tag:blogger.com,1999:blog-26666124.post2770110422322078374..comments2024-03-18T03:28:36.581-04:00Comments on Shrink Rap: Guest Blogger Dr. J: The Well-Planned Unexpected RetirementUnknownnoreply@blogger.comBlogger25125tag:blogger.com,1999:blog-26666124.post-51972388046364406152011-10-18T18:51:22.860-04:002011-10-18T18:51:22.860-04:00beautiful and inspiring....many, many thanks.
htt...beautiful and inspiring....many, many thanks.<br /><br />http://pocketshrink.blogspot.comLizhttps://www.blogger.com/profile/11830164099906188153noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-19472096953194462092011-10-18T18:38:35.851-04:002011-10-18T18:38:35.851-04:00I couldn't agree more and lived my career with...I couldn't agree more and lived my career with that basic philosophy.<br />Dr. J.Dr. J.https://www.blogger.com/profile/00320759011224836162noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-81719952126065341592011-10-06T15:21:26.012-04:002011-10-06T15:21:26.012-04:00Thank you for sharing this story. I read it with g...Thank you for sharing this story. I read it with great interest and some amusement as I have been someones patient a very long time. I wonder if the good doctors see themselves as needing to appear to be perfect and have perfect lives to be good therapists. I see this as a distancing technique and it makes me feel unsafe with the therapist. I have seen my psychiatrist fall asleep in our session. I sat there quietly and waited for him to wake up. He had shingles and was on narcotics. His humanity and his desire to soldier on made him more human to me. I did tell him to take a few days off since he was such a lightweight about narcotics. He did. I have heard my psychiatrist say when he thought I could not hear" that he "didn't feel like being therapeutic today" because he had just been robbed. He was embarrassed but I was entertained and was happy to be supportive in the face of his distress. I have been hurt and felt loss when a psychiatrist moved on to a different practice but I learned why and how to deal with it, to say goodbye and was stronger for it. <br /><br />Personally I can't really trust the "perfect Dr" presentation. I want a heart and soul behind my care provider. Part of being a good caregiver does include some self disclosure, an entering into community with the client.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-50638329025207248082011-10-05T05:23:55.220-04:002011-10-05T05:23:55.220-04:00Dr. J. responding to Jen's direct question.: M...Dr. J. responding to Jen's direct question.: Messy is a fine word. But with time, I felt the bulk of my long career far outweighing the ending, because my former patients are all right now with their new psychiatrists (to my knowledge), because I am well and loving retirement, so I have moved on in life. It's been awhile. But mostly because there were no sources of enduring guilt, having done the very best that I could at the time with life's inevitable "bad patches" which were beyond my control. We all carry regrets, but their residual intensity and demanding conscious persistence can vary with whether we caused them or not. <br /><br />And last but certainly not least, I had good therapy to help me through, to help me with clarity about the experiences! I firmly believe that there is no substitute for that, and it grieves me to see high quality therapy becoming less common in this world of insurance coverage and training.dr. j.https://www.blogger.com/profile/16233220733852225893noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-2881892959622601052011-10-04T23:13:01.976-04:002011-10-04T23:13:01.976-04:00Isn't even a "bad" ending to therapy...Isn't even a "bad" ending to therapy still grist for the mill and therapeutic?Tigermomhttps://www.blogger.com/profile/15525962425980447155noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-52508325521406997782011-10-03T20:14:45.433-04:002011-10-03T20:14:45.433-04:00I was touched by your responses, Dr. J. You remind...I was touched by your responses, Dr. J. You remind me so much of my therapist in how you look at things. From my end, as a patient, I wonder at how it could be really a clean, good ending - both from your end and from your patients'. Not that there is care and respect and compassion and kindness on each end, because it's clear that there is, but that there isn't still an unfinished end. It's easier for me to imagine that clean, finished end from a patients perspective, and I'll readily admit it's uncomfortable to me to think that such a messy (a wrong word here, I think, but not sure which could be better - uncomplicated perhaps?) end could be so complete and clean - not black dust-covered - for you. <br />Can you talk about that a little?Jennoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-23644491119966479182011-10-03T13:09:03.171-04:002011-10-03T13:09:03.171-04:00Another