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Dr. Bob is Robert Hsiung, MD,
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Posted by mair on January 26, 2005, at 21:47:26
In reply to Re: model good eye contact » bimini, posted by gardenergirl on January 25, 2005, at 22:54:57
GG - when you're with a client do you have trouble really listening?
As a client, I'm not always very good with eye contact, although I'm getting better. I do think I listen to my T better when I'm looking at her. Sometimes when I look away, I'm withdrawing and hearing but not listening. I think it makes feeling that connection harder.
I wonder about it from a T's perspective only because I find it hard to pay attention through whole session; (I mean during the time when my T is talking). I assume it must be hard for the T also.
My T takes alot of notes, because she says it helps her remember later on what was discussed, and I suppose, is a way for her to ensure that she doesn't miss anything. I never could figure out how Ts remember as much as they do without taking notes. HOWEVER - I'm starting to think there's a downside with notetaking. I think it's harder for me to make the connection that comes with eye contact if my T is looking down at a note pad. So I think she misses messages that I might convey by expressions, for instance. Sometimes I think the notetaking distracts to the point where she, too, is hearing but not really listening.
What do you think?
Mair
Posted by gardenergirl on January 26, 2005, at 22:47:22
In reply to Re: model good eye contact » gardenergirl, posted by mair on January 26, 2005, at 21:47:26
Good questions, Mair.
I haven't been aware of having trouble listening very often. I do distinctly remember one client who was an 82-year-old man I had been seeing for months. I was very very tired that day, and when he went into the usual recitation of all his bodily complaints, I found myself tuning out and going into a "zone" for a bit. It was hard to shake myself out of it. Ugh. But usually, I'm hooked by whatever the client is talking about.I don't take notes. I also find it distracting, and I rely on the non-verbal probably at least half as much as the verbal information from the client. The only time I take notes is during the first session when I am taking a history. Too much detail to remember then. And I always find myself stopping writing when things get really interesting, anyway.
gg
Posted by All Done on January 26, 2005, at 23:11:40
In reply to Re: model good eye contact » mair, posted by gardenergirl on January 26, 2005, at 22:47:22
Do you remember everything, gg? And if you do, how on earth do you do it?
I have a horrible memory - long-term, short-term, it doesn't matter. My T, on the other hand, seems to remember everything about me and everything I've said. Sometimes it surprises me when I can't, for the life of me, even remember telling him something.
He only (sort of) took notes on my first session, too.
Posted by terrics on January 27, 2005, at 6:35:48
In reply to Re: model good eye contact » gardenergirl, posted by mair on January 26, 2005, at 21:47:26
Just to add to this, my T. takes notes for 1/2 the session then puts her pad down and finishes without anymore notes. terrics
Posted by mair on January 27, 2005, at 7:05:33
In reply to Re: model good eye contact » mair, posted by terrics on January 27, 2005, at 6:35:48
I have other problems with note taking. Sometimes I find myself almost slowing down so my T can catch up with what I'm saying. It makes me feel like I'm dictating. Also, she has a tendency to write down some stuff I say verbatim, and I really dislike having it read back to me. I don't like the implication that what I say is of importance - not in the overall sense, but specific words or phrasing.
Should I tell her all this?
Mair
PS: She never used to take notes. She started when she decided I needed more intensive therapy and had me come twice a week. Now she loves it; she says she takes notes in her sessions with all of her other clients too. I think she really used to feel stressed between sessions trying to write things down about the session she just had, and probably like the rest of us, relieves her of having to try to remember things.
Posted by terrics on January 27, 2005, at 15:00:44
In reply to Re: boundaries » gardenergirl, posted by terrics on January 26, 2005, at 6:09:59
Hi gg, Here are a few examples of what I think are very foolish teachings: Core : teflon mind, watch your thoughts coming and going, the guard at the palace gate. Some good core mindfulness skills: non-judgmentally, letting go of vengeance etc., focus on what works. I think SURFING the URGE is useless. It focuses on the urge and keeps reminding you of the urge and therefore being who I am I complete the urge..Some of the interpersonal skills have been useful. You have to pick and choose. DEAR MAN GIVE has some usefulness; again pick and choose. Acting your way into feeling differently seems impossible to me. Have you ever been in a rage and then just tried an opposite action?
