December 23, 2019

Knitting Again and other Mid-December  Ramblings

This weekend I picked up my knitting needles again. It had been so long since I had knit something. It’s also been a while since I last blogged!   I purchased this yarn over a year ago.  That tells me how I have been neglecting the things I enjoy. One ‘small' reason was I was having to rectify  my Psychiatry Boards which I can gladly report I completed and passed. I started the process in June and finally finished several weeks ago.  This was round three.  It was different this time in that I was able to read 30 articles and pass mini tests.  It was a lot of reading but I would say this was better than sitting for the 3 to 4 hour exam.   Every 10 years we must rectify although the requirements are changing.

Glad I was finally able to pick up my knitting again and just relax. I am taking a few days off each week because of the mid week holiday’s. I don’t like to use vacation time during the winter months, but I will gladly take it.  Knitting for me is meditative. It lets me sit on the couch and get lost in thoughts or if my pattern isn’t too hard I can also binge watch shows I have wanted to catch up on.  I encourage my patients to take time for self care. So whether it’s knitting, painting, yoga or whatever suits her I encourage my patients to do as much as they can. Life can get in the way sometimes of good self care. It is important we make sure we find the time to nourish ourselves.

On a another note I got to go to Star Wars with my teenage  son.  I was in shock he went with me because my mere existence embarrasses him. Thankfully his friends couldn’t go and he really wanted to.  Mom win!  The movie was great but these few and far between moments I will cherish forever.  I love that I got to spend the afternoon with him like I used to when he was young.

Have a happy holiday or few days off!

IMG 1674

September 25, 2109

Should I stay or should I go? The Reunion Tour.

This is a post I wrote almost two years ago.  I thought I would repost it because I had some things I wanted to add.  I will add them at the end.

All therapy comes to an end. The question is what to do when the therapy ends abruptly or the patient has been wanting to leave for a while. But what if it is the therapist who wants out of the relationship and does things unconsciously to get the patient to end the relationship? Like missing an appointment, double booking or even being hostile to a patient. It is always unconscious.  Therapist’s are people too. They have their own psychological wounds.  Sometimes a therapist will tell a patient they don’t need therapy anymore. I believe, it is always up to the patient to decide that.  If a patient seems to be coming less and less I might bring up the idea of working toward an ending. 

I think a proper termination is always the best way to end. However, it doesn’t always go that way. When patients leave abruptly and give a reason it is rarely the reason given.  They may blame it on parking, money or even “ not getting anything” out of therapy any longer.  Or because of schedules the therapy may evaporate. Either way, exploration for the departure is always best. Maybe the work was getting to deep.  Maybe my patient felt uncared for.  Maybe an addiction had resurfaced and she was too ashamed to bring it into session.

I have come to understand that patients leaving abruptly or starting with a new therapist before our work is completed can be from something unaddressed between the me and my patient.    The decision to leave can can arise out of their anger that the therapy isn’t bringing them the happiness they thought it would.  The patient will blame me most of the time. They might say something like "I have been doing this for a few years and I am not getting any better.” They usually say something to me  like “ you  are a nice person or I really like you, but I don’t think it is working" which translates to it being my fault. It is my fault in that something I said has made her feel like she can’t talk to me about her feelings. It is not up to me to "make them better.” It is up to me gently listen and hopefully we can repair our relationship. 

When I was neophyte psychotherapist,  I would have tried to convince my patient to stay. Now I know better. If she really wants to leave I will say OK.  I usually will leave the door open for her return.  

September 15,2019

Moving  doesn’t have to hurt, but sometimes it does.

The office has moved.  As I was leaving my assistant  asked me if I felt sad at all.  Surprisingly, I have no sad feelings about leaving my current office space.  She replied with ”that means this is the right move for you.”    She was right.  In the past when I have felt  angst about  major life change, I still knew it was the right decision for me.  So is this a function of maturity or was it the right time to move to a home office?  Or as I go through more changes they become less “big” for me? The space I have created to go to is very much the way I want it to be.  The colors are new  and fresh.    In the past I had to fight with landlords to give me new paint even when I would  agree to  a three year lease.  I usually got back, well then I will just have to charge you more rent.”  No, thank you!  So maybe for the first time the space is exactly as I want it.  

Sometimes we make decisions because we know it is best for us. It can still be excruciatingly painful. That doesn’t mean it is wrong. We must always look at why we let our lives go  down a path that in the end would hurt us so badly to move on from. It is my job to help my patient deal with the pain initially  and then  to help her see she was the one who led herself to this place.   It is easier for me to see when  I am sitting in the therapist chair. It has taken me a very long time,  much of my own therapy and looking at my own pain to understand this.  My job is really to be with my patient as she goes through the pain.  I am never really sure how it will go but that is ok. 

I am very excited about my new space and as soon as my teenager son wakes up from his 12 hour beauty rest he will help me post a picture of the new space.  For some reason I can’t get the picture upright. Thank goodness he had computer stuff in middle school.  He usually says, “mom, you just have to do this”  and in one felt swoop he makes it all better!

August 30,2019

New Beginnings

It’s hard to believe summer is almost over.  Today it was actually 80 degrees. However, I know in several weeks the chill in the air will return in the early mornings.  I know this because I get up and let my chickens out pretty early. This summer has been a busy one for me. I am studying for my Psychiatry boards again. I will be certifying for the third time.  Not my favorite thing but it has to be done.  I am also moving my office to my home.  I have had mixed reactions from friends, colleagues and even my patients. When I was a resident so many years ago, most of my faculty in Washington, D.C. had home offices. It was much more common.  I have been busy (and stressed) renovating my home. It is going to look very different from my current space. Even the colors are different. I had yellow walls in the past and now I will have white with blue gray accent walls. I bought new comfortable chairs and I am making the office more analytic and less medical.  I believe it is because I am moving into a different phase of my work.  I am also over fifty now.  My life is changing. I have a teenager who is heading to high school. He needs me less and less.  I know I will be refocusing my energy to pursuits I had to abandon when I became a mother.  So in a sense this is a new beginning.  I am excited beyond belief about having a home office, but I will also have some sad feelings about saying goodbye to the office I have spent so much of the last 6 years occupying.  New beginnings can happen at any age.  It’s when we embrace them rather than avoid them they can be wonderful. 

 Hope you have a good end to your summer!

March 17, 2019

When People Betray Us

When we let ourselves be vulnerable we do it at the risk of being betrayed.  It happens in friendships and most often in love relationships. Betrayal can show up as an affair, lying and addictions. There are other ways  betrayals can present but I will focus on the bigger ones here today.  

Betrayal is a funny thing. I believe the reaction mimics a grief reaction such as one similar to death. Because with a betrayal,  comes a huge loss.  The relationship that one thought they had has really suffered a death. I have been watching the show Ozark, on Netflix. The episode I just watched is where the daughter wants to go back to Chicago. Her mother intercepts her in St. Louis.  The daughter says she  wants to go  back to her old life.  The mother responds with, "that life no longer exists."  The characters parents have betrayed her due to their own greed and bad choices.  The daughter suffers the betrayal.  Her old life has died. But so has the relationship she thought she had with her parents.  Can she ever really trust them again?

Betrayal can be too big to overcome.  Sometimes it can be worked through in therapy and other times it cannot.  It is important to talk about it and honor feelings.   I never assume a betrayal is too big for my patients. It is really up to her to decide what she can or cannot live with.

December 21, 2018

I’ve got a Name

In life there will always be things that bother us.  For me one of my biggest pet peeves came when all of a sudden I went from being a psychiatrist to becoming a "behavioral health” provider.  I personally can’t stand it.  I feel like it lessens my training as a psychiatrist.  I am a psychiatrist not a behavioral health specialist.  I think what bothers me more is that we didn’t fight the name change of the field.   Did surgeons become cutting specialists???   I think I detest it so much because I know how hard I worded to become a psychiatrist.  Now to call me a behavioral health specialist takes away from the field of Psychiatry.  There is no such thing as a "behavioral health" residency.  Psychiatrists as a group should have said,”no” when it was implemented by hospital administrators.  I don’t know what drove the decision to change the name of the department.  I see it more in hospitals that don’t have Psychiatry residencies.  I think because all hospitals are required to meet every patient’s mental health needs they came up with a way to offer mental health services that was less stigmatized which gets me onto another topic for another day as to why we still make it a "bad thing" to seek out mental heath care.

September 30, 2018

Losing Your Creative Fire aka as The Little Match Girl

In an effort to be more creative I decided to write in a purple ink and change up my font. Last week one of my patients told me I wear a lot of purple. I was surprised.  I guess she sees something I hadn’t myself.  What was she seeing in me? Something creative?   As women it is important we remain creative in our lives otherwise we can die.  Not physically but emotionally.  Women who are involved in relationships whether it be friends or lovers must never stay if those people try to "put out" her creative fire. It may sound extreme, but it is reality. The reason it has to happen is her life can depend on it. If her psyche dies, it will not be long before her physical body will break down.   In the story of the little Match Girl,  she dies from living in fantasy rather than figuring out how to warm herself. Her creative energy dies.  She also dies in the cold but the important piece is she loses herself in fantasy rather than warming herself.  Something that would have saved her life.  One part of the version I read is that no one will help her.  She accepts less than she deserves.   Many times a woman in “bad” relationships will “ warm”  herself with a fantasy that she  is in  a good relationship.  However, she may be put down, told her dreams are unimportant or  held back financially by her partner.

If I stay with  a partner who puts down my creative efforts, because of his insecurities,  than I am in a sense allowing myself to freeze in the cold.  It is not his fault he is insecure, but it is mine for allowing him to be unkind.  In my office, frequently, women will blast the men and women of their failed relationships.  I tell them it is ok to be angry at them, but lets also look at why you stayed, which is of far more importance (to understand) for their emotional growth.

It s hard when we discover we may be “a little match girl.” However, it’s what we do with the information that matters the most.

June 17, 2018

Just my imagination?

On Sunday mornings I usually do some sort of CME which is short for Continuing Medical Eductaion.  I am required to do this reading but I also find it to be of value.  This morning I got an email from a listserv I subscribe to for articles.  I was not surprised to see what was written about antidepressants.  That they don’t work very well if at all for Major Depressive Disorder (MDD).  I have found that to be more and more the truth in my own practice. I will try multiple antidepressants with patients only to have them not be helpful. Usually by the time the patient reaches me, they have been prescribed  multiple antidepressants  by their PCP.  I know it can leave  the patient feeling like I am not helping them and sometimes it makes me feel helpless.  I have always doubted their efficacy, but in the past my colleagues will try to convince me otherwise.  This morning,  a well respected Psychiatrist in the field has come forward with a meta analysis which is a sophisticated way to say he reviewed many previous studies, only to find that antidepressants really don’t work!  I actually worked with this psychiatrist 20 years ago when I was a resident. He was close to my age  and he had just completed his residency training. He, as was I,  was equally excited about making  peoples lives better. 20 years later we can now both agree, that the medications are not working.  

It’s worth reading the article if you can get through the statical stuff. Bottom line is I knew this all along.  It makes me feel better though to know I wasn’t  imagining it.

June 2, 2018

Good Beginnings

The most important meal of the day has always been said to be breakfast. I am not sure if this holds true, but it got me thinking about if we start our days off feeling well nourished would our days feel better?  Would we be better equipt to make it through the difficult days.  Depressed patients  can have no appetite. It seems interesting to me from a developmental standpoint that appetite becomes so diminished when we are depressed. Some people have increased appetites but my experience in treating depressed patients is it is usually  more diminished if not absent.  My patients who know me well know I am always looking for the symbolic  connection between our bodies and our feelings.  So what is the connection  between hunger and depression?

