Fat Phobia

I am fat. I have been fat since I was in fourth grade. I got very thin in medical school mostly from not eating and dieting. The trouble was I could not keep the weight off. I felt like a failure when I gained back the weight. I weighed a whopping 142 pounds! Over the years and through my own therapy I realized I had to love the body that I had. That I was never going to be thin and that my constant rejection of my body would show up in other ways.

Weight Loss Rarely Lasts

What didn’t help was when my doctors would ask me, “have you ever thought about losing weight?” Are you kidding me?! I don’t know any overweight woman who has not thought about losing weight! Even the thin ones want to be thinner! I don’t know any woman who is truly in love with her body. In my practice so many women reject themselves and their bodies. I am also seeing it more now with men than I had in the past. There seems to be an association with thinness and happiness. Most of the doctors I see for any thing will typically counsel me at the end about weight loss. Thankfully, I have learned to tune it out. I know that weight loss only leads to weight gain and usually we add more back each time. I also know that after five years only 2% can keep the weight off. That is the same statistic as surviving pancreatic cancer. Why would I accept a prescription that has a 98% failure rate? A few years ago I had foot pain from what was diagnosed as a “stress reaction.”. The orthopedist told me I would likely improve if I lost weight. Well, that didn’t happen and HUZZAH my foot got better on it’s own. Guess that blew his theory out of the water.

Attacking our bodies is bad for our health

I am not going to pretend that my own negative feelings never come up now and again. What I must do is take on the battle of rejecting myself. This is what I teach my patients. It’s more about attacking myself rather than the actual struggle. When we reject our bodies it can show up as physical illness. It may show up as Lupus or another autoimmune disorder. Which by definition is the body attacking itself. I will teach my patient not to reject herself. Hopefully she will listen rather than believe I am “not on her side.”

Chickens are the best

This is a picture I would have hesitated to post many years ago because it does not depict a flattering image of myself, BUT this is who I am. I am fat and I love my chickens!  

Face to Face, the Sequel

I haven’t written in a while and I know it is long overdue. I am feeling back to my “new normal.” I play my flute, exercise, garden when the weather permits and talk virtually or by phone with friends. During this time it is important to maintain some sense of structure and connectedness. My practice is entirely Telehealth. I have even met with new patients that way which is quite different than I would have ever done it in the past. Most of my patients are finding it OK. Only a handful have not.

 

Psychotherapy is not Crisis Management

This morning I read an article in the local paper. It is not my first source of daily news but it gets delivered online so I took a look. There, on the front page was an article about therapy. I read it and I found don’t agree with much of what was being said. Sure there was an occasional valid point being made, but my practice is much different from the ones’ being described in the article. I have always felt I practice quite differently from my peers. I believe in depth psychotherapy and my work is not crisis or symptom management driven. My practice certainly has seen an uptick but not due to the pandemic. Talking about the pandemic was surely on the agenda in the beginning of all this but most of my psychotherapy patients continue to work on the very issues that brought them in the first place.

Feelings, whoa Whoa Feelings

One question that is now coming up for some and also for me is when do we go back to face to face meetings? The simple answer is I don’t know. But if I look more deeply at that question, it can mean my patient is missing seeing me.  It can mean she wants to feel more connected in my office space.  I will explore her feelings around this and see if we can get to the heart of what she is feeling. The work I do is always about  feelings.

The Ugly Duckling Strikes Again

I have always felt I was a bit different from my Psychiatrist peers. I used to wonder if that was a bad thing not quite fitting in. When Psychiatrists wanted to become more biological, I was still more in favor of psychotherapy over prescribing. In the fairy tale, The Ugly Ducking, the beautiful swan just needs to grow into herself and find her truth. My truth has always stayed the same. My new truth is Telehealth works. I will stay with this as long as I need to to keep myself and my patients safe. I will deal with my patient’s feelings as they arise the same as I would doing face to face. I do believe we will be back working physically  face to face again. I just don’t know when.

Abandoning Therapy

I am glad to be writing about something other than COVID 19. I feel like my practice is cruising along at the usual pace. I am  still using a Telehealth platform.  Each week I still see the same number of patients. I have had a few people drop out but I don’t think it is due to the pandemic. Sometimes the clues are there. They were never fully in therapy. I probably should have done a better job pointing that out. As a therapist I have to look at my own hesitation to do so. What was I avoiding by not saying something about the irregularity of our work?  Frequently a patient will blame it on erratic schedules, but I know most of my patients come the same time each week despite having unpredictable schedules. Not coming to therapy or not making it a priority is what we call resistance. It is a psychological term that other wise means to avoid. Sometimes patients come in to therapy if their love relationship is failing or a mother and son have stopped talking. They think the therapist will cure the ailment much like a doctor treating a virus. I cannot make someone’s relationship or marriage better. I cannot help a mother and son to start talking again. What I can do is listen and empathize with how hard what they’re dealing with has become. I encourage them to look at themselves and their own behaviors in the relationship which hopefully leads to deeper work.

Women and Men Behave very Differently

Frequently I will be seeing someone and I might suggest they consider couples therapy as well. It’s a gamble when I do that. In couples therapy the relationship is the patient. Sometimes because the patient thinks if the relationship gets better than the therapy need not take place. Nothing could be further from the truth. Unfortunately, I see this more often with women than with men. Women as a group carry much of the responsibility of relationships working out than men. Women socially tend to define themselves by their relationships. Men usually define themselves by their work.

Leaving Before the Therapy is Finished

When people leave therapy without discussing it, I usually see a pattern. One pattern is not wanting to schedule an appointment until they know something about their work schedule. My hope is that they come back in and then I can point out the behavior of leaving. Sometimes they will tell me that is true and other times they might deny it and actually may not be aware of it themselves. Either way, staying put (as we all know currently) is really hard sometimes. If the self work was left unfinished then the problems will come back. I might get a call to resume or they might start seeing someone else. Either way is OK with me. My hope with all my patients is they end up with the lives they want.

 

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.