This is none of my business so you can berate these comments if you like. I think you should go through DBT from beginning to end with a skillfull therapist. You will also need somone to talk with if you decide to use it on borderlines because they act strongly both physically and verbally and can cause a lot of hurt and burnout to a young therapist. Also, if you go through it first, you can pick and choose whatever you find pertinent rather then using the 'silly stuff'. terrics
Posted by Annierose on January 27, 2005, at 15:32:43
In reply to Re: boundaries/ GG, posted by terrics on January 27, 2005, at 15:00:44
Posted by gardenergirl on January 27, 2005, at 19:37:15
In reply to Re: model good eye contact » gardenergirl, posted by All Done on January 26, 2005, at 23:11:40
Oh heavens no, I don't remember everything. I am always referring to my notes when my supervisor or one of the docs asks me a detail question. I'm much more of a big picture, flavor of the session kind of gal.
gg
Posted by gardenergirl on January 27, 2005, at 19:59:28
In reply to Note taking, posted by mair on January 27, 2005, at 7:05:33
> Also, she has a tendency to write down some stuff I say verbatim, and I really dislike having it read back to me. I don't like the implication that what I say is of importance - not in the overall sense, but specific words or phrasing.
Ewww, I would not like this. I think that how you say it today is what's important today. It's okay to note discrepancies or changes. But ick, it almost sounds like reading the transcript back in court. Yuck.
Okay, obviously I have a reaction to that. If it makes you uncomfortable, certainly tell her.
gg
Posted by gardenergirl on January 27, 2005, at 20:30:28
In reply to Re: boundaries/ GG, posted by terrics on January 27, 2005, at 15:00:44
I think this is valuable feedback. I really appreciate you letting me know. You are right, it's important for me to be very familiar with these skills in order to use them effectively. Especially because my supervisor is not familiar with them.
Thanks again,
gg
Posted by mair on January 27, 2005, at 21:23:46
In reply to Re: Note taking » mair, posted by gardenergirl on January 27, 2005, at 19:59:28
Actually I did talk to her about this today - how I don't like having my words repeated back to me and about how equivocal I am about the notetaking. She said she had been trying to cut down on taking notes because she thought maybe it was inhibiting my ability to feel connected with her. (I had noticed the last couple of times that she didn't seem to be as distracted by taking notes) I think she feels that it's a pretty valuable tool for her but certainly one she can pare back on. And I don't mind the notetaking; just the volume of it. She feels less rushed in between sessions if she doesn't have to devote that time to taking notes, although she said that it's not so much of an issue with me because I'm pretty good at making sure I don't run over my time.
And she also said she needs to be more sensitive about my discomfort having my words read back to me. (I have told her I don't like it before; I think she just forgets.) She's not so much reading them to me as reading them to herself - out loud.
So I'm sure she felt like today's session was a positive - she got me to ask for something I needed and to give her feedback on what I like and don't like about the way she conducts sessions, and she was able to respond in a way that showed me it was ok to do that.
It would just be nice if it wasn't all so excruciating.
Mair
Posted by Dinah on January 27, 2005, at 22:27:47
In reply to Re: boundaries/ GG » terrics, posted by gardenergirl on January 27, 2005, at 20:30:28
I think the advice to admit to the silly parts was excellent. As you may know, my main problem right now has to do with work, and since my therapist also has coaching experience, I had asked him if he could call on that to help me.
The other day he did that, but he admitted that parts of what he said would sound silly. And they did. But it didn't matter as much, and I didn't get as angry because he had admitted that. Instead of rolling my eyes and sighing, I smiled at him when I felt patronized, and instead of getting defensive, he smiled back and told me the part of the silly stuff he thought was actually helpful.
It took what has always been a huge problem to me with those one size fits all models and made it into something positive.
Posted by Dinah on January 27, 2005, at 22:36:16
In reply to Re: Note taking » gardenergirl, posted by mair on January 27, 2005, at 21:23:46
>
>
> It would just be nice if it wasn't all so excruciating.
>
> MairAin't it the truth!!
I get a bit paranoid about my therapists notes sometimes and ask him to read them back to me. He always picks apart my request enough that I'm discouraged from doing it often. Fortunately he appears to hate notes as much as I do. They're always something very generic, no matter how intense what we discussed was. "Patient discussed family stressors, and we identified possible coping strategies." or something similarly bland and often oddly off the mark. And usually one line per session. I suspect that even when he takes a lot of notes when he thinks he needs to for self protection, they're probably along the same generic lines.
Oddly, he now remembers things I barely even remember telling him. Quite a change from the early days when he barely remembered my name. It was the change from once a week to twice a week therapy that did it.
I think you are showing an immense amount of trust in your therapist - more than you give yourself credit for. It's hard enough to say things out loud. If I knew they were going to be written down verbatim, they'd never leave my mouth. :(
Posted by Annierose on January 28, 2005, at 12:59:15
In reply to Re: Note taking, posted by Dinah on January 27, 2005, at 22:36:16
All -
My T only takes notes when I lie down, vs. sitting. And I imagine that are not too detailed, although I don't know for sure. Along the same lines as GG, my T is a more "flavor of the session" type person, than specific details. Sometimes I do find that irritating, as I will have to recall information to her, but usually once I start the "story" she'll remember what I as referring to and I can stop the retelling.
