From Psychiatrist-Psychoanalyst to Poet

  

I was trained at a time when the psychiatrist’s role was undergoing a profound change. During my residency all but one of us residents considered our own individual psychological treatment (for which we paid out of pocket) was essential to becoming competent practitioners. Included in our training was weekly group therapy on the ward run by a psychologist specially trained in group therapy. 

Since then, the field has shifted dramatically. Psychiatrists are rarely acknowledged as psychotherapists today. Indeed, younger psychiatrists have had a very different kind of training than those of us in earlier generations. With the entrance of psychologists and social workers into the field, our task has narrowed, often reduced to that of psychopharmacologist.

At times, when I attempt to gather a complete picture of a person’s life, as I believe is my responsibility, some clients seem reluctant to share, thinking that I am trespassing on the turf of their psychotherapist. Their demeanor seems to signal that they want me to get on with the task: JUST PRESCRIBE.

I have no problem prescribing an appropriate medication, but I do find that if I limit the task, the pleasure is diminished, as if the sap has dried up in an old fruit. The delight returns when treating the rare person who has sought me out precisely because of my background in psychodynamic psychotherapy. 

While I continue to work with a limited number of individuals, I’m devoting more of my time to my newer identity as a poet. I hope you will follow me at my Substack, Poet Lair.

Thank you, Dear Readers.

 

Poem for Therapy Dogs and Us

 

 

My Therapy Dog and Me

Meant for each other

Anxiety evaporates in the air between us

The atmosphere is magenta

The clouds are maroon

Who can sing as well as either 

Of us in tune? That is a therapy dog 

For you In synch with the slightest move

The tingle-tangle he hears  like a siren

We run and hide in the closet

We are ready for all time 

Apocalypse we fear but together

Wrapped in paws and arms

We perish and survive.

To Navigate Chaos, Think Simple Pleasures

The Legend Is in Trouble by Trenton Doyle Hancock

Trump’s penchant for flaunting law and precedent cannot help but rattle most of us, including me. 

With national and worldwide chaos reported in the daily news, including shrinkage of our savings, how are we to proceed in our lives without a considerable measure of despair?

 

Fortunately, we have an example of how to move forward in the form of another country, Finland, which has been the happiest country on the planet according to the World Happiness Report. For the New York Times, the journalist Britta Lokting traveled to Helsinki to learn lessons on lifting her spirits. She wrote that the key is to “quiet[ing] the mind and find[ing] pleasure in small acts and observations.”  

 

I reframe her advice to suit us New Yorkers: Visit a museum, plant flowering plants in a windowsill pot, or in the ground surrounding a tree on your block, take a walk in the park or go to the gym to exercise and clear your mind.

 

For me, daily meditation continues to be a soothing practice. I find relief by journaling about daily events, thoughts, feelings, and future plans. Dreams can also provide insight insights, revealing what my conscious mind hasn’t yet faced and might be wise to consider. Just the act of expressing these thoughts and feelings relieves tension.

 

Acknowledging the disorder around us and staying in the moment to appreciate what is working well enough on three levels—body, mind, and feelings (or spirit)—is crucial. Gratitude, wherever we can find it, always helps. 

 

Dear Reader, I invite your comments. 

Jsimon145@gmail.com.

The Gift of Feedback from Client to Psychotherapist

As a seasoned psychotherapist, psychoanalyst and psychopharmacologist with more decades of experience than I care to mention, my mind often touches on the subject gift giving. I know I’m a few days late for Valentine’s Day, but as you well know, we can’t predict when, how or where the mind will take us.

As a therapist, I strive to guide my clients toward personal insights, hoping they’ll give themselves the gift of greater self-awareness. Along the way, my clients also bestow invaluable gifts in the form of feedback, which help me improve and better treat them.

This morning in my daily scribbling, I began to reflect on the different types of gifts we receive. I’d been on a Valentine’s Day cruise where there were several sweet reminders of the love holiday. First, a complimentary dessert of sweet chocolate cake covered with a thin layer of shiny pink icing. Then, our cabins had surprise heart-shaped vanilla cookies sprinkled with red crystals waiting for us in our cabins after returning from dinner. How sweet is that?

