Docsplainin' -- it's what I do

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

Tuesday, August 26, 2008

Unfortunately, business is booming

Just thought I'd share this:

Back in the early 1980s, Minneapolis psychologist Gary Schoener and colleagues wondered if the recession was affecting the mental health of people living in Hennepin County. "We were convinced there was a problem," said Schoener, then chairman of the Council on Mental Health Programs.

How right he was. The study revealed "personal adjustment problems showing up in all kinds of places. It was fairly clear that we were going to be seeing more of those things," he said.

Schoener is, again, seeing more of those things. "We're busier than ever...

We are, too. It would seem odd, given that money is the problem, that people would take on a new expense, like therapy. This is especially true, given that insurance coverage is not as good as it used to be.

Financially challenged companies are cutting back on health insurance coverage, or cutting out coverage completely. Deductibles and copayments are growing, too. "The standard percentage paid by the insurance company used to be 80/20," said licensed social worker Suzanne Harman. "Now it's 70/30 or 60/40."

I will reduce my fee periodically to accommodate a client out of work, and/or go to less-frequent scheduling of sessions, because if someone has lost a job or is teetering on the edge of bankrupty, it's the worst possible time to be out of therapy. But of course eventually that will put me in a bind, too.

And it's not just lower-income families who are affected ... "Families where the main breadwinner is in the mortgage and housing industry are just being killed by this. Therapy is a luxury for every family."

That worries Lesli Kramer, a psychiatrist in private practice in Eden Prairie.

"People, when they're struggling, get more and more immobilized," she said. "It's harder to pick up the phone, especially for those who have never been seen in the mental health system. There's still a stigma. Add economic barriers, and that takes it to another level entirely."

Amen, sistah.

Copyright (c) 2008, Star Tribune, Minneapolis

Distributed by McClatchy-Tribune Information Services.

Monday, August 25, 2008

Mooning gets professor fired

Call me a Pshrinking Violet, but I think I won't try this.

You can read the whole story at Inside Higher Ed
but the gist of it is that the dude got fired for
mooning a room full of students and fellow


Sunday, August 24, 2008

I miss Paula

My PDA beeped me Saturday morning to remind me that her birthday is next week. She spent her last birthday in the hospital, and died a few weeks later. Her office still seems terribly empty to me. And the neighborhood seems terribly empty without her. I can't believe it's already been a year.

We first met back in the early '80s. I don't remember exactly when, probably around '83 or '84, but it wasn't long after her divorce. Her son and mine were the same age, and we lived barely two blocks apart. We didn't really become friends right off, although our sons were in the same first-grade class and hung out a little together.

Friends or not, I admired Paula from the get-go. She had a way about her, which I could never quite put my finger on, that caused people to underestimate both her intelligence and her courage. But she was smart, and she was tough. She was a single Mom raising three kids on her own. Child support was late more often than not, weekend visits with the dad frequently cancelled at the last minute. She worked full time in a pink-collar job for pink-collar wages, drove three hours round-trip several nights a week to complete first her undergraduate degree, then her graduate training, and still found time and money to buy ponies for her kids and schlep them and their tack and gear around the Southeastern horse-show circuit behind "the Skate," that tiny little car not even as big as the pony. And she was strong in her faith.

When she got ready to do her practicum experience for her Masters in counseling, she called to see if she could come to work with me. She did, and stayed for two semesters. She was well-trained in Rogerian therapy and was a serious, hard-working student. She was a joy to supervise. She saw some clients on her own and did some co-therapy with me, and got A's in the course. After she graduated, she wanted to work with us for the Supervised Work Experience she had to have (three years' worth) to get licensed. And after she got licensed, she stayed on as a colleague. I used to joke that I couldn't get rid of her.

All in all, I'd say we'd been together over ten years by the time of her death, and by then she had become a good friend. We walked together some (although she preferred the track and I preferred the neighborhood streets). We swam at the community pool, and we had "Culture Day" once in awhile and went to the museum or to home tours and such. We called each other when there were good birds in the air over our neighborhood ("Go outside! Quick! There's cranes!").

I loved her laugh. I loved that little disgusted spit noise she would make when she was mad.

She'd been sick a long time. It started with some falls that, at the time, did not seem all that unusual. But they got more frequent. Her balance was affected. Her gait was affected. She said her head felt heavy. I don't remember what all else. She visited doctors who said it was this (it wasn't), and it was that (it wasn't) and gave her medications, and changed the prescriptions when they didn't work. But because she had a really crappy HMO, it took months to get an MRI and find the tumor. By the time they did, she could barely walk.

