Docsplainin' -- it's what I do

Docsplainin'--it's what I do.
After all, I'm a doc, aren't I?

Wednesday, July 30, 2008

Seen in traffic...

It's unfortunate that you can't see it in the photo, but this chick's even got a little plastic yellow bat on the tip of her radio antenna!

I also discovered when I was processing the photo that the things hanging off her mirror are chains of tiny bats.


Tuesday, July 29, 2008


Glaring headline in today's Atlanta Journal-Constitution: Blue Cross/Blue Shield accidentally let go of about 202,000 pieces of people's private medical information... in the mail. To other patients. They blame the computer. It's not the computer, though, that will be paying the HIPAA fines (about $200 million, if I understand correctly). And it's not the computer that will pay for the overtime and postage involved in letting every single one of these patients know what happened. And it's not the computer that will pay for the free credit monitoring for the "small percentage" of patients whose violated privacy included, inexplicably, their Social Security numbers. Whoops!

Monday, July 28, 2008

Suicide hot line got calls from 22,000 veterans

Published: 7/28/08, 6:25 AM EDT
WASHINGTON (AP) - "More than 22,000 veterans have sought help from a special suicide hot line in its first year, and 1,221 suicides have been averted, the government says. According to a recent RAND Corp. study, roughly one in five soldiers returning from Iraq and Afghanistan displays symptoms of post-traumatic stress disorder, putting them at a higher risk for suicide. Researchers at Portland State University found that male veterans are twice as likely to commit suicide than men who are not veterans.This month, a former Army medic, Joseph Dwyer, who was shown in a Military Times photograph running through a battle zone carrying an Iraqi boy, died of an accidental overdose after struggling with post-traumatic stress disorder for almost five years. Janet Kemp, national suicide prevention coordinator for the Veterans Affairs Department, said the hot line is in place to help prevent deaths such as Dwyer's. 'We just want them to know there's other options and people do care about them, and we can help them make a difference in their lives,' she said in an interview."
This is enough to break your heart.

Friday, July 25, 2008

Larry Bird

I have this parakeet named Larry Bird. Larry is my anger management therapist.

The product of tens of thousands of years of evolution, Larry is exquisitely sensitive to "vibes" in the flock. He always knows what's going on in a session and is an active participant in most. When I am doing relaxation exercises or hypnosis, he never makes a sound. He burbles along with conversation when my client and I are just talking. But when someone is angry, he SCREECHES. EEK! EEK!

I adopted Larry from a client a few years ago. He didn't have a name, and he came in a tiny cage, on a Friday afternoon. And he was mad as hell about it.

When I came in the following Monday morning, he had thrown seed all over the room. I was amazed at how far (up to 8 feet!) a bird weighing barely two ounces could pitch a seed. Hence the name. My 9 a.m. client suggested we name him after a baseball pitcher, but I couldn't think of one I liked right off. And besides, he was wearing Celtic colors.

Having anger issues of his own, Larry spent most of his first six months at the office EEK-EEKING at the top of his lungs. The office manager could hear him at the other end of the suite, even with my door closed, and used to come knock on my door during sessions and offer to take him out. He drove one client into a neighboring office for her sessions: She couldn't stand him.

But eventually he settled down. He's a happy bird now, and when he EEK!s it's invariably because a client is angry down deep inside and not acknowledging it. It didn't take long to see the pattern. He knows before I do (and about half the time, before the client does!) that there is anger in the room and he gets agitated--there's trouble in the flock, and he responds.

I have learned to ask, as soon as Larry starts in, "What are you feeling?" Sometimes I get "mad," but sometimes I get "nothing," or "I don't know." I tell teen clients straight out that Larry is my Mad Meter and that he is never wrong: I have had kids be talking along in a session, Larry cranks up, and the kid looks over at the cage and says, "I know, I know--I'm ANGRY!"

