Docsplainin' -- it's what I do

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

Thursday, July 31, 2014

I Don't Want To Be a Responsible Adult Any More

Digital Photography School put up an article the other day on using photography for personal growth. The woman who wrote it, Catherine Just, was struggling with being a new mom, and found herself taking a photo every day of the part of the process that was the most frustrating to her. In her case, it was not being able to get the little sprat to take his naps. She wound up with some emotionally stunning iPhone pics of herself and the bébé sleeping together. She said the photos -- and her attitude -- changed in about a month of doing this.

I had been wanting to document Mr. Wood's last year? journey? something, and struggling for a way to do it that captured our emotions but was respectful of his desire for privacy. For example, I wanted to go with him to the barber shop when he got his head shaved the other day (his hair and beard are falling out from the chemo), but he would have none of it. The notion of a daily photo of something that frustrated me really clicked, because that wouldn't necessarily be about him at all, but I still spent two or three days trying to figure out what the theme needed to be.

And finally, a light dawned. I'd been noticing a lot of nights, when it's time to go to bed and I discover I haven't cleaned up the kitchen yet and I'm already tired and my legs are already giving out, that I've been surveying the wreckage and saying to myself, "I'm tired of being a responsible adult." I want to go to bed, let my mother do it. And so it dawned on me that the most frustrating part right now is not about him or even necessarily the cancer itself at all, but about my physical inability to rise to meet the occasion, the limitations that post-polio sequelae put on my ability to care for him. Which does indeed frustrate the $#!% out of me.

And too that phrase encapsulates so much more about what's happening to us and our reactions to it. I find myself wistfully recalling times when we didn't know what we know now -- some times as recently as this spring, other times from the beginning of our relationship -- and wanting that innocence back. Not our youth or our health, even, just that sense that not only is today not threatened, but that there's always a tomorrow. I have even cracked to a high-school friend who asked if there was anything she could do, "Take me back to my childhood and leave me there." I don't want to be a responsible adult any more.

But I digress.

This morning what hit me first was the instructions on top of our dog's food storage container. I left them there for the pet sitter, in case of another medical emergency like the one we had two weeks ago, but they seemed this morning, at 6 a.m., to be a demand on me -- "Feed TWICE daily," the stickers shouted. And it's on me to do it because Mr. Wood's fatigue is so bad that he can't reliably be counted upon to be out of bed before noon, and the animals can't wait. (Sometimes he doesn't get up all day. When he got out of the hospital, he slept 28 hours straight!) So I have been, for quite some time now, getting up 20 minutes early every day to take care of the animals before I leave for work.

I took a photo of it this morning, my first for this project.

Something bugging you? Give it a try!

Wednesday, July 30, 2014

Actually now I'm remembering why I quit reading the paper in the first place

In Sunday's paper there was also a response by "Dear Abby" to a potential sexual assault victim that nearly made me blow my obstreperal lobe. The writer explained that she walks her dog in a park close to her house where a park employee is creeping her out with his staring. She would hate to have to stop walking there. Abby advises her that she's probably worried about nothing, and should ask other women if he creeps them out, too. Gee, she (Abby) sure would hate to see the poor guy lose his job if the writer were to make a complaint. Which, by the way, the writer never even mentioned. She had responded to the staring by being more deferential (smiling, saying "hi") and was looking for a more aggressive response -- how, perhaps, to confront the guy.

Seriously, woman? 

In the first place, this park is close to Dog Walker's home. Perpetrators are known to place themselves in jobs, hobbies, and volunteer positions that give them access to victims. There was a guy around here some years back who worked for a car wash, enabling him to copy the keys of women in the neighborhood, you know, for easy entry into their handily nearby homes at a later date. Where he had followed them after detailing their cars.

In the second place, living in a rape culture as we do, women are taught practically from the cradle not to make a scene. When I first started out doing rape crisis, I was amazed to learn that self-defense instructors had to make their students practice screaming. The women didn't want to do it. Couldn't do it. Our instructor told us that, among other things, women would not cross the street to avoid someone whose demeanor concerned them, would not go into a public place to avoid someone they believed was following them, would not even confront someone who touched them inappropriately -- all for fear of making a scene. Mind you, it doesn't make it a woman's fault when she gets raped: My point is that we are forbidden in this culture to act to protect ourselves, and Abby's perpetuating this with her response to Dog Walker. We are taught not to listen to our gut, not to make a stink when something's rotten in Denmark. The last thing we as women should be doing is blowing off each other's instincts that there's something just wrong about a guy.