Also possibly because of the crappy HMO, she didn't get a second opinion. I'll always wonder if she should have had radiation or chemo or something instead of the surgery, or to shrink the tumor before surgery. I'll always wonder if, had they caught the tumor sooner, or even if they'd caught the infection sooner, she would have lived. But she didn't, and they didn't, and she was gone in what seemed like the snap of your fingers although she'd been sick for nearly a year and in the hospital over a month.

She was 60 years young. She had children she loved and who loved her. She had grandchildren she adored and who adored her. She had plans, goddammit.

I miss her laugh. I miss that little disgusted spit noise she made when she was mad.

Friday, August 22, 2008

Blonde moment, 33 copies

It never fails. I always leave for a trip knowing I've forgotten something, and it's kind of a relief when I figure out what that something is and it's a minor something, like a toothbrush, rather than some disastrous thing, like forgetting to unplug the iron.

My syllabi are something like that: There's always an error somewhere. This one says that my Ethics students' reaction papers should use their student ID numbers in place of the Running Head as their only identifier---which does me no good at all should the pages of a paper become separated, because the Running Head only appears on the front! I meant to say, "manuscript page header", which appears on every page.

E-mailed everybody and got that straightened out before the first paper is due. Heaved a big sigh of relief.

If that's my only misstatement, we'll be in good shape.

Monday, August 18, 2008

And You Know It's STILL Monday

when at 11:12 p.m. you've spent what seems like forever trying to copy and scan an article from the textbook that didn't get ordered, on the world's possibly slowest home copier/scanner, so your students can read it before Wednesday because you've based almost your whole lesson plan around discussing it and you finally get it ready to upload and then the school's frickin' website won't let you because it's too big so you try to e-mail it but that won't work either because the school's e-mail system has the same 20MB size limit so you send all your students an e-mail saying you give up but you'll try again from the office tomorrow where you have a faster copier/scanner and maybe you can get the article into some other file format that will go.


If you're lucky, and Tuesday goes better than Monday did.

It's Definitely Still Monday If...

  • ... you spend 20 minutes circling the parking deck looking for a parking place.
  • You give up and spend another 20 minutes just trying to get out of the parking deck, which by now is a three-story traffic jam.
  • You drive over to the alternative parking lot you used last year and find that it is now closed to faculty.
  • You finally, in desperation, park illegally and are still five minutes late to class.

You Know It's a Monday When...

  1. It's the first day of class, and you can't find your ID--which unfortunately, is also your key to your classroom.
  2. You aren't even at your first class yet, and you're already getting e-mails from students saying that the book orders--for both classes, no less--are screwed up.

Saturday, August 16, 2008

Professors From Hell

I'm really excited about school starting Monday. I love teaching.

When I went back to grad school (for my 2nd masters & my doctorate) my first professor on the first day was John P., Ph.D. John was, without question, one of the best instructors at any level on any subject that I have ever had. Watching him teach was like watching a piece of performance art--every single class, he gave his all. High energy, encyclopedic knowledge, a sense of humor, passion, style--that was John. And one day in class, I remember thinking, "That looks like fun."

My first year out of school, I was lucky if I had six clients in a week, so in order to keep body and soul together, I decided to look for part-time teaching work. As it happened, a local commuter college was looking for someone to take over a course at the last minute, and I got the job. But I had gone to a professional school, and they don't have any interest in teaching teaching, so I graduated without any experience at all. As a result, I was pretty awful. I read a joke to open my first class. But I was right about one thing: This is fun! I loved it from the get-go.

Now, as I wrap up preparations for starting another semester, I think not only about how I wish to teach, which is to say, 'like John', but also about the burden on me how not to teach. Which brings us to the first Professor From Hell. (Further installments to come.)

This gal nearly drove us all crazy. We were beginning a series of three classes about which I was pretty excited as the topic had not received much coverage in my first Masters degree program. I was looking forward to this class. Boy was I disappointed. This instructor was a student of the Dean's from her grad school days at his previous place of employment, and I believe he'd hired her because he liked her rather than for her talents she had as a teacher, since we could never detect that she possessed any.

In preparing for her lectures, she xeroxed the text, then literally cut and pasted sections of it onto legal pad pages and read it to us! Talk about tedious. Hour after hour, she would read. Watching her was more painful than watching grass grow. We asked her not to, but it made no difference. On she read, relentlessly. We complained to the Dean, but it made no difference. She kept on reading. This was back before everybody had cellphones in their pockets or laptops in their backpacks, so we were hard-pressed to find ways to entertain ourselves. Two or three people would fall asleep every class period. Our class clown tried to lighten things up, but after the first few weeks she took him aside during a break and told him if he kept it up all the professors in the department would hate him and it would affect his grades. This reduced him to gloomy silence punctuated by snoring, and left the rest of us to our own devices to stay awake.