One day he began EEKing halfway into a session, and I was dead certain that my client was not angry. We were not talking about anything that could possibly piss her off. She was expressing affect, and it was completely incompatible with anger. So I sat and wondered, "Could it be me?" And sure enough, it was. I was irritated by something going on in the office, outside of the session. So I took a deep breath, let my whole body relax as I exhaled, and Larry shut up instantly.

Amazing, that bird.

Tuesday, July 22, 2008

Audubon Doe

The first time I ever saw her was on the cover of Audubon.

The photograph had been made into a wrap-around cover, but because the magazine was on a waiting-room coffee table back-side up, all I saw at first was the the left half--the half with the spider web sparkling in the sun and all the pink wildflowers and prairie grasses back-lit in the misty early morning. It was absolutely beautiful, so perfect that I thought it was the whole photo: Imagine my amazement when I turned the mag over to find the the other half with that doe looking back at me!

I stole it (sorry, Joen).

I kept that magazine for years, thinking that I'd eventually figure out a way to mat and frame the cover without ruining it. And then one day, some time after Google, it dawned on me that the photographer credited inside might sell prints of his work... duh. Which is how I discovered Carl Sams's website. This particular photo had actually become quite famous as "The Audubon Doe." I ordered a print for myself and eagerly awaited its arrival.

What I got instead was a polite e-mail from Mr. Sams saying that he was sorry, but the photo was out of print. Oh, boo.

But some things are meant to be, I guess, because in a week or so instead of a refund to my credit card, lo and behold I got the print in the mail. There's a wonderful framer down the street from my office who did a perfect job on it and now "The Audubon Doe" hangs on the wall in my office, right across from the Little-Old-Lady-Bad-Back Chair from which I work.

She is so serene. So unto herself. Her huge ears, pricked forward, are backlit pink in the morning sun. Her eyes are large and round and soft and shiny and dark. Her big, black, moist nose dominates her velvet face; long, sensitive whiskers adorn her muzzle. She is all perception, all sensation, her attention totally fixed upon the human before her. She is, in short, the perfect therapist: Silent, attuned, waiting, receptive, ready.

She reminds me to just, simply, be.

Saturday, July 12, 2008


It's a sunny Saturday afternoon. There's just a few cirrus clouds floating high in the sky but I'm inside because of the bumper crop of mosquitoes produced by last week's rains.

I am alternately doing laundry and prepping for class. That's right: In a few weeks I will be back in the classroom, teaching ethics and theories of personality to undergraduates.

It's exciting. I love psychology, and I love teaching. It's fun reading the texts, tweaking my lecture notes, thinking about how I will present information and challenge students to dig into the material, integrate it, use it.

But last semester, my first time back teaching in over a decade, I found that even upperclassmen and women here are not doing college-level work, particularly when it comes to writing papers. My excitement is tempered somewhat by the need to figure out ways I can challenge the good students without leaving the majority floundering.

Some of my colleagues seem to be dealing with this problem by "dumbing it down" to the lowest common denominator. I have seen one syllabus for the personality course which has two single-spaced pages on how not to commit plagiarism. Others have students turn in papers at each stage of the writing process, from topic selection to final draft. We did that back in Mrs. Touchstone's 7th grade English class.

I am not willing to teach a middle-school-level class on how to write an essay. In the first place, I signed on here to teach college, not 7th grade. In the second place, some of these students will be starting work on their doctorates within a year: In my opinion, it's far too late to be cramming remedial English.

But what's the alternative? Wash them out? At this late date? It seems to me that the time for either remedial work or a washout is in their freshman year, not now when they are only months from graduating.

On the other hand, I once worked with a psychologist whose assessment reports were completely incomprehensible. I never received one that I didn't have to walk down the hall and around the corner to ask her to explain. And that's exactly how she got there, I'm convinced: Because her professors kept passing her along even when she couldn't do the work. What's worse, to get a license in this state you have to turn in a work sample: Which begs the question, did somebody else write up the case for her, or did the licensing board give her a social promotion too?

Somebody's got to be the one to say, hey, this kid can't cut the mustard.