If I think about breakfast it is the start of the day; the break of the fast.   In life breakfast is like infancy. Infancy is the start of life.   If we start off feeling nourished and well cared for we will generally have an easier time emotionally. Babies are very vulnerable and when their needs go unmet they can develop many emotional problems that show up  even sometimes  much later in life.  A baby who is left to cry by his depressed or addicted mother, when he feels hungry,  can develop an addiction to alcohol.  His emotional needs went unmet so he grows up and “tries" to  sooth himself with the alcohol.  The woman who’s mother was too depressed to feed her may find the only way to soothe herself is through overeating, even when she is not physically hungry. Her hunger  becomes  emotional.

When my patients tell me they are eating too much, I ask if it comes after a meal. Sometimes they tell me it does.  I ask them if they are feeling hungry. They usually reply, “I feel hungry all the time.”  I then ask them if they just ate, and had enough to eat, then what might they be hungry for other than food.  In each case it is different for each patient.  However, a lot of the time it boils down to not feeling cared for and ultimately unloved.  Getting deep inside the feelings and learning to reparent themselves is part of the work we do.  The hope is that the hunger will eventually go away as they begin to meet their emotional needs.

Disruption at any stage of psychological development can lead to emotional upheaval.  I try to pay close attention to what stage seems affected.  This morning as I made myself breakfast with fresh eggs from my wonderful chickens I thought about how satiated I felt after I ate them. I truly believe there is a connection between feeling well nourished and cared for.  I have always been amazed at people who barely thought about their food.  Maybe they live on cigarettes and diet coke.  I guess in the end we all have ways that help us to feel cared for. For today, I will choose my fresh eggs and fruit.

Fresh Eggs

May 26, 2018

Odd Man Out, or The Ugly Duckling?

Wow, it’s been a few months since I have written in my blog. I guess my psyche is trying to tell me something. Maybe that I have let myself get too busy.  I will have to pay attention as to why I have let this happen. I do actually do as I say and actually practice what I preach to myself.

Today I am writing about what it is like to be in a field of medicine which is so different from what it was like when I signed up for this 24 years ago in 1994.  Today, the specialty of psychiatry is mostly focused on "biological psychiatry" and "evidenced based medicine."  I have chosen to go in a direction of moving my practice as almost entirely psychotherapy.  I find this not only to be far more rewarding professionally, but  to also  be of greater value for my patients who struggle with depression, anxiety and other emotional difficulties like addictions.  

So you ask why I am writing about being the odd man or  should I say odd woman out?  I also have to wear the other hat in my practice the one of “The Psychiatrist.” The one where I have to do umpteen million (not really but it feels like it) CME’s to maintain my board certification. I am part of the Maine community of psychiatrists. Some of them are actually very good and really thoughtful about their work and I value what they have to say.  However,  I find I get discouraged when a lot the discussions are about evidence based medicine and what medication works best.  I will try to offer my view with some “old school” thoughts about why people behave they way they do. I am sometimes met with what I consider hostile remarks, telling me my views are antiquated.  Since when did peoples lives and emotions become so unimportant?

Psychiatrists in general are a funny group.  There is an old joke about what the definition of a psychiatrist is?  It is a Jewish doctor who can’t stand the site of blood.  I am Jewish but  I was phlebotomist long before I became a psychiatrist so I guess that joke is no longer valid, however, it speaks to how psychiatrists were viewed.  That we are “not really” doctors.  So what happened is psychiatrists fought back and we found new ways to be "real doctors."  We now practice "biological psychiatry." We have medications that work!  So now we are part of the club of "real doctors." We are taken seriously. Personally, I don’t need to be taken seriously by other doctors. It took me a long time and truth be told, a lot of therapy to not care what other people thought.  I know I do good work. I know I care deeply for my patients and want them to do well and have good lives.

If you recall in the fairy tale “The Ugly Duckling.”  It took the beautiful swan time to find where he “ fit in”   after he was made fun of by his "ducking siblings.”  I don’t pretend to be the beautiful swan, but what I do know is, in the game of life we are all able to find that place or group we belong to.  Then we a free to be authentic and true to ourselves. While I don’t have a picture of a Swan I will leave you with a beautiful iris from my garden a few years ago. Have a happy start to your summer season which in Maine starts right about now!


February 21,2018

Chasing the (Death) Dragon

Chasing the Dragon is a term used to describe inhaling the vapor from a heated solution of morphineheroinoxycodone, or opium. The term chasing  comes from the action of the drug user who  keeps the heated  liquid moving and inhales the smoke through a tube such as straw.  I have been seeing so much  addiction in my practice of Psychiatry I started thinking about ways in which the term "chasing the dragon” shows  up in other forms of addictions such as compulsive spending, gambling or sex addiction.  

Addictions develop usually because of anxiety and an avoidance of feelings.  Chasing the dragon in essence is keeping the feelings at bay. So what is this dragon that is so appealing to chase that we would risk our lives in order to have it.  Is it really that good?  Or is it just a compulsive attachment to the drug, the love object, money or whatever type of addiction we have? I believe it is the later.  It is not love when we stay in abusive relationships. It is a compulsive attachment to being abused or to feeling bad.  So just like taking a hit of heroin is deadly, so too can be the compulsive attachment to a person or to money. It never ends well unless we can break free of the addiction. So it would be turning away from the dragon  rather than chasing it.  Or choosing life rather than death.

October 14, 2017

Should I stay or should I go?

All therapy comes to an end. The question is what to do when the therapy ends abruptly or the patient has been wanting to leave for a while. But what if it is the therapist who wants out of the relationship and does things unconsciously to get the patient to end the relationship? Like missing an appointment, double booking or even being hostile to a patient. It is always unconscious.  Therapist’s are people too. They have their own psychological wounds.  Sometimes a therapist will tell a patient they don’t need therapy anymore. I believe, it is always up to the patient to decide that.  If a patient seems to be coming less and less I might bring up the idea of working toward an ending. 

I think a proper termination is always the best way to end. However, it doesn’t always go that way. When patients leave abruptly and give a reason it is rarely the reason given.  They may blame it on parking, money or even “ not getting anything” out of therapy any longer.  Or because of schedules the therapy may evaporate. Either way, exploration for the departure is always best. Maybe the work was getting to deep.  Maybe my patient felt uncared for.  Maybe an addiction had resurfaced and she was too ashamed to bring it into session.

Therapy is a relationship and when it ends it is best if there is at the very least saying goodbye. It doesn’t always happen that way. I do my best to help close the loop so that the work is finished.  I mostly tell my patients the door is open should they wish to return. Sometimes, even  years later, that actually happens and then we start again.

August 27 2017

Burn or Bend the Knee

If you are like me you are waiting patiently for tonight's season finale of Game of Thrones.  I had a hard time “getting into it” at first but now I find myself really excited about the show. The acting is superb and the story line couldn’t get better.  This season has been about “bending the knee.”  Meaning that one ruler would have to bow to the other ruler.  Of course this is fictional but it does hit home about relationships that are not to say the least, exactly fair.  Some of the characters refuse to “bend the knee” and they are promptly burned to death by the flame of a dragon.  Now, I actually like the queen of the dragons, Daenerys Targaryen, but she is a bit quick to act as is pointed out to her by her “hand” Tyron Lannister. A “hand" is an advisor type. I guess you could say Daenerys is a woman who knows what she wants and refuses to settle for less than that.  On the other hand, I do admire the characters who refuse to submit to her.  They stay true to themselves.  Modern day relationships can be like this in that submitting to someone would be like giving away a piece of yourself. Or as I have written about before, abandoning ourselves in an effort to please another.  Sometimes it means being “disloyal” to the family or the “bad kid.”  When we can’t  not “bend the knee” it can mean the inability of a child to fully separate from a parent.  The child is afraid to not do what the parent wants for fear of withdrawal of love.   Not “bending the knee" takes courage and it means being loyal to ourselves rather than going along with something just to be loved. In the end, it can’t  save us to abandon ourselves.

If you are watching tonight as I will be…"Winter is here!”

August 16, 2017

Beyond a Shadow of a Doubt

Sorry I have been gone most of the summer but life suddenly got very, very busy.  Not a great excuse, but it will have to do. 

I am sometimes left wondering what to write about. Sometimes things will come up in my work and other times things can come up personally that give me fodder for my blog.  So tonight I thought about how much of my life has passed and how very different it is for me now than even several years ago. For one I am fatherless.  It feels odd to actually write that. I think I always thought I would have my father in my life even though I know he was 30 years older than me and would likely die long before I did.  I think back to what my practice looked like when I first opened it in 1998. It was very different from the mostly psychotherapy practice I currently have.  I listen more and talk less, although some of my patients might argue that personal observation. I try to understand my patient’s feelings better rather than having my own agenda for them to “get well.”  Every day when I get the three or more calls from headhunters to practice “ psychiatry” for what I think is an obscene amount of money,   I sit back and think wow, is this the right decision?  But despite not making the oodles of money and having some fancy title or a radio show I can brag about, I know that  I am happy and without a shadow of a doubt have made the right decision for myself and my family. I had to come to the decisions I made by knowing what I wanted. By exploring not only what made me happy but what also made me very, very unhappy. Kind of like leaving a unsatisfying relationship. You have to look at the good and the bad and if  the bad ultimately outweighs the good, it is likely time to move on.

 Each time I am with my patient I encourage her to have what she wants.  If the important people in her life try to discourage her from having what she wants,  then we have to see why she would surround herself with people like that.   People that somehow hold her back.  It is usually unconscious material that has to be explored.  There is no guarantee  she will  make  the "right decision," but she can see how it feels and can always refine what it is she wants.  

I hope your summers have been fruitful and that you can enjoy the way underrated month of September!

Oh and we added three new chicks to our flock! Funny,  I went thinking i was going to get one type of chicken and I ended up with  three different ones. So sometimes we think we know what we want but then we decide on something else.


July 1, 2017

Mrs. Doubtfire

Many years ago, when I was in medical school the movie, Mrs. Doubtfire, starring Robin Williams, was released. The movie was cute and Mr. Williams was as funny as ever.  The movie is about a father who is thought to be an unfit parent.  He knows deep in his heart he is a good parent for he loves his children more than anything. I won’t tell you the ending but I  will tell you he had to trust in himself and not let the others decide for him what he could or couldn’t do.  Sometimes we can doubt ourselves and what we are capable of.  We  usually come to the table with our own insecurities, however,  we find people to reinforce what we already believe, thus confirming our views of the world.

I am an  “OK” sewer but have always doubted I could sew a zipper. Kind of what you would call a mental block for me.  Anyhow,  I took a class last spring and huzzah, I can actually do it!  I actually found it to be incredibly easy once I knew what to do.  Somewhere in my head I had also  forgotten I had been recruited during my internship for a surgical residency, which I obviously declined. Surgery actually involves a lot of the same fundamentals as sewing.  So how come I would think I could not sew a zipper?  That is something I had to grapple with.  We all grapple with insecurities. I don’t know anyone who is completely free of them.  

Each time I meet with my patient I have to encourage her to deal with her insecurities the same way I do.  My job is to not let her make a case against herself.  That if she really wants something there is no reason why she can’t have what she wants. Or to be able to do what she wants. Too often we are quick to think we can’t do something.  I have no way of knowing if my patient will succeed, but I surely will encourage her to have what she wants and to at the very least give it a try.

Sew…here’s the zipper I thought I couldn’t sew!


June 10, 2017

Can you hear what I hear?

Sometimes a patient will think they hear me say something that I never did.  It can can be an interpretation on their part or even a projection.  For example, if a woman tells me she is afraid of her husband,  I might say something like, "it seems like you think you are in danger,”  which  she interprets as me saying I told her to leave her marriage. So that is what she hears, that I told her to end her “dangerous" relationship.  Interestingly,  it is she who came up with the idea.