In the third place, I purely do hate to see that the "Poor, Pitiful Rapist" syndrome (he's lonely, he's frustrated, he can't control himself, he's sick, he's crazy, blah, blah) is still alive and well. Of course this guy's not a proven rapist, but all the same, what's with all this concern about him?? This is not about him. This is about Dog Walker feeling threatened. He might be mute, Abby writes, or not speak English (although what this has to do with staring is beyond me*). Children stare because they don't know any better. But when someone or something higher up the food chain (be it a man or a leopard) stares at someone or something lower down (be it woman or mountain goat), it's a threat that's recognized across all species and so it has been for millennia. Yet just in case she might hurt his feelings or threaten his job or some such, Dog Walker's not supposed to say anything?

No, no, no, no, no -- a thousand times no, Abby. This man's right to creep women out -- for any reason, harmless or otherwise -- does not trump Dog Walker's right to feel safe in public spaces. You should have told her absolutely to quit walking her dog there, or at the very least to give this dude a very wide berth and never be out when or where there's not large crowds around. And even then. What's to stop him from following her to find out where she lives?

And further, Abby, you should have given her permission to tell anybody she damn well pleases about this guy, although I stress that she is not obligated to do so. She can tell park personnel office, security, other women, whoever she wants. It's her story: She can put up a billboard if she wants to. She doesn't have to check with other women in the park first. If it turns out that it's only that he's mentally ill or intellectually handicapped, fine. Administration can put him in a position or on a shift where so many demands aren't placed upon his limited interpersonal skills. If he's some creep who was never backgrounded before he was hired, then better they know about it and deal with it now than later.

*in fact, it strikes me now that that's even a bit ableist or racist

Tuesday, July 29, 2014

Renouncing Psychology

Deutsch: Phrenologie
Deutsch: Phrenologie (Photo credit: Wikipedia)
Well, maybe not quite yet. 

It did get your attention, though, didn't it? 

And it's true, I do have a beef with psychology. My introduction to psychology was accidental, a story many of you have heard. I wandered into a psych prof's office when I was getting signed up for a business degree, and the rest, as they say, was history. 

But these were academics. I got introduced to clinical psychology through Ann McAllister and Stuart Strenger, Ph.D.s who practiced together in Buckhead back in the '70s. They were wonderful clinicians and even better human beings, and I wanted to be like them when I grew up. 

Twenty years later, I was surrounded by so many psychologists whom I could not even like, never mind respect, that I began to wish I'd never let my counseling license go. I no longer wished to identify with the arrogance, callousness, unscientific thinking, unprofessional behavior, and outright greed that I was encountering on a daily basis. The profession, however, I still loved. I was proud of the science of psychology. 

Psychology was already changing, however, and I can't say I like the direction it has taken. So while I am not quite ready to disavow it, I do have a beef. 

Once upon a time, the scientists in psychology were all rat-runners. The psychotherapists were all theorists. And their theories generally took into account the whole human being. Psychotherapy was an emotional, intellectual, psychological -- dare I say it? -- even spiritual journey that the therapist and patient/client took together. 

And then, along came Skinner. That was the start of our slippery slope. 

Don't get me wrong: Behaviorism is a damn good theory, and behavioral therapies have some great applications. But what happened next was that, coincidentally with our long-standing desire to be taken seriously as doctors came the push to be included in insurance reimbursement, to be classed as healthcare providers. And that, my dears, was the beginning of the end as far as I'm concerned. 

 The number of mental illnesses we can diagnosis (and of course this is psychiatry's fault, not psychology's, but it stems from the same sources and we've been on board with it from the git-go) has multiplied astronomically from what it was 50 years ago. Everything's abnormal now, treatable, and most importantly from the point of view of many practitioners, reimbursable. 