I can't say I learned much on the topic in her class, but I did learn something about how not to teach: Every semester I vow that whatever else happens, "I will not be boring!"

Friday, August 15, 2008

Managed Care is Killing Me

The economy is going into free-fall. The cost of consumer goods is up 5.6% this year, the worst it's been in 17 years. Tax collections in our state are down by more than 6%. Population growth has slowed in the 10-county Metro area. Home values are plummeting in the midst of rising foreclosures. Our state's jobless rate is at a 15-year high and expected to get worse. Everywhere you look there's more bad news.

In the meantime, what insurance will pay for our services has remained stagnant--or declined. Psychologists are probably the only professional group that has lost ground in the last few decades. Managed care is killing us.

One way in which it is doing so is by adding significantly to the paperwork/case management burden that we face. Just one small example is this fax memo I received from one company:
  • Wellness Assessments are to be completed in your office at the time of the initial evaluation and faxed to [insurance company]
  • A second Wellness Assessment is to be completed in your office during the 3rd, 4th, or 5th session and faxed to [insurance company]
  • A set of algorithms are applied to all Wellness Assessments designed to identify potential clinical risk
    • Some potential risks yield a letter that requires you to determine whether the identified concern has been fully assessed and, if applicable, addressed in the treatment plan. It is strongly recommended that you file the letter and document that the risk is being addressed in treatment or has been ruled out in the course of assessment/treatment
    • Potential risks that yield a Care Advocate outreach call require you to complete a brief clinical review
For members who have seen you in the past and return to treatment, representing a new episode of care, the Wellness Assessment should be completed even if the member completed Wellness Assessments during a previous treatment episode.

During the first two quarters of this new initiative, you have seen between one and five new referrals. In all or most cases, a Wellness Assessment was not sent. Please review these requirements to support your implementation of this process.

This is a level of supervision which I have not received since I was in grad school. Let me just say that I don't need an insurance company computer to tell me when a client is at risk or a Care Advocate to tell me--after the fact--what to do about it!

A Wellness Assessment, by the way, asks some very intrusive questions of the client:
  • In the past month have you felt you ought to cut down on your drinking/drug use?
  • In the past month have you felt annoyed by people criticizing your drinking/drug use?
  • In the past month have you felt bad or guilty about your drinking/drug use?
  • In the past week, approximately how many drinks of alcohol did you have?
This is protected information that is now going to be faxed to... who? A clerk? I certainly don't know. And besides running algorithms on it, what will they do with this information? It's not anonymous: It asks for complete identifying information at the top.

These are actually useful questions, as are the others on this sheet, but they are also questions that competent therapists routinely ask. Why we should have to ask them twice and fax them in for someone to second-guess us (we are, after all, fully licensed to practice psychology independently) is beyond me. Besides which, all this c**p takes time I could be spending with the patient! Actually helping them with these problems!!

Thursday, August 14, 2008

Never a dull moment in this job!

Just when you think you've seen it all, the Forest Service brings a handcuffed guy in for an evaluation: Seems he spent the night in a tree overhanging the river that runs through our National Forest, and the Service was concerned about his mental status.

He's still brushing twigs and duff from the forest floor off of his clothes and knocking stuff out of his hair while you're doing the interview.

When you're done, he bows and kisses your hand like a knight of old.

Then the county sheriff handcuffs him and takes him off to the state hospital.

Tuesday, August 12, 2008

Supervisors From Hell, Part I

Back when I was a lowly practicum student, I was asked to perform an assessment and offer an opinion as to the readiness of a parent for unsupervised visits with her kids. I did the evaluation, wrote up a letter for Child Protective Services, and submitted it for my supervisor's signature.

She hung on to it for a week. I couldn't figure out what the deal was--I mean, just sign it already!

When I finally got it back, I found that she had changed my recommendations so that they were no longer based on data from the evaluation. She had felt free to get it re-typed to suit herself, and to add insult to injury, my letter now contained a summary sentence to the effect that visits were "counter-intricated".

She wouldn't believe me when I told her that the correct term was "contraindicated." She argued that "counter" is a word, right? and "intricate" is a word, right? so if they are both real words, you can hyphenate them, and you have a real (compound) word, right? so what was my problem?

She refused to send it back to the typist: I refused to sign it the way it was.


The client never got her letter.

Thursday, August 7, 2008

How I Chose My Major

I was telling this story the other day, and thought it might be worth a re-telling.