It is always difficult to watch a patient in a destructive relationship.  However, it is her choice to make whether or not she stays.  I can only listen and try to understand why it is she stays.  Sometimes she will leave therapy (me) because it is easier to leave me than her husband, lover or partner.

My jobs is to reflect back to her her disappointment, fear or anger which is really how hurt she feels.  My job is also to remind her it has nothing to do with her when someone is unkind or abusive  to her or doesn’t want the same relationship she does.   The problems were there long before the relationship started. I can only help guide her to hopefully have what she wants.

April 14, 2017

Jury Duty

I have been really busy with non work related activities so I have not blogged in a while.  I know  that after my father’s death I needed to go inward for a bit and likely that is what kept me from writing.  Today is the first day I have actually felt like my old self.  I am a bit tired because I just finished a week of federal jury duty.  I learned a great deal about the judicial process and about myself. I won’t discuss the case here, but I will say I felt like all the jurors did a fantastic job. They  all really cared about the process.  I have no way of knowing if our paths will ever cross again.  However, I do know I shared an experience with these people that I may never share again. I am glad I had this experience.  Life is like that sometimes in that we never know what will be around the next corner.  A year ago I could not have told you I would have lost my father.  I knew he was in the winter of his life but I had no way of knowing it would be his last spring, summer and fall. That September 22, 2016 would be the last time we would celebrate his birthday as a family.   Sometimes I wish I had known it was going to be the last time, but I don’t know that I would have done anything different.  I would have probably been very sad.  

So, it is back to my predictable life next week, which I am actually looking forward to. Happy Easter and because I missed saying it last week,   Happy Passover!

March 17, 2017

Sometimes there are no words

Sometimes we have no words for what we are feeling.  At those times I will ask my patients what they feel in their bodies.  Many times they will tell me it "hurts in their stomach,” or  their chests  feel tight. Other  common places it shows up  is headaches and back pain.   I see our bodies as a messenger. The feelings can let us know we are upset.  Many years ago I had a job I did not like and I had come to dread going to work on Monday’s. Every Monday I would have very bad heart burn. I started chewing ant-acids usually late morning.  I didn’t put the two together right away. That feeling left after I left the job.

Insomnia can also be a signal we are upset about something. Last friday my father died.  I have been very, very sad.  Even as I type this I am tearful thinking about never seeing or talking to him again. All week I have had difficulty falling asleep.  Sure I would like to blame it on daylight savings time, but I know it is because I am upset over losing my father.

Despite feeling so sad, I know I am ok and I will be ok. I also know I have to honor my feelings of the greatest loss I have ever known. When we fail to recognize or honor difficult feelings it will likely show up somewhere in our bodies.  The minor symptoms can be dealt with.  It is when it becomes an autoimmune disease or cancer that it can have devastating effects. Of course, not every symptom is psychosomatic, but I do believe  we always need to listen to our bodies even when we think “everything  is ok.” our bodies may be signaling what we think is “ok” in actuality is not. This is of course unconscious and it is our bodies that are trying to bring our difficult feelings to consciousness. I will write more later on this topic because I believe it is one of the most important parts of the work I am  currently involved with in my private practice.

February 26, 2017

Really Wanna Know You (1981)

I can be a throwback, just as much as the next person. I will hear a song and it will take me back to a time when that song was popular. I was shopping at the local market and this song came on. As soon as I heard it, it made me smile.  It was a song that was popular when I was a lot younger and I liked very much. The artist who sang this song was Gary Wright and oddly enough he also sang “ Dream Weaver," another one of my favorites.  When something takes our psyche to a different thought, whether it be a smell, a song or a familiar place, in psychoanalytic terms,  It is what  Freud called  ‘'Free Association.”  Free Association is a way to go deeper inside oneself.  It is a way for patients in therapy to go deep inside their psyches.

The other day when the weather was absolutely gorgeous, I was sitting outside enjoying the sun on my face. As I closed my eyes, I could feel the warmth, I was very quickly taken  (in my mind) to a time when I would sit on the beach at Pine Point. It was a very pleasant memory. As I continued to free associate it actually took me to a less pleasant place which I won’t go into, but it let me feel the feelings and work through them. So in the end it was a deeply meditative experience. I encourage my patients to do the same. Sometimes  my patients will tell me they don’t understand what I mean when I say to go inside themselves.  This can be a hard concept, especially if my patient is a “ thinker," rather than a “feeler,"  but it is a way to get to know themselves at a deeper level. It can be transforming especially if there is past trauma.  

This song is about wanting to get  to know a lover, but I believe the most important person we have to get to know is ourselves. 

Oh and I had another birthday. I don’t mind getting older especially when the cake is really good!


January 1,  2017

What’s “New”  in your New Year?

Every year I think about what I want to be different in my life.  Because my son is in middle school and needing me much less than when he was younger, I have been awarded the freedom to pursue my "other than mothering" passions.  This year I began to think about things I have let slip away from me.  I began to search my soul (and my home) and discovered my very old flute I had tucked away in a closet. I opened up the case and inside was that shiny three piece woodwind in the blue velvety case. Ah, just like the first time I opened it in fourth grade.  When I went to put it together the pieces  didn’t slide into place easily and I realized I needed to bring it in to be tuned up. Sadly, my flute was going to cost almost as much as new one to repair so I bought a new one instead. I also called a flute teacher for lessons and in no time I will be on my way.  

In my practice I see patients with “ ideas" about what they want.  The trouble is ideas can’t be just that, ideas, they have to move from idea to reality. It is like pulling yourself up on the next step of a latter.  So how come so many people get stuck?  Now, of course I see a skewed population, but what keeps so many of us from realizing our potential.  I believe it usually involves fear. So if I can help guide my patient through her fear then the hope is she can take that next step up the latter. Fear is a tricky thing. It can feel so real and can almost paralyze us.  It’s good to talk through the fear.  It can mean creating a different narrative for ourselves.   

Usually fear is placed in our psyche’s by overly critical parents or other important authority figures in our lives.  It is important that we not let our fear overtake us and keep us from taking risks.  Sometimes parents will make a child feel afraid so the child  won’t separate from the parent or it can also be because the parent is envious of the child’s accomplishments. Especially if the parent struggles themselves with self doubt.  

So after I put my new flute together,  if I had watched my son’s face as he sat there fearfully that I wouldn't be able to blow a note on my flute I would have likely given up. Much to his disbelief, I can still blow a pretty mean note or two!

Isn’t she a beauty?!


December 24, 2016

It’s the most wonderful time of the year…or is it?

Christmas is less than twenty four hours away.  Lights, cookies, action!  So many of us believe Christmas is that wonderful day where families get together to exchange gifts and fill our stomachs with delightful foods. But what if it isn’t the day where everyone runs down the stairs in their footed pajamas?  What if Christmas was more about fighting and drunken rages?  The memories come back and it can make for a very difficult day.

Christmas can be a very lonely time for some,  especially if one  doesn’t have family or friends that are close by. How do we cope? Some try to 'get through" the holiday by distraction. Others will try desperately to find someone to date during the holidays and sadly others will drink themselves into oblivion.

I think Christmas can be a time to go inside ourselves and get to the heart of what  still causes us pain.

In my office I see about a  50/50 split  of people looking forward to vs people dreading christmas.  Each time we talk about why. What makes it hard? Maybe it was hard  because Christmas didn’t happen because mom spent all the gift  money on alcohol.  Or the turkey was burned in the oven after mom and dad passed out on the couch.  Or maybe it was just hard because there was no extra money at the end of the month for a big meal and gifts.  Or maybe there was a recent job loss or death of a loved one just before the holiday.  Whatever the reason is,  we must  honor our feelings and then try to think of ways to have the Christmas that we may have wanted.  How can they do something to create a new memory? Or if "getting through the holiday" is all that is wanted, we do that too. I think it is important to pay attention to our feelings whatever they may be and to honor them.    

I wish you all a good holiday and may it come and go with ease.

November 14, 2016

Soup’s On

After last’s weeks election I decided not to blog for a week and let myself sit with my feelings around the results of the election.  In my office I encourage my patients to sit with their feelings all the time.  So while we all process the outcome whether it went the way you wanted or not, it is important to honor your feelings whatever they may be.  Sometimes when our feelings get more difficult we can turn to comfort.  I decided to make some soup.  Fall is also a time I start to cook more foods such as soups and breads.  It is a way to bring comfort into my home, but it is also a way to care for myself.  There are other ways we need to care for ourselves such as exercise, writing, putting good people in our lives and getting enough rest.  Luckily I have great women in my life and one who happened to be in my knitting group gave me a terrific recipe for soup.  So after I made my homemade stock, I started making a butternut squash and coconut cream soup.  So just like having good soup, having good people in our lives can only add to our taking care of ourselves.  If soup isn’t your favorite, whatever brings you comfort is a place to start.  

November 6, 2016

The Procrustean Bed (aka  twisting yourself into a pretzel)

In the Greek mythology, Procrustes was a son of Poseidon.  Procrustes had a bed where he would invite travelers in and in order to spend the night they had to fit his bed.  No one ever fit the bed so he would terrorize them by shortening their legs and eventually they fit the bed.  He reined in terror for a very long time until he  was finally captured by Theseus and made to fit “his bed.”  

In relationships if in order to make it work one person is  having to compromise too much who they are then it would be like cutting parts of one’s self off in order to ‘fit the bed.’   I am not entirely sure why, but in my practice  I see it more in women than in men.  I have also seen it in friendships  and work situations.  So why would we be so willing to cut off parts of ourselves in order to be in a relationship?  It usually comes down to fear. Fear that we won’t be “ OK" without the relationship.  That being alone is worse than cutting off parts of ourselves.  The truth is that a bad relationship is NOT better than no relationship. So how do we get past the fear?  The first step is always in  getting inside the  fear and faulty belief.  Where would this idea of staying in bad relationships come from?  My job is to help my patient excavate and dig deep to find the explanation.  Then the hope is to help my patient  realize (on their own) that  it is better to leave a bad situation. This of course doesn’t always happen. So what I end up seeing is various degrees of depression,  anxiety, somatic illness as well as psychosomatic illness and sometimes although rare, even death.    I can only tell you that if a pretzel is twisted too much it will eventually break.

October 23, 2016

Is this really the answer?

I am always hesitant to generalize when I blog, but when something keeps staring me in the face,  I have to wonder what is the meaning of this?  I am seeing more and more women coming into my practice who seem to “have it all” but are still depressed or very, very anxious.  I listen carefully and when I pose the question "what is it  that they want," the usual request I get is for medication. I suggest therapy if I believe it is indicated which is probably 99 percent of the time.    I would say that 50 percent of the time therapy is rebuffed with reasons like,  “I don’t have the time or the money.” 

 As I mature as a psychiatrist  I become more  conflicted  as a "medication manager”   because it feels like we live  in a world where everything seems to be fixed by a pill.   It also seems like no one wants to spend the time figuring out what is upsetting them.  Like I said I  don’t  like  to generalize so OK,  not everyone, but a good portion of people who present to my practice would rather swallow a pill than look at what is "not right”  in their lives.  I am usually presented with the  list of medications that have been tried in the past and I am often asked if  I have some other "magic pill" that will make everything alright? The answer is usually, "no, I do not."  Now,  there are occasions where  the   depression or anxiety  symptoms are purely biological, like in the case of someone with a bipolar illness.  However,  even my patients with biologically based illness's still benefit greatly from psychotherapy. The biological illness is just one aspect of who they are.  If someone is also very depressed  and they are not functioning  well,  then that is an entirely different situation and medication always has to be a consideration.  Where it gets tough for me on an ethical level is when people say nothing is wrong in their lives but they are irritable and unhappy most of the time. Do I ethically give the prescription knowing that it is only "band-aiding” what is really a problem?  It would be  like taking a "pain killer" without ever getting to the root of what is causing the pain.   I frequently see this show up with women who are in unsatisfying relationships. They are unhappy in their marriages and then start to take an SSRI so they can “tolerate” the unhappiness. I see it more frequently with men who are in unsatisfying jobs. Something is not right so instead they will want to start taking a antidepressant.  I don’t believe medication is "the answer.”  The answer lies in figuring out what is not right, rather then tolerating what is wrong.  