And often times, she misunderstands the story completely (a "language" barrier ... I speak quickly). But I am getting better at speaking slower and I think she is getting better at remembering :)
Posted by mair on January 28, 2005, at 22:38:16
In reply to Re: Note taking, posted by Dinah on January 27, 2005, at 22:36:16
It's not like she makes reading these things back as part of a regular session. Mostly it's when neither one of us can remember something from a recent session and she looks back at her notes and just reads aloud what she had written.
I was a little disconcerted when she first started taking notes, but I guess I don't see the difference between taking them in session or right afterwards so long as it doesn't disrupt the rhythm of the session. I guess she does get stuff in more detail. I know they're not always in super detail. She told me recently that she wrote the word "miss" is large writing after a particularly bad session recently to signify that we just weren't on the same wavelength. That doesn't sound too detailed.
As to the there for posterity part, I guess I do have to trust her. I know with all of these notes, my file is two pretty thick folders. I've never had any desire to read my file, and it doesn't sound as if my file has alot of editorial comment to it anyway. So I figure I can't win either way - I don't like reading my own words, and I don't like seeing myself referred to in clinical terms.
Periodically, I do worry about what happens to my file if she's suddenly killed in an accident. Anyone know the protocol for this?
Mair
Posted by terrics on January 29, 2005, at 7:42:11
In reply to Re: Note taking » Dinah, posted by mair on January 28, 2005, at 22:38:16
Hi Mair, What a good question. What DOES happen to our files if T. dies? I do worry what info is in mine, but what can you do..terrics
Posted by shrinking violet on January 29, 2005, at 10:03:04
In reply to Re: Note taking » Dinah, posted by Annierose on January 28, 2005, at 12:59:15
My T never takes notes. I think she did during the first session or two, but after that she stopped. And she remembers everything, even little details of our conversations or details about me, even things I don't remember! I'm glad, though, b/c it makes me feel like she's more invested and paying attention. I'm sure she writes things in my chart after our sessions, but I've never seen them so I'm not sure how detailed they are.
I'm not sure if I'd rather have a T who took notes and remembered everything, or a T who didn't and couldn't remember much. I'm glad my T doesn't fall into either category. :-)
Posted by antigua on January 29, 2005, at 14:06:57
In reply to Re: Note taking, posted by shrinking violet on January 29, 2005, at 10:03:04
My T says she doesn't take notes or have a record because she doesn't want them ever to be used against me (or any of her patients). She remembers almost everything.
antigua
Posted by Dinah on January 29, 2005, at 14:13:48
In reply to Re: Note taking, posted by antigua on January 29, 2005, at 14:06:57
That's more or less what mine says, too. Or maybe it's me afraid it'll somehow be used against me, and him who agreed. Something like that. He seems to have carried the rules of the clinic where he used to work with him into private practice. He still takes notes but they're definitely even shorter than they were before. And he promises he doesn't mention anything I wouldn't want to see made public.
Paranoid? Who, me?
Posted by Dinah on January 29, 2005, at 14:24:25
In reply to Re: Note taking » Dinah, posted by mair on January 28, 2005, at 22:38:16
I've kept this in my appointment book for a while now, waiting to talk to my therapist about it. I actually managed to put the thought in his head the other day and found that he knew remarkably little about what was required and had made absolutely no plans.
http://www.nesttd.org/Thinking.htm
It doesn't mention the files except in passing, but it sounds like a reasonably sound strategy. I think legally the files have to be kept for seven years?
Posted by gardenergirl on January 29, 2005, at 19:42:56
In reply to Re: Note taking » mair, posted by Dinah on January 29, 2005, at 14:24:25
Great article, Dinah. It is something we don't like to think about, but gosh, it would be so much easier if plans were already spelled out. And not just for psychologists. For everyone.
About records. It may even be 12 years that they need to be kept. That is the number we used at the clinic I trained at last year. I'm not sure, but after 12 years, we may even keep the treatment summary and destroy the rest of the file.
gg
Posted by mair on January 30, 2005, at 14:10:50
In reply to Re: Note taking » Dinah, posted by gardenergirl on January 29, 2005, at 19:42:56
You mentioned treatment summaries. So what's in those files which some of us want to see and some of us are loathe to see? Do all Ts have treatment summaries or is that something prepared when a client terminates? If I looked in my T's file, would I only see those notes she takes during our sessions? Are the notes likely to contain editorial comment/analysis instead of just "she said" stuff? Might there be comments to herself reminding her to delve into a particular area?
