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Freud & Fashion

...BECAUSE IT'S STYLISH TO TALK ABOUT MENTAL HEALTH, ESPECIALLY HOW WE MAINTAIN OUR OWN.

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therapist

Personaltherapy

Weekly Insights

written by freudandfashion
Weekly Insights

{Ventura, California}

I am a perfectionist (sometimes to a fault) and most of my writing is edited at least 10 times until each and every word is as perfect as can be (at least in my mind).  One of the reasons that I don’t post more frequently is due to my perfectionism, because I’d much rather NOT post than write anything that doesn’t meet my standards.  So I am trying really hard to let go of my strong inner self-critic.  Even during residency, my psychiatry supervisors would find me at the clinic after hours typing notes documenting my patient visits.  However, the reason I was there late was not due to having a pile of tasks to complete — it was because I took way too long typing and perfecting each note.

During my training, I recall a free association exercise that my psychoanalytically-trained Program Director had us do as part of an intro to psychoanalytic theory.  Free association is a psychotherapy technique where a patient talks or writes freely about whatever comes to mind in relation to a specific topic, with the goal of bringing unconscious thoughts to the forefront or the emergence of repressed memories, which can provide valuable insight of a patient’s problems.

So, with this exercise in mind, here goes my attempt at free associating by typing nonstop for 3 minutes whatever comes to my mind regarding the following topic: lessons learned from this week.  And, go:

that it’s extremely hard to say goodbye to several of my patients.  a part of me wants to take all of my patients with me to my practice, though I know that it’s probably in some of their best interest to stay within a system with resources to monitor them more closely.

I am sad and exhausted usually by the end of clinic because i didn’t realize saying goodbye would be harder than I thought.

i hate feeling lazy when I get home, but I’m so tired that all I want to do sometimes is lay on the couch and watch shark tank, hotel impossible, or other reality tv-type shows mostly because I don’t want to think.  But then I feel bad because I feel like I should be cleaning my house, writing a blogpost, exercising, going grocery shopping, going out for a run, or anything else that makes me feel like i’m not being useless.

i wish I had the energy i once did because I feel guilty knowing that I need rest, need more sleep, get injured when working out, takes me longer to recover from workouts and pretty much anything that makes me aware that i’m getting older.

i look at other bloggers and wish that I blogged more often like them, wish it didn’t take me so long to write wish that i could go eat a cheesecake or something that was fattening and sweet like a lot of skinny bloggers posting food shots on their social media sites as if they actually eat those things.  how much of reality is blogging anyway, how can we believe anything that people actually write or say and how i can we tell if someone is being authentic or not.  i can’t be fake and maybe that’s why it’s so hard for me to write yet at the same time I don’t know how my image will be perceived and that takes editing that i wish i didn’t have to do.

Thought of the Week:  Interesting that my recurrent body image issues and fear of judgment appeared in this post.  Perhaps a sign that I should process this material with my therapist?

September 26, 2015 20 comments
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Psychiatrytherapy

Are you ready?

written by freudandfashion
Are you ready?

IMG_3253The Great Sand Dune, Point Mugu

I may prescribe psychiatric medications, but the one treatment I advocate for the most is psychotherapy.

Psychotherapy = general term for talk therapy, counseling; meeting with a mental health clinician for support, insight, and development of coping skills for life challenges.

Patients often ask me whether or not I think they should see a therapist.  My general answer: “I think everyone can benefit from therapy.  I think therapy will help you for (insert reason I believe patient will benefit from psychotherapy here based on my formulation of his/her issues).”  However, despite my recommendation of therapy, the more important question is: “Are YOU ready for therapy?”

Here’s a few reasons why I believe this question is so important:

– Therapy can be challenging.  As humans, we develop defenses to help prevent us from feeling the full extent of deep, emotional pain.  Therapy may lower your defenses, which allows you to experience and process painful emotions in a safe environment.  The well-known phrase “no pain, no gain” applies to therapy as well.  With pain = growth and healing.

