Sunday, February 01, 2009

Stolen from The New York Times

Today's post is a cop out. I'm stealing, verbatim, from the Social Q's column in the NY Times.
I've somehow missed the social Dear Abby column, but today's is shrinky, so why not?

"

Social Q’s

My Shrink (Gasp!) Has Shrunk

Published: January 30, 2009

After not seeing my therapist for several months, I returned to find her a wisp of her former self. She was never fat before, but she looks like a marathon runner now. It seems strange not to comment on such a significant change. But even my most innocuous questions — like “How are you?” — are either ignored or turned back on me. Should I be quiet, or can I mention the weight loss?

Christoph Niemann
Elizabeth, Berkeley, Calif. "

And the Social Q person responded:

"Oh, how I envy you! My therapist hasn’t changed so much as his shoes in all the years that I’ve been seeing him. And there’s only so much hay you can make with a scuffed-up pair of Bass Weejuns.

So speak up. Successful therapy requires you to share your thoughts. It may be the one office on earth where unedited candor is a good idea.

There will be consequences, though. If you compliment her on her weight loss, you will spend the balance of your session dissecting your body image. And if you sound a note of alarm for her health, the subject will turn to mortality — either fear of yours, or how the prospect of hers triggers your abandonment issues."

-----------

So I think I practice another brand of psychiatry. When patients comment on my appearance, I usually just mutter "Thank you" (or whatever might be my version of socially appropriate) and move on. I'm not sure I've ever cured anyone by insisting they fully understand their motivations behind noticing that I've lost weight, had my hair blow-dryed to a different style, or am wearing a new outfit. I'm not saying there is nothing to be gained from exploring these issues, I'm just not sure that it's worth the trade-off of taking the time away from talking about things going on in their lives.

11 comments:

Tigermom said...

We are two peas in a pod Dinah.

But I do get slightly thrown off by my especially astute patients who comment on, relatively, minor but accurate comments about changes in hair shade or shoe choices.

In a social setting I am prepared for the give and take personally. But at work, I am prepared to focus most of my energies on the patient.

Penelope said...

I think it is only natural to comment on very noticeable changes in appearance; particularly in a psychiatrist/client relationship where there is often more 'face time' to observe such changes.

While clearly an office visit isn't a "social setting", there is always a social element when two people interact.

Perhaps we should question why having the lens turned back on us (momentarily) seems to cause so much discomfort.

Rach said...

Ugh, Blogger ate my comment.
My shrink started wearing a medic alert bracelet a number of months ago, which was like a huge reality check that he's actually a human being and not an immortal alien from the planet psychotropia.

And while I want to ask him why he wears it, I'm not sure I want to know the answer, nor want to answer the question of why i want to know the answer.

Therapy Patient said...

As I enter the room or sometimes if my shrink and I exit simultaneously we will chat about something which may be the weather, the weekend, music, the opera. I have never commented on his appearance, but I have inquired as to his health when I know he's been ill, and I have commented on new office artwork or his car (which he's very enamored of). He doesn't turn it back on me. It's just casual conversation on the "edges" of the session. My psychiatrist did seem put off when I casually inquired at the beginning of our session on December 26th, if he had a nice Christmas. The look on his face reflected that he must have had a HORRIBLE Christmas, but he mumbled something about it being "fine" which left me feeling uncomfortable because I felt simultaneously that I had pried and that he had lied in answering which isn't what I want to exist in the relationship. I dropped it. I suppose if we were actually friends, he would have told me about his bad Christmas day.

Mr Ian said...

Maybe after Christoph has inquired on her health he can send her a bill?

But I'm sure if Christoph Niemann's shrink reads the NY Times - he won't have to ask now.

And how bizarre might that be... instead of the patient perhaps skulking to meet with their therapist... tis the therapist will be avoiding recognition when with the client perhaps?

"Yeah that's her - Christoph's skinny shrink"

Leave the poor lady alone.

Anonymous said...

I have never commented on my psychiatrist's cool-lookin' necklace or new blouse because I wasn't sure that it would be appropriate or not.

On the flip side, my weight has been a major issue in therapy and I've lost a little over 70 lbs. Whenever I tell my dr. that I've lost x # of lbs over the last week, she congratulates me but she has never commented on my actual appearance. I didn't know if it was because it wasn't appropriate for her to do so(boundries maybe?) or if she just didn't think I looked noticably different. When I was leaving our session last week, she said that I was "looking slim". It threw me completely off guard but really made feel great. It meant some much to me because I never expected to hear that from her. I was a little nervous that she might ask me about it this week but she didn't. Phew!!

Therapy Patient said...

Anonymous:
I feel that it is risky even with friends and acquaintances to comment overly on weight loss because the flip side is that it will be assumed that I notice when weight is gained. I prefer to just tell people how terrific they look without referencing the weight loss unless the topic is brought up by the dieter.

As a person who has gained and lost and gained and lost, I know that there is the temptation to equate weight loss with "GOOD" and weight gain with "BAD" and I feel that making that connection is problematic. Therefore I am not wanting to imply judgment (you are doing well) surrounding the weight issue. I love my friends the way they are and don't judge them based on their weight. That's a good message to give ourselves also, even though eating healthy foods and exercising are "good" for us.

Anonymous said...

kudos to you, Dinah! You are a sane psychiatrist, and I do believe that is a somewhat rare breed.

Anonymous said...

Thursday is a blue shirt day.

Return Of Saturn said...

While I'm not a psychiatrist, I do work in the mental health field, and I have to say, I'm struck by the comments here! In the past, I have been asked where I live, who I'm dating, why I'm not married, specific plans for various holidays, etc. Typically, I'll give a very general response, and sometimes, I'll get questions intended to elicit much more specific responses.

In therapy, I've only felt comfortable commenting on things in the immediate environment. "I like your shoes." or "What a beautiful plant." I've had some therapists engage in super-disclosure. On one hand, I get it, there are clients I'd totally hang out with outside of work. On the other hand, I feel weird... Boundaries, boundaries, boundaries.

RoseAG said...

If someone has lost weight and you don't think they've been ill I think it's nice to mention that you've noticed it to them.

It's hard to lose weight. Anybody who sticks with it deserves to hear that it's noticeable. I wouldn't bring it up unless it's pretty obvious they're shrunk because if they haven't lost weight then you've implied that they needed to!

You don't have to spend 15 minutes discussing your diet or what size you are now. A simple 'thank-you' will suffice.

Rach - I have a medic alert bracelet. It says allergic to latex, no sticks right side. That's because I've had surgery on that side. I sometimes catch people in meetings trying to read it and I think that's nosy. I have another bracelet with a charm I wear with it so people won't do that.