In New York City and many parts of the United States there is a discrepancy in cost for therapy in a private practice based on the discipline of the provider. From what I've seen Social Workers tend to charge less than Psychologists, who usually get somewhere between $125 and $225 per session. A Psychiatrist friend of mine charges about $275 and stated that's mainly because she can prescribe and manage any necessary medications. There's probably some elitism involved in that as well but that's not important right now. I've heard of some Psychiatrists charging upwards of $400 per session and recently as much as $500 but this new benchmark of $600 blows me away, especially given that there's no mention of medication management involved.

For me working with colleagues is generally a positive experience. We share a common bond because we've been through the same years of training and share a similar mindset about people and their problems. Clients who are shrinks themselves know the lingo; they know the format. It usually flows well. Many theorists believe that psychotherapy has an inherent power differential that isn't always comfortable: I am the expert, you are not. I am healthy, you are sick. My life is exactly the way I want it to be, yours is not. If you've read more than two words of this site you know that thought process is skewed, but many people enter a therapeutic relationship with this dynamic intact. I make every attempt to minimize this power differential by making therapy a collaborative relationship where we each share thoughts and ideas. Doing this with colleagues is often quite easy.

Conversely, the potential problem for me with a "pro to pro" relationship is a certain, self-induced pressure. Does she know more about therapy than I do? What if I make a mistake? Will she call me out on it? Is his practice more successful than mine? His Armani suit is much nicer than my Banana Republic khakis and Gap button-down polo shirt. I'll bet he makes more money. He's wearing a ring too...why is he married and I'm old and alone??

The mentally ill are often talked-down to and generally are treated as second-class citizens. During my graduate training I had some experience in psychiatric wards and the patients were often ignored or infantilized by the medical staff. This phenomenon was empirically demonstrated in 1973 by D. L. Rosenhan, whose study had people pretending to be patients in a psychiatric hospital. They approached staff members with questions like "Could you tell me when I will be eligible for grounds privileges?" or "When will my case be presented at Grand Rounds?" 71% of the time the psychiatrists (these are doctors, mind you) simply looked away and walked past. Only 4% of the time did they stop to talk to the people.

35-year-old studies are often not valid to highlight current psychological principles. After watching this video, however, the results seem more relevant than ever. If people want to make the argument that patients can be very demanding and need boundaries and limits, that's all well and good. However, the fact remains that this woman died at the very hospital where she was being treated, and multiple members of the staff watched it and did nothing.

To say that this disgusts me is an understatement. I bash shrinks all the time for being neurotic and weird and elitist and all sorts of other negative shit. I didn't know I should consider some of them to be soulless as well.

It's no secret that many staff workers at psychiatric hospitals are both overworked and underpaid, which often is an underlying cause of poor interpersonal contact and the delivery of therapeutic services. But what occurred in this video is simply inexcusable. And so the staff is fired according to news report. That's it? Does this "doctor" get to keep his license? If so I hope he ends up treating the very people who decided that he can continue to practice medicine.

I don't see a silver lining in this, save for the fact that perhaps people will give some more thought to the idea that the mentally ill are just as significant as the rest of us. But if this is what it takes to make people think, then I'm embarrassed to be part of the mental health community.

"Being able to have a laugh at yourself," she said. "Without being able to poke fun at yourself you'll never have a great sense of humor. You're also a tremendous disappointment to your father and I so please leave me alone."

She was right about that. The sense of humor part that is. And as a pseudo-young, Caucasian male it's important to have a lighthearted view of myself and my fellow white people.

To that end we have with us today Christian Lander, author of the popular website StuffWhitePeopleLike.com and soon-to-be best-selling book. Mr. Lander joins us to discuss the subtle yet complex intricacies of the psychology of being a white person.

My time in this group was preset from the day I walked through the agency's door. September to May. And when May came, I didn't like the idea of leaving. After such an unusual and intense training experience the thought of going back to doing research on projective tests wasn't overly appealing. With the group it felt like I was doing real work but more importantly, I knew that I would miss a lot of the women there.

