Former Drug Czar: going after prescription opioids is wrongheaded

https://www.foxnews.com/health/former-drug-czar-opioid-epidemic-focus-missing-real-culprit

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https://truthout.org/articles/rise-in-white-prisoners-shows-prison-racism-goes-beyond-disparities/

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How does one acquire a “Thicker Skin” in dealing with highly emotional taxing careers such as a Psychologist or Psychiatrist?

“Thick skin” is a provocative notion about which all new therapists should consider, then reject.

In my work and with those younger therapists with whom I’ve taught and consulted, I do the opposite. I try to help them become even more vulnerable to all the vagaries that can, and do, arise in therapy.

Without emotional vulnerability to our patients, we have no way to enter their worlds, and, therefore, can be of no lasting help.

You may be more broadly asking how those of us who do this work keep ourselves going in the face of the natural stresses of this work. How to care for ourselves is a more pertinent question for those of us who work with people who experience extreme mental states: Borderline personality disorders, narcissistic personality disorders, and the psychoses.

Significantly, we all need our therapists as well as consultants, along with routines that help us unwind and engage in pursuits unrelated to our work. Strong friendships and a loving family are essential.

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Should a psychotherapist be completely transparent in patient interactions? More specifically, should they openly express or conceal their emotions and reactions to the patient?

The answer depends on the patient, her/his diagnosis, and the state of the relationship between us. No, in general, I am cautious about many of my thoughts and feelings as I treat them as speculative.

However, if what I am thinking or feeling is drawn into the interaction, especially if asked directly, then, yes I am transparent. I immediately pay close attention to how the patient reacts to this disclosure.

With some patients who grew up having to be exquisitely aware of a parent’s thoughts, feelings, and behavior to survive, I will be far more transparent than with other patients. Coming from a background where physical/psychological safety depended on the patient’s ability to know what’s going on, I have to be more active in helping that person tease out what they “know” and what is going on in me. I don’t want to do anything to increase the patient’s “paranoia” about me.

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I’ve been told that all personality disorders are egosyntonic, and that therefore if I wonder about having BPD I don’t, and should not see a doctor. Is this true?

Ask yourself this, Dan. Would you find the following egosyntonic: afraid that everyone despises your very presence. How about this: you fear close emotional relationships based on the “crazy” closeness that you experienced as a small child. Add to that this; you fear any signs of someone moving away from you emotionally as that signals an abandonment and annihilation that you may not survive. Additionally, suppose that intense emotions can kick you into a state of psychosis from which you fear you may never recover; another form of death. Imagine, if you can, that you wake up every morning and go to sleep every night with this underlying terror: I will be eviscerated and killed.

Imagine all that, Dan, and think about the experience, empathy, and intelligence of those who have told you that this ghastly disorder is “egosyntonic.”

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I think my therapist is retiring.She knows I have abandonment issues.I think she is testing me.Something about the way she is acting makes me feel she’s getting ready to tell me she will be leaving. Do therapist test their clients? How can I tell?

No, I can’t imagine a competent/ethical therapist “testing” any patient. The best way to handle this, and likely a good step for you, would be to talk to your therapist about your fantasies of being abandoned by her. I suspect you might find that difficult if not, you wouldn’t be posing this question here.

I believe your therapist would be pleased if you bring this up and would be happy to discuss this with you. Good luck.

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Should there be a government agency dedicated to reducing the number of psychopaths, sadistic people and people with anti-social personality disorders to improve public health and the overall quality of life?

In short, no. I can’t imagine giving that kind of intrusive power to the state. It smacks of the worst sort of authoritarianism. Education about mental illness and providing sufficient public funding for mental health services would be wondrous. I doubt, though, it will ever happen, especially with our psychopathic president uninterested in such things.

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Yuya, this is an insightful question that seems to trap most inexperienced therapists. I welcome such communications. It often reveals a benchmark of change when the patient can challenge me. This challenge is exquisitely dangerous to the patient as s/he thinks I will become angry, withdrawn, maybe rejecting, haughty or even narcissistically demand that they the retract the objections if they wish to continue working with me. These are usually transference based expectations. However, many patients run into inexperienced or un-analyzed therapists who’ve yet to resolve their issues in this fragile domain. When this happens, the rule is thus for the therapist: do not attack, do not withdraw from the patient. Accept the patient’s point of view and search for the truth of it. Once the therapist can acknowledge the delicate parts of the patient’s experience as real and crucial, then, with great tact and skill, the therapist might inquire into the transference aspects of the communication. A competent therapist will acknowledge her/his contribution to the interaction. S/he will then be able to assist the patient in looking at the historical antecedents of the criticism,, and the patient’s fears of stating her or his truth to the therapist whom they feel, rightfully, injured them.

Without knowing a great deal more about you and what you consider “paranoia” I would be taking huge liberties with you. Those liberties would be crummy psychotherapeutic help; in short, no help at all and very possibly misleading and unethical.

Could you tell me more about exactly what you mean?

For me to say anything more than this right now would be antithetical to my professional duties. Anyone who’d dare make a definitive statement about your 9-word question would be presumptions at best and woefully misleading at worst.

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Do therapists ever have sessions with clients who tell you that you’re not doing a great job and you’re not helping them? How do you feel and what do you do?

Yuya, this is an insightful question that seems to trap most inexperienced therapists.

I welcome such communications. It often reveals a benchmark of change when a patient can challenge me. This challenge is exquisitely dangerous to the patient as s/he thinks I will become angry, withdrawn, maybe rejecting, haughty or even narcissistically demand that they the retract their objections if they wish to continue working with me.

These are usually transference based expectations. However, many patients run into inexperienced or un-analyzed therapists who’ve yet to resolve their issues in this fragile domain.

When criticized by the patient, the rule is thus for the therapist: do not attack, do not withdraw from the patient; the therapist accepts the patient’s point of view and then searches for the truth of it.

Once the therapist can acknowledge the delicate parts of the patient’s experience as real and crucial, then, with great tact and skill, the therapist might inquire into the transference aspects of the communication.

A competent therapist will acknowledge her/his contribution to the interaction. S/he will then be able to assist the patient in looking at the historical antecedents of the criticism, and the patient’s fears of stating her or his truth to the therapist whom they feel, rightfully, injured them.

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Do therapists ever get severe depression? How do they cope with it?

In a word, yes, we therapists are human and are like everyone else subjected to the vagaries of life: divorce, death, illness, etc.
For the better part of my nearly 1/2 century career, I have struggled with the debilitating and often deadly attacks of an exotic auto-immune disease. I have been in and out of hospitals with emergencies, bouts with the grim reaper, mounting disability. These battles, of course, often left me disturbed, sad and depressed.

The impact of my illness is unfortunately quite obvious. I learned early in my career that I had to be transparent not only about the medical issues I struggled with but also the emotional toll on my family and me.

Years ago I had to end my career to deal with the daily complications of a deadly disease. When I was able to return to work, I was a changed man and change therapist, both for the better.

I’ve found that my decades-long illness has sensitized me to all sorts of human experiences which has made me a more empathic, sensitive person whose agony induced misery has made me more fully human.

One of my goals in my work with those on the edges of madness is to discover their humanity and empathy for themselves & others.

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