The twin drives to be taken seriously and be paid as doctors has spawned the evidence-based practice movement, a child of the devil if ever there was one. Ironically, perhaps, it is also the part of the science of psychology with which I most identified in the early days. Why would we waste people's time and money, and offer false hope, for silly woo-woo therapies that don't work? Let's study what does! Sounds great, right? But somehow, in the process, we have reduced diagnosis and treatment if not to the level of the petri dish then to something scarily close to it.

Therapies are manualized. Follow this cookbook recipe with every client you have with this diagnosis, and they'll get better. It's pigeonholing clients, and reducing professionals to technicians. Everything, even assessment, is by the numbers. The person's humanity is out the window, all their experiences and dreams and complexity reduced to three symptoms from group A, two from group B, for a duration of not less than two years, and not due to some other specified disorder or circumstance listed in Appendix C.

Worse, the therapies don't work. Or they only work in the lab. One I got all excited about last year after a workshop turned out to be this sort of dud. Thirty percent of the potential participants in the big study its proponents were trumpeting were weeded out before the study ever started. They had more than one problem, or they were on medication, or whatever variation in their circumstances that normal human beings coming into clinician's offices every day exhibit. So at best, I'm thinking as I'm reading this, the new treatment works with 70% of people with this diagnosis, right?

Not so fast, Virginia. No fewer than 50% of the folk enrolled in the study dropped out! So now, if the new treatment helped every single one of the completers (which, of course, it didn't), we're talking about a therapy that is effective for 35% of the folk for whom a clinician might consider it. Thirty-five percent.

And yet this has now become the only approved therapy for this disorder.

I kid thee not. It works for maybe 35% of the population with this disorder, but if I don't deploy it with every one of them who walks through my front door, I will not be treating my people according to the standard of care, once this gets written into the standards, which it will. Mark my words.

Ironically, chasing the money has led us to fly directly in the face of the best and latest science, offering "treatments" that are absolutely proven not to work for "disorders" that are pretty much proven by now not to exist because they are lucrative. Jumping on the weight-loss bandwagon, as psychology has over the past year or two, is perhaps the best example.

I'm done.

I want to go back to sitting with my clients. And no, they're not patients. They're not sick! I want to go back to being with my clients, not sitting there trying to look attentive while running algorithms in my head or jumping ahead to what I'm supposed to say next according to the treatment protocol. I want to go back to the day when the therapeutic relationship was the primary healing factor, when my own best tool was my self, not a checklist with lines and boxes and graphs to complete to tell me what's the matter with the person. I want to go back to the day when my care was caring, not steps I followed in a manual, to a time when good therapeutic technique mattered, yes, but when there was an art to it.

Is that too much to ask?

Enhanced by Zemanta

Sunday, July 27, 2014

Oh, no. That is SO wrong!

I'm reading the Sunday paper this morning and I'm all like, wha-a-at??

It seems that transcripts of some of Carson McCullers' sessions with her therapist are being released to researchers, and everybody's all excited about how this will give them more insight into her life and art. Well, not everybody. I'm certainly not.

I'll give the therapist a pass on terminating the therapy relationship so they could have a personal relationship. This was the '50s, after all, and things were different then. In fact, they were so different that she might actually have been a bit ahead of her time in that regard. Most people back then didn't bother terminating one relationship before beginning another. I remember when I was just a young sprat of a therapist reading about one famous, leading psychologist who was therapist to a young woman, then her professor (presumably he mentored her into grad school), then her clinical supervisor -- and then her husband! Not sure when, exactly, they became lovers, but good grief. That's like a perfect trifecta of "dual" relationships.

But McCullers' therapist/partner lived until 2013. By which time it should have been glaringly obvious to her that those transcripts should have been destroyed -- back in the 60s, not to put too fine a point on it.

And the university that inherited and is releasing them bears some responsibility here, too, even though the actual custodians are likely academics in literature, not psychiatrists. They should have quietly destroyed them as soon as they realized what they had.  

Thursday, July 24, 2014

Opinionated Much?

Just when I get worried that I've been too opinionated, an angel gives me a quote like this:
"Nothing is more conducive to peace of mind than not having any opinions at all." --Georg Christoph Lichtenberg
I have no idea who Georg is (will Google him later) but I do thank him. 

