When clients fall ill, have scheduling conflicts or bad weather strikes, a full-length session over the telephone can be a viable way to provide treatment in lieu of a client coming to the office. In fact some experts in specific areas of Psychology have entire practices based on phone therapy so that they may work with people all over the world. My understanding is that there isn't intensive research conducted on the efficacy of telephone therapy but that most practitioners believe it can be a useful alternative to a face-to-face session.

Like all forms of therapy such a system is far from perfect. Insurance companies do not pay for telephone sessions. A crackling cell phone can interfere with communication and something is missed when I can't see my clients non-verbal cues. If there is a long pause during a face-to-face session a client is usually either thinking about the conversation or has nothing to say at that moment. Over the phone however it's difficult to tell: is he jotting down a note about something we're discussing? Thinking about the unbelievably potent insight I've just delivered? Could he be reading his email or eating a sandwich? Did I just piss him off and he's giving me the finger?

Recently I got a call from a client, I'll call him Charlie, who stated that he had had an argument with his spouse. Again. He was hoping to come in for a session to talk it through, "because it was my fault as usual." I accommodate clients as best as possible but I simply didn't have any available space that day. Rather than waiting for the first available appointment the following morning he asked if I could do a telephone session at the end of the evening. I told him that I would be driving home from the office at that time but as long as he didn't mind some outside traffic noise it should be fine.

I have a fairly ancient cell phone with a horrible speaker. I've always found headsets and those Blue Tooth things to be cumbersome and, quite frankly, they look ridiculous. It's like a gigantic mosquito has settled onto a person's ear. I also hate the idea of not speaking into a phone. I feel bizarre just throwing words out into the air. So like every other person who doesn't think things through I drive with the phone to my ear, violating New York State law. You would think after seven tickets over the past few years I would have learned something. It takes me a long time to learn things.

Ten minutes into the phone conversation with Charlie I had learned that he was very anxious at having yelled at his wife (again) for burning toast that morning. Charlie has what is known in some circles as Low Frustration Tolerance (LFT). It can sometimes be helpful for clients to put a label to a specific concept that they are trying to work with. As I started to remind Charlie about LFT and its relevance to his immediate problem the flashing red and white lights popped up in my rearview mirror.

"Charlie I'm going to have to call you back in a few minutes," I said.

"Wait! You're not going to charge me for the time off the phone are you?"

"No Charlie I won't do that. I'll make sure you get your full time. I have to hang up now," I said and snapped the phone shut. I considered throwing it out the window and pleading innocent ("Cell phone? What cell phone?") but then remembered that paying a fine costs less than paying a fine and buying a new phone.

I know I am not above the law but I am also not above attempting to get out of tickets. I once feigned a southern accent in an attempt to convince the officer that I was from out of town and my crime was simply an act of ignorance. The attempt was laughable and didn't fool him. This time I decided to put my doctorate to use.

"License and registration please."

"Officer, you have to understand that I'm a doctor and that phone call was a clinical emergency."

"Is that so?" he said suspiciously, eyeing my clothes from the Gap. "You look a little young."

"I'll have you know I'm 36 years old and a private practitioner with a full case load of individuals who need my assistance."

"What type of doctor are you?"

"Um...I'm in mental health."

"A Psychiatrist?"

"In a way."

"What kind of way?"

The untrue way. "I'm a Psychologist."

"I see. And what was the 'clinical emergency?'"

"A client, no a patient of mine is having significant interpersonal skills difficulties with his significant other leading to cognitive distortions that are impacting his mood negatively and significantly I should add. I was restructuring those thinking errors to buoy his mood and reduce any associated anxiety."

"Sir I have no idea what that means nor do I care. Was the man suicidal or homicidal?"

Unfortunately no. "I haven't done a complete risk assessment as of yet."

"Why don't you just tell me what you were doing on the telephone without a headset?"

I hung my head, defeated. I decided to resort to honesty as a final hope for redemption (i.e., no $85 citation). "I was doing a phone session with a client on my way home from the office because he got in a huge fight with his wife and started to feel anxious. I was getting ready to talk him down from the anxiety by going through some simple breathing instructions and by reminding him that he is constantly blowing a gasket over the simplest mishaps on his wife's part which is making both him and her miserable." Are you happy now?? I'm not a real doctor. There was no real emergency. I just try to help people through talk...which is laughable. I suck at life. It's no wonder my friends never call me.

"Did it help?" the officer said.

"Did what help?"

"Talking with him."

"Not yet. We got derailed from our conversation when you pulled me over."

"Well that was nice of you to try to help your guy out on your way home from work." He scribbled something on his pad and handed it to me. It was a warning, not a ticket. "Get yourself a Blue Tooth, Doc" he said and walked away.

But I'll look like such a douchebag. "Thank you officer" I yelled as he closed his door.

The lesson here is that honesty is the best policy. And don't break the laws of the road. And buy a Blue Tooth. And if your name is Charlie stop yelling at your wife over burnt bread. There is probably more to be learned but I've had enough of morality for one day.

Walking through Barnes and Noble recently I noticed a book with a familiar title. It was by Dick Masterson, the man who stole the show on Dr. Phil, the man I had interviewed just a few months ago as part of my research into the mind of misogyny.

Even though I patently disagreed with his beliefs I was morbidly curious to see what "MANspiration" Dick was giving out in his tome. He did say nice things about both his mother and prostitutes during our interview. That was nice of him. And it did cross my mind that I could continue my research using his book as a resource.

Tucking the book under my arm so that a woman wouldn't see me holding it and begin to think I'm a woman-hater, I purchased it from the only male cashier in the store. He gave me a knowing wink as if I had entered the gates of some perfect Man-topia.

Flipping through the book on the subway I noted the venom that is vintage Dick Masterson:

You women are delicate creatures and don't have the stomachs or the brains to look into the supernova of raw and uncensored man-logic that compromises this book. Your fragile women-psyches cannot stand the depths of sophomoric intellect this book conjures on every page. Women, feel free to go broaden your horizons with healing crystals, Feng Shui wheels, or any of that other new-age monkey shit. Ever wonder why no one who anyone respects - like your father or Donald Trump - buys into that crap? Of course you don't, because you're a woman. You don't wonder about anything.

Such disdain. Such hatred. Some of my female friends have healing crystals. They wonder, don't they? In fact one said to me the other day "Rob I wonder why anyone would read your website. It's pretty dumb."

But Dick didn't rely on anecdotal women bashing. He incorporated research findings into his argument that women are the cause of divorce:

Women are always the reason for a divorce: your wife, her bitchy friends, her mother, even your own daughter, all conspire against you to fuck up something that's sacred. Women are sacrilegious as shit.

Don't believe me? Perhaps you'll believe my friend, Science.

Gordon Dahl and Enrico Moretti are responsible for the following data:

Parents of girls are 5% more likely to divorce.
Parents of three girls are 10% more likely to divorce.

This was a complete manipulation of important data! It is not clear why boys hold marriages together but it certainly doesn't prove that women are "sacrilegious as shit." Although my mother did once tell me that if I were to get married my wife would most certainly divorce me within a year, so maybe Dick was on to something.

Finally Dick decided to put all mental and physical health professionals out of work with his simple solution to Erectile Dysfunction (ED): cheat on your wife.

My grandfather had ED. For awhile. Then it went away. Did Pop Pop cheat on Grandma? If Dick had been counseling him over the years there would be hell to pay.

I had had enough of this horrific, disgusting, sickening, abominable, intriguing, page-turning, witty and entertaining book. It was time to contact Dick and tell him that I was done with my research into misogyny.

To: Dick Masterson (DickMasterson@gmail.com)
From: Rob Dobrenski, Ph.D. (RDobrenski@aol.com)
Subject: Termination of Professional Relationship

Dear Dick Mr. Masterson:

Upon careful consideration I have decided that it would be unacceptable for me to continue to read your well-written book as part of my clinical research into the mind of misogyny. This is in spite of the book's colossal merits as a provocative work that you should be ashamed of yourself for having written. You continue to have no respect for women. Thus, as much as it pains me to say, you should consider our relationship null and void. I hope you understand.

An hour or so later I got a response from Dick:

To: Rob Dobrenski, Ph.D. (RDobrenski@aol.com)
From: Dick Masterson (DickMasterson@gmail.com)
Subject: RE: Termination of Professional Relationship

Of course I understand. Trying to objectively find anything wrong with chauvinism once you've read my book is like trying to look North when you've got the North Pole shoved up your ass.
You can't. And it hurts.

As far as respecting women goes, you're right. I don't. I don't respect a microwave for popping my popcorn, I don't respect the fridge for chilling my booze, and I don't respect women for popping out kids and bitching about what a great job they're doing. That's what they were built to do.

By the way, if you or any of your colleagues want to turn that "clinical" research into "practical" research, I can recommend a few other books that will have you guys knocking the pussy off that pedestal like it was a big bronze statue of Saddam Hussein -- and then also riding it into the Soviet Union like you're Slim Pickens.

Yeehaw.

Stay manly,

-Dick

P.S. If you're done reading my book, remember what I tell all the dissatisfied feminist [deleted expletive that my mom would really hate reading] getting copies of Men Are Better Than Women as graduation presents this year.

Don't return it...just burn it.

