventually all you have to hold onto is denial).
I hope you get the help you need but for goodness sake don't place ANY faith in the NHS to provide it for you.
Posted by ramsea on February 25, 2004, at 14:03:28
In reply to Re:Schmidt re: no therapy, posted by Lyrical13 on February 25, 2004, at 4:15:41
Posted by ramsea on February 25, 2004, at 14:08:43
In reply to Re:Schmidt re: no therapy, posted by phazedout on February 25, 2004, at 12:50:04
Posted by Dr. Bob on February 28, 2004, at 11:42:51
In reply to Re:Schmidt re: no therapy, posted by ramsea on February 25, 2004, at 4:07:58
Yes, I think it is the responsibility of the therapist to intervene if he or she does not think the work is productive. The question of rambling is an interesting one; in fact, therapy should be a place where a client can follow their own thoughts to see what emerges and rambling could be one way to describe that often very useful process.
I don't know what is available in the UK but in the US there are options available for obtaining low-fee or reduced-fee psychotherapy. Publicly funded community mental health centers are one place to find such services, as are institutions that train therapists which often have clinics where people can see trainees at a low fee.
While I do think there is much that people can do to deal with their own problems in living and can often find creative, adaptive solutions, I think that is different from therapy. I don't think one can be one's own therapist. The therapy process requires the person of the therapist and the therapeutic relationship as an important vehicle for change. Again, I don't underestimate what people can do, but it's different from what therapy can provide.
Erika Schmidt, LCSW
This is the end of the thread.
Psycho-Babble Psychology | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.