I haven't had too much trouble with outright cheating, but I am mindful that it does occur--probably has in one of my courses and I just haven't caught it. Let me just say here that I find it especially mind-bending to be thinking how to prevent students from cheating, or how to catch them if they do, in an ethics class, for heaven's sake. I thought assigning lots of little reaction papers might do the trick, until I found websites offering reaction papers for sale. Is there no end to my naivete?

I knew you could buy a term paper, of course, but I have to admit that I really was flabbergasted to find that students would pay for a two-page essay. What am I supposed to do, "test" them during discussions to see if they've at least read, if not written, their own papers? I didn't sign up here to be a cop. That's what Teaching Assistants are for. I only wish we had a graduate department I could get one from!

Thursday, July 10, 2008

Dream Analysis

Do dreams mean anything? Absolutely.

Can you look up dream symbols in a book to interpret your dreams? Absolutely not.

Can you solve problems in your dreams? Probably not.

Do dreams, like Joseph's in the Bible, predict the future? No. Not really.

The old Scots-Irish from the North Carolina mountains believed that you could travel out of your body in dreams and your spirit be anywhere in the world during the night. They also believed that you could interpret your dreams as religious symbols and that they predicted the future or revealed secrets of various kinds to the dreamer. People with "the Gift [of prophecy]" would tell of witnessing accidents that took place across the ocean during the night and waking up in the morning to read of them in the daily paper. They would sometimes warn a friend not to take a certain train, and then the train would wreck.

Scientifically, picking the one dream out of thousands (you might have a dozen in a single night) that happens to correspond to a real-world event does not prove that dreams predict the future or that your spirit was 'traveling.' That happens often enough to be coincidence, nothing more. It's like winning the lottery--purely random, and against high odds, therefore very rare.

Last night, I dreamed that I was going dove hunting with my sister. My husband and I were in the middle of a move, so I did not know where my hunting license was and I would just hang out. We were in some fields and pastures near my Dad's farm. It was already getting crowded so my sister went off to find herself a spot to shoot from. I was in a barn helping a little boy tie his boot laces when he started up a tractor and off we went across a dirt road and into a tall cornfield, in reverse, at top speed. I reached over him to steer us away from a tobacco barn then turned off the ignition. I was reading him the riot act when his father came over in a jeep with some other men to retrieve him: The Dad turned out to be Jimmy Carter!

What does it mean? Well, when I am working with a dream in therapy, I have the client tell the dream in the present tense, as if it's happening now. As in, "my sister and I are going dove hunting but I can't find my license..." When the client is done, I ask her or him about feelings they experienced when they had the dream, how they felt if they awoke from the dream, and whether anything about the dream reminds them of their waking life. Sometimes that's all we need: The person has just interpreted her own dream! But if we need to, next I ask the client to "be" each element in the dream--the other people, the tractor, the barn, even the shoelaces, if I have to! Since there is no tractor in the bed with me, and Jimmy C. certainly wasn't there, everything in the dream is a product of my own mind--it's all me, in other words. So characteristics portrayed, actions performed, and feelings experienced by other people in the dream, even my sister, are really me. Playing the role and telling the dream again in the present tense from each different point of view therefore will put me in closer touch with my own feelings and impulses.

If we do these two steps with my dream, we relate it to my annual trip to see my sister (about an hour from my Dad's) at about this time every year. However, there are things going on here (my husband and I are not moving, but we're ringing through lots of changes this year) that might prevent me from going. When we are together, we like to "hunt" for animals to photograph. (She has a big piece of property out in the country with plenty of opportunities.) Whenever I dream about vehicles out of control, especially when someone else is in the driver's seat, it is invariably because something in my life is out of control. As it happens, a family member is experiencing a health problem, and while there are things I can do to help, that is certainly ultimately out of my control.

Not every dream holds a meaning, and not every aspect of a dream means something. Sometimes a dream, dream fragment, or "symbol" in a dream is just random neurons firing. Or day residue, as Freud referred to the bits and pieces left over from the waking day. The other night I had a dream about skate practice, most likely because I had been reading Scott Hamilton's autobiography.

