Monday, December 01, 2008

difficult session with psychiatrist 11/24/08

On November 24, 2008 I had a difficult session with my psychiatrist, Dr. Abraha, at the DC Department of Mental Health, Spring Road Clinic. Here are my thoughts about the session.

1. Authoritarian -- The psychiatrist appears to be conventional in his attitudes, and doesn't accept differing opinions.

2. shame -- "I don't engage in countertransference." "I have never masturbated in my life." The psychiatrist presumably will tend to deny any quality or behavior that is shame endowed. Both of the psychiatrist's statements are not particularly credible. The psychiatrist is a supervised resident who has never undergone a didactic analysis. For him to assert that he does not engage in countertransference is not credible. (On December 1, 2008 the psychiatrist commented on this point. He said: "I have never felt shame in my life. I don't even know what shame is. I have never experienced shame. I might feel shame if I made a big mistake about a patient, but I've never made a big mistake about a patient.)

3. Resistance -- It is inappropriate to tell a patient that he is engaging in "resistance" without interpreting the resistance. Characterizing the patient's behavior as "resistance" without interpretation amounts to psychiatric character assassination. It's simply a form of devaluation. In psychoanalysis, analysis of the resistance and the transference are major parts of the analysis.

4. Competitiveness -- During the session I told the doctor that he had a tendency to show resistance to the materials I gave him. Then I used the phrase, "Those are separate issues--a few weeks ago I said you engaged in countertransference, now I am saying you don't allow opposing opinions. Interestingly later in the session the psychiatrist used those same phrases in relation to me. "You are showing signs of resistance." "Those are separate issues." Suggests a tit for tat approach by the psychiatrist that is suggestive of his feeling competitive with me. Possible sign of Oedipal conflict in the psychiatrist.

5. Oedipal Conflict -- The psychiatrist said angrily: "I'm not your student. Don't bring me any more papers to read. I'M NOT YOUR STUDENT." Note the similarity of the statement "I am not your student" ("You are not my teacher") to the reproach of the child, especially teenager, who is criticized by a nonparental figure. "You're not my father. I don't have to listen to what you say." This is the most clear sign of Oedipal conflict in the psychiatrist, and the clearest indicator of countertransference.

6. Insincerity -- From the beginning of the therapy in July 2007 the patient had been giving papers to the psychiatrist to read. The psychiatrist was effusive in his praise of the patient. "Thank you so much Mr. Freedman for giving me that paper. I really appreciate that. I discussed this paper with my supervisor. Thank you so much Mr. Freedman." Now, the psychiatrist, in anger, tells the patient that he's not interested in accepting any more papers from the patient. The psychiatrist's turn-around in attitude raises questions about the psychiatrist's sincerity.

7. Vindictiveness -- The psychiatrist said he wouldn't accept any more papers from the patient in retaliation for the patient's statement that a paper that the patient gave to the psychiatrist several weeks earlier was an instance of countertransference.

8. Relationship between Psychiatrist and Patient -- It is fully appropriate for a patient to discuss his feelings and thoughts about the therapy and the therapeutic relationship. Instead of chastizing the patient about his opinions, the psychiatrist should have had the patient elaborate his opinions, with a statement such as, "You seem to have negative feelings about me and our relationship. Would you share those thoughts with me?"

Further, under the Clinic's Patient's Bill of Rights a patient is permitted to complain about the quality of care he is receiving. It is totally inappropriate to chastize a patient about his valid concerns about the therapy and the psychiatrist.

9. Failure to see patient's behavior as symptomatic of schizoid disorder -- One of the central fears of the schizoid individual is his fear of not being understood, his fear of being misunderstood. Isn't it possible that the patient's behavior of sharing papers with the psychiatrist is an attempt by the patient to make himself understood by the psychiatrist and not an attempt to place himself in a superior position to the psychiatrist? Was the patient trying to assume the role of teacher and place the psychiatrist in the subordinate role of student by giving papers to the doctor or was the patient trying to make himself comprehensible to the psychiatrist consistent with schizoid personality disorder?

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