This is a post that has been under construction for a while in my notes, I may do more in the future.
Students ask questions of me, often when they discover I am in practice as not all of their professors are.
Some of the questions asked are the same as what friends or family will ask, when their curiosity grows.
Do you get angry with patients, do you cry, are you afraid of any of your patients, do you call them patients…
Which do you use for the people you see, “patients” or “clients”?
I get this question a lot. First off, I don’t use either term with the people that I see, just as your family doctor doesn’t with you, they don’t walk into the exam room and ask how patient #4564 is feeling today.
I deal more with trauma related therapy, mental disorders. Not so much with general counseling, though I of course do this with my patients. So there, is the answer on how I refer to the people that I see, my patients. There has been efforts to use the term “clients” to remove the stigma with seeking help. The issues I deal with, though, are medical. My thinking is that there is no difference between if your leg is broken, your tummy is sore or your if your issues are with your mind. It is all about healing, but with the mind there is stigma. Further separating these just adds to it. I also work with my patients family doctors, psychiatrists, and my clinics and hospitals on staff doctors, with the patients medications. I feel strongly that the therapist must understand what medications the patient is taking, how it is helping or not or if they need changing, adjusting. I also feel the term “client” is more of a business relationship than one of caring. I am a Doctor, Doctors have patients. The patient is in my care. I care.
The terms are however, interchangeable.
Self Harm is often strongly associated with mental disorders. What do you do if you see someone with fresh cuts?
I refer to my above answer partially, the patient is in my care. My first concerns are does the cut need attention. How deep is it, does it need sutures is it or is it likely to become infected. The big question too, is was it a suicide attempt. I must stress though, I do not show judgement. I do not frown, scold, lecture. My mind was not in the same place as my patients was, I am in no position to shake my head and tell them not to do that. So first we deal with safety, to make sure the cut does not need further attention. We judge whether it was a suicide attempt or not, if it was, we need to see if further action needs to be taken in this regard. Is the patient safe? Will there be further attempts?
Having a Doctor on staff makes this issue easier for me, we have nurses as well, so having the cut looked at immediately is easier than sending them off to the hospital. There should be no hesitation to do so though.
Staying with the Self Harm issue. When a patient reveals self harm, do you tell anyone?
The short answer is yes. Sometimes. If the patient is a minor, the parent or guardian needs to know. Do I rush out and blurt to them, no. I would rather the patient tell them, with myself in attendance to answer questions, shield the patient from reactions that may be overpowering or harmful. Often I will tell the parents/guardians with the patient in attendance if they feel they can not, but only after talking with them about it. There are times too, when I must tell them without the patient in attendance, it is important to explain Self Harm, what it is, to them though, not to just say it is occurring. To stress to them, we must not make a huge issue of it, but to watch for cuts that may need attention, that we will be working to help stop this, but if there is no judging, that it is not becoming an issue, a white elephant, the patient will be more open to discussing it, seeking their help to avoid cutting when they feel they need to. There will be trust to go to them when the cut may need attention, without fearing judgement, lectures or shame. With minors too, care must be taken that it was SH and not abuse. Abuse must be reported.
With children that are not minors, but living at home, I will still push them to talk to their parents if possible. This applies to adults that live with someone. I will do the same with them, sit in with them whilst they or I will tell/explain SH to those they live with.
When cutting is not just Self Harm, but a suicide attempt I may also tell someone, often this would involve a hospital visit/evaluation. Patient safety is always your number one concern.
Have you ever placed someone in the hospital against their wishes? As in a 72 hour hold?
Patient safety is always your number one concern.
When I judge they are not “safe”, if possible, we discuss this. It is better if they agree that a hospital visit would help them. I have placed patients in the hospital in this fashion. They will at times, request this too. It is not something that is a big balloon, an issue, if they feel they would be safer there, it is great they made that decision. Respect it. If you feel they should be there and with discussion they agree, that is great too.
Sometimes you may find them in the middle of a suicide attempt, they may not be aware. They need treatment to save their life, after this treatment, an evaluation is necessary, to determine whether they will be safe to return home right away. It is safer to invoke a 72 hour hold.
Sometimes it is harder, they may not agree, but you are sure they are not safe. They may have to be “dragged off kicking and screaming.” Patient safety is your number one concern.
Do you ever cry during sessions?
Yes I have. I try not to. I don’t often. I am a strong empath, sometimes I will deeply feel what the patient feels. Sometimes too I have cried with a patient, in a happy way. When they have been overwhelmed with a breakthrough.
Is it bad to cry during a session? I would hope not to cry often, this is after all, about the patient, not about me. Crying will show you are feeling what they feel though, you care, you empathize. Crying often will, perhaps show, it is more about how you feel rather than how the patient feels, so control is required. I am human though.
Do I cry often? no.
Are you ever afraid of your patients? Are they not dangerous?
This is a question that I get from family or friends more than students. Students will know that patients are very unlikely to be dangerous. Most patients are the opposite, they are very caring of others, most are very emphatic.
The “dangerous” patients, the ones that you will see on the news, are not really patients, they are unlikely to seek help, they don’t feel they have a need for help. The “psychopaths” “sociopaths” those that suffer with Antisocial personality disorder rarely seek treatment. If they do, they are very unlikely to be violent.
When someone seeks help, they are not dangerous to you, possibly to themselves. I have never feared a patient.
Have you had a patient that has formed an attachment to you with romantic feelings rather than just a need to see you?
Yes. It occurs quite often. It is called transference, though this term is used in many ways in therapy, but when someone who has only received contempt in life, with little caring about them, is finally with someone that is caring, helpful who they have shared inner feelings with, deep thoughts, this does occur. The patient often feels shame at this, if you discover your patient has become somewhat smitten with you, it is good to discuss this, to help with possible relationship/attachment issues that may require working through. Again, don’t judge or show contempt, don’t make an issue of it at all.
Do your patients call you or text you? Does this annoy you?
Yes they do, no it doesn’t. I may phone them later in the evening after a session as well, if I feel this contact will be of help or to check to see how they coped with a situation they were going to go through after the session. If they feel a need to reach out, when they are overwhelmed or questioning something that awakened, don’t want to wait until the next session, I am happy to hear from them or to help.
Have you ever had therapy?
In our practice we all have group sessions, and individual sessions. Right down to my receptionists. Working with some of the disorders that we do can be challenging. Facing patients with strong suicide idolization, frequent self harm and emotional episodes can be challenging. So yes, we also have sessions to help cope, and to learn.
I also received some therapy from my mentor, after a SA episode that I do not wish to go into now.
When a patient doesn’t seem to try or move along in therapy, do you become annoyed?
I set goals with a patient, we work toward those goals, there are bumps and sidetracks that often may cause a change in goals or a delay in one. We may discuss that change or it may be obvious. We move at their speed, not mine. If the therapy is not moving along in a way we are both satisfied with, I will try another route. We discuss this as well. Openness and trust are key between a therapist and patient. There should be no hidden feelings, you don’t want the patient wondering what you think or trying to do what they think you want them to do.