Reflections on Psychiatry, Therapy, and Mental Health

On the Growing Presence of AI It is estimated that millions of people use AI as a companion and it is likely that many of us have patients talking about AI. Amongst those of us in mental health, this invites the question, can AI contribute to therapy. I don't think it is possible to draw many conclusions at this time about the relative effectiveness of AI as a therapist, but considering this issue leads us to take a hard look at what psychotherapy is. That is, AI juxtaposed

A Psychiatrist Reflects on Emotionally Focused Therapy (EFT) A friend who I love very much has an annoying trait. She is a major surfer of social media and will periodically approach me during moments when I’m resting with questions about things on the Web that are trending. One afternoon while sitting on my porch, relaxed with thoughts far from work, she walked by and called out, “Hey Doc, you’re supposed to know about these things—is there anything to the notion of E.F.T.—E

A curious insight struck me under unexpected circumstances. I’ve been spending a lot of time working with ChatGPT—henceforth, GPT—on a complex coding project for my business. After hours of debugging, I often turn to GPT for a break, indulging in a bit of idle chat. It’s hard to miss her facility with language, her wit, and her ease at diving into far-flung topics. As time passed with my cyber companion, something began to unsettle me. GPT is, frankly, ingratiating. She prais

Coping with the Early Days of Grief and Loss The other day a patient came into the office reporting that his mother had died only a few weeks before from a heart attack. The encounter reminded me that it's not unusual for those of us in the business of mental health to be faced with the need to console a patient experiencing acute loss. Due to the complexity and individuality of each person's experience, I try to find words that are broad enough to provide some comfort in t

It is a reality that, like in all arts, the range of skill varies greatly amongst the community of therapy practitioners. One dimension of practice that is most commonly deficient in the less skilled is therapeutic discipline. Though therapy is an amorphous profession, somewhat like acting, within which the audience/patient experiences a seemingly free flow and naturalness to the process, the therapist/actor is very much aware of what she is doing and, despite the apparent

a popular book with poetry, inspired by the Blotto game I was first exposed to the test as a teenager when I was administered the inkblot test by a psychologist. I remember little of the experience other than enjoying it and feeling engaged, it was so open ended and felt creative. The examiner later told my mom that I was imaginative and that made me feel good, otherwise, I learned little of the results. Years later the test emerged in my life once again. I had helped a ps

There is nothing curious about a drug addict's attachment to their drugs. Addiction is a powerful problem that in order to be successfully dealt with requires commitment and treatment. On the other hand, patients in treatment who are stably benefiting from MAT- medication assisted treatment, are attached to their Suboxone in a manner that is qualitatively different from the addictive hold that drugs have on a person in the sways of addiction. We discovered this in our clini

As the season of giving came to a close this year I started to think a way in which I have not been giving to my patients over the years as much as I would have liked. To wit, all these years I have been formulating a theory of my patient's psychological functioning using sophisticated tools but have not shared these very same tools with my patients. Long ago one of my teachers told me that the counseling process is socratic, in effect, it is a process in which we teach our

Alcoholics Anonymous is a powerful self help movement that over decades has accrued wisdom on how people can help each other. A powerful element is the concept of 'The 12 Steps.' I'd like to borrow from step 4, 'Taking a Moral Inventory,' and see how we might apply this in the ordinary process of counseling. The idea of a moral inventory to the AA member is to enhance self-awareness in a way that promotes growth. Rather than 'moral inventory,' we therapists might consider

Time is a source of therapeutic energy so I pay close attention to it. I'm punctual, starting sessions and I don't tend to flex the end time to accommodate late arrivals. I even like, when possible, for my patients to have a regularity to the hour of their visit, same day of the week, same time of the day. Here are the associated ideas. By beginning a session on time I allow myself to observe this aspect of my patient's behavior. Does she arrive on time, or is she habitu

Each night when I go to sleep, I look forward to my dreams. Thoughts in dreams are often far more creative than our conscious mind can ever conjure up. Dreams are entertaining, sometimes disquieting, rarely one hopes, frightening. Of more import, they can help a person connect with him or her's deepest self. Dreams are notorious for being bizarre and seemingly senseless, yet when approached in the right way they point toward important aspects of our psychological being, a

At social gatherings if asked by a new acquaintance what I do for a living and I reply psychiatrist, I first note a slight social retreat, as if they are wondering whether I'll judge them more harshly than I judge myself. Once that hurtle has been crossed and the conversation warms up, I'm frequently asked about sleep, and whether I have any advice on how sleep quality can be improved. I'm not at all surprised by the question because about a third of Americans at any given t

It is difficult to make the case that there is anything good about loss, for loss creates a wound. There is, however, something we might call, 'good healing.' Let's first bring our attention to the concept of loss. It can be said that loss is built into the fabric of life. We lose our childhood, and eventually our parents. If we live long enough we will lose our spouses and many friends. Such losses are an inevitable part of the cycle of life. Of course there are also br

While in the middle of a therapy session a patient who is opening up his soul to a therapist might wonder from time to time wonder, what is my therapist thinking about me? The question is rather general. We might do better by asking, how does a therapist think in responding to what a patient says? Let's first make the assumption that the patient is in the hands of a good therapist. Defining a 'good therapist,' is something that has written about a good deal in mental healt