I had been to a hoity-toity, liberal-artsy girls' school in the Old South for two years. It was not a good fit for me, as any of you who know me can well imagine. I dropped out my second summer, got an apartment and a job. A year later, I felt ready to go back, but had acquired some expenses and therefore needed to keep the day job. Back in the day, college was for young persons in dorms, not adults with jobs and apartments: There were no night schools.

But as it happened, the civil rights movement had spawned a federal grant to educate police officers, who, back in the day, only had to have high-school diplomas. Police officers work shifts. Ergo, to get the grant money, a college would have to offer day and night courses. And as it happened, a little school in my hometown decided to open a night school, The Urban Center, and make it available to citizens as well as the police. So I applied.

I was working at the time as a pool typist, and later as a Data Entry Operator, for Dun & Bradstreet. I wanted a promotion to Business Reporter, but to do that I needed some business courses. The company would reimburse a portion of my tuition for every course in which I obtained a "B" or better. Sounded good to me. I got accepted, and in due course went over to register.

Yes, children, it is true: Back in the day, you had to register in person. No Internet. Plus, since it was a night school, and registration normally happened during the day, faculty and administrative staff rather than the secretarial/clerical types were handling it after hours in the main office complex. I drew the Dean for an interview, as I was transferring in from another school. We did our thing with the credits and he wrote down my proposed major and then he left me sitting there while he went across the hall to do his thing with the punch cards (I'm really dating myself here, aren't I?)

I love books. When I'm in someone's home or office for the first time, I go straight for the books. The Dean had great books, including Cleckley's Mask of Sanity. Fascinating!

So he comes back, having signed me up for business courses, and I ask, "What did you major in?" He looked at me warily, like "Oh my god this woman is going to be one of those students who changes her major every semester, isn't she?" and answered, "Psychology. I'm a psychologist." And I said, "That's what I want to do!" and we had to do all the paperwork and the punch cards all over again. But I loved it, and still do. It was the smart decision for me.

Wednesday, August 6, 2008

Credit Card Security

Hello, everybody.

Just a quick post in response to last night's news to reassure everybody that we do not process your credit card transactions over an open network! Don't know what those retailers were thinking. Ours is not only secure, it is secured by a long, complex, randomly-generated WEP code.


Monday, August 4, 2008

Kite Runner

No, not that kind. The Swallow-tailed Kite!

Real unusual in our neighborhood, one showed up just north of my office over the weekend. So I left work in the middle of the day to run up the road and look at it. I rationalized that (1) it would be good for my mental health--certainly true--and (2) that anything that is good for my mental health is bound to be good for my clientele--possibly true.

This was unplanned. No scope, no map, didn't even have any extra camera gear (basics, you know, like a tripod?). But off I went. And sure enough, the Kite showed up a few minutes after I did. After soaring near the road for a few minutes and giving us several good views, it disappeared again.

I trudged up and down the road for a few yards in either direction, getting all hot and sweaty in the middle of my work day, no less, while the other birders jumped back in their truck and went on their merry way. Sensible people, that lot. I was just about to give up and go back to work when I saw the Kite pop up from behind some trees again.

I got so excited that I pulled over on the side of the road again and hopped out to try to get a photo. I was alternately looking at the bird through my binocs and trying to snap a shot off with my compact digital camera (never got one--this one was taken by another birder) when I felt something bite my ankle. I looked down and saw that I had been standing in a fire-ant hill for several minutes! So right after the LIFER! Dance, I did the Fire Ant Dance for the entertainment of passing traffic. My right foot had been smack in the middle of a mound the whole time: I was lucky only one of the little bastards had got onto me.

After that, the Kite left again and I did go back to work.

It's a beautiful, graceful bird. Its white is the purest white, its black pure jet. It soars, but then so do a lot of birds. What makes this one stand out to me is the way it swoops on bugs. When it snatches a meal off the top of a tree it does so with such grace and pin-point accuracy that it does not appear that the leaves even stir!

Great way to spend a lunch hour. I may even do it again tomorrow.

Sunday, August 3, 2008

Woman on a Mission

Yesterday while surfing I found a great blog, "Made A Difference For That One: A Surgeon's Letters Home From Iraq" at

I used to carry a hot pink key chain (harder for this ADD therapist to lose!) that said "Woman on a Mission" on it. A colleague asked me one day what the mission was, and I said that it changed from time to time. His reply was a snort and a statement to the effect that 'that isn't much of a mission, then.'

Wrong, boychik. Missions, once accomplished, must be replaced. And even missions in progress, especially if there's any hope of accomplishing them, must be amended as conditions on the ground change. But mine, at bottom, has always been to leave my little corner of the world a little bit nicer than it was when I found it.

