Clinical Relationship Killers (Part 1)

Unrealistic Expectations, the Extremes

So, you expect your psychiatrist to be M*A*S*H’s Dr. Sydney Freedman’s identical twin? Remember the character?

Dr. Freedman’s god-like Clinical Skills

• A fountain of unrivaled clinical insight
• An unfailingly compassionate listener
• Infinitely intuitive
• Perfect couch-side manner
• Witty

Let me break it to you gently. Your psychiatrist is not Sydney Freedman. In fact, no psychiatrist is. Dr. Sydney Freedman is a unicorn. He doesn’t exist. Unions are perfect and imaginary. Sydney Freeman is perfect and imaginary. I wonder how many people left treatment because their very human psychiatrist didn’t measure up to an ideal.

The opposite extreme to the good Dr. Freedman, Hannibal Lecter:

Hannibal’s Satanic Clinical Skills

• He’s a sociopath
• He’s a serial killer
• He’s a cannibal

Let me reassure you. Your psychiatrist isn’t a serial killer and he doesn’t want to have you as a meal. 

Dr. Lecter is a fictional character designed to scare the daylights out of movie audiences. I wonder how many people decided not to seek needed treatment because their darkest irrational suspicions about psychiatrists were given a face.

Taming expectations is crucial.

Real-World Psychiatry

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          Some psychiatrists are truly gifted. Just as some orthopedists and family physicians are. If you are the patient of a truly gifted MD, treasure him or her.

•      Remember however, that gifted doesn’t mean Dr. Sydney Freedman.
•      Most psychiatrists are in the “mushy middle.”
•      If you find yourself dissatisfied with aspects of your Dr.-patient relationship, the growth potential for you is huge.
•      Working through your dissatisfaction with him will reap enormous clinical benefits for you.
•     I will explore at great length in future blog posts various dissatisfaction we patients have and strategies for working through those complaints with our MDs.
•     Don’t bail on a “mushy middle” clinical relationship. Work through the conflicts.     
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My book Finding My Voice: A 20-Year Psychiatrist-Patient Odyssey is about resolving clinical struggles and creating transformation. I know this subject well.

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 A few psychiatrists should be in the lab, not with patients. Every field of medicine has those rare practitioners who should be doing something else. Psychiatry is no exception.

•     Make every attempt to work through the conflicts with your physician.
•     Seek assistance from your psychotherapist. She can intervene on your behalf
•     If there is no resolution, get a second referral.
•     Don’t stay in an unhealthy or destructive clinical relationship with any physician or psychotherapist
•     Fortunately, this is an uncommon occurrence

The next “Relationship Killer” post will be on “negative mindreading” or the tendency for those of us in treatment to presuppose our clinicians’ meaning or intent. A lot of needless injury is caused by assuming the worst about a clinical insight your psychiatrist or psychotherapist has shared with you. Negative mindreading is a trap to be worked through and avoided.

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