Wednesday, July 23, 2014

Draw, Podna!

Or not.

Some of you may know we have a new gun law here in Georgia. Basically, it says you can carry a gun anywhere, with or without a permit, concealed or 'open carry'. And of course, as you have read in the news, some folk have been exercising that right -- resulting in at least one arrest, but I digress.

The topic came up among colleagues recently, who are all bestirred about exactly what the law says about our ability to prohibit guns in our offices, and several have expressed the felt need for legal consultation before doing anything. There was also some discussion about what to do if a client doesn't like it.

Here's my take on it.

I have always expressly forbidden weapons of any kind, legal or otherwise, permitted or not. No pepper spray, no nunchucks, no knives, no throwing stars, no guns, no clubs. This is a clearly stated, up-front policy: New clients sign a form stating that they have read and understood this. So new clients who do not wish to abide by this policy can go find another therapist. Easy peasy. But I've never had a problem with it. Everybody's reaction, from day one some thirty-three years ago, has always been, "Ok, cool, no problem." Even my gang-banger, whose posse used to stand guard downstairs during his sessions.

I don't anticipate that any of my existing clients will have a problem with it either, if only because (a) they've already agreed to my policy, and (b) because there's no political struggle for them to win here, no point for them to make. After all, I'm a good ol' girl myself, with a gun and a carry permit of my own, and I don't bring my gun to the office! Also, it's not a policy in isolation of other operating procedures I have in place -- all of which I follow as well. I expect 24 hours' notice of cancellations, for example, and in return I let you know the minute I know I'm not going to be able to be there for your appointment. If you no-show, I charge you; if I double-book, the next one is on the house. You can't show up drunk and expect to get a session, but then again, I don't show up drunk to work with you, either.  

There was also a flurry of worry about how to terminate appropriately with a client who violated the policy. Again, I am not concerned about that, because if a client brings a gun into my office or repeatedly shows up drunk, doesn't pay their bill, whatever -- they have already clearly stated by their behaviors that they do not respect me or the terms of our contract. They are in breach of contract and I'm no longer obligated, not to find them another therapist, and not to see them three more times to wind up their treatment. And that is not abandonment, because they knew in advance of the fact that such behavior would terminate our work together. Therefore, by doing so, they are in effect leaving the therapy, same as if they'd walked in the door and said, "I quit." I'm not going to schedule my usual three termination sessions in such a case, knowing they're going to bring in a gun and endanger me, my coworkers, and our other clients in that manner. Now that would be unethical.

I would, because it is a therapeutic issue, a profound statement about how they feel about me/their mother and about their therapy, attempt to analyze it at the time that it occurs. But if we couldn't resolve the issue, then we would be at an impasse which would make any future therapeutic progress impossible anyway. 

Again, this is not about the gun, but about the process. If a client could not come to treatment sober, I would not refer them to another therapist because it would undermine the basic message I wish to send, which is that you can't do outpatient therapy while you are using. You need inpatient first, then come to therapy. Nor would I schedule three termination sessions in such a case, without some assurance that the person would be able to show up clean and sober for same. To do so would send the message that I don't really mean what I say -- that it's ok to show up drunk when I say it's ok. Same points could be made in the case of nonpayment.

So I will continue to forbid weapons -- all weapons, but especially guns because of the irrevocable lethality. The only exception is on-duty cops, who are required by the Job to carry, as has always been the case in my practice. By my reading of the law, it is legal for me to do so as a private person on private property which I have control of by means of my lease of the space. You think I can't? You can take it up with my attorney.

But it's my rule, and it stands. 

Sunday, July 20, 2014

Girls Find Science Boring Says Scottish Expert

Say what?

Gijsbert Stoet, a psychologist at the University of Glasgow, told his audience at the British Education Studies Association conference recently that 'effort is wasted trying to bridge gender divides in education when innate differences meant that boys and girls would always be drawn to different subjects and careers', according to an article on the tes connect website. “Do we really care that only 5 per cent of the programmers are women? Well, actually, I don’t care who programs my computers," he is quoted as saying.

Stoet works for the University of Glasgow’s Robert Owen Centre for Educational Change. Anyone else besides me find that ironic?