It doesn't take Sigmund Freud to know that this is clearly a cry for help. Anyone who mentions Saddam, the former Communist stalwart and the beloved star of Dr. Strangelove in the same sentence clearly needs intervention. However, as we learned help cannot be foisted upon a person. He has to want it. And he has my number. So I will sit patiently and wait for his call at which point I will show him the error of his ways. I'm sure he'll call soon...

Silence. Tumbleweed blows by office door. Fade to black...

Dr. Rob,

Recently I was severely depressed over the death of a close family member. During this time, I started to have thoughts of suicide and while I would never have acted on them I was thinking about it enough that I started to read about suicide online.

What I found startled me. I found "suicide blogs" where people count down the number of days until they kill themselves. And this forms its own little culture with some people writing in to talk the writer out of killing himself or even to encourage him to do it. The furthest I've seen it taken is for the commenter to ask the writer to form a suicide pact.

My understanding is that many of the sites aren't real but I still think that glorifying something like suicide is unhealthy, especially when someone who is intense emotional pain may not realize that.

I suspect you think the same but I'd like to hear more about your take on blogs such as these.

Thanks

You are correct. I do think it's wrong. Who in the mental health field wouldn't? I've heard about these sites and they basically glamorize suicide and portray it as this hip trend that everyone should be considering. Whether the sites are real or bogus, anti-suicide groups are working hard to prevent this type of material from reaching the internet and many countries are asking their governments to get involved.

In graduate school students are taught to treat any and every suicidal thought and gesture seriously. This does not mean that you should attempt to hospitalize every person who mentions thoughts of killing themselves (with a clinical approach such as that you will ultimately alienate your clients as they will feel unable to open up and be honest with you). What it does mean however is when thoughts of self-harm and death do come up they need to be discussed: are these simply passing thoughts of dying? Does the client actively think of ways to hurt himself? Do the person's religious beliefs (if any) prevent her from taking any action? Have these thoughts occurred in the past and, if so, how were they dealt with? It is common for people who are struggling to at least entertain thoughts of death and by telling clients this fact you can free them up to talk openly about their thoughts. It is only when their thoughts might morph into action that a Psychologist is faced with the prospect of needing to hospitalize a client against his or her will. This is not only the code of mental health practitioners but also the law.

There is an important and often misunderstood fact about suicide: people do not commit suicide because they want to be dead. People kill themselves because they don't want to suffer with their intense psychological pain anymore and cannot think of another way to free themselves from it. I had a professor say to me "tell a suicidal client that you won't stop him from killing himself once he doesn't feel depressed anymore. Promise him that. Promise him you won't even try to stop him if he isn't depressed anymore. Then watch what happens over time. Once he's not in such a horrible spot he'll lose some interest in the suicide plan." Whether there are exceptions to this or not, every single suicidal person I have spoken with has agreed that if they could simply feel better they might want to stick around. This admission by a client is an opening to offer help and the possibility of thinking and feeling differently. This is usually is quite helpful. With time and intervention most people are able to stop thinking along these lines.

Unless a writer explicitly stated that he was not suicidal I would follow my training and treat the blog as valid and serious even if I ultimately look like an idiot for doing so. This would be despite many people's take that the site is possibly a complete hoax and that the writer is a total is seeking attention, web traffic or simply gets off on playing with peoples' emotions. I have no firsthand knowledge of how many sites are real versus fake; regardless it is a twisted enterprise.

Writers of real suicide blogs should know that they are in all likelihood depressed and both need and deserve help. Bogus writers need to realize that they are using the most extreme form of self-harm to generate traffic for their websites and are duping naive and vulnerable people into thinking that suicide is a wonderful thing. This is essentially self-absorbed manipulation and exhibitionism. In other words they are ill. I say this in the pejorative sense because they are the ultimate attention whores. I feel sorry for these people. Maybe at one point they were very depressed and needed help. But now they see their former struggles as a way to garner pity and approval. Either way it's a disturbing mess.

I have noticed that many of my clients have certain behaviors that are possibly impeding the therapy progress. Whether it's commenting at length on the curtains in the office or complaining about the poor parking situation at Dr. Steve's office suite (which, for the record, is completely understandable as the parking is horrendous there), these behaviors are possibly interfering with the therapeutic work if only for the fact that they are cutting into our valuable time to work together on problems.

In the past I've talked with clients about these behaviors in detail to understand them better: are they occurring as a way to avoid talking about painful material? Are these behaviors a way to learn more about me? Are they simply a function of self-consciousness? Given that I am a Cognitive Therapist and not a Psychoanalyst these conversations are proving to be more a waste of time that a moment of enlightenment.

Unless I believe these behaviors are truly relevant to a client's difficulties they will be abolished from this point forward. To that end I, Dr. Robert Allen Dobrenski, have decreed a small number of rules and regulations to be enforced in the private sanctuary that is my office. In addition to the standard sanctions against intoxication, nudity, bare-feet, verbally abusing me, physically assaulting me, refusing to pay for services, laughing at my new haircut, calling me 'funny looking,' spitting on my floor and/or furniture and other faux-pas that are highly forbidden in a professional relationship with me, there are new prescripts that are required starting immediately:

1) Stop Looking at me Looking at the Clock

I need to keep track of the time at a few standard moments during the session. The details of time structure for a cognitive therapy session are beyond the scope of a single blog post but it's important to realize that I need X number of minutes for multiple topics: updates since the last session, review of any therapy homework, summary of the topics covered today, planning for the upcoming week and feedback for the session, not to mention other items.

If I'm not on top of these things very often nothing gets done and the session turns into a glorified coffee hour. While I enjoy my coffee just as much as the next person, this is unacceptable. It's a waste of clients' time and money and they deserve better than that. What is also and perhaps even more unacceptable to me is being called out as 'looking bored,' 'wanting me (the client) to leave,' and 'thinking about how much money I'm making per minute.' I'm only looking at the clock to keep the well-oiled machine that is the office running smoothly and efficiently. So stop staring.

2) Stop Wondering why I'm Yawning

I am not the best sleeper, and writing blog posts at 4 AM, as I am doing right now, doesn't help that issue. If I'm very tired on a particular day I will usually inform a client of that fact before the session starts as a pre-emptive strike against offending someone if I yawn or have a glazed look in my eyes. This also protects me against false claims of heavy drug use. The reality is that yawning is going to happen at times no matter how riveting the conversation. I am not necessarily bored if I feel sleepy in session. And even if that were the case it is certainly not the end of the world.

No client is responsible for being the most entertaining or amazingly interesting person who comes through the door. Life is often slow and uneventful and if there are moments of boredom for either therapist or client in session it should be discussed and not taken as some personal affront that the client is the most unbearable person on the planet. Dr. Pete is insufferable, my clients are usually not.

3) Do Not Comment That I Look "Up and to the Right" When I'm Deep in Thought

I've been doing this since I was 12 and I have a feeling that's never going to change. I do it in my own therapy sessions, when socializing, really any time someone asks me a question or I'm pondering something of any importance. That's why I don't think much when I'm crossing the street in New York City. I'll end up staring at a cloud and getting run over by a cab driver who will later sue me for breaking his engine grill with my face. The eye movement is just one of my few thousand quirks. I don't know why I do it and unless my Ophthalmologist says I'm going to give myself retinal cancer from it I am not going to fret over it.

4) My Wardrobe is not Part of the Therapy Discussion

I wear either a) khakis and a button-down shirt or b) jeans, a button-down shirt and a blazer. I don't own a suit and perhaps never will because I hate ties. I also have bad taste in shoes - so bad that Dr. John's sister said that I was an "embarrassment to feet" - so let's just ignore that part of my work attire as well.

5) We are not Going to Analyze Whatever Book is on my Desk

Reading Buddhism for Dummies doesn't make me an anti-Semite and A Confederacy of Dunces on my desk doesn't mean I hate the South. In fact my Jewish friends tell me I'm quite open to all religious viewpoints and SEC football is top-notch so I'm not a hater on these fronts. I'm sure there is some deeper meaning behind what I'm reading at any given moment but we're not getting into that during therapy time. That's what I pay my own shrink for so let's make her earn her money.

These are the new rules which are non-negotiable. I haven't as yet thought of a swift and acute punishment for breaking the new rules other than having to talk about it with me, but since the client is already there to talk it's not much of a punishment. Make no mistake, however, I will come up with something so repugnant that clients will never comment on my eyes, clothes, shoes, books, clock-watching habits or my sleep patterns. Maybe I'll raise my fee $1 if clients breaks one of the rules. That'll teach 'em.

This question seems to come up a lot from readers, so rather than answer thousands (dozens) of emails let's just address it here.

I would never dissuade someone from going into a helping profession. We are a society that is so focused on money and accumulating assets that to have someone want to help and give to others is a fantastic personality trait. That being said becoming and being a Psychologist is definitely not for everyone. There are many positive things about this line of work but you must be able to answer affirmatively to some important questions.

(Note that these points are not necessarily applicable to those who want to become Social Workers, Psychiatrists and other types of mental health professionals such as counselors and substance abuse case workers. I addressed some of the differences between those fields and if enough questions come in regarding specific details I'll post on that in the future. The details of this are also based on my knowledge of practicing Psychologists in the United States, although most of this is likely applicable to other countries as well):

1) Do I want to commit to the extensive schooling?