October 14, 2016

Letting Go

Relationship endings are very difficult, but what happens when a bad relationship ends and keeps dragging on because one or both partners can’t let go?  It keeps the parties from  moving on and fully living their lives. I most often see this in divorce, but today with fewer people marrying, it now presents  itself as the couple who stayed together for many years despite never marrying. However,  It can feel like a divorce.  

I see it when one or both parties refuse to settle on property, alimony, child support (although that is dictated by the law) and even pets. It can look like   it is about the money or business or whatever, but it is really a way the people don’t let go of the relationship.  Unless there are children involved rarely is it necessary for two people to stay involved with one another.  So why is it people have such a hard time letting go of failed relationships?  The answer always lies deep inside the person who  won't let go.   Everyone has different reasons for hanging on. Hanging on  can recreate some old, but familiar feelings we had in our families growing up. For example, a woman who’s father left when she was very young, may keep hanging on to a relationship that ended back in college, despite it never going anywhere.    Or a man who’s mother abandoned him emotionally won’t let go of a "dead end relationship."  

A colleague described not letting go of relationships as a way of dragging around a dead corpse.  She said,'you know what happens to dead corpse’s that get dragged around, don’t you?’   She answered her own question with, “they begin to rot and smell.”  

October 9, 2016

Stuck in the 80’s

Why is it some of us can get stuck developmentally? Well, there are many reasons,  but I will discuss a few I see quite often as a psychotherapist.  First off, we can get stuck emotionally and developmentally because we found that particular time in our life to be fun. It is a way to want to live in and recreate the past.  Maybe it is “hooking up” with an old college boyfriend or girlfriend, just to feel desired again after spending years in an unsatisfying marriage.   Or repeatedly going to "reunion tour" concerts  of bands that were most  popular when we were in college.  It’s ok to go back once in awhile, but when we get stuck at a certain period in our lives, it can prevent us from growing emotionally.  

Another place people become arrested developmentally is with substance abuse. The period of development stops at the age one starts to drink or use drugs heavily. So when someone  gets sober, they go back to that emotional  time when they began to drink. For example a man who started drinking at 15 years of age, will remain at that age of emotional maturity until he gets sober. Once sober he will go back to that age and hopefully restart his development.  

It also happens to people who come out of divorces. They go back to the time they last dated which could be in college.  It is difficult but hopefully it will sort itself out.

I personally  experienced it during medical school.  Any type of intensive graduate work or training requires so much of our attention that it would be hard to develop emotionally as well. Thankfully,  it resumed  upon my graduation!

I also see "being stuck" with people who want to remain forever young. I blogged about this a while back. it shows up as the puer/puella complex.  Like I have said  before, a little puer/puella is actually a good thing, but when the majority of one’s life is not wanting to grow up and instead remain an adolescent, it can be detrimental.

I am all for listening to some good 80's music, but as a psychotherapist if I see a pattern of delayed maturation, I have to ask the question,  “what  seems to have arrested the development?”  Once discovered than the real challenge becomes in how  to get it started again.  I always have faith it will happen,  otherwise I wouldn’t be so committed  to the work I do as a therapist.

Sadly, as the autumn is in full swing it is my garden that is now seeing “arrested development.”  

October 1, 2016

Mirror, Mirror on the Wall…part two

I think most people recognize the title of this entry as being from the fairy tale Snow White, one of my all time favorites, but today I am writing about it in the context of psychotherapy.

Psychotherapy is very, very hard.  It requires commitment.  The commitment is  both  financial and time, but it is also  the  commitment (and courage ) to actually look at one’s self. I am not talking about the nice parts, I am talking about the deeper, darker and quite frankly ugly parts of ourselves that we sometimes call the shadow.   Why must we look, you ask?  Because it is those parts  of ourselves that are needed for us to look at in order to heal.   I am afraid therapy isn’t ice cream cones and unicorns. It can get pretty dark and scary. A colleague once described  it as  descending to the depths of hell.   The job of the therapist is to go along for the journey and help my patient get through this.  In order to do this deeper work, one must be on fairly stable footing. This is why I don’t do deeper work with anyone who has less than a year of sobriety. The work can be painful and cause increased anxiety. If someone were using or had little sobriety, the painful feelings could  fuel a regression which I am afraid could result in relapse. Addiction whether it be alcohol or opiates or whatever,  is about obliterating feelings. In my opinion deeper work  before a year of sobriety would just be too risky. This is another reason why I do careful screenings around substance abuse.

It is very hard to look at the darker parts of our psyche’s.  It means taking responsibility for our own lives and feelings. It means accepting it is us who creates our hardships. Yes, we can unconsciously put people in our lives that add to our misery,  but once it is conscious we don’t have to keep them there. This,  of course is never done in haste, but only  after taking a long hard look at what we want vs. what we actually have. Sometimes patients will elect to stay  in “unsatisfying" relationships,  which is never wrong. This could be because in their minds leaving is worse than staying.  The only way to know if it is truly what we want  is to go deep inside and look at ourselves.

For the most part my patients will stay the course even when the therapy gets very hard. Sadly,  some will leave before the work is completed. However, I try to leave the door open for their return if they should want to resume  the deeper work they started. 

September 16, 2016

“Everybody’s talkin' at Me.

This week I had to call on some of my more intensive skills as a psychiatrist.  In my office I work with  higher functioning patients who are there to look more deeply at their lives.  While working in another setting I had to deal with some more ill patients.  I always get a little sad when I see a young person have their first psychotic break.  It could be  the first year of college or law school. Or they might have just joined the military.  The stress of the new endeavor such as college or grad school will usually unleash the illness that was just below the surface. Sometimes I will  see it after the birth of someone’s first child.  The hard part is that I try to talk  with the patient to understand what they are experiencing but I know that I am just one of the many who they must feel like is just talking at them. It is pretty obvious when I ask a question that is not even remotely answered such as,  "how did you sleep last night?” They might respond with some answer that does not even make sense.  Or they may just tell me to “ go to hell!”  Regardless,  I try to be as kind and empathic as I can be. It must be terrifying to not understand reality.  

One of my all time favorite songs from 1969,  is Harry Nilsson’s Everybody’s Talkin’.  It is the theme song from the movie Midnight Cowboy. I was five years old when I fell in love with the song.  Probably because my father listened to it a lot.  I think about what it might be like to feel like people are talking at me rather than listening.    My guess is it is probably terrifying.  When I was younger I was probably less empathic. When I was a psychiatry resident I was just trying to get through the day,  which sometimes meant I would be awake for 36 hours. Thankfully,  I don’t have those kinds of days any longer. It allows me to be fully engaged with my patient. I also think  as we age and grow in our professions,  we become the people we were supposed to be all along.  

August 20, 2016

"I want  a new drug.

This week the FDA has placed the use of the drug  Ketamine for treatment of major depressive disorder on the fast track for approval. Ketamine, also know as the party drug “special K” is also used in veterinary procedures as an anesthetic.  I personally know very little about this drug, but what I do know is once again we have no way of knowing how this drug works.  I read an article where a patient received a response after one oral does of Ketamine.  How do we  know  this wasn’t  a “placebo effect?”  I get concerned when I see the push by a pharmaceutical giant to get approval for a drug when I know they will benefit financially from the  sale and use of that drug.  I can only imagine what the price tag of this new magic bullet will be.

Over 41,000 people die from suicide every year in the United States.  This is the highest rate of suicide in thirty years.  In 1999,  29,199 people committed suicide.  In 2014   that number was 42,773. That is roughly a 24 percent increase.  Middle aged women saw their own suicide rate go up 63 percent during the period from 1999 to 2014.   Sorry to have to write about such gloomy statistics  but it is to drive a point home. The point is, maybe instead of adding drugs we need to figure out what is driving the suicide rate up?

 Maybe it’s time  we go back and look at the root of the problem. This is what we call a root/cause analysis.   It’s like when someone has congestive heart failure, we look for an underlying cause.  I can’t help but wonder if  this dramatic increase has to be related to less coverage for psychotherapy, shorter hospital stays and the large  increase  in substance use/abuse. 

I don’t know what the correct answer is or how to reduce the number of completed suicides. I only urge caution when we are  using  drugs that we know little about how they actually work. Although for as long as I have been prescribing, this has been true about most of the drugs we use today to treat mental illness. I will be curious to see if the FDA actually goes ahead with the approval of Ketamine for major depression and how long it will take to actually  get that approval.

August 4, 2016

Anniversaries and the Death Mother

Eight years ago this month I made the decision to return to private practice.  Previously,  I had been in practice from 1998 to 2005.  In  2005, I decided to become a mother and I closed my practice for a "stable job with benefits."  I think becoming a mother made me anxious about having a steady income and paid time off.  I probably made the right decision that first year because my son had many ear infections and I think I was off quite bit to take care of him.   I don’t want to second guess my decision, but I likely would have figured it out; how to stay in practice and be a first time mother.  After three and a half years in less than satisfying jobs I made the jump back to private practice.  Being in private practice is really,  really good.  I get to set my hours, I get to decide how long I want to spend with each patient and I get to tailor the  treatment I see as best practices.   There are downsides to being in private practice but I feel like the good times far outweigh the difficult times.  Eight years seems to have passed by very quickly.  I can’t imagine having to go back to a “job.”  This never feels like  "work" to me.  Yes, I can get very tired by the end of the day, but it doesn’t feel like I am working.  After eight years I feel like I am in a rhythm. One where I know who I am as a psychiatrist and more importantly as a therapist.  I am comfortable in my own skin and it feels really good.  

Now on to the "Death Mother.”  Marion Woodman,  a Jungian psychoanalyst  has written about  "Confronting the Death Mother." I will be writing more about The Death Mother Archetype.  I will start by saying it is when a trusted person such as a mother is supposed to love us and instead she is violent, abusive or so self absorbed that the child is forever traumatized.  The Death mother also at some level, “wishes us dead.”  It is a hard concept to understand  but it is showing up everywhere in society.  Woodman goes on to teach that the Death Mother can show up in our bodies physically.  It can show up as cancer, autoimmune disease or something as simple as unexplained abdominal pain.  Over the eight years I have been back in practice doing,  primarily psychotherapy, the Death Mother is one of the most powerful archetypes I have bared witness to.   I will write more about her  in the coming days.  

Oh and Happy Anniversary to me!

July 24, 2016

Why now?

When  a new patient comes to my office for an initial appointment, I try to do my best at letting  her tell  her story.  Unfortunately, because I am having to “ get" a certain amount of information for documentation it may seem to her like I am not listening or interrupting.  This is driven by insurance reimbursement and in a perfect world I could sit back and listen without any interruptions.   Sometimes a patient will think I am doing nothing but ask questions and in fact this is partially true.  The real work is that I am actively listening to everything they tell me.  I am trying to look for something that gives me an idea of what has brought them into treatment.  The biggest question is why now?