What about the menz, he wants to know: Apparently to him this is a zero-sum game -- any help given to girls to get them into STEM takes away from help supposedly needed by boys. And of course, if you have a choice between helping boys and helping girls, well. Helping boys is obviously more important, right?

For any of you ladies who think you are living in a post-feminist world, here's evidence that a stone-age mentality is still alive and well among people who have the power to influence your future.

Saturday, July 19, 2014

What a Wonderful World!

U.S. President Theodore Roosevelt (left) and n...
U.S. President Theodore Roosevelt (left) and nature preservationist John Muir, founder of the Sierra Club, on Glacier Point in Yosemite National Park. In the background: Upper and lower Yosemite Falls. (Photo credit: Wikipedia)
It's kind of a depressing world we live in. Every day the news is full of bad news--oil spills, murdered children, plane crashes, political chicanery, terrorism, disappearing species. Or we have direct exposure: You see a stray dog hit and killed in the road, or you are haunted by childhood memories of domestic violence or alcoholism. Someone you know is killed in Afghanistan. Or maybe the thrushes that have nested in your woods every summer since you bought the place back when your kids were little didn't come back this spring. And it is easy to despair. 

"I'm just one person! What can I do?"
This is the question a client asked me the other day. And my answer was, "A lot! You can do a lot!"

Theodore Roosevelt said it best: "Do what you can, with what you have, where you are." People with great resources (money, some sort of public platform from which to reach millions) can do a lot. The rest of us, not so much. But we can always do something, and in relative terms, it counts for much. 

The point as I see it is to be a good steward of your little corner of the world, to leave it just a little bit better than you found it.

Vote. Write a letter to your congressional representative, or your senator. Attend a school-board or city-council meeting. Write a letter to the editor. Demonstrate. Boycott. Raise money for a good cause.

Spay your cat and keep her up. It seems like a small thing, but it does wonders for her health and happiness: Cats allowed to run free are subject to all kinds of bad outcomes, ranging from injuries in fights to infectious diseases to being hit and killed by cars. In her lifetime, you could save as many as 300 birds' lives. That is no small thing! And by not allowing her to reproduce, think how many homeless kitties you've prevented in succeeding generations. 

If you can't afford a dog yourself, volunteer at your local shelter. Your efforts will make the animals' lives healthier and happier while they're there, and every hour you donate increases their odds of survival. Adopt (don't buy) one yourself, if you can. You may not be single-handedly solving the homeless dog population problem yourself, but your action means everything to that one dog. Everything.

Adopt a child. If you can't afford that, get qualified as a foster parent by your local Department of Family and Children Services. Or become a CASA (Court-Appointed Special Advocate) volunteer. Informally, offer a hand to that overwhelmed parent in the supermarket or in your neighborhood. Or pick up the phone and report a child at risk. You could be saving a life.

I used to carry a hot pink key-chain fob that said, "Woman On a Mission." Quite naturally, people would periodically ask me what the mission was. When I was a child protective services caseworker, I told everybody I was out to change the world, one child at a time. When my practice was predominantly women survivors of domestic abuse, it was "changing the world, one woman at a time." I knew I couldn't change the world, but I believed that my work could be world-changing for the one woman or child in my office, at least for the one hour. You're no different: You, too, can change the world for another living being.

Start a blog. They're free here at and via WordPress. Both will walk you through the set-up process, so you don't even have to be very computer-savvy. Perhaps you know more than you give yourself credit for, and you can share your experience, strength and hope with others. All it will take is a little of your time.

Recycle. Pull your weeds the old-fashioned way instead of poisoning them. Don't use pesticides. You'll help save birds, butterflies, and bees, and our soil and streams will be just that tiny bit much cleaner for your effort. If you have property, plant some milkweed.

Speaking of water, use less. If you can afford it, buy shade-grown organic coffee. If you can't, cut your consumption. Don't eat chocolate produced by companies that exploit children, use slave labor, or rape the environment. If you can't afford Rain Forest Alliance-certified chocolate, give it up. Or eat less. Buy locally-produced food-stuffs when you can.