Virtually all graduate programs require at least five years of graduate education just to get a doctorate and another year or two to get a license to practice independently. This usually means that if you are hard-working you'll have your Ph.D. (or the less commonly obtained Psy.D. after four years of formal education and one year of internship.

If you attend a program that has a strong research component you could easily be in graduate school for more than seven years. I met a Psychologist who went to a program that forced him to do so much research before graduating that he could have easily gone to medical school twice in that same time period. He didn't realize that going in and I'm still shocked that he didn't go postal during his training.

I got my Ph.D. at 29, which is considered fairly young. But during that schooling most of my friends were establishing careers and starting families. Of course it's possible to get married and have kids while in school. However, because you need to complete not only your course work but also work in clinics and hospitals, assist your professors with their research as well as complete a Master's Thesis and Doctoral Dissertation, time can be at a premium. Miraculously I learned to play golf (poorly) and guitar (even more poorly) during school but that was simply because I forced myself to take up hobbies to take my mind off of psychology and to keep myself balanced. But if I hadn't kept my focus on school I might have become a mediocre golf instruction at some non-prestigious country club or the rhythm guitarist for an unpopular chick band.

I was lucky, too, in the fact that I always knew I wanted to be in mental health in some capacity. I was always fascinated with what made people do what they do, what made people tick, and I've always liked sitting with people and simply talking with them. That helped me keep my focus during my graduate work. Not everyone has a similar experience and many people go into mental health as a second career. I've met many Psychologists who began their training in their 30's or 40's after trying their hand in business or real estate or the arts. This can actually be a benefit for some given the life experience they bring to the table. But to go back to full-time schooling and the demands that come with it requires a very serious commitment.

2) Do I want to spend the money?

A little-known secret is that, depending on where you go to school you can get tuition wavers and stipends. Professors' research grants will often fund students' education so you may not have to pay for anything. Directly. However, unless you live the most meager existence you will likely be taking out some loans to pay for your day to day operations (e.g., pizza, beer, waffles, soap, Axe Body Spray, etc.) because your stipend is truly a pittance. So while you don't necessarily have to go hundreds of thousands of dollars in the hole for your training, many people will have at least $40-50K in loans by the time they graduate. If you attend a school that doesn't offer such assistance I would imagine you are looking at least $175K in debt by the time you are done.

3) Can I be happy without being rich?

While it is possible to make a nice living as a practicing Psychologist (consider Dr. Steve who makes well over $250K), more often than not you will be making significantly less money than your medical peers or your friends on Wall Street. Psychology doesn't have to be purely a labor of love but if you lose sight of what the goal of the field is (i.e., the assessment and treatment of psychological distress) you can end up bitter and resentful. This will invariably hurt your job performance. Graduate school teaches you little about running a private practice so the more successful Psychologists have developed a rudimentary knowledge of business and finance. I was fortunate enough to meet a seasoned Psychologist who took me under her wing and taught me how to market a practice, speak with clients about the realities of paying for services, how to work with managed care companies and how to invest both time and money into my practice. And as painful it is to admit, watching Dr. Steve's practice grow didn't hurt my knowledge base.

Some Psychologists simply take a salaried position in a hospital or clinic and leave it at that. As a whole that group makes less income than practitioners in private practice. As an example, in 2002 I was offered my first job at a hospital in New York City that paid $60K. Most private practitioners in this area probably clear six figures but New York is a "therapy friendly" city with a lot of people seeking services. I have colleagues in the Midwest who make under $50K per year.

4) Can I actually do the job / Am I insightful?

This question looks deceivingly easy to answer because no one wants to admit they are not insightful, but give this serious thought before answering. Insight is not simply high I.Q. Insight is an understanding into the nature of human thought, emotion and behavior. Why do people make poor choices? Why are some people depressed when there is nothing overtly wrong with their life? Why can't that person just simply stop washing their hands every 30 seconds? These are questions without direct, linear answers and it takes patience, understanding and a lifetime commitment to learning about human experience to be able to help others.

Perhaps more importantly becoming a Psychologist involves insight into yourself. Before you can hope to understand the problems of those who come to you for help, you have to understand what is going on in your own head. ShrinkTalk.Net has always been about showing the "human side" of mental health professionals. If you're a regular reader you know the foibles of both me and many of my colleagues (most of them aren't pleased about that fact but I will not sacrifice my art). If you don't understand your own idiosyncrasies, neuroses and quirks, you could become cold or condescending toward your patients. Or maybe you just lack a real grasp of the dynamics that develop between you and the people you interact with. Just look at Dr. Pete who was in all likelihood self-medicating his Social Phobia and only recently decided to take a very close look at himself. If he hadn't taken that step I imagine his job satisfaction and performance would have ultimately suffered.

5) Can I accept the fact that I can't "cure" everyone?

The sad reality is that not everyone with psychological/psychiatric problems benefits from therapy and/or medication. Certain problems like Antisocial Personality Disorder and extreme Schizophrenia do not have great track records for treatment. For many conditions you must realize that there is a "ceiling effect" to treatment. This essentially means that certain problems, while they can be worked with to some degree, don't necessarily disappear completely.

For example, the treatment of Obsessive-Compulsive Disorder (OCD) has a success rate of about 80% when both medication and therapy are used. In other words if a client has very good results they can anticipate, on average, an 80% reduction in their symptoms. These facts are particularly important to know as a Psychologist because you need to be honest to both the client and yourself about what can be expected. Without this understanding you are likely to experience "burnout," which is usually caused by lack of results in the treatment room.

This was and still is quite a kick in the teeth for Allison who thinks that every person who comes into her practice is going to walk out a completely different person. The reality is that while many people can and do benefit from therapy or any other intervention there are often clear limits. And even though all of us in the field need to be striving for 100% success rates with all clients, until that happens those limits need to be recognized and acknowledged. This will keep you grounded, not too frustrated with anything short of perfection and ideally free from burnout. Fortunately I've only been practicing independently for about six years so it's probably a bit early for me to burnout (this usually occurs much later in a clinician's career). And I'd like to think that I've got these important points mastered in my own head. But then again what shrink doesn't think that?

6) Can I deal with and confront "neediness?"

Over the past twenty minutes I've received six voicemails. Three were from clients who "need to speak to me immediately," two were to change appointment times to "something that works better for me" and one was from a dad who "wants some advice on how to deal with his kid." Can you set appropriate boundaries so your life remains in your control? I put neediness in quotes because in my experience most people (although not all) don't maliciously try to exploit me or my time. Rather they are in psychological pain and don't know what to do about it. But you can't cater to every whim nor appear at every beck and call. Psychological difficulties are worked through over time as opposed to a phone call or a few magic words. To do the job well, not only do you need to be patient but you have to teach your clients that as well.

Similar to Tucker Max's advice on whether or not you should go to law school I would advise anyone considering this line of work to spend time in the mental health field. Volunteer at a community mental health center, do research in the field with a professor at your university, or even take a job as a receptionist at a large private practice. See what the day to day life in those settings is all about.

More importantly, go to therapy. Some graduate schools actually require this so you might as well get a head start and learn more about yourself. No one has the perfect life and everyone has "issues." Start to talk about them with a professional. This will not only help you to learn more about what therapy is but will also start to hone your insight about yourself and the way you perceive your world (see point 4). If you're not sure how to begin this process read my post on finding a therapist. If the idea of being in therapy seems ridiculous to you because you already know yourself, you have all the answers or that therapy is for crazy people then it's clear that another career path is probably best for you.

All that said, being a Psychologist is a fantastic profession in many ways. Whether you ultimately teach, work in a hospital, become a researcher or run your own private practice you will be contributing to the welfare of mankind. And helping someone change their life from one that is dark and painful into one that is hopeful and worth living gives you a rush like watching Dr. Steve's Lexus get crushed by an anvil. If you are cut out for it then climb aboard. But if you're thinking about becoming a shrink and writing an online column about the life of a Psychologist, think again. That is my gig and I'll club you to death if you steal my thunder.

If other Psychologists/mental health professionals want to chime in, please do so in the Comments thread.

Dr. Rob,

I'm a second year graduate student in Psychology at ________ and I'm just starting to develop my therapy skills. At our school we are encouraged to speak to undergraduate students about therapy and its merits but, truth be told, I'm not very good at it. Do you have any success or failure stories about educating potential clients about therapy and what it can do for them?

Alex

When I was a second year graduate student I was 25 years old with a baby-face that belonged in a junior high school yearbook. Granted it was an amazing face but most of the professional words that came out of it were met with skepticism if not outright laughter and mockery due to my lack of professional credibility. In retrospect I'm probably lucky I wasn't stoned to death so I sympathize with your plight.

Many people come into mental health practices feeling miserable but have no idea how seeing a psychologist or psychiatrist can be helpful. Often these people have had symptoms that they've simply dealt with needlessly and will come in when a friend or family member pushes them to seek help. During my first year of graduate school I saw a young man, I'll call him Jason, who had scheduled an appointment because he recently had been having poor sleep, trouble concentrating on his schoolwork and he felt "jittery" most of the day. His symptoms were very scary for him and, having never seen a mental health professional before, the idea of talking to someone about his problems was very foreign. That in combination with my imposing height (5'11''), massive girth (165 lbs.) and eyes (green) probably left him feeling very intimidated by the entire situation.

