Tag Archives: psychiatrists

When Bonding With Baby Isn’t So Easy

Mothers love their children automatically, right? Well, not always, especially if Mom has pre-existing psychological problems. If Mom is lucky enough to find her way to therapy, there’s a treatment that could help.

Courtesy Wikimedia Commons/ Metropolitan Museum of Art/Public Domain

At the joint annual meeting of the American Academy of Child and Adolescent Psychiatry and the Canadian Academy of Child and Adolescent Psychiatry, a case was shared of a mother who felt no attachment toward her child. The case is ongoing, and therefore the details are confidential, but Dr. Neil Boris of Tulane University (who did not present the case) detailed the treatment plan that was being used.

The Circle of Security is a model for helping a parent with attachment problemsunderstand how to respond to the child’s needs. Attachment isn’t just about the parent protecting the child, Dr. Boris said. Instead, “attachment and social interaction sculpts the brain” for future social interactions.

The Circle of Security protocol is designed to help parents recognize that a child needs to feel welcomed, but can turn away and become distant if a parent’s behavior is unpredictable. Parents should make the child feel safe when he or she needs safety, but give children space when they need to explore, said Dr. Boris.

In the case presented at the meeting, the mother was abused by her uncle as a preteen, then rejected by him at puberty. The doctor presenting the case used the Circle of Security protocol, which involves detailed assessments including video interviews with the mother and videos of interactive play sessions of the mother and child together. He helped the patient realize that her history of abuse was contributing to her fear of bonding with her baby daughter, to protect herself from being hurt should the child reject her.

Even the best parent/child relationships have their bad days, but for those with genuine attachment problems, there is help. And judging from the packed room for this clinical case presentation, psychiatrists want to provide that help.

—Heidi Splete (@hsplete on Twitter)

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Social Media Lack Privacy, a Problem for Psychiatrists

Many psychiatrists of, ahem, a certain age (say, over 30) have been caught by surprise by the reach of online and social media. With the explosion in use of the Internet, e-mail, Google, Facebook, Twitter, LinkedIn, and many other ways to find out information about someone, there’s no such thing as privacy any more. That creates a new set of modern problems for psychiatrists who walk a fine line between building a therapeutic alliance with patients and keeping a professional distance.

Image captured by flickr user smemom87.

I sat in on a fascinating group discussion at the annual meeting of the American College of Psychiatrists to hear how professionals are grappling with these issues. Look for a more detailed report soon in Clinical Psychiatry News. What surprised me is that even some very young psychiatrists who grew up so immersed in online and social media that they seem like part of the natural environment have been surprised by the professional ramifications of the long reach that these tools give to patients.

Some of the challenges are old problems in a new form, it seems. Setting limits on patients’ e-mail contact with psychiatrists is similar to setting limits on phone contact in some ways, but magnified. The Internet and e-mail can be both helpful and problematic in their work, psychiatrists said. The biggest potential land mines are in the social media. What happens when a patient wants to “Friend” a psychiatrist who is on Facebook? No matter how the psychiatrist responds, there’s grist for the psychoanalytic mill. Transference becomes a bigger issue. Even using the highest privacy settings, non-Friend visitors to your page can glean information about you, your “Friends,” and potentially your family. Perhaps not surprisingly, only a handful of psychiatrists in the room said they were on Facebook. And Internet dating? Look out.

Does that mean psychiatrists must be technological hermits, never to enjoy the interconnectedness that social media supply to everyone else in society?

These are all weighty questions that usually have no right or wrong answer. The American Association of Directors of Psychiatry Residency Training (AADPRT) just released new curricula to guide psychiatrists-in-training in discussing these issues, so that they can anticipate the potential consequences of the decisions they make about use of online tools and social media. See my full story for details.

The curricula are available only to AADPRT members, though some of the resources in them may be made available to the general public in the future, said AADPRT President Dr. Sheldon Benjamin. Meanwhile, you can hear him discuss these topics in an AADPRT podcast interview with Dr. Sandra M. DeJong, chair of the Association’s Task Force on Professionalism and the Internet.

I’d love to hear from clinicians of any specialty who are reading this (but especially psychiatrists) — do you use social media? Are they worth the potential professional problems? And will you Friend me? Leave a comment, and let us know.

— Sherry Boschert

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Filed under Family Medicine, Internal Medicine, Pediatrics, Practice Trends, Psychiatry, Uncategorized

When Psychiatrists Experience Suicide

from the American Association of Suicidology annual meeting in Orlando 

It’s not uncommon for psychiatrists to lose a patient to suicide at some point during their training or careers. In fact, about half will, according to a study in 2004

John L. McIntosh, Ph.D. (photo by D. McNamara)

These “clinician survivors” should not isolate themselves. Instead, they should talk with colleagues, family, and friends, John L. McIntosh, Ph.D., of Indiana University, South Bend said. This helps physicians avoid some of the adverse effects: 

  • Fear of blame from the patient’s family
  • Feelings of guilt or responsibility
  • Doubts about professional competency

  Although few psychiatrists leave the field following a client suicide, many change the way they practice, Dr. McIntosh said. 

The American Association of Suicidology maintains a ListServe where psychiatrists can discuss their feelings about client suicide anonymously, Dr. Michael F. Myers of SUNY Downstate in Brooklyn said at the  meeting. 

Michael F. Myers, M.D. (photo by D. McNamara)

In addition, professional counseling can help after client suicide, as it helped Dr.  Myers. He had a roommate in medical school, a fellow medical student, who committed suicide. Later, three patients committed suicide during his training (most psychiatry residents experience this once or not at all during their training, he said, but he was seeing a high-risk population). At the time he felt “responsible, inadequate, confused” and feared his peers would judge him. 

He’s come a long way. “Losing patients to suicide is part of one’s job as a psychiatrist,” Dr. Myers said. “Admit the limitations of our ability to help. Our goal is to help people with mental suffering. All we can do is try our best.” 

–Damian McNamara

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