Verbal Abuse - September 4, 2007

"My God, you're just a kid!"

Although I am 35, I look significantly younger and so this is not an uncommon reaction from new patients who come into the office. They're not really worried about my age per se; what's underneath this comment/insult/observation is a fear and a question. Really, they're saying "I'm here to talk about painful things and that is scary. Can someone who looks like you help me?" In a way, this might be considered a test: do I react with confidence and empathy or do I get defensive? My response gives the client a preview of how I will respond when they begin to talk about what is troubling them: will I step up and help, or crash and burn in a fire of relative youth and naiveté?

While most age comments are broached early on, periodically I will hear dissatisfaction about my boyish face during tense therapeutic moments:

"Gee Dr. Dobrenski, that's great advice! Can you buy beer as well?"

"Wow, did you come up with those pearls of wisdom after you finished your Algebra homework?"

"Thanks Doogie Howser!"

What's the message behind comments like these? "You've hit a nerve. Something that you said is painful (and therefore important), but because it hurts, I need to protect myself." In other words, the insult is a defense mechanism, taking the focus off of the client and onto me. As the therapist, it's my job to understand this and, even more importantly, to help the client understand this.

And yet, where is the line between a defense mechanism and verbal abuse? When has a patient gone from having an internal problem that needs to be explored to simply being an asshole who needs a kick in the spine? These are questions with answers that vary from therapist to therapist. My background and personality allow me to put up with more than most would. Early on in my training at the wide-eyed age of 24, one of my professors told me, "everyone says or does something for a reason. That reason isn't always obvious, but that doesn't mean it's not there. Look closely and, if you're meant to be in this field, Boy Wonder, you'll see it." Those words, along with my idiosyncrasy of finding mean-spirited statements quite funny, generally allow me to not get defensive and help the client explore why he or she made such an insult.

Last week, Dr. Carol had an experience that tested her ability to "look closely," as we had been trained to do. Jim is a successful and cocky businessman, early 40's, whose wife left him after discovering his affair. This loss is more a blow to his ego than his companionship and according to Dr. Carol, after 6 months, she isn't coming back.

Dr. Carol: Jim, loss is painful, we all know that. But it seems as if you're making it harder by insisting that your wife MUST come back, that this can't be happening to YOU of all people. What is stopping you from acknowledging, even accepting, that she isn't coming back? Some schools of thought would say that your turning your pain into suffering.

Jim: Oh? Is that what they taught you in Jew School?

Dr. Carol: Actually, I think it's a Buddhist way of...what?

Jim: Jew School. Where you heebs get together and talk about taking gentiles' money.

Dr. Carol: I...what did you just call me?

Jim: A heeb. That's what you are, pushing your elitist "chosen people" crap on me.

Dr. Carol: I don't even know what to make of what you're saying. I've never even mentioned my Judaism once in our sessions!

Jim: You don't need to, I know how you Jews think. You think that...

Dr. Carol: I am going to give you one chance to apologize, or else I am going to ask you to leave and not come back.

Therapist Rule: Once you take on a new patient, you are obligated to provide them with alternative services should you decide that working with them is no longer feasible. I imagine that if push comes to shove, Dr. Carol would simply mail a referral sheet to Jim.

Jim: Why the fuck should I apologize? You're the Goddamn Jew who's always spouting how I need to get over...

Dr. Carol: Get out! NOW!

According to Dr. Carol, Jim simply got up, threw down a $100 bill (her normal fee) and walked out, at which she point she cried for about an hour. Remembering our training, I later asked what brought on those tears. Could Dr. Carol be the new Dr. Pete? "We're just people, aren't we?" Carol asked, her eyes turning a little red. "We're not robots or superheroes, we have feelings. And everyone has their Achilles' heel, something you just don't attack. Mine is my religion. What's yours?" My first thought was beer, but immediately decided to hug Dr. Carol in an act of solidarity while silently hoping that she not repeat the question.

Unfortunately Jim's behavior is not unheard of in the therapeutic world, albeit it is rare to witness an exchange that extreme. Jim decided to push the envelope even further by not only requesting a referral to another therapist, but demanding $47.00 in return, as he "paid in full but had not received his full session time." So Dr. Carol did what any self-respecting practitioner would do: she mailed him the referral and 4,700 pennies.

Posted by Rob Dobrenski at 12:00 PM

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Comments

It's a shame how in our modern world, Racist comments still exist, even in New York City.

Its always interesting to see how they treat psychiatrists. They are the ones with problems, seeking your guidance, but their ignorant comments makes them lose their money. I guess its a Win-Win for the Therapist.

Posted by: fr00tloops at September 4, 2007 07:11 PM

good stuff, I always kind of wondered how therapists dealt with the real jackasses.

Posted by: Ploin at September 4, 2007 08:10 PM

Did she really mail him 4,700 pennies?

That's brilliant!

Posted by: Jesus H. Christ at September 4, 2007 09:07 PM

that is a lot of pennies. cheerio!

Posted by: Abe Lincoln at September 4, 2007 11:56 PM

i would have told him that its a flat rate...although the pennies were a nice touch.

Posted by: Pat at September 19, 2007 07:09 PM

This so called psychologist is full a load of useless shit. By the way, a shrink is referred to as a psychiatrist and since he is not one of those he should change the title of his page. He is quite feminine and seriously needs to come to grips with that!

Posted by: Janet at October 24, 2007 12:02 AM

I would've mailed 4,699 pennies

Posted by: Manny at November 22, 2007 10:53 AM

Issues of transference can definitely be powerful, just as much so as the counter transference it causes. It is definitely a challenge to look past the verbal barbs and talk about the meaning, but damn if it doesn't get under the skin sometimes.

Posted by: Therapeutic Ramblings at March 16, 2008 12:59 PM