After talking with Jason for about 30 minutes it was clear that he was suffering from what is known as Generalized Anxiety Disorder. The treatment options for GAD are therapy, medication or a combination of both. When anxiety isn't debilitating (i.e., the person attends school or work without major impairment) and hasn't been a problem for a lengthy period of time medication isn't usually considered a first line of treatment unless the patient prefers it. Therapy can usually work pretty well in cases like these.

One of my professors warned me to be careful of the terminology used when offering treatment to clients who are not expecting it or have never been in therapy before. The word "psychotherapy" can scare people simply because of the "psycho" part. We have Alfred Hitchcock to thank for that. "Therapy" is a little vague and is used in many different settings (e.g., physical therapy). Jason was pretty distressed at being told that he had an "anxiety" problem so carefully chosen words were required.

"I think you could benefit from having someone to talk to," I said.

"What do you mean, talk to someone? Like a psychiatrist? Do I have to go to the hospital??"

"No no," I said, smiling my big baby-face smile in an attempt to seem like a mental giant who has all the answers. "I mean sitting down with one of the graduate students here and talking through some of your difficulties."

"Wait, do you mean, like, psycho-ther-a-py?" he said with a look that was half suspicion, half terror. He pronounced the word 'psycho-ther-a-py' with a fearful timbre, as if I had just offered him a 'pe-nis-ec-tomy.'

"What?! Psychotherapy? That's ridiculous. Here, um...we call it 'growth enhancement.'" Strangely this term is almost the opposite of the Penisectomy that came to mind when he said 'psychotherapy.'

"Growth enhancement? I don't understand. Like counseling?"

"Yes yes! Counseling is a great term!"

"Mr. Rob, I don't understand all these terms and you're confusing me. Just call it what is and tell me what's involved."

Therapist Rule: A client's belief in his success can play a significant role in therapy outcome. Thus it is important that he be given accurate and ideally hopeful information about what therapy can do for him to maximize the likelihood for a positive outcome.

Having been called out on my idiocy (a real shocker there), I fessed up. "You're right, let's call it what is. I'm suggesting that you see a therapist for psychotherapy. Psychotherapy is just a fancy term for using talk to help people feel better about psychological problems. It helps people to change the way they think, feel and behave. It helps people to lead happier lives. In your case I would recommend a therapist who could help you to better understand what exactly is making you anxious and show you ways to control it."

"But how does talking help?"

"That's a great question and the truth is that no one knows for sure exactly how it works. That being said you might want to think of your brain as a muscle. If you hurt a leg muscle and went to physical therapy you would exercise that muscle, stretch it, move it, get it active. The same is true for your brain. It needs to be worked-out properly. A good therapist can help you to get your brain to flex itself and to think differently. This will make you feel better. In other words, having a guided series of discussions can help you change your thoughts and feelings. How does that sound?"

"I know I want to feel better."

"Then why don't you try it for awhile. I really do think it will help."

"Will you be my therapist, Mr. Rob?"

"No, I'm just a first year. I only do evaluations at this point. And stop calling me 'Mr. Rob.' I'm only three years older than you and you're making me feel like some perverted uncle."

Sure enough Jason began working with a therapist in the clinic. Although I never did get the details of his sessions, I was told that he got some very good results in a reasonable time frame and was off and running. Apparently Jason's departure was a real downer to the female students as he was 'so hot' that they were upset he wasn't coming into the clinic anymore. They still had me, though, so they really had no right to complain. Whatever, graduate students clearly don't know a good thing when they see it.

Today we're joined by internet celebrity and multiple psychological affliction sufferer Jesus Martinez, author of DrunkenStepfather.com. Despite struggling with alcoholism, impotence, self-loathing, an unsatisfying marriage, stepfatherhood and obesity, Jesus has carved out a successful niche for himself as a Mexican blogger located in Montreal, Canada. His areas of expertise include boozing, sex and the bashing of our beloved celebrities who are constantly making asses of themselves as they parade the streets living their frivolous existence. As many of you know full-time blogging is time-intensive so we're grateful to have him with us today. I suspect he is drunk right now given his extremely comprehensive answers but having had a stepfather myself I can see why intoxication would be a daily part of any stepdad's regimen. Believe me I was a nightmare to live with.

For those who are not familiar with your work, could you elaborate on the psychological phenomenon that is celebrity gossip?

People are clearly miserable in their lives and enjoy experiencing the flaws, failures and human weaknesses of celebrities because celebrities are made out to be the end all be all of success, glamour and luxury. I guess it makes them feel better about their useless existence. It's one of those kick the motherfucker off their high horse then kick them while they are down and find pleasure in it. I'm not the doctor here, you probably have a much better take on this, but I know people are into it and I'm into being an asshole so it kinda all works out. The truth is that I am not really a gossip site but more a skin site. I usually focus on female celebrities who everyone likes to shit on even though they are substantially better looking than their wives, girlfriends or pretty much anyone they've ever banged. I guess it's the same kind of resentment guys have for the high school cheerleader in their class, they all want to fuck her but she won't fuck them so instead they either laugh at their misery or do something worse that you'd see on an episode of CSI, but I'm not into morbid shit or physical pain to others so I'll leave it at that.

Yes, leaving it at that sounds like a good idea. Jesus, you've written extensively about your difficulties as a husband, stepfather and Canadian. Are you currently seeking treatment for any of these afflictions?

You know what, I went to court ordered therapy once. It was kinda fun but that's just because I like fucking with people, so I'd lie to the guy and get prescriptions to meds I didn't need but had fun taking. In recent years I joined some group therapy shit for material, I guess I kinda ripped off the idea from fight club but met a lot of weird fuckers. I also did some cognitive therapy where you learn breathing exercises because I stopped drinking and suffered from severe panic attacks and was prescribed some shitty anti- depressant that I didn't want to get caught up in. It was one of those take daily so that you can stomach your shitty job, shitty wife and lose all sense of your individuality, neurosis and creativity. I wasn't down for that but I wasn't down with panic attacks either. My psychologist was fresh out of school, probably 24 and I'd just tell him drinking stories, sex stories and all that good stuff, which wasn't the nature of the session. He'd always get me to shut up and pretend I was on the beach and stuff. I considered him to be my only friend at the time, but he never sent me a birthday card, so I pretty much wrote him off. That said, I am back on the bottle and it's been a good time, probably not so good to my liver but who needs a liver when you're dead...right?

Oh definitely, a liver is useless at that point. And since we don't have a professional relationship I will send you an e-card this year. Now, you've made it clear that you would like to have sexual intercourse with many of the celebrities you write about. This desire is in spite of the obvious adulterous implications as well as your self-reportedly rampant impotence. That being said, who is at the top of Jesus' "To Do" List?

I think it's one of those want what you can't have situations. Historically, I had lots of sex with lots of girls all of whom were probably 6's on my scale which is more like a 2 or 3 to the rest of the world. I am talking fat and disgusting or skinny and disgusting, addicts, vagrants, homeless chicks, drunk and horny girls. I've pretty much been there and done and it's left me scarred. Not nearly as scarred as marriage. I've cheated on my wife, at least I did in the beginning before she put an end to that, so the last couple years I've been stuck with her. My wife isn't attractive and no matter how horny I get, my penis just doesn't want anything to do with it. Sometimes I get boners and cherish the moment, but for the most part, bitch has turned me asexual. The good news is that I still like hot chicks and I'd fuck every single girl ever posted on my site. Even this nasty amateur chick who covered herself in blood. I have no standards. On "To Do" list, I'd have to start with the girls with the most money and lowest self esteem. K-Fed is kind of a hero and has a great retirement plan so I'd try to get up on that. I'd say someone like Lohan or even Britney would be a good start, but they are all therapied out and working on killing their inner demons. Maybe the best angle would be to go with someone older trying to reclaim her youth or some shit. The reality is I will never meet any of these girls and fantasies of fucking celebrities are for weirdos who have seen all their movies, cut out all their magazine spreads and staple pictures of them on their pillow to make fucking their rubber vaginas more realistic. Lusting after anything just isn't my style.

I'd like to get up on that too, K-Fed is a pioneer that way. What therapeutic gains have you made from your writing about celebrities? Is your art simply cathartic or is there a deeper meaning that the mental health community and my readers should know about?

I think the best form of therapy is to write down your thoughts, if you are angry let it out, if you are depressed let it out, writing is my release and I get all this shit I was bottling up out there, whether it is worth reading or not is questionable, but the fact that I may never run out of things to write, even in times I feel like shutting myself out and not talking to anyone, is really the cure to a lot of things. I am repetitive, probably boring to read, but it's definitely my therapy.

What isn't my therapy is actually running the site, trying to get content first in hopes of getting traffic, the constant rejection I get because I am labeled a porn site, the lack of money I make when I put a lot of me into something is all downers. That doesn't even touch on technical issues, hackers, the asshole who stole my computer.

Writing a blog is a self involved thing, and sometimes being too into yourself isn't a good thing, you lose your grasp on reality. Sometimes death threats make you paranoid, hate mail makes you feel inadequate, declines in traffic make you feel like you're time's up, but I got nothing better to do and in recent months don't let it bother me because it's a waste of time and because I am the first to say that what I write doesn't matter, if you like it that's good, if you hate it that's ok too, we're all people here and separating myself from a virtual world has made me appreciate what I do more than consider it a curse.