Shrinks who say they love or even like all their clients are either delusional or lying. Not everyone who comes into therapy is likable and often their psychological problems can make them very difficult to deal with. Other times people are just disagreeable and make no mistake that the reverse is true as well: no shrink is going to be a perfect fit for every client and certain clients will actively dislike their therapists. That being said I was fortunate in this particular situation because I did like many of the women there and the feeling appeared to be mutual.

Even though our support group wasn't a formal therapy setting, many of the women improved to the point that they didn't need the group anymore (assuming their significant others were no longer in treatment). Others reported that they would stay in the group for as long as it existed, that they always took something new from what the members had to say. I believe that some of the women saw themselves as role models for new members and relished the opportunity to serve as a sponsor of sorts for new participants.

For the last group I had a small speech planned: review what we learned together, tell them how proud I am of them, never stop growing, rah rah rah! I've never successfully delivered a pre-determined speech and I knew this would be no exception so I scrapped it before group and decided to let the final session flow organically.

My supervisor had some charts and notes for me to sign before I left the agency for the last time so I took care of all that before group began. I arrived a few minutes late to find the women already there talking up a storm.

"He did what? That's horrible."

"He should be lynched for that."

"String him up by his balls!"

"Hi ladies," I said. "I think I'm missing an interesting conversation here."

"Jill's husband was late for their anniversary dinner. Being late...is something we don't tolerate around here," Anne winked.

"Ah, my supervisor warned me about negative reactions toward me. This is because I'm a man?"

"Yep. You're all the same," Jill said.

"Fortunately not everyone is like our men," Anne said with a small frown.

"No, not everyone is like that," I said. "You all have a very unique situation."

We talked about this notion of 'being different.' Some women challenged the idea, stating that plenty of people have family members who are murderers, thieves, rapists, or even a combination of those things. "No one has a perfect family," one woman asserted. "People are messed up, they do messed up things. Sometimes really messed up things. Do you know how many thousands upon thousands of people are in prison? Well those people have families. That's us."

Others held fast to the idea that the lives of the women in this group weren't like anyone else's. "I don't know anyone who is married to a Pedophile," said Ann. "I know these people exist but when I picture them they're just hypothetical figures, blank faces on generic bodies. So it's only here that I feel I'm with my own kind."

"That's why I'm here and I'll probably never leave. Because we're different." Jill said. "However, this one," she said pointing at me, "is leaving us," and smiled.

I couldn't help but think there wasn't at least some resentment behind that.

"Yes, as we had discussed, today is the day." I said. "I'd like to ask each of you how you feel about this."

"And are you going to share as well?" one woman asked.

"Absolutely."

Jill spoke. "I have mixed feelings about this. Our last two group leaders were women so this is a new experience for me." She paused and looked down into her lap. "I'm happy for you in some ways. You've taken another step toward getting your Ph.D. You probably learned a lot between working with us and our partners. And you were helpful and I'm grateful for that."

"Thank you," I said.

Jill

The group met in a large conference room at the mental health center. It was empty save for the large table that could have easily sat 25 people. Because we had less than one third of that we scattered around the table, maybe to make the group seem larger which would magically mean that even more people struggled from the same troubles. I always got to the room first and sat at the head of the table to establish my faux-authority as the group leader. Most of the ladies would come in one at a time, except for a few veteran members who had become friends and arrived together. Most women always had at least a perfunctory smile and no visible distress. Some came in with cups of coffee, others with bottled water and one woman even brought in cupcakes for the group. Sometimes I thought we were about to begin book club rather than talk about sex offending. In retrospect I think the women arrived still holding on to the façade they showed to the outside world: strong, put together, functional. Some women maintained that stance throughout their time in group. "I want to be in control and I'm going to fake it 'til I make it."

Lengthy introductions were not required at each meeting. Instead people just went around the room and gave their first name as a reminder to the other members. Even though my self-loathing anxiety had dissipated I generally managed to flub even the simplest of introductions. "I'm Roberr. I mean Robert. Just Rob is fine. I'm the leader. Or facilitator. Whichever you prefer. Let's go with facilitator."

When a new member came to group each person gave a more detailed account of who she was and why she was here but only if she so chose. The new member was then asked to say hello and share whatever information she would like.

