“…everyone who goes into psychology is fucked up anyway.”
– Sean, a fan
I don’t refer to those seeking help as crazy, weak, ‘fucked-up,’ or insane. In fact, “insanity” is actually a legal term, not a clinical one; you’d be more likely to see the word at Philalawyer. In all fairness, then, it would be inappropriate to refer to the mental health providers in similar terms. However, it has been argued that people who go into psychology/therapy as a profession are quite neurotic themselves. With the exception of yours truly (assuming you ignore the issues with dying, aging, conflicts with child and adolescent clients, and a plenitude of other issues), there are a great number of mental health providers with…idiosyncrasies.
Many therapists are taught to (over)analyze everything that is said by a client. This is especially true of those trained in the Freudian way of thinking. If a new client mentions that it was difficult to find a parking space this afternoon, you’re taught to consider, “Does he mean, subconsciously, that he might have difficulty ‘parking’ his problems in this office? Should I interpret this for the client?” This is a particularly annoying quirk when you go to meet your analyst friend for a beer and she raises an eyebrow when you ask how her smoking cessation program is coming along.
“Is this reference to my cigarette some sort of phallic comment, a come-on, Rob?”
“No, it’s me just asking if you’ve retarded the development of lung cancer so you don’t die in two years. Oh, and you’re a narcissist.”
Fortunately, by the time I made it to graduate school, many Psychologists realized that sometimes a cigar is just a cigar and Cognitive Therapy was all the rage. This type of approach shunned the focus on subconscious conflicts and interpretations. The guy’s parking problem probably isn’t a metaphor for fear of opening up to his therapist and, if it is, that fear will come out in plain language soon enough.
Even with a newer, more “user-friendly” approach to treatment, Cognitive Therapists have their share of quirks as well. Although I am a Master of Catastrophizing, if I walk into the office murmuring that I’ve had an awful morning so far, I’m forced to hear a colleague say, “Rob, was it truly awful? Did you break an arm? Maybe you hit some bad traffic, but it’s hardly ‘awful’ now, is it?” It’s at that time I look for a pen from one of the drug companies to jab him in the eye with.
To highlight the somewhat unique and eccentric subculture that is the field of mental health, consider the peer supervision session. Peer supervision in group format is generally a one-hour, roundtable discussion with anywhere from 3-15 professionals. Similar to a staff meeting, the purported goal of the session is for therapists to help each other with difficult cases and to offer new perspectives for the provider on a client’s problems. The members of the group essentially serve as consultants to a presenting therapist. This is particularly useful if the therapist is seeing a client that is out of his area of expertise, when ethical dilemmas arise, or if the therapist has been working with a client for a significant period of time and would like a fresh take on a client’s problems. In reality, however, these meetings prove more to be an exercise in mental masturbation and a time for therapists to hear themselves talk.
I don’t think most therapists particularly enjoy these sessions but, as New York State has no requirement for continuing education, group supervision does alleviate some of the guilt associated with lack of attendance at non-required seminars on new developments in treatment. As one colleague put it, “New York State doesn’t make us do anything to keep our license. I if didn’t pick up a journal or attend those stupid peer supervision meetings, I would practicing in my own little vacuum. That’s pretty irresponsible. Plus I’d get fired if I didn’t go to the meetings.”
This particular peer supervision session includes Drs. Gail (the Director of the group private practice, age 51), Mike (Co-Director, age 44), Allison (Assistant to the Co-Director, age 32), and myself, a “consultant.” We make up the entire practice, rendering the titles essentially pointless. Gail is the leader and a business entrepreneur in the mental health field. Mike is her lackey. It wouldn’t surprise me if he was secretly planning to assassinate her to assume her throne. Allison is the hypersensitive member of the group and a neophyte in the field, with no concept of how the real world works. While I don’t know my official place in the group’s dynamic, I’ve heard whispers in the coffee room that I am “asocial, and kind of annoyed all the time.” We don’t interact all much throughout the day, as we’re generally working with clients behind closed doors. Smile, nod, ask the mandatory questions about wife / husband / cat / dog / lover / mistress / hermaphroditic son, then grab your coffee and go do your thing. In other words, everyone is generally cordial to each other. However, there is always that air of “if we didn’t work together, I could easily see myself punching your face.” After five years, familiarity breeds contempt.
This is our 15th meeting of the year, each one growing in tension as we all realize the inherent uselessness of them:
Gail: Alright, let’s get started so we can get back to work, we’ve patients to cure, people!
Allison: I’d like to present a case, if no one else has anything pressing. If anyone does, it’s okay, I’d just like to, you know, talk at some point.
Rob: Did anyone order in lunch?
Gail: No Rob, didn’t you read the memo I sent out last week, or the posting on the cork board? It specifically said that this is a “Brown Bag Lunch.” See everybody else’s lunches?
Rob: I do. Those are pretty impressive looking.
Mike: Then you didn’t see the flier for the upcoming seminar on Avoidant Personality Disorders and Antipsychotic medications on the aforementioned cork board?
Rob: No, I think I missed that.
Gail: It seems like Rob “avoided” that flier.