That's how I feel today anyway, my feelings about it are constantly changing depending on what's going on, but lately I don't feel really bothered by the negativity, I don't feel really pressured about getting out there when I used to let it really get to me, even though I project negativity. I guess I am a hypocrite.

You've stalked and/or met extremely famous people like Paris Hilton, Lindsay Lohan and now me. Who have been most worth the hassle?

Paris Hilton is the only one who played back a little bit, I guess because she wasn't busy having premarital unprotected sex the days I hit her up. She's all about getting herself out there and I can't imagine her taking herself seriously since no one else does. She is always on "tour" or whatever you call what she does, she always meets new people and gets involved in all kinds of projects so she is pretty accessible. I was given her phone number, I'd call her, we'd talk for 5 minutes or less, she had no idea who I was but had the decency to be friendly. Once she left the phone on and we heard a whole conversation ripping into Lohan about having herpes and not telling people and about how Nicole and that Good Charlotte Gaylord should have a baby before they were publicly an item all while she was smoking a joint. It was golden blogging moment. I didn't get shit out of having her number and it was later released to the public forcing her to change it, so it never really amounted to much for me other than a funny story to tell 16 year old girls at Starbucks. That shit impresses them.

Nicole Richie was another number I had and she was a total cunt to deal with. I hung out with her once accidentally and tried to steal her phone, she wasn't a fan but was chain smoking the whole time while I drank the free booze.

I haven't really stalked as hard as I'd like to, I haven't really interacted with these people and I am ok with that, I have little interest, but if it falls in my lap they are all been worth the energy or hassle for the sake of personal entertainment. I just get off on the accessibility of these people you grow up thinking are untouchable.

While there are other celebrity gossip sites available on the internet none bring it with the intensity and self-loathing that is DrunkenStepfather.com. Do you attribute your success to low self-esteem?

It's a tough call. I am a personality that people who read my site can relate to. How can you hate on a guy who calls himself a pig before calling a celebrity one. I guess people like that I am honest, or myself in my writing, I don't really hold back or censor myself. They may also like that I tie things into my day or my life. I started this site as a personal blog to throw up my personal experiences and shit I see or find online, it just ended up being celebrity heavy because that's what people are interested in. So it's my way to get a couple eyeballs and throw in my 2 cents the way I want to.

Is the site a success because I have low self-esteem and a negative body image, possibly, but it probably would have worked if I was an ego talking about how great I am or how much better I am than whoever I am writing about. I think people like to look into someone's life a little bit, they feel like they know you and they respect you more that way, even when they don't agree with what you say.

My site is hardly a success and my low self-esteem doesn't override my confidence in my own voice or opinion. So I am like a guy who hates himself, doesn't think what I say is all that important to the world, or interesting to read but still puts it out there. Most people with low self esteem lack the drive to put themselves out there everyday, so I don't know if what I have is low self esteem or just self hatred. I don't even know if it's the same thing...You're the doctor, you tell me.

This is not the appropriate forum for psychological intervention so please book an appointment after this interview. I will say however that your depth of insight is impressive. Now there are a number of aspiring actors who read ShrinkTalk.Net. Should they become famous, what should they do to avoid being lambasted on DrunkenStepfather.com?

I think acting is the biggest joke of a career. I feel like it's a right place, right time, right look kind of thing. I am convinced I could win an Oscar even though I have no acting background or interest if the roll called for a Fat Mexican drunk. Actors try to make their careers seem important because I guess no one likes to admit they are a joke, or pursuing a joke of a career, and the compensation is so high that it's hard to grasp that it's a joke of a career, but it is and no one is safe from being featured on my site. I have an opinion about everything so I could talk about my couch for 4 days and that fucker doesn't talk back, say stupid shit or do stupid shit. Give me the pictures and I'll do it right now.

(Mental Note: Remove all photos of self from the internet, especially that "Psychologists Gone Wild" video. Man I'd like to forget that day.) I'm not sure you remember, but when we first spoke, you were drunk to the point of slurring your words. Have you attended the Alcoholics Anonymous meetings that I recommended for you last week?

Yeah, I just go for the pussy. Drunk girls are easy, drunk girls with alcohol problems that they are trying to get over are easier, you just have to lure them back to your place and pretend that you've found a bottle of wine lying around, make them think you are being bad with them and falling off the wagon too, that way it'll be easier for them to break their vow of sobriety and next thing you know you have a drunk girl who thinks she's been bad on your hands. Either she'll break down in tears or she'll fuck you, I usually try to keep the breakdowns until after I bang a chick, it's kinda usually how it goes when they realize what they've done and how low they've stooped.

The thing I hate about AA is how they turn it into a God thing and how your future is late nights in coffee shops drinking tons of coffee and smoking packs upon packs of cigarettes talking about the good days when you used to drink with other addicts, because quitting drinking doesn't make anyone happy and is a lot more depressing than drinking your life away....

Well now that all of my substance-addicted readers are off the wagon, let's wrap it up. Assuming you don't die prematurely of liver toxicity, what is next for Jesus Martinez?

I have a feeling that I will probably die young, but my friend told me that God doesn't kill people like me off, he likes to watch us squirm in misery through all the trials and tribulations life shits on us. I am having issues with the site now because the paparazzi want to shut me down , but feel like I am not really going anywhere. I'd write a book but it would suck, I'd write a movie but I am not good at telling stories so I guess I am stuck to the internet, it seems to be the only place a talentless fuck can get girls sending in videos of them playing with their tits and that's pretty much the only reason I started the site.

Thanks for the talk doctor, sorry I can't pay you for this session, I am kinda broke as fuck.

---

Other Interviews with Dr. Rob. The Mind of Male Chauvinism

When I'm having a bad day, I have this voice in my head that tells me "You should not have to deal with all of these hassles in your life. You help people for a living, you deserve immunity from the annoyances of daily living." If the word "should" appears in the first few words of a sentence than it's usually a ridiculous statement because the world rarely works they way we want it to. I should be the new Head Writer for HBO's 'In Treatment'. Random House should contact me to write a (fictional) book about a Psychologist who goes on a psychopathic killing spree after Medicare denies all of his correctly submitted bills for the 3rd time. Neither of those "shoulds" has happened. Yet.

I'm very lucky that when I'm actually working I generally feel a sense of equanimity and empowerment. "It's therapy, it's work, it's supposed to be hard" is my mind set, so I don't mind the challenges that come with it. It's the shit that occurs when I'm not "working" that makes the days feel like weeks. Money is one of those things. I'm in this because I love helping people and I want to see them resolve whatever issues they have in their lives. I'm not doing this to get rich. Given that, I sometimes feel like it's bullshit that money should stand in the way of me providing therapy. So issues like dealing with insurance companies and collecting fees from clients send me into my perfectly developed annoyed state.

The late, great Dr. Albert Ellis told me that the biggest mistake a person can make is to believe that the world is a horrible place when things aren't going your way. I make this mistake regularly and unless I catch myself doing it I easily become miserable. This is especially important when I get into a mind set that I need my non-therapy life to go smoothly because I'm busting my ass in the office. With faulty logic like that it's no wonder shrinks can be so neurotic:

9:00 AM: Arrive at work. Dr. Steve complains that my rent checks are "crinkled" when they get to his desk. I explain that is because I (purposely) put them in my front pocket before I leave my apartment (to annoy him). He is not pleased with this response and asks for "more pride" in my money which is really his money after I've written the check. He adds that the rent will be going up by $100 retroactive to last month. The day hasn't really begun and I'm already in the red.

9:45 AM: Complete first session with new client who forgets checkbook, debit card, any and all credit cards, and of course cash. She says she is not sure if she would like a second session but will "mail the fee in as soon as possible." The odds of getting paid the reduced fee of $90 for this session are slim. Most people are taking their first coffee break of the morning, I'm $190 in the hole. It's okay, no biggie. I can do this, I tell myself as I picture Dr. Ellis beating me over the head with his cane repeating his sagacious words.

10:30 AM: Different client breaks statuette in Dr. Steve's waiting room.

10:32 AM: Invoice from Dr. Steve for broken statuette ($75) slides under my office door. The client is paying all she can afford for therapy ($70) so I don't tell her about the bill. I tear a check out of my checkbook and crumble it into a ball before writing it out to Dr. Steve. I'm a rebel that way. The running total in my head tells me that I'm minus $5 for this hour. Ironically even when my clients pay I'm still losing money at my place of business. I do feel good to be helping someone who benefits from therapy ... except for today given that she broke the statuette.

11:30 AM: Client and I hear someone, presumably a client, screaming at Dr. Steve in his office, ultimately telling him to "go fuck himself." Door slams a few seconds later. I smile. I'm down $195 and it's not even a problem.

12:00 PM: Dr. Steve decides that he doesn't want to have unlimited long distance on his office phones anymore and states that all consultants should "pay as they go" with phone service, documenting all regional and long-distance calls on the designated spiral-bound notepad placed next to the telephone. I bask in the glory of his client's single great line "Go fuck yourself, Dr. Steve" while he's talking.

1:00 PM: Dr. Pete calls to go through which ABBA songs would best serve his Music Therapy practice, which is now "booming." I hang up on him in a moment of envy.