– Talking about yourself can be uncomfortable.  You might feel like you’re being judged, which is especially difficult.  And if you’re one who loves talking about yourself, perhaps talking about yourself (and not acknowledging others) may be the reason for your problems (a good therapist should be able to point this out).

– You can never predict what might come up in therapy, so being open to the process can lead to development of great insights.  There might be times when you want to stop therapy or may question if it’s even helping.  Being open to processing your resistance may lead to great insights as well (i.e. any material that comes up in therapy may have meaning and be subject to processing during session).

I write this post not only as a clinician, but also as one who has experienced all I mentioned above in my own therapy process.  Even as a psychiatry resident physician, I resisted starting therapy because I feared what I might learn about myself.  I grieved the loss of my grandfather, struggled to adapt to my move to Oregon for residency, and felt depressed because I wasn’t performing as well academically, and various other reasons.  In effort to avoid therapy, I first turned to exercise, shopping therapy (not the best on your credit card), and talked to friends, which helped temporarily but didn’t help me learn to better cope with my issues.  I eventually gave in, faced my fears, and as a result I’m much more self-aware, insightful, and comfortable with myself as a person.  I’m also a much better psychiatrist to my patients (nothing makes you more empathetic towards your patients than putting yourself in their shoes and sitting in the patient’s chair).

P.S.  Not all therapists are the same.  If you don’t have a connection with your therapist, don’t give up on finding the right one! (stay tuned for a future post on how to find the right therapist)

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September 25, 2014 4 comments
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therapy

Thankful Thursdays

written by freudandfashion
Thankful Thursdays

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Malibu Beach

People who meet me tend to perceive me as a positive person, but I’ll admit that I wasn’t always that way.  I was quite the complainer growing up and blamed others if things didn’t go my way.  My negativity improved through maturation over time, but my four years of psychiatric residency training certainly helped me become more self-aware. Learning about different psychotherapy techniques sharpened my skills even further, and one modality that I use involves Positive Psychotherapy.

What is Positive Psychotherapy (PPT)?

In a nutshell, Dr. Martin E.P. Seligman spearheaded the development and research of PPT as an intervention for treatment of depression and the theory consists of some of the following concepts:

– focus on the POSITIVE (factors that contribute to happiness and build upon one’s strengths)

– build POSITIVE EMOTIONS (about the past, present, and future)

– identify and utilize your STRENGTHS

  • for example, if you’re a creative person, do things that bring out your creativity (such as writing, photography, etc).  If you’re competitive, consider joining a recreational group or league

–  instead of letting your strengths and talents go to waste, apply them towards something MEANINGFUL (such as in your job, community, family, religious institution, etc)

Naturally, this can take a lot of work/effort especially since our minds may automatically take us down a negative spiral in the face of challenge and negativity.  With our often stressful and hectic lives, when something goes wrong, it seems like it requires more time and energy to switch to a positive mindframe.  With that in mind, Seligman’s team developed a series of exercises to help shift your mind towards more positive thinking, one of which includes listing “3 good things” that went well during your day.

So, with a slight twist and in the spirit of PPT, I created a new series on my blog called “Thankful Thursdays” where I will list 3 things I’m thankful for from the week and I encourage all of you to do the same!

Here’s my list from this week:

1.  Took advantage of living a few miles away from the beach and spent some time there to escape the triple digit California heat wave (picture above).

2.  I’m thankful for my family stopping by my office to visit and instead of my usual routine of going home to check email and watch tv, I enjoyed quality time with them over a delicious meal.

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Dinner in West Hollywood

3.  Received a “sign” today which steered me in a different direction regarding a work project.  I truly believe that when one door closes, another one opens, so I’m staying focused and optimistic!

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On a boat in South Lake Tahoe

What 3 things are you thankful for?