 Lately,  I am seeing more and more anxiety in my practice.   I will hear about my patient’s life  and sometimes it will be that "everything was fine" until something happened such as a divorce, death of a parent or a newly diagnosed medical condition.  However, more often than not I will hear that life has been pretty hard along.  So the question is what is driving him into treatment now?  Sometimes it can be worsening substance abuse. That  which was initially thought of as “just wanting to party”  during his younger years has now remained the “point of the activity” when he socializes.  This is actually a good  thing if it  gets him in the door to do the deeper work.

Whatever it is that gets my patient to even make that initial phone call for an appointment is a good thing.   It could be wanting to develop more  meaningful relationships, better sleep at night or wanting to stop feeling so badly from drinking too much alcohol.

The telling of the story can take some time.  Once the initial visit is through and I gather all the necessary information for the insurance documentation I can hopefully sit back a little and let my patient’s story unfold.   I will always  ask the “why now” question even though it is not a part of the “required documentation.” 

Oh and happy summer!

July 12, 2016

"That’s Amore"

When two people fall in love it is what we call chemistry or alchemy.  Or what is also said in Italiano to be amore’.  So what is it that draws two people close together?  It does feel like “love," but what it entails is the lining up of each ones insecurities.  Basically what we call a match.  What if the match is not so good and although there is chemistry,  the insecurities do  dovetail but not  in a positive way.  If that is the case,  it can make for a very difficult and unsatisfying relationship.  

Love and relationships  "should" be easy and not hard. When one person feels like they are doing all the work it can be very unsatisfying. Relationships require both people to make it work.  Otherwise the relationship can feel one sided.

There are many levels of love and relationships. There is the love we feel for a child which is like no other love.  The love we feel for friends and then of course the love we feel for that special someone like a husband or a wife.  So when we feel “ in love”  we have to honor our feelings, but only if they aren’t painful. Love does not equal pain. Deeper love is based on mutual respect and caring. Romance is exciting  but it is the deeper love and caring that makes it last.  The initial stages of attraction are always based on projections.  Once the projections wear off we have to see if what stands in front of us is enough to keep going.  If not we have to say that’s not amore'

July 6, 2016


Terminations are never easy.    I am disappointed and saddened when  patients will leave therapy and never come in for a final visit.  Therapy is a relationship between psychotherapist and patient.  The hope is that it will end well and that the experience is good for the patient.  When it ends abruptly it can leave the therapist feeling unsettled.  This is of course, something that the therapist must work through on her own. It is important that the therapeutic  relationship be honored and that saying goodbye is as important as the work that has gone on during the therapy relationship. Usually there are signs that it is coming to an end.  However, sometimes we do not figure it out until after the patient is gone. Sometimes the patient has been leaving since the very first visit.     When I was a psychiatric resident, I can honestly say I was given very little guidance about terminating with my patients. At the time  I was moving away and I pretty much handed my caseload over to the next resident who would settle in to my tiny psychiatry resident  office.  In those days my office could barely hold two chairs and a box of tissues. As I look back, I now realize how important it was for my patients  to experience a proper termination. My current practice of psychotherapy allows for the time to say goodbye and  teaching  patients that  endings don't have to be negative.

June 29, 2016

Gastric Bypass, Smartphones and Staying in the Moment

Psychiatry has always been the field of medicine that takes a while for symptoms to improve.  The only time I have seen a “quick response” to medication is when it is placebo based or to something short acting such as the stimulants or benzodiazepines. Neither drug class is great in that they both are risky to prescribe because of the high rates of addiction. I know I frequently refer back to residency about information I learned.  I will do that again because that was where I was given the foundation on how to be a good and safe psychiatrist.  I used to struggle early on wanting to fix my patients problems. One faculty member told me I needed to sit back and not try to fix things so quickly. Basically I had to let my patients find their own way.  Man, that was hard.  I think I still struggle sometimes with that today.  When I find myself working harder than the patient, that is a problem.  It isn’t my therapy.  Sometimes patients will accuse me of not doing enough. That is what they want to believe and it may in fact feel that way to them, but the best outcome for them is for me to allow them to find their own way.   Some patients will leave, angry that they feel I am not giving them what they want. Others will plant their feet firmly on the ground and stick with it.  That is where the test of time comes in.

With the invention of gastric bypass and  smartphones, I feel like I am seeing patients who more and more want instant fixes.  In general life has become a series of upgrades. If I don’t like my smartphone for a small fee I can just get a new one. Or if I get tired of the color of my car I can lease a different one.  Gastric Bypass is the same. It promises quick weight loss. When patients lose the weight they feel great. However, on more than one occasion I have seen patients begin to regain the quickly lost weight.The body has a way of doing that thing of "wanting it her way.”

So how do I begin to practice psychiatry in a world of quick fixes?  I sit tight, hold back on my own desire to fix things too quickly and encourage my patents to find their own way.  If I find it for them I am doing them a disservice.  I would be creating a greater dependency on me.  Life is about making decisions and seeing what happens.  Kind of like prescribing insulin to a diabetic. You pick a number of units of insulin and see where the blood sugar lands in the morning.  If the blood sugar is too low you decrease the dose.  Too high and you increase the dose.  It’s not magic. It just requires making a decision and then seeing what happens.  The hard part for me is convincing my patient to stick with it when things don’t move quickly enough for him.  Staying in the moment is the hard part.  I don’t have a shiny new upgrade to offer them. I only offer me showing up for them each week and the tincture of  time. I also know that sticking with therapy even during the less crisis driven times does work. 

June 27, 2016

Depression or Grief?

Frequently, I have patients arrive in my office after a loss. It can be from divorce,  pregnancy loss, death of a spouse or child or layoff from a job.  Whatever the loss may be it can still feel pretty awful emotionally. The question is when to medicate  depression that could be related to grief.  When I was a resident I was taught that “we don’t medicate grief.”  I would have agreed whole heartedly with that except it isn’t always so clear cut.  Sometimes the grief goes on for too long. The sad and hopeless feelings don’t seem to be  improving.  I try to hold back on medication as long as possible because usually the grief feelings can be worked through. However, if the loss is great and the grief seems to have gone into the realm of  a major depressive episode, it can be time to give medication a try.  It also depends of level of functioning. If someone needs to be able to work, then they may need medication sooner. When I was a resident,   I had the opportunity to work alongside some great faculty. I sometimes wish I could go back and learn from them again.  I do recall one psychiatrist who was explaining to a patient why it was so important to process difficult feelings.  The patient did not want to deal with the difficult feelings.  He said "you can’t go around the mountain, the only way to the other side is through it.”  It made so much sense to me.

Even though I feel psychotropic mediations have become overprescribed, I still believe there is a place for  medication in psychiatry. The tough prescribing comes when trying to decide if it is  better to let the normal process of grieving occur.  I don’t think of  it is an all or none type of decision.  Each time, I carefully weigh out the options with my patent and let her decide what might be best. Again, it is a personal decision and time and severity of symptoms must always be considered.   

June 21, 2016

Dream Weaver

Dreaming is a way in which we can learn about our unconscious life.  Our dreams do not tell us what we know, but rather what we don't know.  Dreams are usually associated with something happening in our waking lives.  When we dream,  the dream is trying to tell us something about our lives.  The question I always ask is, “why this dream now?"   There is a lot to be learned from our dreams.  Sometimes, a  place to start  is with a book about dreams.  Psychotherapy is also a place to look at one's dreams.  It is best to record dreams as soon as possible after waking.    This way information  is not lost.  Dreams can give us information that is not quite yet conscious.  Last night at a summer solstice event I went to,  one of the people who attended told me she has been writing her dreams down for 15 years.  I was really impressed.  She talked about how she had been having a recurrent dream and the dream had suddenly  begun to change. Even though she had found it somewhat scary,  the important part is when our dream begin to change, it can mean emotional growth is about to take place. Of course,  I am not sure  what her dream means, the dreamer gets to decide that.  However, I know when my dreams change it is usually a time  of personal growth for me.

Pleasant Dreams and Happy Solstice!

June 16, 2016

Mirror, Mirror on the Wall

Hopefully we all recognize the title of my blog as being from the fairy tale Snow White.  This happens to be one of my favorite fairy tales. I am not referring to the Disney version, but rather the actual tale about a wicked queen and her attempt to poison Snow White. In the fairy tale the queen has two unsuccessful attempts before she goes back for a third time to “do it right.”  The problem here  is that by the third time you would think Snow White would get the drift and that if she eats the apple it will kill her. Slow learner or just someone who enjoys being poisoned? By the last time you want to scream "hey, Snow, don’t take the apple!" Well we all know what she does.

In life we can become our own versions of  Snow White. This happens when we do the same things over and over and expect a different outcome.  Some would say that is the definition of insanity.  It could be hoping or thinking someone will be different in a   "bad relationship.”  Bad by definition is very individual and what feels bad to one person may not feel bad to another.  We can sometimes fill the gaps in with fantasy partners or relationships. Unfortunately, the *real*  person or friend shows up every time. It’s when  we begin to move away from things that are not good for us that we are no longer Snow White and are no longer willing to  eat the poison apple.  

The only behavior we can change is our own.  We can never expect others to change. We can however, choose whether we agree to accept what is being offered to us in relationships. As I have said  many times before, if what is being offered is less than what you want, then settling for less is not the answer. The answer lies deep inside the psyche. Once unlocked, just like in the fairy tale, Snow White wakes up.

And because I like posting pictures, here is my son and his cousins supporting the LGBT Community after the unfathomable events of last weekend in Orlando.

June 12, 2016

Water Finds it’s Level

Last night after  my high school reunion I got to thinking about what to blog about. When I looked around  the room what I saw was  the relationships that have endured the test of time.  I saw people who I have probably not seen in over 30 years.  Some divorced, some no longer working because of disabilities, some who already have a grandchild or some who are already retired.   What I also saw was the same people pretty much socialized all night with their groups from high school. It’s funny how those things happen even 35 years later. What it got me thinking about was that in life we gravitate toward the very people who we tend to have something in common with.  It can be based on shared values  or how much people party or don’t party anymore.  I don’t mean this to come across as disrespectful in any way, it was just an observation I was making.   I was glad to hear I wasn’t the only one that, “doesn’t stay out late anymore.”  I was even more happy to see the caution that everyone took about drinking and driving.  Yes, I think it was good to see we have all grown up.

With so much emphasis nowadays placed on physical appearance and materialism do we end up in relationships that can be based too much on attractiveness and not paying attention to if we are really a match and more importantly  if  we really want the same things in life?   As I have mentioned before, in relationships our insecurities tend to dovetail with their insecurities but there also has to be some lining up of basic values in order to work.  If that shared basic value system is not there then the relationship can be doomed from the start. 

I have to admit I had a really great time. It was  good to see people, meet their spouses and see how their lives have turned out. Some have had some heartache along the way.  One of my good friends from high school sadly has lost both her parents.  Another lost a sibling.  Some have dealt with cancer and thankfully survived.   Divorces have happened. Some have never married, but we were all able to come together for a night again and go back in time. It was really fun!

June 11 ,2016

I’ve Got a Name

35 years ago I graduated from Portland High School.  At the time of graduation I would never have known I would be a psychiatrist writing a blog about life, psychiatry and psychotherapy.In 1981, the year of my graduation,    I was headed to Northeastern University in Boston Massachusettes as a Business Administration  major.  Oddly enough, even though I am a doctor I do  run a small business.   I was only 17 when I graduated. I didn’t quite feel ready for the big world.  I probably was too immature for college at that point but somehow I made it through . Not exactly on a traditional timeline, but I did.  I had the same “not quite ready” feeling when I finished my Psychiatry residency.  I know I bitched and moaned during my residency.  I couldn’t wait to be out, but when it was time to go I felt a bittersweet sadness and a feeling of “are they crazy letting me out now?!”  I have learned more in the 18 years since I graduated residency than I could have possibly imagined.  Life is funny like that sometimes.  I don’t think I could have ever been prepared enough during my residency training for all that I would eventually see.  I still learn something  new everyday.  