1:30 PM: Attempting to eat a quiet lunch my mother calls to tell me that she "accidentally" gave her dog some Ambien ("like 3 pills I think") and is wondering if she will be okay. Coincidentally she gave the hyperactive dog a needed grooming while passed out. I wonder if I can even afford to bail my mother out of jail at this point on a Cruelty to Animals charge.

2:30 PM: Session with client that goes very well but she indicates that she is "intimidated" by my insights and is not sure if she should come back. This is completely understandable so I can't be too bothered by this.

3:30 PM: Mail arrives, which includes a moving violation ($80) from one of those police monitors at a traffic light and two denials of payment ($225 and $175) from insurance companies. Is it even possible for someone to lose so much money while at work? This is horrible, coming to work has cost me $675 dollars, not counting lunch! No Rob, it isn't horrible. It's not pleasant and it's not the way you want it to be but you'll be alright. It could be worse: you could be your mother who might go to jail for killing the family dog.

5:51 PM: Voicemail from mother indicates that dog has regained consciousness and that she "won't have to borrow money for a doggie funeral." Life is getting better. Your mom isn't a murderer. At least not a successful one.

6:00 PM: Stepfather calls to tell me that he and my mother are having a "disagreement" (for the fifth time this week) and could I find some time to mediate the discussion. I tell him that due to ethical implications he should find a therapist where they live. "Thanks for nothing. I'm glad you're not my son," he says before hanging up. It briefly crosses my mind to conduct a session over the phone and charge him for it.

7:00 PM: Chinese food arrives and I accidentally pay with a $50 instead of a $20, which doesn't surprise me given how the day is going. I burn my tongue on the tea as I realize my error.

8:00 PM: Blazing headache sets in from the M.S.G. in the aforementioned Chinese food.

8:45 PM: New client does not show up. He answers phone and when asked for an explanation for his truancy replies, "I'm supposed to call if I won't be there?" $125 dollars evaporates before my eyes and I mentally start prioritizing my bills into "need to pay" and "can sit another week".

10:00 PM: Arrive at home around $800 dollars poorer than when I left. I'm exhausted and don't want to hear about any more problems in people's lives or deal with the daily grind of living. I need a break. I get into the elevator of my apartment building with a middle-aged woman and her dog. I lean over and pet the dog and he stares at me with an ever-so-slightly beating tail. "I'm sorry to bother you," the woman says, "but you seem to have a sharp eye. Do you think my dog looks sad? I think he could use some professional help. Know anyone?" I wonder what the going rate for doggy therapy is but nix the idea as I've got a bottle of wine in my apartment with my name written all over it.

11:02 PM: Sleep. Dr. Ellis and I play golf in a dream and he tells me to wake up ready to go at it again, because even though I let ridiculous things like money and Dr. Steve get under my skin I still love the job and can't imagine doing anything else. I wake up and I remember Dr. Ellis shouting out that I control how I feel, independent of finances and other people's actions and the unfortunate fact that the world doesn't always spin the way I want it to. And then I remember I didn't have a single client tell me to go fuck myself yesterday, so at least I'm ahead of Dr. Steve.

Dear Dr. Rob,

My name is ___________ and I'm a 21 year-old college student. I've had a girlfriend for about two years. I'm basically a nice guy and treat her well and our relationship is pretty strong. But when she has a problem, whether it be work, school or family, and I try to solve it for her she says I'm not listening. Is it me? I know I can't send you a transcript of our conversation to dissect but is there any advice you have for young men out there on how to listen to their girlfriends?

I always have advice. It's rarely very good but that's never stopped me from giving it. In this case however I some information that might save our protagonist from getting dumped for not listening. That will leave ladies with only emotional immaturity, infidelity, lack of finances, ugliness, hyper-focus on computer games and sports and beer and friends, lack of ambition and poor personal hygiene as their sole reasons for ending what was once a fulfilling relationship.

When a person has a problem the old adage is that men want the problem solved while women want to be listened to and understood. Although overly stereotypical, conventional thought predicts that men will go into problem-solving mode while women will become empathic because that is what that person would want for him/herself. Rarely is that enough for either however; the reality is that we all tend to want both: to feel validated and understood while being given practical advice for getting through a problem.

If you're a guy, here's your job: validate first then help solve the problem. You can remember this two-part formula through my simple mnemonic device: Robert Allen Dobrenski's Listen (Or) Validate Then Address Problem Strategy (RAD-LOV-TAPS). Mnemonics are a great way to take complex ideas and make them simple.

Let's highlight the RAD-LOV-TAPS by a simple example. Men, let's say your wife or girlfriend or mistress comes to you and is very distressed about her boss. Let's say the boss is being abusive, yelling, asking her to do tasks beyond the scope of her job description and is generally making her feel like shit. Immediately you may begin to consider options: quit, suck it up and deal because the pay is good, complain to Human Resources, shoot the boss in the thigh with an elephant gun, whatever. More often than not you will lose points, however, because you skipping over the validation / listening / empathic voice part and jumping right to the solution. Big mistake.

Watch how it plays out using the RAD-LOV-TAPS:

Part 1: Validation

Woman: I hate my job. My boss is mean, she yells and makes me feel horrible about myself. I don't know what to do.

You: That's a horrible thing for her to do to you. Why don't you tell me more about it and we'll see if we can come up with something to help you.

Woman: Well, I try to be on time, look professional, be courteous to her and her colleagues, and get all the tasks done for her when she wants them. It just never seems to be enough. She can always find some subtle flaw in what I do and make me feel miserable about it.

You: (Honey, Babe, Sexy or whatever term you use that generally leads to sexual intercourse), you don't deserve that. You work hard and do your best. You should be getting more respect from her.

Woman: You think so?

You: Yes, absolutely. Do you want to hear about what I think you should do or would you like to talk more about what you're feeling?

Woman: No tell me what you would do.

Part 2: Problem-Solving

You: I think you need to assert yourself and tell her what you will and will not put up with. You need to command respect from her because she is not going to give it to you out the kindness of her heart. Of course it may backfire and you could get fired but at this rate you'll end up quitting soon anyway, and I think you're self-esteem will be buoyed by standing up to her.

Woman: Thank you, sweetie. And I think you're right. I really appreciate that you listened to me. How about I get you a beer and cook you dinner and then I'll call up my runway model friend and we'll all have sex together and then she and I will leave and you can have your buddies come over and watch the game. I'll stop by every hour to see if you need me to go on a beer run or want me to pick up a pizza. How does that sound?

You: Only if that's what you want.

Woman: It is, Wonderstud. It is.

See how easy listening can be? Just remember RAD-LOVE-TAPS and name your first four kids after me because you're about to become a much happier man.

My job is extremely satisfying when a client is able to work through problems efficiently and establish a new level of happiness. To have a client identify a problem and take the necessary steps to resolve the situation gives me a true feeling of gratification. Unfortunately, however, life in therapy isn't always happiness, red wine and lingerie models. More often than not clients have obstacles that prevent them from living the best life possible. These barriers are usually a combination of both internal and external forces that are working against them. An empathic voice is my modus operandi, but sometimes clients need a stronger approach to facilitate change.

The late Dr. Albert Ellis was by far the best at confronting clients. His approach was later stolen by hacks such as Dr. Laura and Dr. Phil. While sometimes labeled as vulgar and harsh, Ellis was a shrewd clinician who made it clear that he was attacking a client's thoughts and behaviors, not the person. This is a subtle but important difference. If he thought you were acting like a douchebag he told you so. But he made it a point to say that isolated thoughts and actions do not define you as a person. This helped to mobilize clients to not label themselves or have their self-esteem be compromised.

Therapist Rule: Confronting a client is most effective within a solid therapeutic relationship that is built on trust and respect for both therapist and client.

Consider my work with Craig, a mid-30's man not unlike the completely fabricated Marc. Craig had been trying for months to get out of an unsatisfying relationship with a long-term girlfriend. This is an extremely common problem seen in the therapy room and one that many of us can relate to. Whether this need to hold onto a partner is due to stability/comfort, a fear of the unknown, a fear of being alone, a concern that we will regret breaking things off, or countless other reasons, many clients struggle when attempting to break free from a relationship that is not meeting their needs.

Craig and I worked on this issue for many months with no change. We used Freudian interpretations, self-esteem building exercises, simple pros and cons checklists to decide if the relationship was worth abandoning (according to the list, it was), and every other intervention under the sun. We even role-played the break-up conversation (note: let the record show that I hate being a woman). We were both getting annoyed with the lack of results and it must have shown on my face.

"Dr. Rob are you angry with me?"

Back in the late 90's a professor said to me, "Rob, you are an extremely attractive man. In addition, when a client asks you about a personal feeling and you choose to answer, take a moment and consider what your emotion actually is rather than giving a knee-jerk response based on what you think the client might want to hear. Therapy is a reflective process and modeling this for your clients will help them take a step back and look at themselves more closely."

"Thank you, Dr. Johnson. I've been working out."

I remembered her words of wisdom and put it into practice with Craig. I considered his question for a few moments.

"No. I'm not angry per se. However I am frustrated with our lack progress on this issue."

"So you're not angry, you're frustrated with me?"