Another unexpected gift I was given came from a client of mine who introduced me to the concept of love languages. She lent me her copy of The 5 Love Languages by Gary Chapman, so that I may have a better understanding of her personal issues. 

You, dear clients, give us therapists a gift when you tell us what we may be missing or how we could be erring in our treatment. Just like anyone who is interested in personal growth, we also learn from our mistakes and your feedback is critical.

Recently, an appreciative client told me that a suggestion I’d offered on how to approach a romantic interest wasn’t helpful. They thanked me for my effort, then shared that they were going to find another provider who might be better suited to their needs. I certainly appreciate the fact that they let me know. I didn’t have the nerve to ask them why my input failed to hit the mark. Dear client, you do not owe a detailed account of your dissatisfaction, but when you do offer feedback, I am grateful for it and do experience your words as ones that deliver the gift of information. 

Dear Reader, I welcome your comments.

jsimon145@gmail.com

GHOSTING

                                      

    I am a psychotherapist/psychopharmacologist. I work with a platform where patients can not only schedule their own appointments, but they can also cancel them. This style of scheduling is a new phenomenon that puts a strain on real life relationships. 

    I have now become too familiar with the term ghosting: a person’s sudden disappearance without any proper communication. Even something as seemingly impersonal as when someone makes an appointment on my online calendar and then deletes it before we’ve met can fall into this category. Here in six lines is a poetic expression of the perturbing phenomenon. 

    Please, dear client, I would appreciate even a brief explanation when you disappear.

    Gratefully, Dr Jane S.

    P.S. Please feel free to offer your comments and experiences.

    jsimon145@gmail.com

Being Ghosted

I’ve been ghosted and must pick 

up the slack, crossing off the names 

of those who have shucked me off their list. 

My brain will tidy up the matter 

with an intellectual broom of 

the mind janitor sweeping the hallways clean.

POSITIVE PSYCHOLOGY: WHY NOT?

A new term has creeped into the psychological lexicon within the last few years. I first encountered it when the then-president of the APA, Dilip Jeste, M.D. presented a paper on Positive Psychology, as if the term were something entirely new.

A bit concerned about its perceived “newness” I queried Google and was surprised to read that Google also referenced its recent emergence. But Google also credits ancient philosophical traditions, such as the Greek concept of eudaimonia, as well as humanistic psychology and theorists including Martin Seligman, Mihaly Csikszentmihalyi and Christopher Peterson.

In a recent session, a college student-patient mentioned that they are taking a Positive Psychology course centered on the study of human flourishing and reaching one’s potential. The course emphasizes the identification and development of individual strengths, rather than focusing on on problems and weaknesses (in any given individual).

According to the portion of the Hebrew Bible Ecclesiastes there is nothing new under the sun.  (Why we persist in giving new names to phenomenon that have already been identified is a question for later exploration.)

Rather than getting bogged down in the above question, the real question is: Why isn’t all (or most) psychological help/psychotherapy focused on positivity?

After all, as Freud’s message is often summarized, the goal is to love and to work—to relieve neurotic suffering and learn to experience the suffering common to human beings. 

Neo-Freudians like Karen Horney and many who followed emphasized the importance of living a gratifying, authentic life rather than one imposed by role models and societal expectations.  

Individuals seek therapy because they are unhappy and/or experience a block in their path. They may feel unanchored, unsure of what they want in their careers or relationships. As therapists, we aim to help them identify the obstacles. 

The psychotherapist’s task is ideally always positive: to help/encourage/support/mirror/guide and educate (as the origin of the word suggests, to guide in a positive direction). Sadly, that isn’t always the case. I offer two personal vignettes to illustrate when therapy falls short of being positive. 

During med school, I consulted the school psychiatrist. I don’t remember what my issue was at the time. But he immediately said with an air of authority, “I know what your problem is: YOU ARE PREGNANT!” His response was so out-base, and inappropriate that I realized his problems were far bigger than mine! Stunned by his presumptuous remark, I decided against seeking further psychological help.

(Other women medical students must have had a similar experience with him because I heard that he was dismissed from his job after no one knows how many people he led astray.) 

During my psychoanalytic training, the first psychoanalyst assigned to me, Dr. P., grew overwhelmed as I became increasingly depressed and feared that I wouldn’t be able to function in my roles as psychiatric resident and mother. When I told him I had to stop treatment for a while, he said abruptly, “Just don’t come back.” 