Some people mention that Ts sometimes don't like notes because they don't want the notes coming back to hurt them in a lawsuit for instance. I would think some would want the notes there to protect themselves.
Thoughts?
Mair
Posted by gardenergirl on January 30, 2005, at 18:26:18
In reply to Question for you » gardenergirl, posted by mair on January 30, 2005, at 14:10:50
Well, I suppose it depends on the requirements of the site and/or the third party payors. Usually there is a note documenting the initial session, which may have some detail about history or it may not. Again, this is T's preference and also depends on the site. Usually there is some documentation of each session. Some T's simply write that the session occured. Others write in general about what was covered. Some write at length about process and content. There is a distinction between notes documenting that service occured and psychotherapy notes. Psychotherapy notes (what has more detail, and could include T's thoughts, speculations, reactions, etc. or could just rehash the session) are in general more protected for privacy. HIPAA says that insurers cannot access psychotherapy notes. You might find a treatment plan. Often, this is shared with the client and may even be signed by the client. This might include a diagnosis or at least something describing the problem, relevant goals, treatment interventions, and progress signs. And finally, after termination, there should be a termination summary. This is pretty much what it sounds like. It summarizes the presenting problem, course of treatment, any unusual events, progress or lack of, and disposition.
All of this may be very general or very detailed. The best I could suggest would be to ask your T about what they document. Frankly, I don't know what my own T does! I did have a discussion about how they are protected, since they don't fall under HIPAA but rather some other protection related to educational records.
I know I try (don't always succeed) to make sure that whatever I write in the note is not soemthing that I would be concerned about the client reading. Because they do have a right to read them, at least in my state.
Hope this helps.
gg
Posted by mair on January 31, 2005, at 12:27:11
In reply to Re: Question for you, posted by gardenergirl on January 30, 2005, at 18:26:18
Thanks GG - that's pretty much what I would have expected.
I am not a person who is dying to read my file. I find it very discomforting to read about myself or hear me discussed by someone using clinical verbiage. I'm sure part of it is just the way you feel when you're referred to in the third person - like when someone is talking about you but not to you. It would be a little strange even if it were another kind of medical record, but when it's derived from a T's or pdoc's records, it's hard not to read into it some sort of judgment.
I switched pdocs 4 years ago when the man who had been my therapist for about 2 years and my meds guy for 2 years after that retired. He wrote a lengthy letter to my new pdoc outlining mostly just my drug history and in much briefer terms, my therapy history. Overly sensitive me read so many judgments into what he wrote, that even years later, it pains me just to think about it. I've probably devoted at least 5 or 6 different sessions with my current T to a discussion of this letter and my feelings about what was written. I can't even begin to imagine how I'd react to a whole file!!
Mair
Posted by Dinah on February 1, 2005, at 7:54:15
In reply to Re: Question for you » gardenergirl, posted by mair on January 31, 2005, at 12:27:11
I can relate!
I have a real fondness for saving my medical records. I get hold of all the ones I can, I ask for copies of my test results, which I keep in a big old file somewhere. It's come in really handy at times as one provider ceased doing business and another lost my file.
I'm the same way about psych records. I ask for copies the second the relationship is over. Then I not infrequently get outraged because they either got something completely wrong or they said something that sounded awful. I got so upset over one of the psych notes in my pediatric file (my pscyh file has long since been destroyed, drat it), that I tracked down my psychiatrist from the period (who left private practice shortly after seeing me and was away from this area for some time and had just returned) to ask him what on earth he meant by the comments. He appeared astonished, but not angry, that I could find him, said he was glad to hear from me and that I could call him if I thought of any further questions. He remembered me but vaguely, my parents better, and his comments about what he had written were soothing and framed in terms that patients didn't have access to their files back then. Then he said that if what he had written were correct, I certainly would have known it by now, so I could safely assume he was mistaken. Hardly reassuring. But while I was upset at the time, I'm glad I did it in retrospect. I learned a lot and remembered a lot working through it with my therapist.
But...
I would never ever ask to see my therapist's notes, not now, not in a million years. He hurt me enough with the second hand comments quoted by the pdoc from Hades, and which he never denied. Similarly I never have requested the notes from the pdoc from Hades because of what they might contain from my therapist. Although the limitation period for keeping those notes is nearly up and I ought to request them, even if I never read them. The difference is that I care about my therapist and he has the power to really hurt me as opposed to just angering me or causing brief injury.
This is the end of the thread.
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