"No that's not exactly right. I'm frustrated with what is happening here. I think part of me is frustrated with you for not taking the action that we both agree is good for you. Part of me is frustrated with myself for not getting you to that point of action. And still another part of me is frustrated with the sad reality that things don't always work with the efficiency that we want."

"That just sounds like therapy-speech. I think you're angry with me."

Again, pause. "I really don't see it that way, but as I conceded I am bothered by your lack of action. I think your fear is holding you back from getting out of this relationship and moving on."

"So you think I'm a pussy, is that it?"

"Is that what we're calling your lack of progress? If so then yes I think you are acting like a pussy. But the fact that you are introducing such a strong term makes me think that you yourself believe that you're a pussy."

"But I'm not!"

"Then stop acting like one and be a fucking man and get out of this relationship. You're miserable and quite frankly I can't fathom how she can't be miserable as well! In fact this whole conversation is making me miserable."

"You're right. Screw her!"

"Good for you. Take care of business!"

"Yeah, take care of business. I should kill that whore!"

"Yeah you should...wait, what?"

"Nothing nothing. Just a figure of speech."

I scrutinized Craig very closely with squinted eyes. "Craig, if you say that is a figure of speech, you better mean that. I'm not screwing around here."

Craig laughed. "Dr. Rob, I swear. I'm just pumped."

"Fine, be pumped. But if you hurt anyone I won't even visit your sorry ass in prison."

I would love to say that Craig came back the next week a single man but it didn't quite work out that way. He was still in the relationship for a few more weeks but it did finally end at his behest. When it was over I asked him what prompted him to take action.

"Well the heated discussion we had helped I think," he said. "I was so excited to break things off, but the feeling didn't last. Over the next few days though I continued to think about it and something sort of clicked. Like 'I'm not being fair to anyone here, not me, not my girlfriend, and I'm certainly wasting my money in therapy if I don't make a change.'"

"Well I'm glad something finally worked. Congratulations on making that change. How do you feel?"

"I miss her a little bit but not as much as I had expected. I'm pretty happy overall."

The lessons here are multiple:

1) Do not kill anyone, especially someone with whom you are about to break-up.
2) Unhealthy relationships take a long time to end. Far too long for my tastes.
3) I can be a bad-ass when necessary. Well, if by "bad-ass" I mean slightly confrontational.
4) A little tough love can go a long way.

Yep, that's why I get paid the big bucks.

I need to get something off my chest.

I've been working with a man, I'll call him Marc, for many months. He is approximately my age and very angry: divorced twice, a foundering career and three children to support. While he doesn't directly blame me for the cause of his problems he constantly reminds me that I haven't fixed his current situation. This has been a point of contention for many weeks now in therapy.

"This therapy is bullshit. You don't help me, you don't make me feel better, you just nod and say stupid clichés. You suck."

These statements are essentially on a loop by this point. A solid therapist can handle this aggression and help the client understand it and I've been trying to do that. Until now.

"Marc...we've gone over this. You're turning this into a primitive game where you blame me for all of your problems. It's not my fault."

"No but it is your fault for not fixing them. Do your Goddamn job!"

I've been told to "do my Goddamn job" dozens of times but hearing it week in and week out from the same person who wants to accept no responsibility is getting to me.

"So that's it? That's what we have here? You continue to fuck up every aspect of your so-called "life" and put it on me to fix it?"

"What the fuck did you just say?" he said, his face reddening.

"You heard me. You don't want to take any responsibility. It's easier to blame the Psychologist isn't it? You think you can just continue to screw up everything and have someone to pin it on. That's just cowardly. You're a coward."

He stood up, and although only approximately my size if not smaller, his resolve seemed gargantuan at that moment and he started to walk toward me from the couch.

"I'm a coward? You're going to wish you had bitten your tongue for once in your life, Shrink Boy."

Refusing to be intimidated I stood up as well. "Get out of this office," I said. "Don't make this worse."

He kept coming and before I could brace myself he had pushed me back onto my chair.
"Get the fuck up. We'll see who's a coward" he said. He seemed ironically calm at that moment although I'm sure the rage was brewing just below his skin.

I stood up only to be pushed down again. "Is this what you're about?" I said. "Pushing me down when I try to stand up to you? You're a bully and we all know that bullies are really just cowards."

"Get up!" he repeated.

Ready for a third go-around I slowly began to stand then immediately drove myself shoulder first into his midriff, driving him back onto the therapy couch. We landed with a thud and although he tried throwing weak punches at my back I was able to break free and stand up, breathing heavily.

"Get the hell out of my office" I said.

He stood up, panting himself. He stared at me for a moment, seemingly to consider his options and suddenly fired a right cross toward me.

I took some boxing in college and know the basics of self-defense so I ducked his punch. At that point I should have fled the room, ducked into the common area of the office suite and called the police. My adrenaline rush was so strong though that as he missed with his punch and began to lose his balance I drove a fist into his right ribcage, looking up quickly enough to see the spit fly from his mouth as the wind was taken out of him. The crack of the ribs didn't even register until he was lying on the ground wincing.

"Now get out," I said. "And look for a fucking bill in the mail."

He left, demoralized, having gotten a serious ass-kicking at the hands of his shrink.

Three hours and half a bottle of Dewar's Scotch later my nerves were less rattled and the guilt began to sink in.

I can't believe I did this. I hurt a man. I hurt a client. He's probably at the hospital right now. I'll lose my license, my reputation, my good name. It's over.

Then I realized that anyone who knows me, whether it be personally or through my writing, will realize that today is April Fool's Day and that none of this could have possibly happened. There is no Marc, no boxing class, and certainly no Dewar's. That stuff is disgusting.

With the nursing home strike still going strong it's been tense going into work. While no one has crossed the line into overtly violent behavior there is plenty of yelling involved when anyone gets near the building. I've escaped with mostly insults thus far, the most enigmatic being "Go away you reverse Uncle Tom!" One striker "accidentally" tripped into me and knocked over my coffee and my "How Do You Feel Today?" workbook into a pile of mud, rendering me dangerously under-caffeinated.

One of my clients at the home, Ruth, was particularly agitated when I walked into her room. With my personal nemesis Dr. Phil blasting in the background she immediately clicked off the television and motioned for me to sit. "Rob, I don't feel right."

"What is it? Are you ill?"

"No, no. I'm not sure. I think I'm dying."

Oh my God. Not again.

With a skyrocketing heart rate and my stomach turning into knots I remembered what Andy said to me that day and how poorly I handled it. When we are reminded of previous (and traumatic) experiences our bodies will often respond in a way that is similar to how it did during the original event. This is a premise of trauma work: the body believes it is re-experiencing the event and needs time and a reminder that this new experience is not the same as the previous. I could taste the shame I felt when I found out that Andy had died. I hated myself for what had happened with him but wasn't about to make the same mistake again.

Rob, stay calm. Unlike last time, pay attention and fucking listen.

"Ruth, tell me what it is that makes you say that."

"I don't know I just feel strange. It's scary."

"Okay...okay. Tell me more."

"I don't want to die yet, I'm not ready."

The nurses always tell me if a resident is ill so I knew there wasn't anything physically wrong with Ruth. That was the case with Andy as well though.

"Ruth, the nurse hasn't said anything about you being sick but only you truly know how you feel. Is it possible that you're confusing your fear of death with actually dying?"

"I don't know. Maybe. I just don't know."

"That's okay. You don't need to know for sure. We're just considering some things."

"You won't leave me will you?"

"I won't leave you."

"Promise me."

"How about this: I promise to not leave you if you do the same for me."

"What do you mean?"

"I can only keep working with you if you stick around here. You have to promise not to go anywhere just yet."

Ruth gave a hint of a smile at this. "Okay," she said. "Deal." She paused. "Since neither of us are going anywhere just yet do you want to watch Dr. Phil together?"

"Honestly? Not really. I can't stand him."

This time there was a full smile. "That's okay. Let's talk more about my feelings. You seem to like doing that and I clearly have some things on my mind."

Smarter people have said and continue to say far more insightful and helpful things than I do but at least my words did something positive this time around. Although she is elderly and won't be here forever, for the moment Ruth is feeling better. As we've talked over the past few sessions she's a bit less agitated and fearful about death. Discussing it has started to give her what she is lacking: a sense of closure about her life. The elderly who have a fear of dying often lack the ability to look back on life with integrity and a sense of having lived it as best as possible. And although Ruth, like many of us, is still struggling at times with the prospect of dying we've developed a credo for her that she repeats every day:

"I can reflect on my life with pride. I did a lot of things, loved a lot of people and was, for the most part, a happy person. I will be with God and my husband at some point so there's no reason to fret."

A professor once told me "do not utilize your work with clients to navigate through your own issues." In theory this is a great rule but simply not realistic. When I go to the home now and see Ruth not just alive, but growing as a person in her last stage of life I feel fantastic. Not just for her but for myself as well. The unfortunate reality is that therapy is not a panacea and sometimes it does nothing for people. But when it does work I feel the most powerful experience in the world: validation for what I set out to do with my life.

After Andy died I used wine to self-medicate my shame and guilt from what I considered inexcusable behavior. I can't take back what happened with him. And yet it's as if I was given a second chance, a chance for redemption. By doing right by Ruth I could do what my therapist instructed me to: forgive myself for my mistake. It was important to do a good job. To do a great job. And now I feel...well, redeemed.