References:

Seligman, M. E. P., Rashid, T., & Parks, A.C. (2006). Positive psychotherapy. American Psychologist, 61, 774-778.

Photo Credits: Marlon Santos (Diamond Reel Media), Alex Manipod

Disclaimer: this post describes one therapeutic technique and should not be used to replace treatment with your primary clinicians

September 18, 2014 9 comments
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Psychiatrytherapy

Stay or Leave?

written by freudandfashion
Stay or Leave?

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Office Balcony Sunset

I recently made a difficult decision regarding my job, which triggered feelings of uncertainty, fear, and self-doubt.  In the process of contemplating my decision, I recalled one of my patients, a college student who struggled with depression.  Despite going to a prestigious university, his overwhelming fear of not getting accepted into law school further exacerbated his depressive symptoms.  I responded with seemingly consoling statements such as “you’re still young…you’ll get there…you have a lot going for you…I went through the same situation and it worked out okay.” However, my attempts to reassure really weren’t reassuring at all (it’s well known in psychiatry that reassurance generally doesn’t reassure mostly because the statements fail to validate the patient’s current experience).  Reflecting back, I realized that in the moment I didn’t want to relive my own pain, uncertainty, and fears that I experienced in my process of applying to medical school.  I recalled the discouragement I felt with each rejection letter I received.  And I was still feeling discouraged at my current job.  Since I gained insight from connecting his experience with my own, I looked forward to validating his feelings at his next appointment.  Unfortunately, he cancelled his appointment and never returned.

I realize that contemplating decisions regarding a career path, relationships, love, and pretty much anything pertaining to life in general, makes us vulnerable and uncomfortable.  The idea of change can trigger fear and act as a barrier towards future ventures.  After a year long process, I finally decided to resign.  My anxiety peaked even more because I felt uncertain of the next step to take.  Where do I go from here?  Will I feel happier?  Will I regret my decision?
Seeking motivation to push forward and take risks, I read quotes by famous writers, all with similar themes to never give up, choose the “road less traveled,” try new things, and learn from your mistakes.
The dangers of life are infinite, and among them are safety.  ~ Goethe
Yet, it took being on a plane last night watching The Amazing Spiderman 2 hearing Gwen Stacy (played by Emma Stone) give her valedictorian speech to make me realize how mainstream and pervasive this dilemma is:
“…I say it today of all days to remind us that time is luck. So don’t waste it living someone else’s life, make yours count for something. Fight for what matters to you, no matter what. Because even if you fall short, what better way is there to live?”
As mentioned above, my decision involved resigning from my highly-desired, well-paid job in order to take control of my life, practice, and career.   Since my last day, I have mixed emotions of feeling liberated, hopeful, excited, yet completely scared at the same time.
I made the right decision.
“…you can fail at what you don’t want, so you might as well take a chance on doing what you love.”  
                ~Jim Carrey
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Putting in work at my new office in West Hollywood
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Photos courtesy of Marlon Santos (Diamond Reel Media)
September 10, 2014 24 comments
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Psychiatry

Know Your Limit

written by freudandfashion
Know Your Limit

266

 

Came home from work late today…again.

I’m passionate about my job as a psychiatrist and spent about two hours with each patient that I was called to consult on the medical floor this weekend.  Lunch and dinner were an afterthought.  I felt the hunger pangs, but pushed on because the appreciation received from each patient for taking time to understand their situation made hypoglycemia worthwhile.

Today, I spent several hours on a complicated case.   Coordination of care took place, notes thoroughly written, and necessary calls made.  I left the clinic with a goal to leave work behind.  However, the patient is still on my mind.  Accepting that I can’t save a patient is one of the most difficult aspects of my job.  No words of appreciation expected, no reassurance of their safety, no guarantee of tomorrow.

I can’t cure, I can’t heal, I can’t save, but it would be out of my character not to at least try.

December 4, 2012 30 comments
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THE WRITINGS OF A MODERN PSYCHIATRIST

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