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Friday, November 14. 2008

The odds

What are the odds that a patient you see for an initial Psychiatric consultation will show up for a follow-up second office visit? In my experience, around 90%.

What are the odds that a patient you see for an initial consultation, who has a past (not current) history of drug abuse and alcohol abuse and messy relationships, will show up for their follow-up office visit? In my experience, around 25-30% (unless court-ordered).

Which is why I am free to post this at this moment. People who mess things up tend to mess up getting help, too. But those 25% who do show up tend to be powerfully  motivated to work on things, are highly helpable, and it is a pleasure and a privilege to help them grow up and take charge of their lives.

Posted by Dr. Joy Bliss in Psychology, and Dr. Bliss at 09:24 | Comments (24) | Trackbacks (0)

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Man comes into a psychiatrist's office and says, "doc, i can't stop drinking! no matter what i try, nothing seems to work, and i just can't stop. can you help me?"

psychiatrist says, "well, you can pay me a lot of money to come here once a week for an hour long session for the next five years, and there is a chance that we will see some progress.

or, you can do what i did, and just go to AA."
#1 kab on 2008-11-14 10:21 (Reply)
Took me a long while to figure out the difference between being an alcoholic and just a plain ol' drunk. As an alcoholic, there were a great many meetings to attend. (ooops, late for my appointment; my how time flies!)
#1.1 Pajak on 2008-11-14 17:19 (Reply)
"it is a pleasure and a privilege to help them grow up and take charge of their lives."

Odd choice of words there with "grow up". Intensely condescending coming from a shrink.

Anyway....

Dr. Bliss,

I've done most of my graduate work on complex PTSD and am interested in what you think based on your years of work. Could you give an approximate percentage of how many of your patients have some degree of trauma-related illness that caused them to seek psychiatric help?

Thanks..
`
#2 Meta on 2008-11-14 13:55 (Reply)
Meta, are you all "growed up"? I sure in hell ain't. Ease up on Dr Joy. She has a great tan, cooks, plays tennis , golf, and is a part time plumber, with a beautiful plumber's crack. Plus she thinks I am normal with all my carnal thoughts of her.

I'll trade you 5 klonpins for 5 of those adderall 30 mg. I want my wife to attack me! You big Jessica Simpson : )
#2.1 jappy on 2008-11-14 16:34 (Reply)
Jappy,

Can you tell me what 'grown up' means? I have no idea. I'm sure not grown up, nor do I intend to ever grow up. I am responsible for my actions, I take very good care of those I love and those who pass through my life. I couldn't conjure up a victim mentality if I tried. And I'm thoughtful. If someone were to tell me to grow up, I'd laugh in their face and tell them to get a life.

I think you're very normal. It might be dangerous if you took Adderall. :) But ask Jephnol how to woo your wife. You lie in her arms and say mushy things about how you're feeling inside and how vulnerable you are.

ack!!! hahaha. Don't do it! I was just kidding!
`
#2.1.1 Meta on 2008-11-14 19:41 (Reply)
"it is a pleasure and a privilege to help them grow up and take charge of their lives."

which actually perfectly demonstrates why professionals have a hard time getting through to those afflicted with the disease. your statement would indicate the individual has a choice in the matter. "i think i'll grow up today and stop drinking!"

shame on you, dr bliss!
#3 kab on 2008-11-14 16:30 (Reply)
You mean someone is holding a gun to the head of the drinker forcing him to drink or be shot?
#3.1 class-factotum on 2008-11-14 16:47 (Reply)
yes, that is exactly what i mean.
#3.1.1 kab on 2008-11-14 17:36 (Reply)
Clearly, someone broke an appt with the doc --clearly becuz she says so, duh --and her annoyance forced itself to expression with the "grow up". It's that damned no-show who needs to grow up. Not us readers. i think.
#4 buddy larsen on 2008-11-14 17:24 (Reply)
Naked guy walks into psychiatrist's office. Receptionist says "Please take a seat, I can see your nuts".

(joke works better verbally, as you don't have to choose between "you're" and "your" --which is of course the whole joke. Maybe use "yer"?)
#5 buddy larsen on 2008-11-14 17:29 (Reply)
" ... help them grow up and take charge of their lives."

It jumped right out at me too. So mental illness is caused by immaturity. Hmm.
#6 Richard on 2008-11-14 20:01 (Reply)
I always hate it when I see a lot of dumb comments on alcoholism made by people who have little or no knowledge of the subject, but are quite willing to lower the average IQ by sharing their lack of knowledge.

Alcoholics have some common characteristics. One of those is an inability to see life as it is. Rather, they will see life as they think it should be. Developing the ability to see life as it is, is called "growing up". There was nothing condescending about the original statement. It is a statement of fact.

Other idiotic comments fail to understand the profoundly different effect alcohol has on an alcoholic. Alcohol creates a craving and is impervious to rational thinking. That is why an alcoholic will keep drinking long after others are satisfied. Alcoholism is a disease of "more".