Dr. Jones and I sat across from each other, drinking the piping hot coffee, him smiling politely and me silently annoyed. He didn't speak for close to a minute, almost as if he had forgotten why we were there.

"So have you enjoyed your time working here?" he finally asked slowly, the caffeine seemingly the cause of an ironic peacefulness.

"Oh yes, very much."

"That's good."

"Yes."

"Yes it is." After a long pause he said, coming out of his social trance, "So. Let's play 'What Should Dr. Dobrenski do During a Crisis at __________ Hospital."

"That sounds just wonderful."

"Bear with me," he said as he started flipping through files in a drawer. "It's been a little while since I've done this part." Taking out a manila folder clearly marked "DERMATOLOGY" in giant letters on the front he immediately asked "Question 1: What is your policy on notifying patients of Malignant Melanoma?"

"Psychology."

"What?"

"I'm a Psychologist, not a Dermatologist."

"Really? Are you sure?"

"Oh yes I'm quite certain." Seeing this man as a symbol of pointless red tape, incompetent authority and inane hospital procedures I briefly considered scalding him with my coffee.

"Then you need to meet with Dr. Alexander. She handles all behavioral health issues."

I must have been Adolph Hitler in my previous life because no one deserves to endure not one but two episodes of bureaucratic water torture.

"Dr. Jones, I really have done more than my fair share to make this work," I said. I then recounted for him the series of events leading up to this moment. "Can you work with me just a bit on this?"

Seeing what he probably saw as sadness and pleading in my eyes I think he felt sorry for me. Little did he know that he was witnessing homicidal rage that I had been sublimated to gain his sympathy.

"Okay, I'll see what I can do. Just get me your two letters of recommendation and you should be fine."

Please kill me.

"Letters?"

"Yes we need to letters from colleagues who are familiar with you in a professional capacity. People who have seen your work firsthand."

"But my work is behind closed doors so no colleagues see me. It's not as if I'm a surgeon that is part of a team."

"Hmmm," he said, scratching his head, me secretly hoping he would actually find a soft spot on his skull and poke his finger through it. "Then let's do this: get a short paragraph from two colleagues saying that you are a well-qualified professional and we'll call it a day."

He was lucky I'm a gentle man or else he would have been dead twice over. "Thank you, I do appreciate that."

"Just make sure that the paragraphs state that you are both a good Psychologist and a good person," he warned. "The Credentialing Committee has rejected applicants whose letters are suspect in any way."

Having come this far I decided to give this last part some serious thought. Who would craft the best missives? Dr. Gail was my first choice given her ridiculously formal approach to life and the fact that I know she approves of my work despite my generally grouchy demeanor at her office suite. But who for the second letter? Dr. Steve would have probably billed me for his time. Dr. Pete was still angry at me for our little rendez-vous with his client on the street many, many months ago. That left MILF-loving Dr. John as the colleague of choice.

John has a special sense of humor. By special I mean that he loves to watch others suffer. I warned him that this letter, while brief, had to be good so that I could put the credentialing process behind me and go back to the hospital. Of course he said "No problem!" the same way he said those exact words to other requests:

- Please don't sleep with Dr. Pete's girlfriend, I think he's in love with her.

- Do not call my office pretending to be a client and scream that you are suicidal or homicidal.

- Do not sit in my waiting room with my clients and have an argument with your "invisible friend."

Knowing that there would likely be some sick twist of humor involved with the letter I insisted he show it to me upon completion. If acceptable, I would personally mail it out so that he couldn't alter it later.

Of course John waited until the last possible moment to give me the letter just to make me anxious. To his credit however the letter itself was quite good:

Dear Members of the Credentialing Committee:

It is without reservation that I recommend Dr. Robert Dobrenski to become a member of your hospital's outstanding professional community. I have had the pleasure of knowing Dr. Dobrenski for many years in both a professional and personal capacity. Not only is he an outstanding clinician with impeccable academic credentials but also a caring and giving person who is quite active in the community. I can say with confidence that he will prove to be an asset to your already accomplished facility.

Please do not hesitate to contact me should you have any questions.

Sincerely,
John _________, Ph.D.

P.S. Please do not discriminate against Dr. Dobrenski's extremely small genitalia when considering his candidacy.

This last line was unacceptable (nor true for that matter). Of course he refused to take it out, leaving me scrambling to find a bottle of White-Out or Liquid Paper. John must have found some Super Bold Function on Microsoft Word because the letters, while small, were almost carved into the paper, indelibly leaving their heinous (and incorrect) remark about my manhood. After watching me huddle over my desk with a tiny brush attempting in vain to eradicate the egregious comment he took pity on me and gave me another copy, identical to the first save for the last line.

I submitted the letters and waited. And waited. Two more months went by without word. I then got a call from the woman in the Credentialing Office who apologized for the committee's decision to "bump my application" until the next meeting due to "more important matters" (probably like how to make applicants wait even longer than they already do). Weeks later I finally got a message on my voicemail stating I was a "near unanimous" decision, that I could return to work. "Please try to be a bit more affable to your colleagues in the future," the woman from Credentialing admonished, "you probably perceive yourself as very dry and witty but a few of the committee members didn't appreciate your demeanor, myself included."

So I'm back at the hospital, fully credentialed, armed with new knowledge about infectious diseases and how not to spread them, along with a polite but firm criticism about my interpersonal skills. As an added bonus I learned more about Malignant Melanoma online. And to think this whole process only took seven months. Given enough time who knows what __________ Hospital is capable of accomplishing. I wouldn't advise asking the administration to acquire a grant to cure cancer but I'm sure they could manage to order a new vending machine for the waiting room if you give them ten years. Maybe more.

One of the myths of being self-employed in the mental health field is that you are free from bureaucracy and Corporate America. Many people assume that working in psychology allows complete freedom in the workplace. Little could be further from the truth. Whether it's dealing with insurance panels, submitting personal injury statements to lawyers or writing doctor's notes for clients I too deal with red tape and paperwork like it's going out of style. Even as a simple consultant at a local hospital I am not free from the stranglehold that is "The Man."

A few months ago a call came in from Joan, the Surgical Coordinator at _______ Hospital. "Rob, you can't come back to work."

"Why? Am I fired?"

"No the state is requiring all of our treatment providers to be credentialed before working here. You literally can't step foot in the building until you've applied to work here."

"But I'm not a treatment provider. I just do the weight loss evaluations."

"This applies to all providers, regardless of role."

"I've worked there for five years, can't they make an exception in my case?"

"Sorry Rob it's not in my hands."

"So who is going to do the psychological evaluations while I'm not there?"

"They are being temporarily outsourced to a local practitioner."

"You're giving my work to a competitor? Judas!"

"Your application is already in the mail. Please complete it right away and we can have you back within the month."

I got the packet two weeks later, immediately putting me behind schedule. I filled out the application which consisted of mostly questions related to academic background and sent it off. I got a call two weeks later from a woman in the Credentialing Office.

"Dr. Dobrenski, we need some ancillary materials from you."

"Ancillary?"

"Most of what we need can be photocopied and faxed: license to practice, malpractice insurance form, graduate transcripts and your diploma."

"They have all of those things in the Department of Surgery."

"Well," she said, "it would better if you sent them yourself."

"Better for whom?"

"Me."

"But my diploma has been framed and matted."

"I suppose you could try to put the entire frame under the copy machine" she said.

"You said most things can be faxed. What cannot be faxed?"

"This may sound a bit silly..."

"This all sounds silly."

"But I need you to come out here with your driver's license to prove that you are, in fact, you."

If you are unfamiliar with New York City note that it can easily take over an hour to drive 10 miles. This is particularly annoying when I clearly know that I am me.

"There are plenty of people at the hospital who can verify who I am."

"Sorry it's per regulation."

"If I can't get the giant diploma under the copy machine can I at least bring it out to you so that I don't have to de-mat it?"

"No."

I think I hate you. "Fine, when can I come out and prove my existence?"

"I see applicants on Monday from 4:15 to 5 and Friday 4:30 to 5:30."

Perfectly timed for rush hour, you nefarious shrew.

I copied one-half of my diploma (the other half couldn't fit under the machine cover), thus having one line as "Rober" and the next line as "Psycho." I mailed in all of the required materials and went out to the hospital. The woman at the Credentialing Office eyed the driver's license.

"This doesn't look like you."

"It's a few years old."

"You don't have a more recent one?"

"I don't carry more than one driver's license at a time, but I can assure you it's me."

"Hmmm...okay. Have you taken your online Infectious Disease course yet?"

"I don't deal with any infectious diseases."

"Oh but you must take the course. Regulations. Register and take the course as soon as possible. You can do it all on the hospital's website. And it isn't very expensive either."

"The hospital is not going to pay for it I take?"

"It is the applicant's responsibility. When you've passed that class then we will set up your interview."

"My interview?"

"Yes, everyone must meet with the head of neurology."

"I'm not a neurologist. I'm a psychologist and I work in surgery."

At this point she was probably wondering how someone so contrary and cranky could possibly help people for a living. "It doesn't matter what you are, you still need to meet with him. Go and get your course done."

I took the online course that night. Only true experts in infectious disease control could possibly thrive on an exam with such difficult questions as:

- Where should one dispose of a used syringe?
a) In a wastepaper basket
b) In a clearly designa