My life circumstances were very difficult. I was in an abusive marriage and contemplating a divorce. Dr. P may have been hampered by his countertransference, perhaps viewing me as one of his daughters. He even said that he didn’t think any man would want a woman with two children. Ultimately, my situation proved too much for him to handle.

Devastated and lost, I made an appointment with Dr. S, a hypnotherapist who had taught a class on hypnotherapy during my residency. During our consultation he advised that due to my high susceptibility to hypnosis, psychoanalysis might not be the best choice of treatment for me 

I began an alternative treatment—gestalt therapy—that was more supportive and helped me get through this difficult period of my life. 

About a later, I received a call inviting me to return to the psychoanalytic institute to be treated by another psychoanalyst. Curious and hoping to complete my psychoanalytic education, I accepted the chance to try again. 

The next psychoanalyst, Dr. Van Bark, was enormously helpful. Despite having similar training to Dr. P., her perceptivity and life experience made all the difference. She grasped my issues and knew how to engage me, to form a meaningful dialogue in a supportive alliance, to question and guide with sufficient accuracy for me to trust her.

COMPLEXITY

So, unfortunately, dear reader, you can see the complexity of the situation: the brand or label of treatment may not be the last word about what will be most helpful to a particular client. More important may be the therapist, their personal outlook, perceptivity and life experience. Essential is the dialogue between client and therapist: to hear and perceive each other in a deep, meaningful, encouraging way. 

Duke Ellington once said, “There are only two kinds of music—good music and bad music. I like both kinds.”. I think what he meant is that one can learn from each. 

Maybe we can make an analogy about therapy.  My first analytic experience with Dr. P, although painful, led me into another psychotherapeutic approach that added to my psychological toolbox.

Conclusion: Effective psychotherapy or analysis should fundamentally be positive. If a client doesn’t feel encouraged, optimistic and supported within the therapeutic relationship, regardless of its approach or label, it may be wise to move on.

Dear Reader, I welcome your comments.

Jsimon145@gmail.com

A (Brief) Summary: My Journey From Psychoanalysis and Beyond

 

Throughout my career, I've been privileged to explore the intricate tapestry of the human mind, encountering many concepts that have not only shaped my professional outlook but have also offered profound insights into the essence of human nature. 

Psychiatry has always been a field of endless discovery. Each patient brings a unique story, each case a unique challenge, and each I've learned has unlocked new dimensions of understanding. Here, I share some of the key concepts and developments that have been pivotal in my work, critical in unlocking human potential - and even revolutionary in my practice. 

Nature vs. Nurture

From the outset, the realm of psychological treatment has, to a greater or lesser degree, acknowledged the inter-relationship of nature and nurture. Nature refers to inborn traits stemming from our genetic constitution - the structure and functioning of the brain. While nurture refers to the environmental factors that operate and change us throughout our lives. 

Nothing is static. Nothing stays the same, Even the hardest rock changes in the continuous process of wearing away as in erosion and the accumulation of detritus in the process of aggregation. Such is the case with our nature as it is shaped by the different experiences we encounter throughout our lives. 

Freudian Psychoanalysis 

Psychoanalysis was the predominant approach to the psyche/psychological treatment from the 1940s to the1960s. 

This method focused on the individual and their past with a study of dreams, memories and defense mechanisms (defenses are like ship stabilizers that maintain our equilibrium, to help us function in the real world and prevent us from reeling off course).

Anna Freud, a prominent psychoanalyst and daughter of Sigmund, worked in the early to mid-20th century and identified the common defense mechanisms. 

*DEFENSE MECHANISMS include: 

1. Denial, the refusal to acknowledge or accept a concept of reality that causes distress. (For example, an older person may deny the loss of intellectual and/ or physical faculties that occur in the aging process.)

2. Repression operates to keep painful or distressing memories out of our consciousness or awareness.

3. Projection operates when an individual attributes their unacceptable thoughts or feelings or impulses to another person.

4. Displacement describes what happens when an individual re-directs their emotions or impulses from their original source to a less threatening target. 

5. Rationalization is a thought process that operates to find a logical or socially acceptable explanation for unacceptable behaviors, feelings or thoughts.