Dr. J. response: Dinah, I have actually be...Another Dr. J. response: Dinah, I have actually been enriched by this blogging idea of yours. No, not transported backwards except as I read them, and that is a good thing, to continue the ongoing process of making sense of our lives as we go along, and not just in a convalescent home one day! It is what therapists innately do, I think: put it all together as best that can be done, and it is a kind of inborn reflex that leads us into this kind of privileged career. I have been very grateful for the effort of all the responders, all of them even when negative. I'm afraid that my prior response gave the impression that I still feel guilty or regretful, and infact that black dust settled months ago, as I saw each patient and could see that the dust didn't cover them, that they were there to say good-bye in some meaningful way, without ever feeling that the final sessions that we had had weren't useful, and knowing that the ending was beyond all of our control, itself a natural thing. We could talk about what therapy had meant and what was still ahead for them with their new therapists. Many brought gifts that they'd know I'd accept (small enough!) but absolutely dripping with thoughtfulness in their choices. They were so pleased at my pleasure, which was very real, of course. This is a time when we can accept the small gift of thanks that patients so want to give, and the pleasure that they too received created an atmosphere of bittersweetness that is hard to describe, but captured something very dear at the heart of our relationships. So, this is fascinating to me, so often a gift to me (Jesse Hellman, what a mensch you are!!), and I thank you Dinah for the experience and continuity offered.dr. j.https://www.blogger.com/profile/16233220733852225893noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-77721485692563105292011-10-03T12:09:04.603-04:002011-10-03T12:09:04.603-04:00I greatly respect and appreciate Dr. J's respo...I greatly respect and appreciate Dr. J's response. My point was, and is, that sometimes the therapist does use the patient. In the best case scenario, this is not out of any intent to harm or abusiveness on the part of the therapist. It happens out of some sense that one is more powerful than is realistically so. Dr J appears to understand this. She seems like an amazing therapist,yet, even such people can make mistakes. Dinah, do you feel that Dr. J is so fragile that you must protect her from any criticism, including that which she seems to take as food for thought as opposed to a personal attack, which it most certainly is not?No one is saying that the therapist must always be perfect in order to protect their patients. And yes, patients may be adversely affected by the best intentioned therapist, in the short term.No therapist is super human. Mistakes will be made. That is not a personal affront. So long as the relationship was "good enough "the patient will be fine in the end. So long as therapist/doc is remunerated for services rendered, it behooves them to consider how much of a help they are or can be. Dr. J. can hear this. Perhaps, in the thick of things, it was difficult for her to determine what was best, for her or her patients. Whether or not she continued too long is not for me to determine but, again, there are times when unwittingly, perhaps on both parts, patients pay to help the therapist feel better. I wish Dr J. the very best. I am certain her patients were lucky to have know her. We can all learn a great deal from her experience, whether as patient or as therapist. An open mind is key.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-52573719062254304562011-10-02T23:35:12.964-04:002011-10-02T23:35:12.964-04:00when I read tonight that Andy Rooney, age 92, just...when I read tonight that Andy Rooney, age 92, just retired from his thirty-three years with 60-Minutes, it reminded me of this post. Did Andy stay too long? Who knows?<br /><br />From your narrative, Dr. J., it was clear that you were trying to bring your practice to an appropriate ending point before retiring, but illness stopped you. I am sure psychiatrists die and abruptly leave all their patients and the difference is merely one of degree. You did not cause your illness. The fact that you were not able to overcome the illness and keep working was not your fault any more than it would have been your fault if you had died in the same time period. <br /><br />If my psychiatrist fell asleep in my appointment, now, after knowing him for so long, I would not think it was because he was bored or disinterested, because he has shown clearly in our meetings that he is interested and does care. please don't beat yourself up over this. It sounds like you had successful relationships with your patients and helped many people in your career. That is what is important to remember at this point, not the one day when you were working when you ought to have been at home.Sunny CAhttps://www.blogger.com/profile/11451116932556227816noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-24046619610022984992011-10-02T23:13:19.751-04:002011-10-02T23:13:19.751-04:00Oh, my-- it's like you've tried so hard to...Oh, my-- it's like you've tried so hard to retire and I've dredged everything up all over for you and dragged you back to work!!!