If you have no knowledge of these things, please don't make dumb comments. it is virtually impossible for a non alcoholic to understand alcoholism.

Rick

Rick
#7 Rick C on 2008-11-14 20:47 (Reply)
This thread and post is not about alcoholics. Reread the post.

"One of those is an inability to see life as it is. Rather, they will see life as they think it should be. "

It may be that the ability to see life as it is is what makes a person choose alcohol. It may be they know their life isn't as it 'should be' and can't cope. Pick any addiction and you might find the equation the same.
`
#7.1 Meta on 2008-11-14 23:46 (Reply)
Reality is for those who can't cope with drugs
#7.1.1 buddy larsen on 2008-11-15 00:24 (Reply)
Yet there's plenty of reformed alcoholics. They quit somehow. That's just a fact.
#8 buddy larsen on 2008-11-14 22:12 (Reply)
It's not one-size-fits-all. Some need AA, some find it makes them worse. Some need talk therapy, some find it makes them worse.

As to the degree of choice or control a person has, it is better not to think of it as an either-or. People have neither complete control nor no control over their actions. Giving in to addictive behaviors diminishes your control over time, but that never goes to zero.

Showing up for a second appointment is not that hard. Sitting through a few AA meetings to see if they work for you is not that hard, even if they bore or irritate you. People who refuse to endure the slightest discomfort are not going anywhere. You have to be willing to place some gift on the altar, even if you no longer have the ability to pay the full cost.
#9 Assistant Village Idiot (Link) on 2008-11-14 23:03 (Reply)
It's not one-size-fits-all. Some need AA, some find it makes them worse. Some need talk therapy, some find it makes them worse.

As to the degree of choice or control a person has, it is better not to think of it as an either-or. People have neither complete control nor no control over their actions. Giving in to addictive behaviors diminishes your control over time, but that never goes to zero.

Tangent alert: Blogroll comment. If Americans are allowed in the category, I think I belong in Anglosphere.

Showing up for a second appointment is not that hard. Sitting through a few AA meetings to see if they work for you is not that hard, even if they bore or irritate you. People who refuse to endure the slightest discomfort are not going anywhere. You have to be willing to place some gift on the altar, even if you no longer have the ability to pay the full cost.
#10 Assistant Village Idiot (Link) on 2008-11-14 23:05 (Reply)
I got a rise out of our readers. Shrinks have feelings too, and do not enjoy being blown off any more than anybody else. Re AA, I think it is wonderful. Readers missed the detail that this consultation was not an active user, just a person who had an unsteady life story and a prior coke habit. She wanted help with her relationships, feeling that they were too immature. I can help with that, but there is no doubt that unreliability can be a problem with users - and many non-users too, which can be part of their problem with relationships. BTW, I think I have been very helpful to many substance abusers over the years, and have the utmost respect for those who conquer it with God's help.
Re the "growing up" thing - everybody can use some of that, including me. It's neither condescending nor demeaning. All it means to me is taking better charge of one's life, and building it in the way you want.
#11 Dr B on 2008-11-15 08:25 (Reply)
Making needed changes in one's life is probably not as difficult as it seems --what's difficult is overcoming the invisible barrier to all initiative, that root of much evil, that perverse attempt to out-duel mother nature on the very battlefield of Time itself: "procrastination".

IOW, most of us can fix ourselves --but not right now --later, when the time is right.
#11.1 buddy larsen on 2008-11-15 11:13 (Reply)
Welcome to being blown off, Doc. Why just this week I was told to go to church with sinners like me so they could help me with my 'fangs and claws' and some breast feeding mojo.

You had a syntax error: "...help them grow up..." is an infinitive and the way you used it indicated you could bring about a finite state. "Growing up" is a continuum. That was the problem, but you cleared it up here.

Did you go to church with sinners and get help with your syn tax?

:]

`
#11.2 Meta on 2008-11-15 18:12 (Reply)
meta, what if i said i thought you perhaps have 'authority issues'?
#11.2.1 buddy larsen on 2008-11-15 20:17 (Reply)
I mean that in a jesterly way of course --heh heh (*sweat*) (*tugs shirt collar*) (*wishes he had a do-over on previous comment*).
:-(
#11.2.1.1 buddy larsen on 2008-11-15 20:21 (Reply)
haha. God, I hate the word "issues". As far as me having problems with authority, I don't any more than I do with any other person. "Authority" means nothing to me. Using your 'place' to demean others matters a great deal to me.
`
#11.2.1.1.1 Meta on 2008-11-15 21:23 (Reply)
"Using your 'place' to demean others matters a great deal to me"

A courtesy Olde Fashionede and rare, a tiny shimmering jewel in the dark void of the categorical imperative.
#11.2.1.1.1.1 buddy larsen on 2008-11-15 21:56 (Reply)

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