Our class song in high school was “I’ve Got a Name” by Jim Croce.  The chorus has always been a favorite of mine. It says,  “moving me down the highway, rolling me down the highway, I’m moving ahead so life won’t pass me by.”  At high school graduation, I had no idea where I was really headed or where I would finally end up. The same thing was true for my graduations from medical school and residency.   Psychotherapy can actually be like the lyrics from the song.  Hopefully, my  patient moves on down the highway of their life in a positive way.  Of course there are bumps along the way,  but what if it isn’t that easy. What if, the bumps are really hard and feel insurmountable at times?  I still think you have to cast your gaze forward if you can.  Hopefully, we all end up in the very places we were meant to be.  I am not a religious person but  in the bible when Lot’s wife looked back she turned into a pillar of salt. Looking back or trying to go back cannot really work.  In psychotherapy we do a lot of looking back, but this is to learn what not to do again.  

Tonight is my 35th high school  reunion. It is ok to "go back" for a night.  It will be good to see old friends. Sadly, we lost a classmate about a month ago. We have lost a few others over the years. However, they will always be there in spirit.  So for  tonight I will be “moving me down the highway” to Dimillo’s.  Go Bulldogs!

June 2, 2016

Here Comes the Sun  

It is hard to believe it is time to put my A/C units in again. I try to think back to what I was doing a year ago and hopefully my life is better in some way, shape or form.  I think that birthdays are always a good time to take stock, but what if things are not so good or we feel less happy than the year before?    What if it doesn’t feel so bright today?  It means it is time to figure out why.  Sometimes life does hand us lemons. It is what we choose to do with those lemons can make all the difference in the world.

Last year my  flower garden seemed to not do so well. This year it is blooming and seems to have taken off to new heights. Interestingly,   my private practice and my personal  life are doing just the same. Do the things in our life seem to grow just when we begin to open ourselves up to new possibilities?   I can’t help but think it does.  It also means when we pay attention to our lives, or our gardens, we reap the fruits of our labor.  Gardens need to be weeded in order to flourish.  I believe our lives need to be weeded as well.   One way is to remove  unkind  or uncaring people from our lives.  Whether it be a friend, a boss or even a someone we do business with.  It can be   people who want nothing more than to see us fail or who don’t wish us well.  We would never put garbage into our gardens. If we think of our lives as gardens, we need to do the same and be careful not to put “garbage" into our life gardens.

In relationships, we  tend to attract and are attracted to  people  who dovetail our insecurities. This is not always bad. However, when the people we attract  or we are attracted to seem to want nothing more than to hurt us based on their own insecurities or fears of intimacy, it may be time to take a hard look at why we stay emotionally connected to them.  If we try hard at making it work and it still doesn’t seem to get better,  then  the only answer  may be to weed the difficult relationships from our lives.  It can be hard to say goodbye to people who we thought had  our best interest at heart, but in order to grow it has to happen.  This could mean saying goodbye to work, family or love relationships.  An important part of gardening is something we gardner's call preventative maintenance.  So in life it would mean paying attention to the patterns we  have developed in the past which have not been fruitful for us.  Letting go of relationships  is not something to do  in haste and of course it involves a process of separating oneself, but it can happen.  Also the endings need not  be negative or dramatic.  Slowly the clouds will part, the sun will shine and our life gardens will once again be blooming and full.

May 21, 2016

What lies beneath?

A  lot of my work  lately seems to focus around relationship dissatisfaction and unexplained physical symptoms.  What  can drive both men and women into my office may be symptoms of depression,  anxiety, physical complaints or lack of sleep.  Sometime addiction will drive the person into treatment which is thankfully a good place to start. In those instances it would be important to have a solid twelve months of sobriety before embarking on deeper psychological work. This is because the deeper work can cause difficult emotions which can trigger relapse.  

 The “ surface symptoms” are the depression, anxiety or maybe intractable headaches.   It is my job to find out what lies beneath the surface. It is kind of like an excavation project. I never know what will be unearthed.  When I see the symptoms it is  a signal to me that something is not right in their life.  It is very rare that one’s  symptoms are entirely biologically based.  

When we become upset the first place it may show up is in our bodies.  Sometimes,  I will see a presenting  physical symptom such as insomnia,   low energy,  or stomach pain.    Patients can end up in my office after a thorough medical evaluation has been completed and nothing was determined to be the cause of  the physical symptoms.  Even if something is found medically it still can cause significant distress.   I encourage all my patients to listen to their bodies.  Our bodies can give us  so many messages.  It is important to pay attention to the message.  An example, would be  the husband or wife who is having very bad stomach  pain or migraine headaches after years of being in an unsatisfying marriage.  The difficult feelings get internalized.  

It can take a long time to figure out what is causing the stomach pains or headaches.  This is where the paying attention to when and where the pain or physical symptoms happen. What seem to be the triggers?  

Psychotherapy gets patients to talk about what is bothering them emotionally.  While it can take time, once uncovered it can lead to the needed life changes.  The physical symptoms may not go away entirely but there is usually a marked reduction in the depression, anxiety and/or physical symptoms. Or in some cases there may be complete resolution. In residency one of my fellow residents Dr. Menekse Alpay, who is also a practicing psychiatrist in Boston,   always said, “it’s good to feel good.”  I couldn’t agree more.

May 15, 2016

Dry Wells and the Fish

Someone once asked me,"if you were thirsty would you go to a dry well for a drink?"  I thought, of course not!  So how come it is that we will find ourselves going to people that may not give us what we want or need?  For example a parent that claims to be “ there for a child”   but in reality they abandon the child emotionally if the child does not live up to the "parent’s expectations."  The child keeps trying to win the approval of the parent but it never comes.  This could show up through sports and/or academic achievements.  Another example is  putting the very people in our lives that don't want the same things  that we want in relationships.   Psychotherapy can help us to learn about ourselves and why we would do things (or not ) that seem so obvious?  It is often not discovered until it is spoken about.  Patterns such as this  can exist for years but because we are immersed in them, it may be hard to recognize. This  very idea was described to me by my colleague,  Dr Cheryl Fuller. She said,   "I am not sure who discovered the ocean but I am pretty sure it wasn’t the fish.”   You can find her website at

Psychotherapy can be very painful at times, especially when we discover the very behaviors that have interfered with us having what we want.  However, once discovered, it can set our course in the  right direction.

May 11, 2016

Bleeding Hearts

Spring is full on this year. My garden seems way ahead of schedule.  I couldn’t help but notice my bleeding heart perennial was already showing it’s beautiful flowers. It got me thinking about the name bleeding heart.  So many times as a  therapist  I listen to my patient’s joys but more often than not I am witness to their sadness and suffering.  Sadness because they still may not have what they want whether it be a relationship, the child they thought they would have by now  or the job that they have always wanted. Or life may have thrown them a difficult challenge such as cancer, an unexpected divorce or a job loss.  Lately, as I find myself becoming more spiritual and by this I do not mean religious, I find the stories I hear seem to be penetrating my heart more.  Sometimes, I can find myself tearing up when I listen to the heartache. When I was an early career psychiatrist I would have fought back any emotion seeing it as unnatural. Not “doctor like.”  However, as I mature in my years and in my profession, I realize I am human first and a psychiatrist second.  I would have to be emotionally cut off  not to feel my patient's sadness.  When I worked as an intern in order to save patients or deal with an unimaginable trauma I had to do just that.  I would say to myself, “ok,  this needs to be fixed.” It was almost a form of dissociation.  It had to happen so I could do what needed to be done. It served me well back then.  Now though, I am no longer an intern putting out fires.  I am a seasoned psychiatrist who can take her time listening.  There is something now called "compassion fatigue" which is where dealing with too much trauma can burn out the mental health professional. That is why I have to limit how many high acuity patients I can have in my practice at any one time.  For now, I listen and I will sit with my patients who are happy or sad and yes, I can also say sometimes I will have a bleeding heart too.  I would have to be inhuman not to.

May 7, 2016

Two for One

I never blog twice in the same day but something was compelling me to write.  Yesterday was a tough day for me as a mother.  Mothering certainly has it’s challenges but I have found, one of the hardest things to do as a mother is to have your child have a procedure under general anesthesia. This was not my first time and I can honestly say it never gets easier.  I think being a doctor is hard sometimes when you have children. I know what can go wrong and unfortunately, I   have actually  witnessed when it does.  As I signed the consent form which includes the possibility of death it always takes my breath away, even if for a moment.  Fortunately, it was a quick procedure, just a bunch of teeth that needed to be pulled, but until he was safely back in my arms I was pretty anxious.   My son who is now eleven was a little nervous.  As a parent it is very important that we do not let our own anxieties be felt by our children.  Easier said than done.  I decided to give him a heart rock I had found last winter to have in his pocket during the procedure.  I told him I would be with him.  Maybe it was more for me than for him but it worked.  On the way into the surgeon’s office I looked down and there on the ground lay a tiny heart rock. I picked it up and put it in my pocket. I felt like the universe had brought me that rock.     Even as  psychiatrist I can have moments of intense anxiety.  Sometimes my patients fantasize that I am superhuman and never have a bad emotion.  I think the fact that I have experienced emotions makes me a better psychiatrist.  I  can also empathize with any parent's anxiety.  Needless to say my son is fine and already demanding his fifth round of pancakes!

May 7, 2016

Al-ANON and Connecting the Dots

I don’t usually blog about organizations but lately I have been seeing a need for families faced with addiction who need support. I have to come clean in that until recently I only knew very little about AL-ANON. I would suggest it to patients who were in someway affected by addiction.  A colleague gave me “the AL-ANON book” recently to have a copy for my practice. I had a very quiet  Monday last week which is unusual so I began to thumb through the book.  I found it to be very comforting to read.  As what usually happens in my practice is something will happen that seems to connect the dots for me.  Later that week I found that my practice presented me with patients who needed referrals for AL-ANON.

Carl Jung suggested that I will be brought the very patients I need in my practice. That somehow they will find their way to my door and in fact they do.  It really is amazing how they do. 

Connecting the dots  in math creates a line. Many times I am following the thread of a session which in actuality is a line. My job is to connect the dots.  Somehow my having a chance to read may have opened my eyes (and ears) to be able to connect the dots more effectively.  I guess CJ was right again.

May 1 , 2016

Diet’s Don’t Work and Fish Taco’s

I came across ANOTHER article that reaffirms that diets do not work. In actuality only 2% of people who lose weight  are able to keep the weight off after 5 years. That is roughly the same statistic for patients who survive pancreatic cancer.  So why is it we, as a culture,  call people weak, lazy,  or unmotivated if they can’t seem to keep weight off?  Would we ever tell someone who didn’t survive pancreatic cancer they just didn’t try hard enough?! I get tired of all the comments made about weight loss which ultimately results in women (and sometimes men) who feel bad about their bodies. When I see parents doing it to their daughter’s it makes me sad and angry. The last thing a young girl needs to feel bad about is her body. When fathers tell me they worry about their daughter’s becoming fat I can feel my blood begin to boil.  If I can feel the shame and hostility they have toward their daughter’s body type, then I can only imagine how badly the daughters already feel. I don’t know why young women and for that matter women of all ages need to continue to feel like failures if they can’t maintain weight loss. It is  really about genetics and there  is not much you can do about the weight. I am all for exercising (not extremes though, because that is just a  compulsive way to stay thin)  and for women to remain as strong as they can physically.  However, if I see someone in my practice restrict foods groups entirely or go on fad diets I know that they will likely lose the  weight. However,   in a short amount of time the body will find it’s way back to the starting point and sometimes even gain back more than what was lost.

