Waves of Emotions

During these uncertain times it is not unusual for my patients to feel different emotions in very short periods of time. I hear mostly of anxiety. However, I also hear of sadness and feelings of loss and grief. Even as my patients stay healthy physically the emotional toll the COVID-19 Pandemic has inflicted is quite high. We mourn for the people who have died. We mourn for the families who have been inflicted with economic hardship. I know some of my patients will sail through this seemingly unaffected and others who will be deeply affected for a long time. Each patient is dealing with this differently. I have to listen and meet my patient wherever she is.

Create your  immediate future

Dealing with different emotions can be scary and exhausting. Because the future is so uncertain it is important to create the future we need in this moment. If there is a picture that needs to be painted get out the paints and start painting. If that yarn has been sitting in the bag since it was purchased get those needles going. If there is a book you have been wanting to write start writing. If my patient is feeling helpless she can take back some control. Life will feel less helpless if she can determine even the immediate future.

Staying Connected Matters

I am seeing all of my patients each week via Telehealth. I am happy that the hour they come we can stay connected. Staying connected is so important right now. If you are not already in therapy, it can start now. If you feel alone it can help you feel that someone is there for you week after week.  Relationships are what will help us get through this emotionally.

I’m your Venus

 Take good care of yourselves. On another note, if you look at the evening sky in Portland, Maine Venus is very bright tonight. I think this is symbolic for the brightness that needs to shine over all of us right now. Be well, stay safe and stay home!

Stay Calm and Keep Your Distance

I made the difficult decision to increase social distancing in my private practice. As a whole, we must do this to flatten the curve of new infections from the coronavirus. Right now, if we don’t our health care system and workers will be over whelmed. I felt I needed to do my part and have moved my practice to a HIPPA compliant video tele-health platform. If this creates a hardship for anyone in my practice I am asking you to call me and we will come up with an alternative plan. My hope is this will be short and we will resume our face to face meetings once things have settled down.

Worrying Increases Cortisol Levels

Staying calm is something you can do to boost your immune system.  Stress and anxiety increase cortisol levels and is not good for our immune systems.  Good self care is very important right now.  Meditate, knit, bake, paint or watch movies. If you can, stay connected with loved ones.  If watching the news heightens your anxiety-turn it off!  Stay calm and wash your hands!

 

COVID-19 Guidelines for Established Patients

Today at around 3:45 p.m. President Trump declared a national emergency. He has restricted any laws that would not allow me to provide Tele-Psychiatry to all of my patients. I am currently giving my patients the choice to see me via HIPPA COMPLIANT video platforms. If patients still want to come to the office they may  only come  if they do not have any of the following symptoms: fever, cough, runny nose, difficulty breathing.  They may also not come  if they believe they have been exposed to the Coronavirus within the last 14 days. I will continue to  reassess the situation over the next two days to determine if I will move to Tele-Psychiatry entirely.

This is not Fake News

 

This is very big news and thankfully it lets me continue to provide the best care to my patients during this very difficult time.  If you are a current patient and have any questions or concerns, or are unsure if you should come to the office,  please call me or contact me via the contact page

Stay Tuned!

High Anxiety

Sometimes in life, we can get very anxious about things. I try not to worry about things that have not happened yet, but how do we do this when every day on the news we are hearing of a potentially fatal virus?! I have no idea of how this whole COVID-19 (aka Coronavirus) will go. I have no idea who will get sick or how sick they will get. What I do know is I have to breathe and do the best I can to take good care of myself and my family. In my practice I speak often about trait vs. state anxiety. Trait anxiety is when it is in the background all the time. State anxiety as in what is  going on with this whole COVID-19 business.

Surprisingly no one is talking about it

Oddly, not many of my patients are talking about it. It was the same thing with 911. My patients seemed to continue to focus on their lives. It got me thinking about being in therapy helps when there is something big going on in the world or even locally. Is there something protective about  already being in psychotherapy? Therapy helps you to feel cared for in so many ways. Just knowing that someone shows up for you week after week is comforting. There is so much more to being in therapy than solving problems. It truly is about the relationship. Many years ago I gave a talk about psychotherapy to a large group of mental health professionals. I described the various types and how they differed. At then end of my talk I said that the most important thing was the relationship with the therapist and not so much the type of therapy being done in the office. Much to my surprise I received an evaluation that said I was reckless and basically a crappy Psychiatrist because everyone knew that this one type of therapy (I will leave nameless) was the best blah, blah blah. The person also said I was irresponsible because there were students in the audience and how could I teach such garbage?! I still to this day believe what I said many years ago at that presentation. The bottom line is the relationship between therapist and patient. So many of my patients felt uncared for growing up. I do care about them and their lives. How could I not?

Preparing for distance therapy

Another issue that may arise is I may have to see my patients via Tele-Psychiatry. I have done it before, like during snowstorms and it works just about the same as face to face. So I am here and I know my patients feel a sense of relief knowing we have a plan in place if it should move to that. My hope is that if it  should come to this that there is no disruption in our work. We will get through this. My other hope is it passes quickly and we can all resume worrying about other things in life like whether Tom Brady is coming back to to New England!

Wash your hands and don’t touch your face!

Fly like an Eagle!

Welcome to my new website! This website is now more user friendly for most devices. I am excited to start blogging and will have a monthly newsletter as it relates to my practice starting in the early spring of 2020. You may notice the phone number is gone from the contact page. That is because it is really only for referrals and it was being used for far more practice related requests. Established patients should continue to call the office for assistance. If you wish to become a patient in my private practice please use the contact form on the contact page. I will be taking mostly psychotherapy patients now but will also provide consultation on a case by case basis.

Too Little, Too Late?

Closed Sign

At the end of a very long day I sat down to read the local newspaper online. I was disappointed to see a major provider of mental health services in the area  is closing leaving 170 patients to find services. The agency had provided care in the form of case management for 27 years. A little longer than me being back in Portland.    I am disappointed  each week when I read of more  and more agencies having to close their doors.  I actually have as much work as I feel I can safely provide.  This work is very strenuous at times so I know my limits. I do feel badly when a colleague will want me to see a patient and I just don’t have the time to take the patient on.  Sometimes things will open up briefly in my practice, but those appointment times  fill quickly.  I also don’t want to take on a new referral if I could not give appropriate followup appointments in a timely manner. Could I add a day a week to my schedule, sure, but then my own self care would be compromised.  In my opinion, no one would benefit from an over tired doctor/therapist. I am adding to my psychotherapy practice but that type of work is weekly for a 50 minute hour and I get to know my patients very well. Although it can be strenuous at times, it is entirely different from working in community mental health. Patient’s have to be much more independent and able to manage symptoms with little involvement from me outside of the office.

I would say that 90 percent of my practice is providing therapy.  It is the work I truly love and why I went into Psychiatry in the first place.   While there is a part of me that feels helpless when I see another agency close. I know that I am only one small piece of the puzzle.  I never quite understand why the “bigger players” don’t step in.  

I
hope that reimbursement improves which seems to be the driving
force behind the closures. That would mean that the State would have to
allocate dollars toward caring for these patients and I know it has been
an uphill battle the last eight years. I am hopeful things will improve
over time. I just hope it’s not too little too late!

I have 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 worked 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.

Should I stay or should I go. The Re-union Tour.

Packed Bags

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.  

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.

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.