Not touching ground at all

22 08 2017

Sucks to look for a therapist.

Physician? Not a problem: as long as the person’s competent and friendly (enough), I can work with him or her. I found my current doc via a walk-in service I used when insurance-less; now insured, I still see her, and she’s fine.

But a therapist? I gotta click with the person, and since I don’t know ahead of time who I’ll think, Yeah, okay, this is someone I’m willing to talk to even when I’m unwilling to talk, it’s a pain in the ass to search.

Well, that, and that I’m looking for a therapist means I’m NOT IN THE MOOD to be looking for a therapist.

I’ve had two good therapists, one nice-but-not-great one, and a number of non-starters. The two good ones were nothing alike—one was a younger psychiatrist who taught in the UW med school and was laid-back in her approach; the other was older, had a master’s in counseling psychology, and pushed—but both were tough and kind. I trusted each of them as much as I’ve trusted anyone.

So, beyond “tough and kind”, I don’t really have a type. I’ll know within a session or two—well, honestly, I’ll know within one session if I cannot work with someone, a few more if I can—which means I have to do the therapeutic equivalent of speed-dating before deciding on a relationship.

This shouldn’t be that big of a deal: meet for an introductory session, and if it works, great, and if not, well, it was only one session. But this seems like an enormous obstacle when one is NOT IN THE MOOD to be doing much of anything—which is, of course, no small part of the reason why I’m looking for a therapist in the first place.

I’ve been avoiding looking for months, but tonight I finally hopped on to my insurer’s website and looked for therapists who a) they covered; b) dealt with affective disorders; c) were in a convenient location; and d) had a schedule which would accommodate my own. I found three who met these criteria, although if none of these work out, there are plenty more available.

Now, having managed to drag myself out of my torpor long enough to find some possible therapists, I need to maintain this momentum (hah!) to confirm that my insurance coverage does, indeed, cover the therapist AND THEN book an appointment! Horrors.

Do I have it in me? I’d better, if I’m not to sink any further into this lassitude. I’m not in crisis, which makes it easy to put this off, but if I put it off too much longer, well, I might still be fine, or fine enough.

But knowing what not-fine is like and that that’s a risk? Yeah, I’d best get on this.

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The rest is silence

9 06 2013

Say nothing.

I am, as you may have guessed, a talker, someone who always has something to say and almost always knows how to say it. I can be quite obnoxious—always something to say—but also useful in social situations. And as a professor who glances at rather than reads her notes, the ability to float words into air comes in handy.

Like a lot of talkers, I can be unnerved by spaces without sounds. I almost always have the radio on, and in class I’ve had to force myself after tossing out a question to wait one, two, three or more beats for a student to grab it, rather than reeling it back in immediately. I’m a pushy broad who has to restrain herself not always to push so hard, to give time to the laconic to make themselves heard.

Yet whether despite or because of that need for words, I know the force of silence.

When I was an undergrad I went into therapy, briefly, with a psych resident, J. She was. . . fine, I guess, but I was pissed off and messed up and deeply, deeply ambivalent about therapy. I was abashed at my need to talk to someone, so—I could see this only in hindsight—cast about for any reason not to talk.

J. gave me that reason.

Not on purpose, of course. It’s just that she had this rule that she would follow no matter what: the client had to start the conversation. Well.

The first coupla’ sessions I’d wait a bit, and then start in. J. would follow up, but too often in that Interviewing-101 kind of way.

Me: I’m just, I’m always worried what people are thinking of me, like I’m doing something wrong.

J: So you’re feeling kind of judged, huh?

(I don’t know if that’s exactly what I said, but I do remember, for whatever memory is worth, her saying that exact phrase back to me.)

It got worse from there. There was a large plant next to the loveseat on which I sat, and while I could see J. concentrating the hell on me as she shifted from one attentive position to another in her office chair, I’d  lean back, finger the leaves of that plant. And say nothing. Five minutes. Ten minutes. By our later sessions, I was silent for 20, maybe even 30 minutes.

Did I mention that, because she was a resident under supervision, all of our sessions were taped?