But back to our analysis. If I play the part of tractor, I would describe myself as large, slow, ponderous, dangerous, but a very useful working tool that produces food for a nation, a family, a community. My family member's illness is certainly dangerous, but the productive part is that we discovered it (by accident, although not a tractor accident) and are working to resolve it. The tractor was out of control for part of the dream, but ultimately brought to a stop.

This demonstrates why you can't look up symbols in a book. They are very personal to your own unconscious mind, based on your own life history. There are very, very few (probably less than a handful) of universal symbols. For example, if you dream you are in a house, it usually represents your body. Snakes are often stand-ins for something sexual. But the specifics are still very personal. For example, is the house in good repair? Is it being invaded by somebody or something? Look up "tractor" as a symbol in dreams in a book or on the web: I'll bet you won't find what came out when I worked through my dream this morning! Worse, once you look up something like that, it will color how you interpret your dream and you might miss the real meaning of your personal symbol system.

Can you solve a problem in your dream? Probably not. The dreaming mind is pretty irrational. It's called dream logic: Ever 'swim' through the air in your dreams? Not logical in waking life, but makes perfect sense in dream logic. So the unconscious produces lots of random stuff, along with sometimes some information about yourself that you can use to solve a problem, but we don't usually come up with direct answers to personal dilemmas in our dreams. My dream reminds me that there are some things I can control, and some I can't. But it does not, in and of itself, answer a question or solve a problem for me. It simply reminds me that I have an issue in my life and prompts me to deal with it. I need to have the serenity to accept the things I can't change, courage to change the things I can, and the wisdom to know the difference, but the dream can't tell me how to accomplish that.

As for predicting the future, the only way a dream can possibly do that is if you already have some sense of how a thing is going to turn out. Otherwise, what the dream is expressing is your wishes and fears--sometimes conscious, sometimes not. People will dream that a thing turns out well, then when that happens (there's a 50% chance, remember) they think, wow, I predicted that in my dream. For example, we're in the second year of a severe drought. I could say that the tall corn in my dream (as high as our heads on the tractor!) predicts that the last few days' rain is a drought-breaker, and that we are going to have a good summer. And if it rains, I could say "See? I knew that!" But I can guarantee you, odds are that somewhere in the South last night, some farmer dreamed of burnt-up stubble in hard, cracked ground. Why should his dream be any more or less of a prophecy than mine?

This dream-analysis technique, by the way, comes from Gestalt therapy and it is very powerful Fritz Perls, a leading proponent of Gestalt therapy, taught that we project aspects of ourselves onto other people and things in our dreams, and that a way to take back ownership of all parts of ourselves was the empty chair technique, a kind of role-play conducted in therapy. A purely psychodynamic psychotherapist would have you free-associate to various elements in the dream, and might offer his own interpretations of aspects of it. But I find this additional bit of technique more powerful. Powerful in the sense that it produces lots of information and teaches you much about yourself, but also powerful emotionally. You can certainly do it yourself, but it works much better with a therapist.

Wednesday, July 9, 2008

Cool, calm and collected

The Cherokee Ledger-News has an article in this week's paper about the hostage negotiating team and how they "use psychology to diffuse [sic] situations." Using 'diffuse' instead of 'defuse' isn't the only error, but it makes interesting reading anyway!


I'm reading Scott Hamilton's Landing It and Lance Armstrong's It's Not About the Bike and thinking a lot about focus. And about how easy it is to lose focus.

Specifically, about how easy it is to lose focus on what is important in the private practice of psychology. It's too easy to get bogged down in the running of the business, and to forget that the reason that I am really here is to give this one person sitting across from me the best hour right now that I possibly can.

The bigger goal is to be the best psychologist that I can be, which means reading and studying between sessions, too. That's my version of Armstrong's workouts before the big race.

Maintaining focus is harder than it used to be. Sometimes it feels like the business end has taken over: Managed care, insurance billing, file-keeping requirements, employment taxes... the list goes on.

So I have to remember: "It's not about the bike."