Thursday, July 26, 2012

Hug a Narcissist

What happened to empathy? Narcissists are people too. But narcissism seems to have become the new universal pejorative label with which to criticize, externalize or marginalize someone you dislike. It's the new borderline. Narcissism has become the whipping boy for anything you want to see as a problem in society, especially if you can associate it with bad parenting.

Don't bother to examine the individual or obtain information about their personality functioning over much of their life. Watch them on TV or observe them at a party for a few moments, and you can make the diagnosis. Even rank amateurs can do it.

Want to improve your appearance? Narcissism. Watch movies about superheroes? Narcissism. Use Facebook? Narcissism. Send tweets to your followers about what you are doing? Narcissism. Use a smart phone? Narcissism. Feel good about yourself? Narcissism.

Mother Teresa got a kick out of helping others? Narcissism. Big time.

Blame it on the Me Generation and the Self Esteem Movement. Ayn Rand and Nathaniel Branden.

Can these narcissists, human beings like you and me, really be the root of all that evil?

Thursday, July 19, 2012

Birth of a Terminology: Unified Psychotherapy

Watch BehaveNet's newest psychotherapy glossary grow in real time. Psychiatrist David Allen's Family Dysfunction and Mental Health Blog has long occupied a space on the blog list you see here. Dr. Allen has created a new psychotherapy method he calls Unified Psychotherapy and a glossary of related terminology. He has permitted BehaveNet to publish the definitions on BehaveNet. With minor edits by yours truly we plan to add more definitions during the next few weeks.

Thank you, Dr. Allen. We are excited to be part of this project.

If you would like to comment on the terms or definitions, please do so below. We also need suggestions of YouTube videos to illustrate or complement the definitions.

Thursday, July 12, 2012

Blind Leading the Blind

I cringe every time I see this: A patient's counselor or psychotherapist, rather than referring him to a psychiatrist for whatever reason, instead recommends a drug they think has helped some of their clients, and the patient's physician prescribes it, often with no other justification than the fact that the (unqualified) psychotherapist recommended it. From a purely clinical perspective most psychiatric drugs cause little harm, even to those who should take a different drug -- or no drug at all. But in participating both professionals do the patient a disservice. Psychiatrists can make mistakes too, but we bring much more knowledge and experience to the table, and when those not adequately trained play psychiatrist they risk malpractice, and their license to practice.

Occasionally as well, the patient's record will come under scrutiny by a forensic psychiatrist, insurance reviewer or other third party, perhaps related to a claim, a problem at work, divorce, or a disability application. Indications for the drug, as well as adverse effects and therapeutic response can carry substantial implications in such cases, but the reviewing psychiatrist may be forced to discount what might otherwise have been useful in arriving at a determination, often to the detriment of the subject.

Many primary care physicians have sufficient experience to competently prescribe psychiatric drugs, but many non-psychiatric specialists do not. Inexperienced physicians will serve their patients -- and themselves -- better by declining to prescribe psychiatric drugs, and non-physician psychotherapists should let qualified prescribers decide which drugs to recommend to their patients.

Thursday, July 5, 2012

Psychotherapy: Informed Consent

There are more kinds of psychotherapy than I can count. I trained most in family systems, but my residency exposed me to Jungian analysis, Freudian analysis, psychodynamic psychotherapy, cognitive behavior therapy and biofeedback. I stopped offering psychotherapy myself a couple years ago, so when I recommend that modality to a new patient at the end of an initial evaluation I find it difficult to omit a brief lecture on the differences among psychotherapies, especially the ones I recommend for that particular patient.

If you do psychotherapy yourself how far should you go to educate the patient, especially about alternatives you do not offer? If all your patients get whichever version you provide, whether or not it is the one most likely to succeed for that patient, how much should you tell about alternatives and advantages and disadvantages? Do you know enough about different kinds of psychotherapy to adequately describe the prime candidates? If you have reason to believe the patient will do better with a kind of psychotherapy that you cannot offer, will you admit as much and refer them out? Some items for consideration:

  • How it works
  • What determines duration of treatment
  • Likely frequency of sessions
  • Who will attend: individual, group, family
  • Cost
  • Availability
  • Risks
  • Benefits

What do you do if you know (or find out the hard way) that the kind of treatment you believe would best serve that patient cannot be found in your community?

Like so much of what we do a good starting point might involve considering what you would want a professional to tell you or your loved one if the roles were reversed. So you are the patient? Take these questions with you to that evaluation and ask a million questions.