<br /><br />Too much weight in all this. It seems we've bought in to this concept that the psychiatrist has to be absolutely perfect --for everyone, somehow colluding with the idea that one must never feel abandoned by or disappointed by their psychiatrist who must--even in death or near-death--never ever rekindle the momentary pain of past distresses. I would be shocked if patients who knew you well and saw that you were sick felt rejected by your illness. Yes, time to go home, but to beat yourself up for a misjudgement about your health?Dinahhttps://www.blogger.com/profile/09227988351623862689noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-83585122445729308562011-10-02T22:59:13.919-04:002011-10-02T22:59:13.919-04:00At this point, reading all of these very thought-f...At this point, reading all of these very thought-full comments, I am touched by the efforts so many have taken to respond as they see it. Naturally the compliments make me feel such gratitude and fortune, but I have learned more from the people who have strong feelings that I essentially used my patients at the end. There is truth to this, and were it a trajectory that I could have seen from above, that I knew where my body would take me next (when it was supposed to be Okay Now), I hope that I would have retired earlier. Instead, I took small leaves to try to get myself rested and in shape to work, only to get exhausted again. I think that falling asleep on a patient is one of the worst things we can do, leaving a patient feeling profoundly rejected. I did fall asleep twice, in a row, then cancelled and went home, my last day in my office. It is a sort of amazing "luck" (an odd term, for which I apologize for the way it felt to me, and not to them), that I had known both patients for years, they both KNEW that I treasured them, and both asked immediately whether I was going to be okay, what they could do. I explained fully, heavens knows they deserved it, and felt such gratitude to them for their instant appreciation that this truly was not about them, as I also said aloud. This is no defense. I did wait too long to "shut down", but it is a statement that we can and should have such important relationships with our patients that they understand when they see such a real life medical situation in play. <br /><br />These comments have given me enormous food for thought, and have taken on the job that my patients didn't take on: taking me to task for my acted-upon wish to go on longer than I reasonably could. <br /><br />The kindness of some comments makes me virtually weak in my knees. Kindness has been hard to take when there is so much room for criticism. I am very grateful to Jesse, Daniella and Carrie in particular because they mounted defenses of me that I could see and feel as particularly true, as well as comforting and kind, obviously. Yes, narrative is the center of being, and we are, inevitably, the hero of our own tale. The best I ever knew how to do was Try to hear my patients' tales, as thoroughly as they could manage, which is no small act of heroism on their parts.<br />Dr. J.dr. j.https://www.blogger.com/profile/16233220733852225893noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-3147721452075958482011-10-02T22:48:32.033-04:002011-10-02T22:48:32.033-04:00Dr. J.'s story reminds me of that famous remar...Dr. J.'s story reminds me of that famous remark by Phineas Fogg in Around the World in Eighty Days: "The unforeseen does not exist." Well, we all know what happened there. Despite Dr. J.'s efforts and intelligence, nothing went exactly as she hoped. Yet due to her caring, sensitivity and maturity, it all worked out for her patients for the best.jessehttps://www.blogger.com/profile/11077223398907532291noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-2735532835064936202011-10-01T23:12:28.500-04:002011-10-01T23:12:28.500-04:00I find this to be such a beautiful example of narr...I find this to be such a beautiful example of narrative ethics. To tell one's story, no matter who you are, can be both challenging and a catharsis. It's so important that in our fast-paced, 140 character lives, we remember the story. Her writing was very moving, and you can definitely feel the emotion within it. I do believe that Dr. J demonstrates that all psychiatrists are people too. We're all patients at some point in our lives.