"My name is Ann. I'm...not sure why I even need to be here. My husband is...well he did bad things to our neighbor's daughter. He spent some time in jail and now he's home and getting...help here. She became teary-eyed. "I just can't believe this has happened. My husband is a convicted sex offender. Just saying that makes me sick to my stomach. I feel horrible for the girl he did this too and I'm so embarrassed. I don't even know what to say to her family."

She cried for a few moments and a group member reached for a tissue to give to her. "NO!" shouted a woman named Jill, a seasoned member of the group.

"What? Why not?"

"You're interrupting the healing process," she said.

I work in a high security psychiatric hospital and was told that while highly unlikely the patients could become aggressive at times. I'm new to the field (I have a Bachelor's Degree in Psychology) and I wouldn't say I'm afraid but at least concerned. Have you ever been involved in any episodes of violence? How did you handle it?

"Dr. Dobrenski, this is Dr. Straka," she said in a heavy accent that sounded Eastern European. "I'm a Psychiatrist at ___________ Hospital and I'm wondering if you'd be interested in sitting down to discuss an opening we have in our department."

Psychiatrists are fairly strange folk so the idea of sitting down with one didn't sound overly appealing, especially since I'm not actively looking for more work.

"What type of opening?" I asked just in case it paid four million dollars per week. Plus benefits.

"We just need someone to come in a few days each week to see some of our patients for therapy. I only have time to do the meds and there's no one else in the department who is available. You should know up front that you'd have to do your own billing and scheduling and that there is no group supervision unfortunately. It's just not in the budget. You know how it is."

"Yes yes, that's a shame," I said and a big smile grew across my face. You don't need to be an entrepreneur to appreciate this type of opportunity. Complete autonomy. No one like Dr. Allison chasing me around to talk about some obscure article on "Psychoanalysis for Cats" that no one will ever read. No Dr. Gail to get on my case about placing a period after each "A" and "M" on my morning clients' progress notes. No Dr. Pete to make me listen to Hall and Oates and discuss its ramifications on his music therapy practice. And of course no rent increase from Dr. Steve. I could just go in, see the patients, help them as best as possible and go home.

"Can we sit down tomorrow?" I asked.

When people report success with group work they usually speak of what is known as 'Universality.' Clients will often say "It felt good to know that I'm not the only one with this problem," "I felt very accepted by the other members," or "It helps to be able to talk things through with people who understand, people who are struggling with this as well." The therapist or group leader's main responsibility is to facilitate group cohesiveness and disclosure to bring about the Universality phenomenon.

One important attribute for a group leader to help maximize success is known as 'credibility,' of which I had none. My age (25), gender (male), marital status (single), prior number of groups conducted (zero) and practical experience working with sexual offenders (none) essentially made me the worst possible person for this endeavor.

The morning of the first group I decided to play up my strengths rather than focus on my weaknesses. Like Stuart Smalley I engaged in an affirmation that quickly turned sour:

You, Rob Dobrenski, are...a nice person. You are fairly tall and...take very good care of your teeth. You're a good listener. You know the basics of human behavior and what makes people tick. Someday you might be very good at sex offender work because you've been reading about it incessantly over the past few weeks. In fact you probably have a thousand more great qualities but your low I.Q. is preventing you from thinking of any of them. What the hell is wrong with you?? Shit! I'll never be successful. Why did my parents have to get divorced? It was probably my fault because I'm so ugly. Only a blind dog would ever love me. Possibly a starving cat.

What I truly crave however is that ability to help a sufferer outside of the office in an emergency situation. Much like the doctor who performs the impromptu tracheotomy on a man in the street using only a # 2 pencil and an alcohol wipe, I too would relish performing a psychological service to one truly in need: a sociopathic killer holding a damsel in distress on the George Washington Bridge who is talked down from his maniacal plan by the soothing and sagacious words of Dr. Rob. This of course would be followed by the cheers of a gathering crowd who hoist me onto its shoulders and whisk me away to the nearest ale house. That would be nice.

I had decided that such heroism would never occur and that I would have a simpler career with quality therapy delivered in healthy doses to those who seek out my services. Strangely it was after I came to that conclusion that my professional life got just a bit more interesting.

