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Changing Our Consciousness
Imagining the emotional experience of the other

 

Waging Dialogue

Dialogue

Emotional Imprint

Education

The mission of COC is closely aligned with that of the Hot Stove Project The Hot Stove Project

The Hot Stove Project

Why Do We Have War and What Can Our Generation Do About It? Conversations with Dr. Vamık D. Volkan and Lord John Alderdice

View the transcript of the Volkan video in PDF

CHANGING OUR CONSCIOUSNESS is a non-profit organization that develops theoretical, methodological and educational tools to understand and mitigate intergroup conflict. By developing emotional literacy – the capacity to view the world through others' eyes – we facilitate dialogue between people of different thoughts, beliefs and communication styles, counter prejudice and stigma, and transform education.

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Our video, Why Do We Have War & What Can Our Generation Do About It? includes "A Conversation with Dr. Vamık D. Volkan" and "A Conversation with Lord John Alderdice." These were filmed in January 2014, and September 2015, with young people associated with the Emotional Imprint program. Dr. Volkan is a five-time Nobel Peace Prize nominee who has led mediation efforts on the world stage and Lord Alderdice negotiated the Belfast Agreement in Northern Ireland. Both are globally renowned for their work on the dynamics of prejudice, ethnic conflict, and the forces that lead to war."


My Four Decades in Psychiatry

(Consciousness changing, whether we like it or not)

I originally posted this on the Women’s Psychiatry Group Facebook page. Responses were very moving. It was reposted in several other arenas, including the longstanding blog, “Shrink Rap.”


I’ll be 65 next month, I will have been in private practice for nearly 40 years, and I’m trying to decide where to go from here. If you have time, would you help me think through this difficult decision?

I trained in a time and a place when psychiatric treatment, other than for the severe mental illnesses, was about psychoanalysis. Even if you didn’t go on for analytic training (which I did, right after residency, at one of the most classical institutes in NYC), your primary goal was to search for and speak to the complex humanity of the other. My 4th year psychopharm course was optional.

Yes, the classical model was flawed in significant ways, but over time I took what I needed from it, I owned it and I loved it.

Then prozac arrived on the scene and I woke up in a different profession. No longer was it about meaning and humanity and insight into who you are, how you got to be that way, and the unconscious forces that led you to get in your own way. No longer was transference the mechanism of action. My field became about symptom constellations, drugs and/or skills to fix what was wrong with you.

This perspective always felt wrong to me, but over time I came to integrate the parts that felt right with the work I was trained to do, and it worked pretty well. I have a very good practice, partially private pay and partially insurance based. Aside from Medicare (helpful when some of your patients have been with you for 30 years), the other insurance I accept is the one that the NYC Dept of Education uses. Many of my patients are teachers, so their psychopathology falls within a range that I’m comfortable treating.

Once long ago, that insurance company called and asked me to take a patient off their hands. She was a paranoid, depressed, obsessional, suicidal, entitled, angry and litigious woman who fired every psychiatrist she saw, called the plan daily and threatened to sue everyone she spoke to. I told them I would only take her if I could see her 4 days/week indefinitely, no questions asked. They said yes, and she never bothered them again.

They left me alone after that. I’ve seen some people weekly for years without being bothered.

But times are changing, yet again. No one would remember me from that time. No one would bend the rules to allow a shrink with dynamic understanding to engage a patient like that. The billing, coding and documentation requirements, and the medical complexities, are becoming more than I feel comfortable with. I’m finding it increasingly hard to integrate the complex, struggling human being that I see with the symptom and treatment picture that I’m required to see.

I’ve moved into other arenas, including a not-for- profit organization, documentary film-making, and the development of an emotional literacy curriculum for young people. But there’s no money involved in any of them. They cost money.

I love my work and I love my patients and I think they benefit from working with me. I know what I know and I know when to refer or ask for help. When I do psychodynamic “talk therapy” (I hate when they call it that!!), I’m doing something very complex, something I’m very well trained for. But there’s no code for that and very little respect for it, and I live in fear of being audited.

If you’ve read this far, thanks so much. I’d be grateful to hear your reactions.


Read more, from Dr. Alice Maher and others, at the Changing Our Consciousness blog >>