<br /><br />Imagine what life would be like without stories? In some ways, we've already come so far from storytelling that the art is lost. But - our lives are so enriched by them. The anger or negative feelings against someone may sort of dull or fade completely away once we know their story. When you drive in a car and get angry at other drivers, it's natural because everyone is anonymized. But when you know the stories of all of those around you, you may feel quite differently.<br /><br />Regarding staying longer than you should - this is a problem in so many walks of life. It is SO hard to give up what you love and what you have done for so long. I've watched people in various places of my life stay past the point where they should, and it's never easy. One of my preceptors for my current job has an autoimmune illness that has severely disabled her life. Before she stopped working, she was using oxygen to get from the car to the hospital unit - and took it off when she got to the unit. She didn't want to stop working. Why? The moment her sister stopped working with the same disease, she declined rapidly and died. So she soldiered on - in a way that was heroic to me and to all of us. Eventually she had to stop once she was being evaluated for a lung transplant. I think of her all the time and miss the chance to talk to her about so many things.<br /><br />In all the rush of life, we need to appreciate stories. We can all learn something from them - be it more compassion, more humanity from psychiatrists, or other things - it's important to stop and listen to each other. <br /><br />Dr. J: Thank you for writing such a beautiful post. I wish you the best as you continue on life's journey.Carrienoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-75696440748537434252011-10-01T22:47:43.303-04:002011-10-01T22:47:43.303-04:00This is a wonderful article. Thank you Dr. J. for ...This is a wonderful article. Thank you Dr. J. for writing this. You have a great deal of courage and wisdom. Your patients were very fortunate to have been able to work with you.jessehttps://www.blogger.com/profile/11077223398907532291noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-66557741350047762282011-10-01T22:18:26.007-04:002011-10-01T22:18:26.007-04:00it terrifies me that god forbid something like thi...it terrifies me that god forbid something like this could happen to my beloved, well-liked, trusted and respected psychiatrist. Terrifies me for her and for me.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-60046469704889222512011-10-01T19:00:55.883-04:002011-10-01T19:00:55.883-04:00I am a patient, and appreciated reading this. I fo...I am a patient, and appreciated reading this. I found it a touching story that I could relate to, and could put myself into both her shoes and those of her patients while reading it. I am also one who soldiers on despite illness, and could understand that aspect, yet also understand the impossibility of fighting one's body and mind, at times.<br /><br />My own psychiatrist is 70 and appears healthy, but just decided to cut his practice down to 3 days a week (from 4) and it is the first ramp-down towards retirement. I feel very well at present and have been debated whether I should end treatment now, or continue, but at longer intervals between sessions, hence termination has been on my mind also.<br /><br />Bill Clinton suffered noticeable cognitive and emotional effects from heart surgery also. I think it is much more common than acknowledged.Sunny CAhttps://www.blogger.com/profile/11451116932556227816noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-63318721054439144262011-10-01T13:19:14.479-04:002011-10-01T13:19:14.479-04:00Re the comment about this blog being by psychiatri...Re the comment about this blog being by psychiatrists for psychiatrists and patient voices perhaps not being wanted, many of the psychiatrists and other therapists I have known have been or are in therapy and do go back at times of crisis in their lives. Dentists get their teeth cleaned, too. Why do we have to feel pitted against one another. When the doc is in therapy, they act like patients and they are patients.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-46464217694889427512011-10-01T13:12:26.769-04:002011-10-01T13:12:26.769-04:00As Dinah wrote:
"To anyone who is very invest...As Dinah wrote:<br />"To anyone who is very invested in seeing their psychiatrist as being "all about the patient, all the time" or to anyone who would like to hold their psychiatrist in some idealized form, maybe Shrink Rap isn't the best read?"<br />Anon 1 here. I do not hold to either of these ideas. I think the story highlighted how the patients did not hold their psychiatrist in some idealized form or as all about the patient all the time. I think that it is possible for patients to take very good care of their doctors feelings and to be acutely aware when the doctor needs care taking. I think the doctor had the best of intentions and was blindsided by all that happened to her. I am sure she was a wonderful therapist but probably not during that time. I had an experience with a therapist whose own life was falling apart. I stuck around for the falling apart, tried not to stress the therapist out, expressed concern for them. I also had a final meeting after an extended time during which I expressed my gratitude etc and then began seeing a new therapist, spending a very long time dealing with the issues I dared not bring up with the ill therapist. My point is that if it does not make sense to idealize the therapist, and it does not, it makes no sense to believe that all these patients, seeing a therapist for a reason, would not be activated into the care taking mode and would not have feelings to work with through that they felt they could not burden the sick therapist with. While Dr J wanted to avoid an abrupt termination her own idealization of her abilities or power to bounce back, which I called denial, put her patients in an uncomfortable spot for a longer time than needed to happen had she been more willing to let go. The story highlights the fact that the therapist was as human as any other person but at some point it may be fair to say that rather than being all about the patient all the time it was much more all about the therapist's own needs, which the patients continued to fulfill. No offense intended. To err is human.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-39833141771392116372011-10-01T08:29:06.228-04:002011-10-01T08:29:06.228-04:00Anons (especially the one who wants to why this wa...Anons (especially the one who wants to why this was posted or what to take from it):<br /><br />I posted it because I've never seen a psychiatrist write such a raw (to borrow Jesse's word) and revealing article. It seems to aim for exactly what's in her heart with very little held back and very little censure, and this piece was written for a venue that is read exclusively by psychiatrists-- So Dr. J told all to all her colleagues and as well as several hundred professional strangers. It took guts. I think it was good for other professionals to read-- because 'stuff' really does happen to us, good or bad (illness,moves, death, retirement, maternity leave, deaths of family members) and getting it exactly right so that you leave or take off in a way that is optimal for everyone is hard--and here Dr. J tries so very hard, with a one-year lead time-- to do it so perfectly and life just doesn't comply. Of course no one thinks that a psychiatrist should fall asleep, but clearly, Dr. J also thought this wouldn't happen and was surprised herself (I am assuming she didn't fall asleep during 3 sessions one day, then work the next day anyway...). We all know retirement and illness and death are hard on our patients, but she details this in a way and with an honesty that I haven't seen, so I wanted it on Shrink Rap.<br /><br />You're supposed to take from it that Shrinks are human, vulnerable, and often struggling, too. Maybe she did work too long or try to go back too soon-- it sounds like an absolutely horrendous stream of events in her life, and I was amazed that she was thinking so hard about her patients and worrying so much about not being there for them when she was in pain and concerned that she might imminently die.<br /><br />To anyone who is very invested in seeing their psychiatrist as being "all about the patient, all the time" or to anyone who would like to hold their psychiatrist in some idealized form, maybe Shrink Rap isn't the best read?<br /><br />I'm moderating the comments because I wanted to shield Dr. J from any serious negativity (shrinks are people, too, and this one has clearly struggled)...so far I've let them all through, but I've hesitated here....Dinahhttps://www.blogger.com/profile/09227988351623862689noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-18424200918181413922011-10-01T05:13:15.782-04:002011-10-01T05:13:15.782-04:00As a trainee psychiatrist , I thank you for taking...As a trainee psychiatrist , I thank you for taking the time to write that . You have given me much to think about , and I can hopefully learn from your experience in the future . The message for me, is you need to care for yourself first , before you can efficiently care for others.Antoinettenoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-78951827159305116322011-10-01T02:17:38.782-04:002011-10-01T02:17:38.782-04:00I'm really not quite sure what to think about ...I'm really not quite sure what to think about this post. On one hand, yes, clearly it was moving and courageous and deep. On the other hand, as a patient, what am I supposed to take from it? At the very least, I feel vaguely uncomfortable. I respect and like my therapist very, very much and deeply hope that if a similar experience were to happen to her, I would behave similarly "heroically." On the other hand - do I need to know all the info in this article? How is this helpful? I agree wholeheartedly with anonymous 1 that most (if not all) patients would not burden their dr with feelings or concerns of abandonment, etc. - even though in this situation they would truly be genuine and reasonable! To assume otherwise is to really do your patients a disservice. Like I said, I'm just not sure what was supposed to be taken from this article.