At the time of the above conversation, it was "Changing the World, One Woman at a Time" in respect of the fact that my entire caseload was female. I don't know why: In a supervision group I used to attend, we joked about the Gods of Therapy, who knew just what to send you and when. So I just respected that the universe wanted me to work exclusively with women for awhile, and I put my all into it.

One of my earliest clinical supervisors, back when I was working on my first Masters degree, warned me that I could not measure the value of my work by my clients' progress. She said that what I had to do was first, do good work and second, know that I had done a good job. And I have found over the intervening decades that she was to a large extent correct. There are so many times you can do good work and see absolutely no result for the simple reason that personal growth is an inside job. You can't make it happen for the client--the client has to do it. And some days, they just won't.

Days like those, I only know I make a difference by being part of something bigger. As a psychologist, I am one of about 98,000 nationwide. And believe me, 98,000 people, organized, can make one hell of a difference.

On the other hand, there are times when you can make a difference. A tiny difference, but a just noticeable difference nonetheless. And I find that most days--sometimes even on my day off--I can achieve that.

Yesterday a client called as she was planning a relapse. It was my day off, and I had been sleeping in. But of course I got up and made myself a pot of coffee and called her back. We spoke for ten minutes or so, and when we hung up she sounded more centered. All I had done was remind her of coping skills that she already had but had forgotten in a moment of panic, yet when I hung up I could pump my fist and say to myself, "Made a difference to that one!"

That comes from a parable about a woman walking along a beach who finds a starfish stranded above the tide line and throws it back into the sea. Another walker comments that there are so many animals stranded that way every day for miles up and down the beach, why bother? What difference could it possibly make? The woman replies, "It makes a difference to that one." Which tickled me, because I am the dotty old lady who is forever pulling over to the side of the road and gimping out into traffic to move a turtle to safety. (Made a difference to that one!) Or picking up strays and boarding them at my vet's until I can find their owners.

So when I think, What can I do? I come back to 'I can make a difference for somebody, or some thing, somewhere, somehow, today.' And that's my mission these days: "Make a Difference to That One!"

Saturday, August 2, 2008

Parcoblatta virginica

It never ceases to amaze me how long it takes psychology as a profession to get something into print. For example, it can take up to two years to get an obituary into the American Psychologist! Mail announcements from my state organization are frequently delivered days, if not weeks, after an event. Last year's Annual Report only just arrived from the national organization, in the July/August 2008 edition of the American Psychologist. Wall Street would have a cow if any publicly-held corporation took that long to get its profit statements out.

The Report rarely makes for interesting reading. There's lots of drek in there, like pages and pages of teeny-weeny type reporting who joined last year: Who cares? and pages of committee reports. This year, however, I am happy to be able to say that the issue contains a restatement of our opposition to torture. (Did you really think that we could come out in favor of it?)

We're also for health care reform and we adopted the Guidelines for Psychological Practice with Girls and Women as official policy. We also adopted as policy the Record Keeping Guidelines. Most amusing, we have officially rejected Intelligent Design: As a scientific organization, we should never have had to discuss any other option, but there it is.

I do always like to read the Report of the Ethics Committee, however, because this always includes the number and kinds of complaints that were filed in the previous year. I confess to a certain amount of morbid fascination with this data. In addition, this year I plan to use it to focus my efforts in my ethics class. For example, among the winning student papers on ethics last year was one entitled "MySpace or Yours? The Ethical Dilemma of Graduate Students' Personal Lives on the Internet," to be published in Ethics & Behavior this year. This strikes me as a perfect topic for an in-class discussion.

Apropos of the above, I Googled myself to see what personal, embarrassing, unprofessional stuff might be 'out there' about me... and discovered the Virginia wood cockroach (Parcoblatta virginica), a portrait of whom I have included above for your enjoyment. This particular one was once a denizen of Fort Sill, Oklahoma. I've never met her.

Friday, August 1, 2008


It's Friday, my Regular Day Off. I like to have at least one day every week when I don't have to go anywhere or talk to anybody, or even get dressed if I don't want to. This is not it, as we are going out to dinner with friends later, but so far it has been a quiet day at home.

For months, it seems, I have spent my "off" days prepping for classes or writing reports: Today I have mainly been reading Just Another Soldier and practicing "The Fishing Hole Song" with my parrot. I have attended to some household chores--I've done a load of dishes and two of laundry, and tried to clean up a bit in the back hall where the dog sleeps, but mainly it's just been a long-needed, relaxing day at home.