Group Supervision: Neurotic Shrinks Bicker for your Amusement

“…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?

Allison: No.

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?

Rob: Yes!

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.

Silence.

Rob: And?

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?

Rob: Z.Z.

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!

Mike: Reeeer!

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.

(Visited 110 times, 1 visits today)

25 Responses to “Group Supervision: Neurotic Shrinks Bicker for your Amusement”

  1. Anonymous says:

    wow, Allison sounds like she needs a punch in the head.

  2. Wayland says:

    Dude!!! Oh my…I am almost in tears. Thank you so much! Holy crap. I’m going to have to give your URL to my psychology professor that I had last semester. Again man, this was awesome!

  3. Charles says:

    I laughed very, very hard at this. By far the funniest piece you’ve written. I’m loving the insight on how wierd shrinks can be when they cross examine each others words.
    Definetly need more updates with these characters.

  4. Jon says:

    Reading this entry made me feel like I was watching a version of The Office with psychologists. Seriously, you know how Michael Crichton practiced law for 10 years then wrote a bunch of best sellers? You should try that…collect all of this crazy stuff and you could put together a sitcom or novel. I swear you could put together a long lasting story with a whole host of dynamic characters and situations. Try it.

  5. Drew says:

    Sweet Jesus. This is fast becoming my favorite blog read. Keep it up old boy.

  6. IRISHNBRITISH says:

    I really liked this piece – it reminds me of some of the anally retentive people I work with.
    I particularly enjoyed the image of poor old Allison ‘standing… in front of three people’- so, so funny! Thanks for sharing.
    Like you, I feel familiarity breeds contempt (in all aspects of life) and though I always start off with good intentions, in meetings, my capacity for dealing with bullshit reduces all the time.
    Going from the Tuckman’s four/five stage model, your group seems to be still at the ‘storming’ stage. Don’t worry though, I actually think this is the best stage. Enjoy.
    Your little group seems to me like it may be stuck there for sometime… in fact, I actually think you may be stuck there forever!*
    Never mind though, if you are stuck, I’d suggest you just ‘keep on keepin’ on,’ making your own entertainment – that’s what I do – sometimes I manage to keep my thoughts in my head, but more often than not it’s out loud. If others in the team laugh, then that’s even better, but if they don’t, then so be it. As long as someone’s laughing that’s all that really matters.
    *[I secretly hope you are stuck – just so you can tell us more]

  7. Anonymous says:

    As he labeled me, I will quote Sean as well, it’s “Clientguy” calling again…
    Dr. Sensitivo asks that we ignore his issues, but his request only serves as a reminder to me. This latest installment not only confirms Sean’s remark, but magnifies it. One shrink is more fucked up than the next!
    None of this inspires confidence.
    Viva la repartee I suppose…

  8. Glugory says:

    Holy crap, the people you work with suck.

  9. pullablank says:

    This made my week! I can’t wait for the next post, keep up the good work!

  10. Ninja says:

    Sounds like where I work. Except my managers threw bags of skittles at us our last meeting. Whikle quizzing us on how to make the food properly. Then locked us in the resturaunt for 30 minutes to force us to clean things. We just stole the rest of the candy and went out the back doors.
    I want to go to school to study psychology. Mostly because I want to get away from working at a crazy place like I do now. I guess I’m never going to escape it am I? The disgruntled people, co-workers being stupid. Too bad I actually enjoy those things the most, because if my job went smoothly, there would be no excitement. Plus, I love making others happy, and helping. So it’s a win-win for me.

  11. Rorshak says:

    Aw gee, I’m glad I chose to start studying psychology now if this is the future that awaits me.
    Funny stuff as usual, I enjoy reading this blog.

  12. Anonymous says:

    I think I would go crazy from over-analyzation. It sounds as if you’ve got a couple of that type in your group. Honestly, constantly hearing “well, by this, do you mean this,” would annoy me. Don’t know how you manage it without punching somebody in the face.

  13. Amber says:

    Unbelievable! I’d like to request footage of these meetings. I think you’d have better luck bringing in people that deny, but truly need, help if they see their psychologist is not as bright, cheery, and perky as they seem.
    So when does the term normal get an edit of definition in the dictionary?

  14. Sean says:

    1. For the record, I’m a psych major, so I don’t exclude myself from that quote, heh.
    2. This is a hilarious entry. This blog is becoming a must read.
    3. Allison deserves a boot to the head. Anyone who’s taken even an undergrad abnormal psych class knows schizophrenia is biologically based and needs medication to control the crazy before you even think of therapy, especially psychoanalysis. She’s allowed her personal opinion to endanger her client and everyone he knows.
    4. Clientguy, don’t worry about it too much. Think of it like this — do you lose confidence in your doctor if they get sick? Besides, just gaining some psych knowledge causes you to over-analyze your own life. So long as Dr. Rob isn’t running down the halls naked screaming the star spangled banner, it’s probably not going to hurt your sessions, and as I said before, lets you know he’s human too.
    5. Which leads to the counter of my quote my friends and I came up with — In the end, everyone’s fucked up somehow, it’s just psychologists (and their clients) know it and are doing something about it.

  15. Anonymous says:

    Sean,
    Dude, if my Doctor got lung cancer from smoking, then yes I would lose confidence in him…. a flu, well then no, but point taken, thanks!
    And thanks for the painful visual I now have of Dr. Rob running naked down the hall singing!
    Clientguy

  16. kakutogi says:

    This scene should be made into a short movie

  17. Eli says:

    Loved this. Cat fight turn on the females was great.

  18. Grant says:

    HAHAHHAHAHAHAHAA
    Please provide more anecdotes like this. It provides a great insight into the life of a psychologist, and endorphins!

  19. jackie says:

    dr. allison should have her license removed. that’s bullshit. licensing is supposed to protect the public… and it’s making it seem as if she is an “expert” to them, when she is clearly not.

  20. futurecollegue says:

    Sounds pretty much like every meeting I have ever attended, well minus the parts about medication….

  21. Joy says:

    This made me feel much better about how my group supervision went yesterday.. Thanks for mentioning it in the latest column. 😉

  22. s says:

    One of your best pieces ever! I hope you do a follow-up. This sounds eerily similar to a bunch of internists.
    And actually, if the guy is functioning, I’d say let him hallucinate. You can work while hearing voices. You probably can’t with amotivation from antipsychotics. Also, visual hallucinations are less likely to be psychiatric…

  23. So that is what I have to look forward to….damn. Btw, there is a group of schizophrenics out there that advocate against medications. I’d be *very* concerned if my patient was actively hallucinating and not on meds….but maybe that is jut me, and 99% of professionals out there. I’m dynamic, but working with someone who is actively psychotic is challenging to say the least.

  24. Tippy says:

    Wow. Allison doesn’t believe in meds and my psychiatrist doesn’t believe in schizophrenia.

    I keep meaning to have him elaborate on this disbelief.

Leave a Reply