<br /><br />I know this is a blog "by psychiatrists for psychiatrists" but you guys know well that you have a large readership from the patient side. I am not critiquing. I am just not certain what exactly you hoped those of us on that end would take from this. Or, for that matter, on second thought, what anyone is supposed to take from this. That it's okay to go on indefinitely while you're not capable of working? I am not a shrink but work with a vulnerable population. For me to do that would be absolutely wrong. What makes it okay for a shrink to do the same? <br /><br />I don't know....This is a nice and moving story, but after reading it several times I'm less and less sure what's meant to be taken from it - whether as clinician or patient.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-7555803453276442882011-10-01T00:23:29.628-04:002011-10-01T00:23:29.628-04:00just wanted to let you know that i have posted you...just wanted to let you know that i have posted your blog on my blog...maybe some of my readers will come your way.<br /><br />http://pocketshrink.blogspot.comLizhttps://www.blogger.com/profile/11830164099906188153noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-47920286685283488832011-09-30T23:03:57.546-04:002011-09-30T23:03:57.546-04:00Beautiful. Heartfelt. Raw. That relationship with...Beautiful. Heartfelt. Raw. That relationship with a psychiatrist is a unique one. I loved how she described her patients giving back in their own way.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-73872059271503761522011-09-30T13:27:48.663-04:002011-09-30T13:27:48.663-04:00Thank you so much for sharing this incredible post...Thank you so much for sharing this incredible post by Dr. J. Dear Dr. J: I'm so moved: by the courage it took to share your vulnerabilities and foibles, by the integrity of it and by the compassion implicit in it, for yourself, for patients and for peers. For as physicians, we often treat ourselves far less well than we do our patients. We get into the habit of soldiering on, for the sake of others. Into the habit of thinking we're in control, when we're not. Into the habit of ignoring the warning signals.... Thank you so much for the reminder that the weakest link in the chain of service is taking care of ourselves. That's why flight crew instruct passengers to first put on their own oxygen masks before assisting others with theirs. My original plan after sending off this comment was to go do x, y and z, but you've made me rethink that. Think I'll go lay down for a little rest instead. Get well soon and best wishes for an enjoyable and refueling retirement.Danielahttp://www.shrinkunwrapped.comnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-86653818390533609382011-09-30T10:41:51.928-04:002011-09-30T10:41:51.928-04:00Certainly a moving story. It is not surprising tha...Certainly a moving story. It is not surprising that the patients were "heroic". They saw it coming well before the doc. If a doc manages 8 or 9 days of work in several months, people start preparing themselves in one way or another, at least on some level. That a patient suggested Ambien has a funny side, I suppose, but it also demonstrates, aside from caring about the doc, caring for the doc. It must have been clear to most patients that the doc probably needed more caring for than they did. Perhaps some were returning the favor of her years of care. Others my have been acting out the old script of care taking. Whatever unfinished business any of them may have had, most people are going to feel sympathy for the doc and express that. Most people won't burden the doc with any feelings of abandonment. True, she had begun the process of termination already (hate that word; it sounds like an abortion. Other relationships end. Psychotherapeutic relationships terminate) but it is a good bet that they spent a good lot of time with their new therapists dealing with the feelings this ending stirred up. Everyone will retire, unless they die first. The unexpected happens. I probably was not great to allow her patients to take care of her for so long. Lots of docs practice while in some degree of denial. Everyone does.Anonymousnoreply@blogger.com