Inside the mind of a psychiatrist – Page 123 – Inside The Mind of a Psychiatrist

I’m sitting in my psychiatrist’s office and my mind’s a blank. Nothing in there.

After a minute of silence I say, “It’s costing a fortune to just sit here. I have nothing to say.”

The doctor nods, not in an unfriendly way, but also not very helpful.

“Maybe you’re just sitting there thinking about lunch; or napping with your eyes open?” I laugh, but it comes out a little too high-pitched. The sound of my wimpy laugh really annoys me. I blurt out. “What a great way to make a living. I do all the work and you get the money.”

“What work are you doing?” The doctor asks with a wry smile.

“What work? Well maybe I’m not doing anything, but you’re still getting paid.” Now the doctor thinks he’s a real comedian. Next he’ll be auditioning to MC the Oscars.

“You’re pretty angry this morning. What’s going on?”

“I don’t like you today. There’s an arrogance, a kind of power you have over me. Who do you think you are?”

Silence. A quizzical expression is on the doctor’s face.

I glance out the window at the sky. I don’t feel like looking at the son-of-a-bitch.

Finally I say, “You know my insurance pays almost nothing for this. It all comes out of my own pocket. Obamacare, Oshmamacare, certainly isn’t helping me!”

The doctor nods, like he agrees.

“Screw them! The idiots in Washington. I’m furious!”

The doctor nods again.

“Shit!” I shake my head and close my eyes.

“What?”

“I know why I’m so angry…”

Silence.

“I spoke to my father last night. He’s such an insensitive jerk! I told him how boring my job was, how I need to find something more fulfilling. He said, ‘I worked at the same job for thirty years.’ I ended the conversation and watched the Lakers. They even lost! Does he want me to be just as miserable as he is?”

“Maybe he didn’t understand how unhappy you are?”

“He was NEVER understanding. Ever! My mother says the same thing. It’s been going on my whole life.”

This is an example of how psychotherapy and the concept of transference works. The patient transfers angry feelings from a parent (or another important person, usually from the past) to the psychiatrist. Often it’s more complicated. The feelings aren’t so much on the surface, but hidden in the unconscious part off the mind. Sometimes a patient can be angry for weeks or months at his doctor, but eventually the original source of the anger is clarified. As the old wound is being relived in the transference, it can be examined in the safety of the psychiatrist’s office. Once it’s out there, and not being repressed, the issue can be dealt with in a more productive manner.

Any similar experiences or ideas about the unconscious or transference?

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You know the one — black leather, you’re lying face-up, with your psychiatrist sitting behind you. You’re silent. No thoughts are coming to mind.

“So what are your thoughts?” the doctor asks.

“Nothing. My mind’s a blank… I didn’t feel like coming in today and knew it would be a waste. I’m all blocked off. You know numb. The way I was when I first visited you two months ago.”

Silence

“I feel like you’re sitting back there criticizing me. You probably think I’m a real loser.”

“Why do you think that?”

“I don’t know why.”

Silence

“I know you like me. You smile when I come in. You’re always kind and try to accommodate my schedule. Christ, am I back to blocking off my feelings? Didn’t I do that when I got into a fight with my wife?”

“Are you fighting with her again?”

“No, we’re really doing much better, but I’m in such a crappy mood!”

“Any other ideas why?”

“It’s not home. It’s not work…or maybe it is. Damn, I got into it at work again with my boss. She’s such a bitch!”

“What did she do?”

“Just the way she looks at me. Her criticism is intolerable.”

“What kind of look?”

“It’s hard to describe… Just something about her that pushes my buttons.”

“Are your feelings similar to the way you felt when our session started? The way you thought I was criticizing you?”

“Maybe? You know what’s so interesting. Just as you were talking, I pictured my boss. There’s something about her that’s familiar. Not good familiar, but uncomfortable familiar.”

Silence.

“You’re going to laugh. My boss reminds me of my mother. That’s it! That’s the trigger. That’s why I felt she was criticizing me. Maybe she wasn’t. Maybe that mother-thing we’ve been working on is still plaguing me?”

The unconscious part of our mind is like the hidden part of an iceberg. Compared to the conscious part, it’s huge and drives so much of what we say and do. Most times we’re not even aware of its existence.

One reason why the couch works so well, is that the patient isn’t getting direct feedback from the doctor. He can’t see facial expressions and is forced to let his own fantasies of what’s going on in the mind of the psychiatrist run wild. It’s the opportunity to freely associate that’s so helpful. In this case, the patient is very psychologically minded and is able to experience the connection between his thinking that his doctor is criticizing him and then connecting it to what happened with his boss.

As expected, most people can’t afford 4 or 5 times a week on the couch (which is what a psychoanalysis entails). In the real world, the principles of psychoanalysis are applied in once-a-week psychotherapy. A patient can still learn from all we know about the science of the mind and benefit greatly.

Interested in more? See you next week.

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