(Becoming a psychotherapist to work out one’s persnal conflicts.)

6. Sublimation channels negative or unacceptable impulses into socially acceptable activities or behaviors. (Becoming a nutritionist to combat one’s 

impulsive eating habits).

7.Regression: reverting to earlier, less mature behaviors in response to stress or conflict. (E.g. a depressed person who withdraws from social interactions.)

8.Reaction formation: expressing the opposite of one’s true feelings or impulses to cope with anxiety.

9.Intellectualization: Avoiding emotional distress by focusing on a logical or intellectual explanation for a situation. 

(For example, to regard one’s abnormal EKG as an interesting study of heart functioning). 

10. Undoing: Engaging in behaviors to try to “undo” or make up for unacceptable thoughts, feelings, or actions.

Shakespeare’s Lady Macbeth is a classic literary example. She repeatedly washes her hands after engineering a murder.

Recognizing defense mechanisms can remove obstacles to progress.  

The process of analyzing the unconscious and the mechanism of defense could last for years.

Following the Freudians, the Neo-Freudians broadened the array of psychological techniques available. Austrian psychoanalyst Heinz Kohut (1913-1981) contributed significantly to this expansion with his introduction of concepts such as empathy, mirroring, and confrontation. These ideas enhanced our comprehension psychology. Kohut's theoretical frameworks provided psychotherapists with new tools to address the needs of individuals with personality disorders, particularly those who had suffered psychological or physical trauma in their early lives. 

Stigma

In the past, personality disorders were often viewed with significant stigma and posed challenges in treatment. Nowadays, some clients actively inquire if their issues are related to such disorders. Unlike several decades ago, when being diagnosed with a personality disorder was a shameful label, many young people today find comfort in knowing that their symptoms are part of a recognized diagnostic category and can be treated effectively. 

Diagnosis

A diagnosis is crucial for providing the right treatment, yet it should be approached with flexibility and openness to change. It's wise to remain prepared for unforeseen developments, as diagnoses can sometimes shift unexpectedly. 

For instance, some years ago I was surprised to learn that Mr. C, whom I had treated for depression for decades, overnight developed manic symptoms. This rapid shift of mood suggested that his depression was one aspect of a bipolar disorder with the potential for moods to fluctuate rapidly from a depressed state to a state of pathological euphoria.

Since the 1960s, various approaches have been developed to expedite the journey towards better mental health. These approaches focus on elements such as interpersonal relationships, the integration of mind, body and emotions as well as Eastern meditation practices.

The range of techniques introduced included behavioral, cognitive, humanistic and integrative-holistic therapies. Additionally, therapies specifically aimed at treating trauma, such as EDMR (Eye Movement Desensitization and Reprocessing), have been designed to target symptoms of Post Traumatic Stress Disorder directly. 

The object relationships school addresses the problem of "splitting", in which a person or a situation is viewed as "all good" or "all bad", a relatively common problem with far-reaching consequences in the realm of personal, interpersonal and world events. 

If you perceive the world as toxic, you end up shaping a hostile environment. In truth, the world both nurtures and deprives, and it is the individual's task to discern reality in the present moment and manage to integrate both aspects. Typically, the ability to see objects (people, places and things) as neither wholly good nor wholly bad develops in the brain around the age of twelve. However, some individuals, particularly those who have experienced trauma - be it psychological or physical - struggle to perceive and reconcile these dual aspects of reality. 

Any form of psychotherapy can address this dichotomy, which can cause discord with and individual, (intrapersonal or within oneself), in interpersonal relationships (our connections with others) and in the broader world. 

Curiosity

While scientists have yet to pinpoint the exact area of the brain responsible for curiosity, it remains a crucial trait for adapting to our constantly changing world and for a deeper understanding of ourselves. 

Summary

Attempting to categorize humans into strictly defined boxes - without acknowledging the fluidity and openness needed in ongoing dialogues - is not only limiting but potentially harmful. 

The field neuropsychology has become increasingly complex, enhancing our understanding of the brain and mind. As a species, we continue to evolve in a dynamic world. Keeping this in mind reinforces the value of maintaining an openness to change. 

Paradoxically, while we often crave stability, a rarity in its true form, real life presents us with turbulence, akin to ocean currents or the shifting of tectonic plates at the Earth's core