It’s not bad enough that if you go see a psychiatrist that they may give you medications of questionable efficacy that may be complicated by making it hard for you to get off your couch and other side effects. But as I was discussing at lunch the other day with Charles Whitfield MD, friend and fellow Atlanta MD author and author of The Truth About Mental Illness and other books in the trauma field, psychotherapy can be helpful but can also be a double edged sword. That made me think about my long term psychotherapy supervision as a Yale psychiatry resident. The supervisors were great, I followed a patient for several years and they met with me (two of them) for an hour a week, they were both with the New England Psychoanalytical Institute, which was affiliated with Yale, and both had offices on Trumbull Street in New Haven, CT, which was “therapy row”.

Therapy Row, Trumbull St, in New Haven CT

Their names were Charles Gardner MD and Ira Levine MD. After I graduated I subletted Charlie Gardner’s office for my own small private practice for a while. Then I moved my practice to my house. My five year old daughter liked to talk to the borderline-strippers with total body tatoos in the waiting room. Oddly they seemed to be at a similar level of psychological development.

When I moved from Yale to Emory in 2000, the Director of Clinical Services, Steven Levy MD, who was (is) a psychoanalyst, kind of eyed me funny, as I was a researcher who was primarily focused on brain imaging studies in PTSD. He is now the acting chair of psychiatry at Emory. How ironic. He probably doesn’t know that I was born at the Meninger Clinic in Topeka KS, where my father was a psychiatry resident and whose mentor was the famous American psychoanalyst Karl Menninger MD. One of his jobs was entertaining visitors to the Meninger Clinic, who included Aldous Huxley, the author of the book Brave New World, who had dinner at our house.

We don't need soma, since we have Seroquel

Dr. B. outside Berggasse 19, Vienna

Anyhoo Charlie Gardner gave me a paper by a psychiatrist and analyst named Robert Langs, MD. He wrote several books including Rating Your Psychotherapist which I went back and repurchased. The gist of these books is that there are certain principles that characterize good therapists, including the fact that they start and end on time. Langs discussed the “frame” of therapy as something almost religious, which at the time I thought sounded nuts, but with time I came to appreciate as being very important. He makes these points about what is required for a good therapy:

• A single set fee
• A single, set location
• A set time for and length of sessions
• A soundproof office
• The rule of free association
• The therapist limited to neutral interventions (i.e. not from personal needs of therapist)
• The relative anonymity of the therapist (no self revelation or opinions, work limited to the material from the patient)
• total privacy
• total confidentiality

I don’t think this list is unreasonable. And I don’t think it is unreasonable to request that someone you are paying money to should abide by these rules if that is what you want. And yes dreams are important, in spite of what the Shrink Rap bloggers think, and I recommend this book by Robert Langs called Decoding Your Dreams. He recommends free association from the elements of the dream, identifying the day’s event that triggered the dream, and not writing it down or talking about it with others (to let the dream continue to grow in meaning).

Unfortunately the current generation of psychiatrists was trained by the pharma-bio consortium, and doesn’t always take dreams and therapy seriously, but the ”New Psychiatry” is on the way (stay tuned).