Say something nice to somebody today. Do somebody a favor. Or just smile at them. It may not seem like a big thing to you, but it could be the highlight of their day.

My first ethics text, If Everybody Did, by Jo Ann Stover, asks children to consider their actions in the light of this question: What if everybody did that? When you are taking one tiny step toward improving your world even one tiny little bit, ask yourself that. What if everybody did? 

What a wonderful world it would be!
Enhanced by Zemanta

Thursday, July 17, 2014

The Circle of Life, or

Red-Shouldered hawk portrait
Red-Shouldered hawk portrait (Photo credit: San Diego Shooter)

Hawks Gotta Eat, Too.

 I was out on the deck one day last Spring, brushing the dog and catching some rays, and watching the nuthatches take possession of the owl box from a squirrel. It was a quiet day, so when I heard the doves suddenly fly up in alarm one yard over, I looked to see what was up. A hawk had apparently caught one of them. He flew up into a tree, paused for a moment to get a better grip and took off, presumably for his own family's nest with dinner for his mate & nestlings.  

It seemed significant to me, somehow. There it was, new life beginning for the nuthatches, a life ending for the dove, and maybe for its babies if it already had any at this point, and life, presumably, continuing for the hawk and his family. 

When one of us dies, it doesn't (usually) contribute to the continuing life of another being--these days, we tend to do that while we're living, with dying for another being the exception rather than the rule. But the other part, the suddenness and the unpredictability, that fits with our experience. 

We are here, until we are not. 

That particular afternoon it could just have easily been the other dove that the hawk caught, or one of the nuthatches. Or the nuthatches could have lost their standoff with the squirrel whose box that has been all winter. Or the dog or I could have been hit by a falling limb. 

We are here. Until we are not.
Enhanced by Zemanta

Wednesday, July 16, 2014


I read an article a while back about physicians' arrogance and how it results in poor patient care. And as I read, I thought that much of it translated well to the field of psychology.

Psychologists, as a rule, are an arrogant bunch.

I was lucky to be therapized, supervised, taught, and mentored into the profession primarily by psychologists who understood respect. But I had some bad experiences, too, with arrogant supervisors that left me so scarred it took years to recover. And I'm not the only one -- I once had a prospective supervisee burst into tears when I told her I never yelled at students. Apparently she'd been yelled at through most of her grad-school career and was expecting more of the same from her practica.

We as a profession have a tendency to believe that we know it all now that we have that 'terminal' degree, and to fail to take seriously those coming up behind us. We stop being teachable. In our arrogance, we can fail to take our duties to our clients seriously, as well, resulting in everything from poor service to egregious ethical lapses. In that vein, I have seen:
  • A psychologist disrupting a psychometrist's testing sessions to ask questions, obtain items from the testing room, and even to introduce another patient -- because it would have been an inconvenience to wait
  • A psychologist deleting critical safety recommendation from an intern's report
  • A psychologist stating he didn't need to read the new manual for a radically revised test, then disagreeing with the intern about conclusions based on new norms
  • A psychologist using cheap photocopies of test materials and cutting corners in administration  because s/he wasn't getting paid what s/he thought s/he was worth to do the work right
In these cases confidentiality was violated, tests were invalidated, a staff member was assaulted, a client failed a placement, and countless inaccurate conclusions went out in reports. The seriousness of these consequences would be hard to overestimate.

Arrogance can produce abuse or neglect of student interns and staff as well as of patients. I have either experienced myself or witnessed:
  • Staff psychologists and professors sexually harassing students, interns, and nursing staff
  • Staff psychologists attempting to influence interns' communications with site visitors from certifying bodies
  • Senior psychologist telling junior psychologist, who was asking for help with staff management problems on her unit, "Buck up, Bucko!" 
  • Psychologist telling intern, "[Expletive deleted] rolls downhill. And you're downhill."
  • The psychologist leading a supervision group being dismissive of supervisees' input, actively discouraging such participation as "taking over my group"
  • Clinical faculty blowing off supervision appointments and seminar meetings required to meet state licensing standards and then threatening interns who complain
Needless to say, not a lot of learning can occur in such an atmosphere, and that translates into obvious gaps in the care of those students' patients down through the decades over the course of their careers. Over and above the gaps in the learning of facts and skills, such an atmosphere sets an example for students that says that patient appointments are not important to respect, patient and staff input is not valuable, rules and regulations can be bent as long as nobody knows about it, and nobody should ever report anything untoward.