I was an asshole, and while some of the jerk things I did while I was messed up were due to my being messed up, this wasn’t one of them. I knew I was being an asshole, knew that she’d have to go back to her supervisor with that half-blank tape—knew that by not talking I had power over her—and I enjoyed it. You gotta rule about who talks first? Yeah, well, here’s what you can do with that rule!

I did, finally, put an end to it all. I don’t remember if I thought, Okay, quit being a jerk or This ain’t working or some other mashup of decency and practicality, but I knew that this particular therapeutic relationship was stillborn.

The ambivalence over therapy remained, even throughout two good, if difficult, therapeutic relationships (as well as a number of abortive ones), but in those good relationships I tried not to be an asshole, tried (not always successfully) not to use silence as a weapon. I did more often use it as a shield, but in a decent therapeutic relationship you learn—well, I learned—that the person sitting attentively a few feet away from you might just want to help, and that the best way for that attentively-sitting person to help is to tell her how you need help.

And thus the ambivalence, all the way through: The need beyond desire to tell, and not tell, on myself. Was it revelation or betrayal? The urgency of that question faded, but never entirely went away.

All of this is a verrrrrrrrrrrrrrrrrrrrry long prelude to my own disquiet with the social admonition to reveal oneself. Now that I’m no longer so neurotic that I worry much about what people think of me—mainly because I folks have better things to do than think of me—I wonder about the social pressure to display oneself, be it on Facebook or Foursquare or whatever. If you don’t know me, what should it matter that I’m not visible to you? (And if you do know me, well, there are other ways to get in contact with me.)

Most folks I know who are on Facebook like it because it’s a great way to connect with or keep up on friends, and thus don’t really get my unease with the platform. It’s just a. . . thing, nothing more.

I don’t see it that way, of course. Yes, on one level it is just a thing, just a handy tool to stay on top of relationships, but on other levels it’s a signal of your interest in others, a scripted performance of oneself, a marker of one’s willingness to go along with social expectations, and, of course, a vast database for a corporation to mine for profit. To choose not to participate is to set oneself apart as an object of suspicion.

Think that’s too much? I don’t want to hang too much on example, but. . . I’m going to hang a lot on this interchange between Farhad Manjoo & Emily Yoffe on Slate:

Farhad: . . .That question came up in the context of a debate about online dating. I said that if you’re going to set up a date with someone and you can’t find anything about them on Facebook… I’d extend that to other social networks. If you can’t find a photo of them and there’s no photo on the dating site either, then you should be suspicious. That person seems to be trying to hide something.

Emily: We’re all trying to hide something, Farhad.

Farhad: Well, the person might be married or have a girlfriend, or in some ways trying to hide their activities. I don’t think it’s a slam-dunk case. I don’t think that’s necessarily the situation, but I would be a little bit suspicious.

But to the letter writer’s question beyond dating, I think that it’s better to have a social networking profile for a couple reasons. You are taking control of your online life then.

[. . .]

And if you don’t have [an online presence], I think people will judge you based on that. . . .

I’ve looked at the numbers for Facebook. If you look at the demographics, it’s not like only young people have Facebook. It pretty much cuts across most demographic lines, and from what I can tell, also socioeconomic lines. They have a billion people around the world. Lots of people are on Facebook and I think you’re kind of judged now, for better or worse, if you don’t. [emph added]

Manjoo is a tech fanboy who is puzzled by any criticism of tech which is not about glitches or efficiency—he does not get the concept of social-techno-coercion—and thus ought not be considered a general representative of all social media users.

But he ain’t alone, either. Consider Senator Lindsay Graham’s response to concerns about the NSA’s vacuum-cleaner approach to electronic information: “I don’t have anything to worry about because I’m not talking to terrorists.”

And there it is: If you have nothing to hide, you shouldn’t be afraid to show—with the barely concealed implication, If you don’t show, you must have something to hide.

Do I have something to hide? Like Emily Yoffe, I’m of the belief that “We’re all trying to hide something”, that it’s normal to keep a few things to oneself and not something which has to be justified.

