Selecting a Shrink
Poses Problem
Daily Observer
“You’re distraught, Harry,” were the words S.Q.
Lapius greeted me with as he entered my office.
“Why do you say that, Simon? Just because I threw this sheaf of papers on
my desk in disgust and they scattered all over the floor?”
“That was a clue, I must admit,” Lapius said
impassively. “What seems to be the
trouble?”
“How the deuce do you choose a psychiatrist?”
“Come Harry, things can’t be that bad. Take a warm bath. That will sooth you.”
“Not for me, Simon,” I said with no little
exasperation, “for one of my patients.”
“That should be simple, Harry. Look up psychiatrists in the medical
directory, under ‘P’.”
“It’s not that simple, Simon. An internist is an internist, a surgeon is a
surgeon, but a psychiatrist isn’t always the psychiatrist for a given
patient. They differ. I get varying results, and I can’t figure it
out.”
“Too bad, Harry,” he lamented, squinting owl-like
through his bifocals. He placed a cigar
into his mouth and said, “You haven’t been keeping up with the literature, I
see.”
“How so?”
“The problem is explained in the
He lists four particular models by which
psychotherapy might be effected: the medical model; the psychological model;
the behavioral model and the social model.”
“I must admit I missed that one, since I’m only up to
the 1967 volume of the Journal, but I’ll get to it, I promise.”
“Skip ahead, Harry, it will be worth your while.”
“Will it help me pick the right psychiatrist for the
right ‘patient’?”
“Perhaps. At the very least, it will show you what you are up
against. For instance, the medical
model. Here the physician makes the
diagnosis of depression. Once the
diagnosis is made he seeks a medical form of treatment, either drugs or
electric shock therapy.
But if your psychiatrist is oriented to the
psychological model he is oriented to treating personality that has been
distorted by past experiences and he attempts treatment that the patient
suffered as a child.
The doctor forms an alliance with the patient so that
together they might examine the past, and try to straighten out the distortions
once the patient becomes aware of them.
“But then there is the behavioral model, in which the
doctor attempts to alter aberrant behavior patterns and doesn’t worry about the
prior traumas that caused them. These
doctors use terms like desensitization, reciprocal inhibition, and conditioned
avoidance.”
“What do they mean?”
“Beats me. But
the important thing is that the psychiatrist in this model identifies the symptoms
of lack of appetite, feelings of helplessness and so forth.
He determines that the symptoms started shortly after
the death of her husband who, throughout the marriage had been a continuing
source of reinforcement.
His death is considered ‘a sudden withholding of
positive reinforcement of adaptive behavior’.
The treatment consists of reinforcing behavior patterns that are
inconsistent with depression and attempting to extinguish depressive behaviors.
Here the psychiatrist has to teach the family to
reinforce positive behavior patterns.”
I started to say something unpleasant, but Lapius
raised his hand pontifically to silence me.
"Not a word until I’ve finished, please. We have yet to cover the social model.”
I sank back into my swivel chair, defeated. Lapius continued. “In the social model the psychiatrist
concentrates on how the individual functions in the social system ‘—the type
and his ‘connectedness’ to the groups which make up his life space.’ Here the therapy consists of reorganizing the
social system in which the patient exists.
Have the patient move out of her daughters house, or go to another town,
or change jobs, things of the like.”
“Let’s get back to the original question. How do I fit my patient to the proper
psychiatrist?”
“I guess the only proper way, Harry, is for you to
acquaint yourself with the ideologies of the psychiatrists to whom you would
refer patients, and then monitor the therapy.”
If the patient after a reasonable period of time is
not improving, suggest, perhaps another mode of treatment. To do this you must discuss the case with the
psychiatrist in advance.”
“I’m confused.”
“Of course, my boy.
Let me help you. I will treat you
with the four modalities. Knowing
something of your background, and having just learned of the problem that
besets you, we can dispense with the psychological approach. For the behavioral, I will urge you not to
scatter your papers or get into a huff, it is most uneconomical.
“The social therapy is simple. We must change your environment. We do this by repairing to the nearest
watering hole. There, James will take
over from me, and supply the medical treatment.”
“Who is James?”
“The bartender.”