Mike (giggling): Good one, boss!
Gail: Alright, let’s get back to business. Allison, please present your case.
Allison (standing…in front of 3 people): This is a case that has been giving me problems for the past few weeks, and I’d like your input. M.C. is a…
Mike: ALLISON! Confidentiality is at stake here. Please use different initials.
Rob: You know a lot of M.C.’s, Mike? Maybe she’s talking about you perhaps?
Mike: Hilarious, Rob. I’m just saying that we can possibly identify him from his initials.
Rob: Mike, we all know who the guy is, he sits in the waiting room every Wednesday at 2 o’clock! I met him when he was outside having a cigarette.
Gail: You socialized with a client???
Rob: We just introduced each other and shook hands. We chatted a bit while I was waiting for a cab.
Mike: How could you do something like that?!
Rob: Mike, he’s just a client, it’s not like he’s an escaped serial killer.
Mike: It’s a dual relationship!
Rob: I didn’t have dinner with the guy, I just said hello and talked about the weather for a minute or so. Am I supposed to run down the street and hide because he gets his therapy here?
Allison: Okay boys, settle down. No need not to love each other. Mike, if it will make you feel better, I’ll change the initials. Z.Z. is…wait, are those initials too fake-sounding?
Rob: Jesus, Allison. How about you just get to the issue that M.C. is suffering from?
Mike: It’s Z.Z.!
Allison: Mike, please. Remember our discussion: indoor voices only in the therapy office. Yelling sets a bad example for our clients. Z.Z has not improved with regard to his visual hallucinations, and we are in our 19th week of analysis. Any initial thoughts?
Rob: Have you spoken to his psychiatrist about his medications?
Allison: What psychiatrist?
Rob: Doesn’t the man have a psychiatrist?
Gail: You’ve been doing psychoanalysis, a treatment with no proven track record for Schizophrenia, and have not gotten a psychiatry consult for medication?
Mike: How do you know he has Schizophrenia?
Rob: Because he’s literally a poster man for increasing awareness of Schizophrenia. You know, the poster on the “aforementioned cork board?”
Mike: Oh, that’s this guy?
Mike: So why are we calling him Z.Z.?
Rob: Because you’re being a tool under the guise of a pretentious ethicist.
Allison: You know schizophrenia runs in my family.
Allison: And…nothing. I just thought I’d throw that out there. Just, you know, to make conversation.
Mike: So what were you saying about a psychiatrist, Rob?
Rob: That he clearly needs one, that Schizophrenia is widely considered a biologically-based disorder, that we have no real reason to believe that he will get better unless he is at least considered for medication, and that Allison needs to get her shit together.
Allison: I just don’t believe in medication.
Mike: Allison, are you prepared to tell…what are his fake initials again?
Mike: Are you prepared to tell Z.Z. that, while there are plenty of medicines that can be very helpful in treating his symptoms, you’ve withheld that information because you “don’t believe” in medicine.
Allison: I didn’t withhold it. We discussed it, he asked me my opinion. I told him that since he is functioning pretty well, my personal belief is that we should try to work through this in therapy.
Mike: How the hell can the guy be functioning if he’s hallucinating!? What the fuck is wrong with you?
Gail: Okay, let’s pause for a second. Yes, Allison has an ethical obligation to bring up the issue of psychiatry but, if Z.Z. declines, that’s his choice. Perhaps though, Allison, you might consider pushing him a bit to at least speak with a psychiatrist, given that he isn’t improving in many ways?
Allison: Yes yes Gail, I can definitely do that.
Gail: Mike, Rob? Can you perhaps give constructive criticism without being…’tools’ as you call it? Perhaps give advice to colleagues the way I just modeled for you?
Rob: I…I can try.
Mike: Me too.
Rob: I apologize, Allison.
Allison: I accept.
Mike: What about me? Where’s my apology?
Rob: For what?
Mike: For calling me pretentious.
Rob: You are pretentious.
Gail: See, this is what Freud called the Paranoid Position. Basically, it’s…
Rob: Gail, it’s enough, can you just shut up now?
Allison: Rob, although you deserve praise for using your indoor voice, telling Gail to shut up is not only insubordination, it’s aggressive.
Gail: Allison, although you might be validated now, that doesn’t give you permission to fight my battles for me. Some might say that you are being aggressive by assuming the role of protector.
Allison: Jesus Gail, I was just trying to help!
Gail: Well don’t!
Rob: Yes, Cat Fight!
Rob: Twenty bucks on Gail.
Mike: I’ll take that bet.
Gail: Both of you shut up! Alright, today hasn’t gone very well. In fact, we’ve only been here about three minutes and we’ve accomplished very little.
Rob: That’s a new record for us.
Mike: We learned that Allison doesn’t like medicine.
Gail: Notwithstanding, unless someone has something else productive to say about Allison’s case or any other matters in this practice, I suggest we call it a day.
Silence. I raise my hand.
Gail: Yes Rob?
Rob: Could we order in lunch next time?
Gail: Rob, please get the fuck out of this office before I stick this butter knife through your heart.