**Addendum: I should  not have  suggested that it is  only the  fathers  who make daughter’s feel badly about their bodies. Many mothers also make their daughters feel bad.   It is usually the parent's issue with their own body that gets projected onto the child.

Many people who know me well know that my first career was cooking professionally.  When I get home after a long day,  I find cooking therapeutic.  Tonight, on the way home  I stopped by  the Fisherman’s Net on Forest Avenue and saw amazing looking halibut filets.  It was pricey but well worth it.  I cooked up the halibut in olive oil with carrots, onions, cumin, kosher salt and some white wine.  I used this delightful creation for fish tacos.  Man,there is nothing like a good piece of fish! Bon Appetit!

April 27, 2016

The baby chicks have arrived!

This is a non-psych related post…my chicks have arrived.  I received a call from the post office at 6:42 a.m. and was told they were waiting for me.  After I had my one cup of caffiene so I could safely drive there,  I grabbed my son (actually dragged him out of bed) and we went and got them. They chirped all the way home in the car.  Chirping is a very good sign.  I opened the box and all three had made it.  Phew!  I forgot how tiny they are at one day old.  They really are cute and they make my heart sing!  Pictures to follow…This is Lionel Messi!

April 26 2016

Time to move on

By now any New England Patriot’s fan has learned that we will be without our star quarterback for the first four games of the season.  Tom Brady’s decision regarding his suspension was reversed and he will now have to serve it. Personally,  I am ready for this whole business to be over. I read that Mr. Brady wants to “look at his legal options.”  I think it is time to let this one go and move on. I am not sure what a fair punishment would be. I only know what the media outlets present to us.

In life we are presented with unfair things all the time.  We can ether choose to dwell on them or accept the unfairness and move on. It can be hard but at what point does it take too much of a  emotional toll on our lives. It can be when a divorce doesn’t get settled. The spouses continue to fight over what they believe is theirs.   It can be because one person wants alimony and the other refuses to agree to it.  It can be over  property or even pets.  However, if the emotional  toll becomes too great, it may not  be worth any amount of money there is to be gotten through the judicial system.

It is difficult to watch my patients suffer emotionally at the hands of others, whether it be family members, employers, partners or ex spouses.  I will listen patiently.  My job is to continue to reflect back to my patient how hard it is to be so beaten down emotionally. I gently try to introduce the concept of moving on if and when the patient is ready.  It can take a long time.  The choice is always theirs. I stay with them and will support them as long as they need me to.

As far as the Patriot’s, I think it is time to move on.  To keep this going just makes for  another difficult season. As Bill B. always says,”we’re on to next week."

April 19, 2016

"Partying like it is 1999

Ok, so I am pretty sure if you listen to the radio at all you recognize  this lyric from a song that “The Artist  formerly known as Prince” sang and I am pretty sure he wrote it as well,  back in the 1980’s. I know I recall hearing it  many, many times. I was thinking what exactly does that mean today, now that  it is 2016?  If you are still partying like it is 1999 and you are well beyond college or even graduate school it could be a problem. 

When I meet a patient for the first time it is really just that, a meeting. For me I am trying to get to know the person. Yes, I am doing what is considered a "diagnostic interview” but more importantly I  am listening closely to  their story and who they are.  I listen carefully for what they have been experiencing lately as far as symptoms and what seems to have driven them into treatment now. I had a supervisor back when I was in residency who to this day, I can still hear his voice saying  “why now?”  Why is this person struggling now?  What has happened in their life?

One of the important parts of the initial meeting is to see if we (doctor and patient)  are a good fit.  The patient has to see if I will work for them and I have to know if I think I can work with the patient.  I don’t guarantee that just because we meet it will automatically establish a doctor patient relationship. Each initial visit is really a consultation.

One thing I have to listen closely for is the degree of substance use. Sometimes if I have a sense about it I may even ask over the phone while deciding whether or not to offer an initial appointment.  This is because there are many practices that are focused entirely on helping sort through the substance abuse problems which can prepare them  for the in depth work later on.  

 While people are in their early to mid  twenties, it is very common to party a bit. It is when the partying continues past this age that it can become problematic.  It can signal a  substance abuse problem or maybe even dependence.  I know that even some therapists I know  think I am tough in that I won’t prescribe to anyone using substances daily or what I consider chronic or excessive use. It  is because the medications really won’t work.  It would be like me trying to put out a  house fire using my backyard hose. The effort would be futile. The same can hold true for trying to engage in psychotherapy. If someone is actively abusing substances there is really not much I can do, that we can do together.  

Sometime patients won’t readily admit to substance abuse. This could be  because in their mind they may not believe it is a problem.   What I have to pay attention to  is when there s eems to be a failure at moving past a stage of  emotional development or serious lack of motivation.  It can also present itself as an inability to fully separate from one’s parents. What can complicate matters even more is if the parents  abuse substances and they hinder any efforts the children attempt to make at separation.   I see it quite a bit with people who smoke marijuana daily, but it can happen with daily alcohol use as well. Even in moderate amounts. The brain actually can and does change. 

So, if someone is still partying  like it is 1999 and they were actually partying back in 1999, then it really could be a problem. The year really doesn’t matter so much as the age that one wants to continue to party excessively. I am sure the micro breweries of Portland, Maine  will be less than thrilled with this posting!

Addendum:  ** The song is actually from the Album 1989, which was written and produced by Prince. It was released in 1982 and  rereleased in 1998.

Second addendum: ** I reviewed the DEEP guidelines just to remind myself what is considered too much alcohol consumption. As of this moment (4/27/16)  DEEP suggests that more than 14 drinks a week is considered too much alcohol consumption.

April 9, 2016

Gas Lighting

Last night I was out with some great friends  and we got onto the topic of Gas Lighting.   In 1944 there was movie about husband who uses a form of psychological abuse to make his wife feel like she is going crazy.  He basically keeps moving furniture around and each time she comes home he denies he has moved anything.  This type of psychological abuse is striking in that the victim of the gas lighter can begin to doubt themselves and in essence feel like they are going crazy.   It can also happen when there is a group of people who gas light one individual. You may see this in families where one person is essentially “scapegoated." 

Gas lighting can look like mind games or mixed messages. For example   a family member will be told what time to arrive for dinner.  They arrive on time or the time which was agreed upon and all the guests have already eaten. When the person asks what happened they will be told the agreed upon time was actually 30 minutes earlier and that they must have gotten it wrong.   If the family member has seen this before ( kind of like ground hog day)  they will usually just get annoyed.   If not, they may begin to buy into the lies. 

Gas lighting can happen at the workplace.  A boss can tell an employee how they like things done,  then  without warning the boss will change or abandon the directions altogether. The employee feels betrayed and sometimes feels like they are not able to handle the job.  It has sometimes been referred to as “moving the goal posts.”  The employee will try to adjust only to have it happen again.  

Gas lighting can go on in love relationships.  It can show up as mixed messages. When it gets extreme and one person begins to doubt themselves repeatedly  it becomes a form  of emotional abuse. Gas lighting can happen when one spouse has repeated affairs and keeps telling the other spouse they are “crazy" when asked about the affairs. The affairs are ultimately denied. Gas lighting is pretty common with people with addiction or as I described in an earlier post compulsions that are destructive.  The lying is just another way to gas light.

Unfortunately,  milder forms of gas lighting go on all the time. However, when the gas lighting is repetitive  and over longer periods is when we begin to see depression and anxiety.  It is rather striking when it happens.   The good news is once the victim is out of the relationship the symptoms of depression and anxiety usually diminish rather quickly.

April 8, 2016

Happy Baby, Happy Mother and Tough Decisions…

I came across an article today about pregnant mothers with  depressive symptoms  who are trying to decide whether or not to take prescribed antidepressants during their pregnancies. I am seeing more and more women who come to me with this very concern.    I think any mother can say it is a tough decision to take any medications  not just psychotropic ones during a pregnancy.   For years pregnant women have struggled with whether or not to eat Sushi, drink caffeinated coffee or highlight their hair.  Now your asking us to decide whether or not to take a drug that works directly on our central nervous systems and possibly that of our unborn children?!  If the mother is in the midst of a severe depressive episode than that raises other concerns.  Is this an undiagnosed Bipolar Disorder?  If the depression is mild to moderate, shouldn't psychotherapy be tried first?  As a psychiatrist who has prescribed to pregnant women with depression and anxiety in the past, it is very hard to decide what is the best treatment to follow, hence it is a very personal decision.   If the child ends up with an illness that is in no way related to taking the prescribed medication, will the mother  still carry guilt thinking if "I had only foregone the medication this would not have happened?"  I do not believe there is a definitive answer to this question except to say, in mild and moderate forms of depression, I think every non-psychotropic modality should be tried first. I think it is very important to explore if  the depression has a  psychological basis rather than a biological basis.  Some past Canadian studies  that looked at pregnant rats have cited "happy mother, happy baby,"  meaning that the  cortisol levels in depressed rats were elevated enough to cause prematurity and smaller brains.  One study concluded  that the risks associated with the elevated cortisol levels was great enough to risk the treatment with antidepressants.  I think in severe cases of depression medication has to be considered very strongly particularly if mom is suicidal.  However, in mild to moderate forms of depression let’s not jump too quickly on the prescribing band wagon.  

Tough decisions can also apply to what bead combination I will use in my next creation. I think it came out pretty good!

April 2, 2016

Addiction,  Lies and Psychotherapy

I have been home sick with the flu or some really bad viral infection. Today is day 3. It is the first day I can actually think clearly.   My chest still hurts every time I cough, but I can now say I feel like I am on the mend. 

I was thinking about what to blog about and for some reason lying kept coming to mind.  Everyone lies. It can be a small white lie, or something as big as saying one is divorced despite still or never being married.  Or it  could be the woman who claims to be using "birth control" knowing that she is trying to conceive a baby with her unsuspecting partner.   I try to give the benefit of the doubt if I can in any situation, but when there is a lot of lying it can  become next to  impossible to work with someone in psychotherapy.  It would be as though I was doing psychotherapy with a different person. The question for me is always what do the lies mean?    In personal relationships the same holds true. If the lies are excessive, any relationship would have a hard time surviving.

I have worked with addiction in the past, but until more recently I never realized how much the lying is part of the the disease.   Addiction can usually only be preserved  by lying. This can be applied to any compulsive behavior which is really what an addiction is.  To preserve the addiction/compulsion there may be many lies or mistruths.  It could be as simple as the women who hides cigarettes in her car thinking her husband won’t notice she is a smoker, but he seems to  taste something “ funny" every time he kisses her.  Or the man who drinks a six pack every night but says he is only an "occasional drinker." 

Addictions/compulsions can come in other forms that are more accepted by society such as extreme exercising or working.  When one’s  life begins to revolve around one area of life whether it be socially acceptable or not it can begin to erode the other important areas of one’s life such as relationships and/or health.

In therapy,  there will always be lies.  There can be  a theme to the lying. Sometimes,  my patient will worry I might judge them. Or they might think if I knew the “real" person I wouldn’t want to work with them.  It is very rare for me to not be willing to work with someone.     Patients may  also lie if they want me to take their side.  It can certainly be their truth. However,  it is easier to divorce your spouse if I "seem to agree" with what they are telling me.  I have to be careful not to get pulled into an impossible situation. I try to remain neutral and let my patient decide  if ending the marriage is right for them. Sometime I will suggest couples therapy to help prevent a one sided ending.    

I edited this blog several times and I apologize if you read it already.  It just wasn’t feeling right to me and I may still revise this.  I think what I am always trying to say is that everything has meaning.  Even when someone lies to us.

