Wednesday, June 29, 2011

Psychiatric Help is Five Cents, Please


"I just needed a little psychoanalysis -- did I say that right?"

"Yes, Jake, you said it fine."

"It's my first big word, you know. Will you take me out to the bathroom now?"

"Sure, hop down and let's go."

Having a patient sit on your lap probably isn't quite what Dr. Freud would approve, but neither did he have patients with fur. Then again, the potential for soiled trousers may been precisely the reason why he insisted on sitting behind patients while they reclined on a couch. And all this time we've thought it was to avoid contaminating the transference. I mean, who knew?

Furthermore, under most circumstances the idea of taking a patient out to the bathroom is questionable, rather like taking one out to the ballgame, except there are conditions where that could be considered therapeutic. You think I'm kidding? Not at all. Exposure therapy for what most clinicians call Baseball Stress Disorder. It happens a lot in cities with major league teams, though more cases are reported in Boston and New York, depending on whether the Yankees or Red Sox won the pennant any given year. Actually, the DSM-IV labels it Post-Pennant Syndrome (PPS) -- I'm sure you've heard of it, it's been in all the papers. This morning however, since my patient was Jake the Puppy, a visit to the front yard was hardly a boundary violation.

It all came about because Jake has been thinking about a behavior problem that troubles us both. It concerns his proclivity for growling and barring his teeth when he's sitting, contentedly, on my lap and I happen to move. I thought it was a dominance issue, his answer to the age-old question, Who's the boss? But he said it wasn't that way at all.

According to Jake, he spent most of his early life scratching and clawing for his share of the food, blanket, and play toys at various adoption centers between Arkansas and Maine. It wasn't horrid, he said, but it was dog eat dog and since he was a little baby puppy, he had to learn to be tough. Now, things are different. He has his very own crate, food and bowl, a big brother, the Cat and me, and he's very happy. But when he growls, he says it's because he feels like he's back at the animal shelter. I told him not to worry, it was an unconscious response, and now that it's out in the open, he'll be more able to regulate his behavior. And since he wants to be a "good dog," like his older brother, the motivation for change is already built-in to his character structure.

It was a good session and Jake accomplished a lot. Naturally, there was the question of fee, since the therapeutic frame must be maintained. "Jake?" I asked, stopping for a moment at the door.

"Mm? Are we going out or not? You know what happens when we don't."

"I know and we are, but first, I need to be paid for my services. Psychiatric help is five cents, please."

"Grrrrr."


(Photo copyright 2011 by the author)

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