I had left Dr. Pete's apartment after a peer supervision session where the focus had annoyingly shifted from discussing important cases and therapy styles to Dr. Jane and Dr. Allison debating who was better looking: Freud or Rorschach (yes, Rorschach was a real man). I should have just followed MILF-loving colleague Dr. John's modus operandi and not attended at all ("Supervision is for pussies. Real shrinks don't need help.") but was at least smart enough to bail before they started talking about which male clients they would like to sleep with. Getting into the elevator on the 35th floor I came face to face with a middle-aged woman who was teary-eyed and panting.

This is known as Exposure Therapy and is based on the idea that anxiety is often a physiological reaction to a perceived danger. Through multiple plane rides (called "trials" in the shrink world) the body and mind starts to recognize that inherent danger is not present and the anxiety subsides. When a client can take that final step and begin exposure trials outside the therapy room life often becomes much better because Exposure Therapy has a great track record for treating fears and aversions. When he can't take that step his therapist has to at least consider the possibility of taking it for him.

Consider my work with Bryan, a young graduate student who was working with me on a variety of dating issues for some time. Bryan put a lot of effort into therapy and we had a very strong working relationship. Most recently Bryan had been grappling with initiating phone contact with women. He could speak with them in person, get their phone numbers and even make tentative plans to go out with them but when the time came to make the call to solidify those plans, he would freeze.

Bryan and I talked about this ad nauseum over many weeks using every therapeutic technique in the book.

When it comes to the human condition you don't learn all that much from textbooks. You learn by doing. You get into the room with the person and you interact. While you try to remember what the books and the professors said and you memorize the jargon, the real learning is by trial and error. Sometimes the training opportunities present themselves before a you have had any book knowledge whatsoever. For me this occurred when I facilitated a support group for the spouses/significant others of sexual offenders, a group comprised entirely of women.

"Support groups" generally differ from "therapy groups" in the sense that they often don't have a specific outline for each session, the members of the group tend to have varying levels of participation and attendance, and that their purpose is exactly what it sounds like: to simply provide support to the members who are dealing with a particular issue. Sometimes they are facilitated by non-professionals. Therapy groups, by contrast, are theoretically designed to treat a particular psychological problem. They are run by professionals and usually have an overarching objective or goal for the participants.

The Significant Others of Sexual Offenders Group was unique in the sense that enrollment in the group was required. If you wanted your partner to be treated for his sexual offending, you needed to be a part of the group. If you were not there during the regular meeting times, your man was kicked out of treatment, plain and simple. This requirement was based on certain theoretical principles:

Even though I work in the Department of Surgery I sometimes go by Outpatient Psychiatry to be among my own kind. Today outside the main door was a male administrator, late 40's, well-dressed and groomed. He was speaking to a man who was in all likelihood a patient at the hospital. The man was about 60 and overweight, had a few nervous twitches and was speaking in a soft voice. He was unshaven and his clothes were tattered. I have a guess that he might suffer from Schizophrenia. I've seen him before in a worse way, responding anxiously to voices and people that no one else could hear or see. Today however he seemed much healthier and functional.

"Rob," she said, clearly anxiety-stricken. "I don't want to alarm you, but one of the clinicians here at the practice has been getting threatening voicemails from one of our clients. We just had a meeting to discuss our recourse."

I'm rarely at Gail's office these days so I'm never invited to the meetings. At the last one I attended Dr. Allison and Dr. Mike got into a fight over how to spell 'Zyprexa,' (an antipsychotic drug) and both initially refused to even look it up because each was so convinced of his/her position. Eleven minutes later, dictionary.com proved them both wrong. It was neither 'Zipprecksa,' nor 'Xyprekksa.'

"What did the client say?" I asked.

"I don't want you to get upset, but she said, get this: I'll see you in hell!"

You might remember that I had received some highly vague threats as well as a more direct one so I'm not a stranger to a client's potential for a strong reaction to his mental health provider.

"And what exactly is the problem?" I said.

"Rob! This is a direct threat and a crime!"

"How is it a threat? You're probably not going to hell anytime soon and even if you are she just said she'll see you there. What's the big deal?"