March 25

Commitment and no school

Lately, I have been seeing commitment issues showing up everywhere. I believe it is just a way that intimacy issues get played out. I recently saw a book about men and commitment issues and it can easily apply to women as well.  It is "pop culture’s" way of giving intimacy problems a name.   I frequently hear people  say 'this one has commitment issues or that one will never commit," but in actuality I believe everyone has commitment issues to a degree. It is just that sometimes it can take a more severe form.  I see it weekly in my office.  For example, a forgotten appointment time, canceling at the last minute, a check that gets returned for insufficient funds, or even a copayment that is forgotten all together.  All of it has meaning. It can get really difficult though in love or parent child  relationships. It can play out in different ways. One person being unfaithful, maybe the other acts out around spending.  Agreeing to have children and then not keeping one’s end of the bargain. If the parent’s are no longer together it can look like one or both parents not keeping up with  the amount of agreed upon visitation. It can look like the parent who chooses not to  have health  or life  insurance   but instead buys expensive cars or season tickets to professional sports teams. Or promising a child tuition money for college and then spending the money on expensive vacations.   Sadly, it is the children who are the innocent parties.  

Sometimes commitment will get verbalized but then never really followed through on.  For example  I might  have a patient  who threatens to leave therapy at  the start of each visit. They still show up each week, we get through the threats and then we begin our work again.  It is kind of like “groundhog day."

As far as no school…yes, another snow day in the same week. Funny how the school board knows we will use those extra days every year. Do they commit to it no matter what? Would they still cancel if by late March it was sunny and 80?  That would be hard to do now wouldn’t it...

March 22, 2016

Settling for less than what we want and baby chicks are coming soon!

When I was a medical student I was what might be called a “gunner.”  It is an expression for medical students who go for what they want.  It usually applies to student rotations. Meaning getting the best and most sought after clinical experiences.  I knew I had to become a gunner because I knew it would get me what I wanted most and that was a good and solid clinical foundation.  Twenty two years later, even as a psychiatrist,  when I have to recall important medical information, I am glad that I “ gunned” for those good rotations.    I also knew that from good rotations, I could make some contacts in the field and hopefully the faculty would remember  me well when it came time to apply for internship or residency.  

Many times in life we settle for less than we want.  Does that mean we need to behave like “gunners?”  In a sense,  the answer is "yes.”  That knowing what we want is important whether it be in buying a home or  car or getting involved in a relationship.  Fortunately, If we stay true to ourselves and know what we will and won’t accept upfront,  aka deal breakers then we should have the desired outcome.

Three years ago when I decided  to raise  backyard chickens for eggs, I knew I wanted cold hardy breeds with good temperaments who were also considered good layers. To figure this out, or get what I wanted for breeds, I read three books on raising chickens and also asked around at the local feed store.  I ended up with just what I wanted.  So in life the only person who will look out for me is me. So when it comes to anything whether it be chickens or cars or relationships, knowing our deal breakers up front is the best medicine and when someone tries to talk you into anything less…just say NO! Or yes to chickens!

February 28, 2016

And then there is more

What I failed to say in my earlier post about the Puer/Puella is that therapy can help tremendously. That this way of living  is not mental illness,  it is just a way that fear of commitment and intimacy issues can get played out. With a patient therapist, the Puer/Puella can see that commitment really is not something to be afraid of. The rewards can be so wonderful.  That good and kind relationships are better to one’s overall emotional and physical  health.  The work around the fears can take years to overcome, but in the end, the emotional rewards are  worth it.

It’s good to feel loved…

February 26, 2016

When is it time to grow up?

Life is about stages of development.  I am watching my only child begin to grow up.  I adopted him just about 11 years ago.  I made a promise to his birth mother that I would raise him to be a good man.  I still intend to keep that very promise. I know he will have to experience many challenges in life.  One of those challenges will be when he has to chose between remaining a boy or becoming a man.  Carl Jung has written a lot about the Puer Aeternus, which is the archetype of the  man/child.  There are both positive and negative elements of the Puer. On the positive side is the energy that children have  can be wonderfully creative which is what you want in anyone to a degree.  Children are great reminders of how exciting it can be to think about the future.   On the negative side, it presents itself  as the man who refuses to grow up. He may avoid  taking on life’s responsibilities.  It can look like the man who never has had a job or profession. He may avoid relationship commitments or he may refuse to grow up emotionally and take care of him or herself.  While the Puer can be very intoxicating to “ date" and  may even marry someday, eventually the unwillingness to grow up will present itself in different ways in the relationship. Women are not immune to this archetype.  The female equivalent of the Puer  is named Puella.   

The shadow of the Puer is the Senex or the old man.  Growing old for the Puer is actually  more frightening than the notion of death.    To the Puer, It is better to die then to deal with  physical aging or growing old.  It can be something as small as failing eye sight which is “normal” and   needing  to wear glasses but a refusal to do so because it makes one look old.  

My job as a mother is to teach my son how to grow up so that he can face life head on. While remaining a man/child can certainly be appealing. In the end it can leave a path of heartache and in the worst case scenarios destruction.  It is ok to be less than responsible when you are young, but there  comes a time where in order to feel whole, one must leave behind childhood and experience life as an adult.

February 25, 2016

Can I get a witness?

Many years ago when I was a student doctor I recall needing the consent of a patient prior to performing a procedure.  This is customary in hospitals and out patient clinics.  My attending who was a "very happy" doctor started to  sing the song that had the lyrics, “can I get a witness.”  I laughed at the time.  In psychiatry and psychotherapy we don’t have much need for consent forms.  I do think that during therapy we bare witness to the psyche and the journey  that psyche is on.  My job for my patient is careful listening but also to bare witness to what is happening in her life. Sometimes she may only need me to listen while other times it is to reflect back to her the very things she wants in her life but is for some unknown reason unable to obtain it.  This could be in love, work or financial areas of her life. Or it can be all three. There is usually some thread that ties it all together. It can take time for the story to unfold.  Sometimes years, but it really doesn’t matter how long it takes so long as the story gets told and hopefully she can find that which has been alluding her. Psyche  usually presents itself in the form or anxiety or just plain old unhappiness.  My only hope for any of my patents is that they ultimately have the life they want and deserve.  Sometimes they will ask for advice. I will explain I cannot give it because it would be based on what is right for me and my life.  However, I can be a witness which is really better than going it alone during difficult times.

February 16, 2016

How does it feel?

Sometimes in life we want nothing more than to seek revenge on someone who has hurt us deeply, but what exactly would that accomplish in the grand scheme of things? Absolutely nothing.     The best revenge is to live well.  I know that in the moment in might feel good to say something hurtful but it really changes nothing.  For example, one wouldn’t call their ex heroin dealer to say "hey, I am not using drugs anymore,” as though that would make the drug dealer feel bad.  In life we are bound to come across people who take us for granted,  don’t treat us well or who only see to it their needs are met in the relationship.  However, if presented with the opportunity to say what you needed to say in a relationship but were either afraid to or for whatever reason  felt like you couldn't, It could be important to have that opportunity.  Like with a parent you felt was abusive or neglectful or a friend or relative who you felt was unkind.  You are saying it not so much  for the other person’s sake but for your own chance to actually be heard.  As I said earlier tho, living well is  really the *best* revenge.

Roller Coaster of Love

I have never been a fan of roller coasters, not even as a child. Sometimes  our lives can feel like roller coasters. For some it may feel wonderful.  For others, like myself it feels like agony.  I can't recall my first experience of life feeling like a roller coaster, but I can easily think of  times where life felt this way.  In life we tend to gravitate toward relationships that match what we knew growing up, even if they are unpleasant. Sigmund Freud, the father of psychoanalysis,  has written a lot about repetition compulsion, which, I feel so far is the best explanation as to why  we  repeat patterns in our lives.  For example, if I am treating a woman whose father was an alcoholic, despite her wanting desperately to date or marry non-alcoholics,  she will find the very man who drinks too much and reawakens all the difficult feelings she had in the relationship with her father.  I can put forty five men in a  room, forty four  of which do not have an alcohol problem and she will be drawn unconsciously to the one who is actively abusing substances.  This is where psychotherapy can help her to not recreate the same patterns over and over again, or at least recognize the red flags sooner.  If she chooses to stay because she loves him,  at the very least learning how to care for herself if it seems too difficult to leave.

Roller coasters, in love can be very painful.   Heck,  love is complicated enough even without it feeling like a roller coaster.  Years ago when I was living in Michigan I had been seeing a therapist who was really wonderful.  I had been in a relationship which felt very much like being on a roller coaster. One day my therapist asked me if I enjoyed riding roller coasters  and I replied, " no way!”   He then asked me when  I planned  to get off this ride?  It was like a light bulb went off in me.  Thankfully, I got off.  I can’t say I haven’t been on a few more less than awesome rides, but I can assure I am not heading to any amusement parks any time soon.

February 7, 2016

Archived and renewed commitment

So I decided to move some of my older posts to archives and inadvertently (or maybe unconsciously ) deleted the old posts.  So I see this as the universe telling me it is time to put away old things and start new. Kind of like spring cleaning or getting a new wardrobe.   I am looking forward to my new blog entries.  My new,  commitment is to myself, this website, my practice and for having the life I want. This is what I truly wish for any of my patients.  I tell them I don’t have a horse in the race. I only want for them what they truly want and deserve.  A few months back,  I was  asked what I actually do with patients who are in psychotherapy. I replied that I embark on a journey with them. I am with them  and walk alongside them while they find their way. Sometimes patients will  come in for what we call brief work to deal with a specific issue.   It could be as short as weeks or months or as long as years.  A good friend and colleague told me recently that "people come into our lives for a reason, a season or a lifetime.”  I think it is sort of saying the same thing.   I hope you will join me. 

February 6, 2016

New rules aka one more thing to worry about

I recently brought  my son for an appointment  at his pediatric specialty practice and I was presented with a new form about giving my authorization to be contacted by my cell phone.  I was surprised because this was the first I had heard of this new rule in medical practices. So I have now instituted the same policy in my own practice.  Sometimes I feel like all the new rules take away from the actual reason I went to medical school which was to  provide good and safe  patient care.  Instead  I now  find myself bogged down with paperwork which takes so much actual time away from my patients.  Not the face to face time but anything else I might do focused toward patient care such as conferences.  It is a much different experience now than when I entered medical school in 1990.  I have no regrets that  I became a doctor and I can’t imagine a different career.  I love my work,   but  it is very different than how I imagined it would be. 

Oh and when I am not doing extra paperwork, continuing medical education,  doctoring, being a mother or an urban chicken farmer here are a few things I like to do:

February 4, 2016

And so I am back…

I haven’t blogged in sometime and my blog is now in a new format. I am trying to decide if I should republish the earlier posts or just archive and start new.  I think it is  time for a change or a new beginning, a new direction.  I have a few topics in mind to start this new year and new direction. One topic is about surrendering.  A colleague of mine blogged that sometimes we can’t get what we want until we are able to surrender.  That is surrendering to the idea we don’t always get what we want in life, but we will get what we need. This tends to reveal  itself earliest in life  when we are raised in less than desirable conditions and our emotional needs are not met.    What any child needs is  parents who are emotionally healthy enough to be able to put their own  needs aside,  whether this be because of addiction, lack of maturity, medical illness (if they can) or narcissism.  If not than it is important that they ask for the very help they need to meet the child’s needs.   We also have to accept as difficult as it is, that what we needed, and was not given for whatever reason,  can never be gotten back.  We have to accept  that we will never have it and then make sure as adults we give ourselves what we need.  It is about reparenting ourselves and making sure that the very people we put into our lives do not recreate the emotional trauma of our childhoods.  

Check out the website of Dr. Cheryl Fuller, A Jungian psychotherapist in  Belfast, Maine.  Her entry about surrender is the one I was referring to. It really is a great piece about getting what we need.