It’s also normal to want to share oneself, not to hide away everything. Even as I’m a non-Facebooker, I am a blogger, and I call and text friends and colleagues and regularly go out in public. I’m a private person in society, someone who believes one ought to be able to be both private and social as she sees fit.

 

To bring this back around, not all or even most of my political beliefs can be traced in any direct way to my personal experiences, but my views on privacy and sociality are most definitely jacked into something deep inside of me. Even as I write that “I’m a private person in society” I fret over the tension contained within that assertion, wonder if it is possible to be both without betraying either the private or social side of me.

In the end, I think I ought to be the one who decides whether to speak, or not. More than that, the conditions under which I choose to speak ought not unduly pressure me one way or the other. I get that there will always be some pressure, but there should be freedom, too.

And if not, well, I like to talk, but if you tell me I have to talk, I’ll enjoy your frustration as I lean back, and say nothing.





Now give me money, that’s what I want

6 03 2011

Dr. Donald Levin feels bad.

The psychiatrist is no longer able to treat patients with talk therapy, is no longer able to meet with them for those regular 50-minute-hour sessions, no longer able to sit and take in the vagaries of human existence. Instead, he must limit himself to 15-minute increments, enough time to write a scrip for meds but not, alas, much time to get to know them, or even remember their names.

As he told a reporter from the New York Times,

“I miss the mystery and intrigue of psychotherapy,” he said. “Now I feel like a good Volkswagen mechanic.”

“I’m good at it,” Dr. Levin went on, “but there’s not a lot to master in medications. It’s like ‘2001: A Space Odyssey,’ where you had Hal the supercomputer juxtaposed with the ape with the bone. I feel like I’m the ape with the bone now.”

I had some sympathy for Dr. Levin. Insurers are stingy in reimbursing all types of medical care, and can be especially stingy in mental health care. Levin has to pay the bills, which means adjusting to a reimbursement system which pays him more and more reliably for those 15-minute increments than it does for the 5/6 hour.

But then I read this:

He could have accepted less money and could have provided time to patients even when insurers did not pay, but, he said, “I want to retire with the lifestyle that my wife and I have been living for the last 40 years.”

“Nobody wants to go backwards, moneywise, in their career,” he said. “Would you?”

My sympathy shriveled.

There is still a nugget of fell0w-feeling: The man has lost a way of life which was both congenial and supported him, and loss is loss.

The shrivel comes in, however, insofar as he made a choice: Psychotherapy or money, and he chose money.

A very practical choice, and not one to be gainsaid. After all, as the article pointed out, a psychiatrist can make $150 for three 15-minute med visits versus $90 for 50 minutes of talk therapy. Levin (with help from his wife, a former psychotherapist), now works 11-hour days and sees around 40 patients per day. They charge for missed appointments, faxed refills, and penalize for missed co-pays.

It’s quite a business they have set up, and the patients who spoke to the reporter seemed satisfied with their relationship to Dr. Levin.

But here’s where the shrivel comes in: Levin chose this business. Not a “free” choice, true, but most vocational choices are not. He could have chosen to continue to practice psychotherapy and forgo the money; he could have chosen to mix psychotherapy with the scrip mill, sacrificing some money but keeping some of the “intrigue” of the therapeutic relationship; or he could turn his office into a full-time scrip mill, in order to maximize financial returns—which is, of course, what he did.

He may lament the consequences of this choice, but, as he noted himself, he wanted the money. More than anything else, he wanted the money.

I don’t begrudge him that. Really. There is nothing dishonorable in what he’s doing, and, as noted, he appears to be helping his clients.

But I also don’t know why I should in any way care about Dr. Levin’s lament that “I had to train myself not to get too interested in their problems”—because doing so would mean he’d spend too much non-reimbursable time with them.

He might genuinely feel bad about his loss, but if so, he’s crying all the way to the bank.





No comment

2 09 2010

On giving a two-year old antipsychotics for bipolar disorder:

“It’s a controversial diagnosis, I agree with that,” said Dr. Concepcion. “But if you will commit yourself in giving these children these medicines, you have to have a diagnosis that supports your treatment plan. You can’t just give a nondiagnosis and give them the atypical antipsychotic.”

