Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Tuesday, July 15, 2014

More Analytic Wierdness

I'm wondering what other psychiatrists do when they see their patients in a setting outside the office. I'm not talking about boundary violations-inviting a patient for a drink, attending a patient's wedding. I just mean you're simply walking down the street, and there's your patient.

My own policy is that I won't approach the patient, nor will I even acknowledge her, unless she acknowledges me first. And then I'm polite and I smile and nod or say hello. Then I walk away. This has been tricky a couple times, on the subway. I can't really walk away. It's true, you can walk from one car to the next, but ever since I got a $75 fine for doing so, I stay put.

The lack of acknowledgement is not intended to be rude. It's just that there have been occasions when a patient was clearly uncomfortable seeing me, and didn't want to interact at all, so I feel like it's not right for me to put her in that position.

And I know from my experience as a patient just how uncomfortable that can be. I've written before about taking the stairs at the Institute to avoid getting into a small elevator with my analyst. I've occasionally avoided eye contact when I see her on the street or in a restaurant near her office. And at the annual dinner, it's all I can do (well, me and a glass of wine) not to run when she's in my vicinity, or when I see her talking to someone I'm friendly with, or standing with her husband.

Over the course of my analysis, I've gotten better about this. A couple of months ago, I was at a talk at the Institute, and in walks my analyst. I was sitting in the back, so I could cut out early (I'm on the scientific program committee, so I'm sort of required to be there, and I enjoy the talks, but I also just want to get home). I was actually reading something on my phone, but as she walked by me, I recognized her boots.  And I was fine with that. Of course, I didn't need to make eye contact with her. And I had the strange experience of second guessing myself. "Was that really her? I only saw her from the back. Maybe it was someone else." She's kind of short, so I couldn't see her well from where I was sitting.

I know from speaking with colleagues that I have a more extreme reaction to "outside" encounters with my analyst. Some people are a lot more comfortable in those settings. And I have one friend who's at the other extreme, and  will actively approach her analyst and say hi, or wave at him. I actually think she and I share the same feeling, but with differing responses.  We're both intensely, maybe grotesquely interested in our analysts' personal lives, in the fantasy of being part of those lives, only I'm avoidant, and she's counter-phobic.

And I find the experience of exclusion particularly painful, since I know that I am both my analyst's patient, and her colleague, and if I had worked with a different training analyst, I might have even been her friend.

Or not. She's a little annoying.

My analyst's office is on the Upper East Side, and my office is in Greenwich Village. For those unfamiliar with New York City, we're not neighbors. The actual distance is just under 5 miles, but Manhattan is made up of micro-neighborhoods, so we might as well work on different planets.

Tonight, I was walking to the subway from my office, taking my usual route, and way up ahead of me, walking right towards me, is a woman who looks a lot like my analyst. I can't see details from this distance, but she has the same distinctive walk I recognize. A kind of brisk, side-to-side movement.

There's no one else on the block, nothing to stop us from looking straight at each other.

I panic and cross the street. It takes a while because I'm in the middle of the block and there are a bunch of cars I have to wait for. I hope she doesn't spot me skulking between two parked vehicles.

I tell myself she wouldn't have noticed it was me. She was on the phone so she was probably distracted. But I recently got a new bag, which is kind of, well, pink and obvious, even from a distance.

I cross the street and keep my back to the side she's walking on. I feel like an idiot and try to think of something to do that would make it seem like there's a reason I abruptly crossed the street. One that has nothing to do with her.

I take out my phone and start to take pictures of a building on my side of the street. I've taken photos of this particular building before, but she doesn't know that, so I can just tell her tomorrow that I'd been planning to photograph that building for a long time, and this seemed like the perfect opportunity, at the end of the day, in bad light, when I'm dead tired, and it's about to rain.

I take a lot of photos of my work neighborhood. It's an older part of the city, with these lovely tree-lines streets and townhouses galore. All kinds of cool stuff. Mark Twain and Eleanor Roosevelt both lived within 100 yards of my office.

This is the building:

The Building

It's the 2nd in a row of 6 Greek Revival/Federal style buildings that were clearly built at the same time. You can see what the other five look like in the building to the left. But this one has that weirdo modern angled facade. Now, I generally prefer modern architecture, but it doesn't work here. And I could never understand why anyone would go to the trouble of completely altering the facade,  as was obviously done, and have it look like this.

It turns out, as I recently learned, that this is the building where the Weathermen constructed and unintentionally detonated their bomb. Which explains why the building needed a new facade. But not why whoever payed for it chose this particular style.

So I definitely needed to take this picture. I wasn't avoiding my analyst at all.

I waited for a bit, and was going to continue to the subway, but then I had that same nagging feeling that maybe it wasn't my analyst. After all, I didn't really see her. And she was wearing a different dress earlier today. But then she was obviously coming from the west side subway, so she may have gone home to change (she lives on the Upper West side, don't ask how I know).

But it couldn't have been her, because if it were, she would have been walking one block north, where the subway exit is, to the building where her husband works (don't ask how I know where he works, I just do, and it's a block from my office).

So I did the obvious and completely natural thing. I followed her. I had to hurry to catch up, and then I had to lag behind so I wouldn't get too close. I trailed her for about a block, only seeing her back, and when I finally convinced myself that it couldn't have been her (yes, "she" is grammatically correct, but I'm trying not to sound pompous in my writing), I saw her go into a restaurant that's a block from my office.

Well, that left me across the street from my office, wearing a raincoat that was making me swelter, so I decided to go back to my office and leave my raincoat.

I was feeling pretty good at that point. quite convinced that it wasn't my analyst, and that I therefore wouldn't have to bring this ridiculous and embarrassing experience up in my session tomorrow, even if I really ought to.

I left the office, planning to walk my usual route to the subway. That's when I saw her husband crossing the street. I stayed on my side, he stayed on his, and I followed him until I saw him go into the restaurant.

I hovered in place for about a minute, torn between turning around and taking my usual route, or walking past the restaurant and getting onto the subway at a different stop. Then I worried that she might see me if I walked right by the restaurant. I resolved to walk another block out of my way and take the next street. Then at the last minute, and only because the light was in my favor, I walked along the same block as the restaurant, but on the opposite side of the street.

This will all be "grist for the mill" tomorrow, unless I completely lose my nerve. And writing it kind of makes me wonder how effective analysis has been for my general neurosis.

But the August break is coming up, the great analytic migration to the Hamptons, and I'm sad when I anticipate the feeling of loss.

And it reminds me to keep in mind, with all the compassion I can muster, and before my own August break, how important I am to my patients.


  1. That was funny :) If you talk to your analyst about this stuff, she will probably think it's humorous as well. She'll have a little chuckle in her head.

    1. She did. And I appreciate the moral support.

  2. I think this depends on the setting. Someone with serious mental illness might see the person near the CMHC and say hello easily or see the medical director of their agency at a wellness fair. Or sometimes a doctor like that will make calls at a group home to see other psychopharm patients, and your roommates all share the same psychiatrist. But these people are not engaged in psychotherapy.

    On a long-term inpatient unit, the patient will see the psychiatrist in the hall or at community meeting...

    1. True. There was a small park right next to the hospital where I did my residency, and lots of patients would sit on those benches and wave and say hi when I and other residents would walk by. That setting was a bit more relaxed, though.