Wednesday, July 01, 2009

When the Shrink Needs a Shrink.

Somehow I missed this one, and Meg was kind enough to send it along.

Last week's New York Times had a piece by Elissa Ely on psychiatrists who need someone to talk to. I started reading it and immediately thought, oh, this is why we have friends, why we get together for lunch, why I have Camel and Roy and ClinkShrink! But as I read on, I realized that the issue raised was more than about having friends. It's about how awkward it gets as a psychiatrist ages, when s/he knows all the players in town, when s/he needs someone outside his circle to talk to about the more personal things. Therapy, after all, is not simply a substitute for friendship. Dr. Ely asks:

But no amount of wisdom prevents personal frailty. You are never too old for your own problems. Yet when you are the professional others go to, where do you bring your sorrows and secret pain?

She goes on to write:

Often, though, the situation is not straightforward, and medication is not the problem. Life is. Maybe we are overcome, maybe ashamed, maybe despairing. Self-revelation — the nakedness necessary in therapy — is hard when you have been a model to others.

“In my situation, it would be difficult to find someone,” Dr. Dan Buie, a beloved senior analyst in Boston, told me. It is not that psychiatrists aren’t waiting in wing chairs all over the city. It is that so many of them are former students and former patients. One generation of psychiatrists grows the next through teaching and treatment.

Surrendering that professional identity to become a patient reverses a kind of natural order. “You can’t be a simple patient,” Dr. Buie said. “Anyone I’d go to, I’ve known.” To avoid it, some travel to other cities for therapy (probably passing colleagues in trains heading in the other direction).

Dr. Ely goes on to talk about how some psychiatrists may have a preference for therapists who are older and wiser, that there is comfort to seeing someone who's been there before and who may have gained insights. Is this true for everyone? When I started at this, nearly all my patients were older than I am, and still, many people I see have children my age. They aren't psychiatrists, though.

I liked the piece. I've just started on the psychotherapy section for our book, and I'm struggling.
I've been working on the concept that some people seek care for insight and education (as opposed to for treatment of symptoms) and it's not easy forming my ideas.