Emphasis added.





Targets and stray arrows

3 01 2009

The Dawn Chorus linked to this story in the (Australian) Courier-Mail, ‘Economic decline sees return of 1950s housewife.’ An (apparent) DIY sensibility toward food and clothing = housewifery!

That’s right, girls and boys, any turning away from corporate culture means a return to those mystical 1950s gender roles. After all, MEN certainly couldn’t be interested in gardening, cooking, or sewing, could they?

After all, the poll embedded in the story asks: Where should a woman’s place be?

Possible answers: In the home; in the workplace; both; wherever she wants.

Ha. Now, about man’s place. . . .

_____

C.’s blog is finally up and running. I’d been nagging and trying not to nag her into getting this sucker going, not least because I’m looking forward to our conversations and arguments.

SoundofRain.net

Check it out. I’m expecting brilliance. (But no pressure, C.)

_____

Reconnected with an old friend/colleague from my FelineCity days. Ct. works at a university in Ontario, and writes on nationalism (among other matters).

It is directly a result of her arguments in favor of some versions of nationalism that has caused me to rethink my absolutist stance against it. I’m still a skeptic, but Ct.’s observations that nationalism isn’t always exclusionary or aggressive (and that, sometimes, even when it is, it has its purposes) has intruded in and unsettled my thoughts over the years.

So I’m glad she’s back. A friend who can calmly unsettle you is a good thing!

_____

I never read blogs before I started writing my own. I have my regulars now (some of which—the political ones, natch—send me into a ditch screaming), but I still poke around, looking for something to catch me.

Admittedly, this is partly out of self-interest: I’d like it if others would be willing to be caught by me.

But it’s not all calculation, given that I find sites I truly enjoy. Mo at The DailySnark cracks me up, and I’ve just started reading bandnerdtx.

Should I overreach and say that this approach justifies my avidity for messiness? That a mix of motives can itself increase hybridity, leading one ever further into. . . .

Okay, okay, I’ll save me huffin’ an’ puffin’ fer another day.

_____

Struck by silence. Still in the midst of Tremlett’s Ghosts of Spain, and he makes much of both silence and forgetting. (They are not, of course, the same thing, and the holding of one’s tongue can, in some circumstances, lead to the preservation of memory. But I’ll save that for another time.)

I tend to think well of silence, seeing it (among other things) as a refuge from authority. I’m a terrible liar, but even I, of the endless words, knows how—and when—to keep my mouth shut. Sometimes silence is the only defense one has.

Of course, silence can also be self-defeating. Silence while in a therapist’s office, for example, tends to work against the purpose of therapy. Still, my determination to hold my tongue did lead me quickly to end one budding therapeutic relationship:

I was in college, self-destructive, and, uh, encouraged by the dean’s office at BigTenU to seek therapy. So I saw one person, N., who I quite liked but couldn’t afford. She recommended J., a resident. It was not a good match. J. had a very clear sense of how therapy should work, and that included the iron-clad rule that the client start every session. Not a word from her until I spoke. And when she did speak, she tended to repeat what I just said. So I became less and less willing to speak. I would sit silently five, ten, minutes, watching her shift in her seat, in full-concentration mode, waiting. By the last session (four or five, I think), I said nothing for almost thirty minutes. I looked at the plant.

Did I mention that she was recording the session to discuss later with her supervisor?

I returned to N. and worked with her. I was a terrible client, alternately trying to help and sabotaging my self, but I did talk.

Anyway. Silence can work as self-preservation, as I think it did with J., but I would also use it as, if not precisely a weapon, then a shield, in therapy with both N. and K. These were good therapists, and I did myself no favors in withholding information from them. Even so, N. and K. were smart enough not to get into a battle of wills with me about it: they knew the silence was for me to overcome.

Of course, authority figures often consider silence as a threat. Why not profess one’s allegiances—unless you have something to hide? Some dictators are more than happy with silence—keep the populace scared and alone—but others hear treason in the quiet. I’m about to start reading Orlando Figes’s The Whisperers, about life in the Stalinist USSR. I have a hunch Stalin feared everything.