Inadequate supervision of students and staff (when the arrogant psychologist just can't be bothered) translates into patient abuse going unchecked, and in patient neglect. Patients in turn are inadequately supervised or under- or mis-treated, resulting in self-injuries, untreated medical issues, assaults, suicide attempts, elopements, and deaths. I am not just speaking theoretically here, either: These things have actually taken place.

Then there's the arrogant dismissal of patients' needs and lived experiences. We have
  • A psychologist commenting in reference to a severely mentally ill patient s/he deems hopeless, "I can heal the sick but I can't raise the dead!" 
  • A center director considering it taken as read that a person with schizophrenia (most of the center's caseload) is incapable of participating in hir own treatment planning
  • Psychologists failing to advocate appropriately for minor clients or to support self-advocacy in adults
  • Psychologist making fun of a client's parenting style
  • Psychologist blaming dead victim of domestic violence (parent of a child client) for getting into/not leaving the relationship
This sort of attitude trickles down to other staff, students, and even clerical employees, with the bizarre end result that one clinic I worked at was actually cited in an audit for -- wait for it! -- not providing mental health care.  I am not making this up.

The experience of stigma is, by the way, a known health risk. By copping an attitude that we are better than our clients (because we are thinner or healthier or more fit, better-educated or more financially well-off -- any measure seems to be fair game these days), not only are we not being helpful, we're actively making our clients' mental and physical health worse. We're putting tremendous pressure on our students and staff, who are, after all, exposed to our prejudices many more hours each week than are our clients, and we're setting terrible examples for them.
    Obviously parents from different cultures, with differing parenting styles and victims of domestic violence and their children are not getting good therapy from such therapists. But there's a ripple effect. A respectful therapist working with members of such groups is going to be reluctant to be forthcoming in a team treatment setting or in clinical supervision, where the sharing of information is normally considered necessary to good treatment, lest their patient become a target. 

    And then there's
    • Psychologists using patients to house-sit
    • Psychologist using client to help pack up office at retirement
    • Psychologist having intern come in to clean the office on the intern's off days
    • Psychologists using students and patients to buttle parties in their homes, and
    • Faculty using students to babysit.
    A patient is not a servant. Neither is a grad student. And it is the height of arrogance to presume so.

    I think part of the problem is that we live in a cultural climate of general disrespect. We are always attuned to matters of class and rank, to where we stand in the pecking order -- and woe betide anyone on the rungs below. And then of course there are some people who just seem, as individuals, to be particularly arrogant/disrespectful. We've all known at least a few: No one, it seems, is safe from their disdain or their verbal abuse.

    Plus, with some psychologists, there's a tendency to overvalue the doctorate, to demand respect for themselves while believing it somehow frees them from the obligation to show respect for others who might be just as smart, just as knowledgeable, but who for one reason or another, lack the diploma. They seem blissfully unaware that there is often no difference in intelligence or drive between them and the therapist with a masters--or, for that matter, the parapro with the high school diploma. To a degree (if you'll pardon the pun) the difference is often only a matter of privilege: The "I'm-a-doctor-and-don't-you-ever-forget-it" crowd as often as not are people who were born on third base but think they hit a triple.

    And speaking of triples, sometimes you get the triple-whammy -- a psychologist who is (1) not only a product of hir culture but who also is (2) particularly self-important and who (3) takes too much credit for the achievement of a degree which is in itself overvalued*. . . and you have someone who is especially bad for morale, disruptive to the work of the unit/practice/facility/team, and who is potentially downright dangerous to patients.

    Get people like that at the top of the office heap, and they tend to run off the folks who aren't like them and hire more who are, until the whole culture of the institution, be it a huge psychiatric hospital or tiny private practice, will be disrespectful. And when that happens, patients beware!

    I don't know what we can do about it, other than shout out,
    Find out what it means to me!

    *Trust me, it's not all that special -- there are thousands of us in the state of Georgia alone.