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Episode 2: Real lessons from a Fake Therapist: with Special Guest Lisa Levy
60 Plays4 years ago
Lisa Levy is a performing artist and comedian with her irreverent radio show “Dr. Lisa Gives a Shit”. Here we speak with her about the trials and tribulations of a marketing pro turned artist, performer, and comedian as she discusses her experiences with various therapists over the years and how she uses her own experience to help her live audience.
Find more on Lisa Levy here: https://radiofreebrooklyn.com/show/dr-lisa-gives-a-shit/
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Transcript
Introducing Dornoff Comments
00:00:17
Speaker
Welcome to Dornoff Comments. I'm Dr. Farah White. And I'm Dr. Grant Brenner. Thank you for joining us on Dornoff Comments, a podcast that we created to discuss all things involving mental health. We take the view that psychiatry is not just about the absence of illness, but rather the positive qualities, presence of health, and strong relationships, and all the wonderful things that make life worth living.
00:00:39
Speaker
The show is named for a phenomenon that sometimes happens at the end of a therapy session when the patient may mention something important or something they're conflicted about right as they're walking out the door. Sometimes they may have been quietly thinking about it the whole session without saying anything at all. Equal parts frustrating and intriguing. It leaves the therapist holding the emotional bag.
Meet Lisa Levy
00:00:59
Speaker
We're here today with Lisa Levy, self-proclaimed psychotherapist since 2001. You can hear Dr. Levy every Thursday from 2 to 3 p.m. on her radio show, RadioFreeBrooklyn.org. It's called Dr. Lisa Gives a Shit, and Dr. Lisa is a performing artist and a visual artist and a great talent, and we're very happy to have her here today.
00:01:23
Speaker
Thank you for joining us. Well, thank you. Thank you, Grant and Farrah. Nice to be here. I'm really honored that I'm here with actual real shrinks that you invited me on. So thank you for that. We're really happy to have you here. Have a lot of questions for you. You've been in
00:01:43
Speaker
practice, I guess, or have been doing this for... Well, since 2001 when I decided I was a therapist.
Performance-Based Therapy: Lisa's Journey
00:01:52
Speaker
And so what was the inspiration to start the... Well, it's really funny because I had never performed before and I have no credentials as a therapist, but I really have been in therapy since I was 18 when I went to college on and off.
00:02:11
Speaker
And I was kind of like really, I'd been to so many different kinds of therapists and psychiatrists and I'd been in a study on depression. I'd been an inpatient in Mount Sinai on a real, so I had enough experience with therapists and I went up getting like really cynical about them. There's a lot of good ones, but not all. And I just thought, you know, I feel like I'm pretty, I feel like I have a desire skill.
00:02:42
Speaker
at reading people's emotions and figuring them out so I just thought it'd be really funny to do it on stage to like have audience volunteers have you know the shrink couch the whole scene the whole setup and see what happens and I was
00:02:59
Speaker
pleasantly surprised. I did it a couple of times. I got a tape. I got in a festival. Then I got a monthly show at Here Art Center where the festival was. And then within a year, I'd had a feature story in the New York Times. And so I was working as an art director at the time. So it was busy. But it kind of, you know, and then it moved to a bigger
Comedy Meets Therapy
00:03:22
Speaker
venue. It was surprisingly successful, I'll say that. So that's how it started.
00:03:29
Speaker
I've been to a couple of your events and you've had me as a guest at a couple, but I've seen how the audience responds and how you can pull things out in front of people. As a therapist, I'm fascinated by this because I think a lot of therapists have an idea that they'd like to do what we do in front of other people.
00:03:46
Speaker
Because if you're amazing, if you have an amazing session, who are you going to tell about it? Maybe in some supervision group, but no one actually gets to see it and you're not supposed to record them unless it's for training purposes. But you get to do it for almost entertainment, but I also get the sense that you're trying to do some good for people as well.
00:04:07
Speaker
Yeah, I mean, it's funny because that's one of the things people say. Is it serious or is it funny? And I think that's been like an obstacle as far as marketing it, but it is really both. And you never really know. Sometimes it's really serious. Sometimes it's really funny.
00:04:25
Speaker
I feel like that I mean I hear what you're saying because I feel like I take just the fun part and I do that and I have nothing at stake because since I make it very clear I'm a self-proclaimed psychotherapist and I'm just doing this on the fly that I have no real responsibility and because I include the audience and there I say call out like you're at a sporting
Breakthrough Stories
00:04:49
Speaker
event
00:04:49
Speaker
It's not all up to me, and I think there is something potentially cathartic about the quote-unquote patient being in front of an audience, so I like that part.
00:05:00
Speaker
Have you ever had experiences where the patients have come back and told you that they had, you know, I guess my question is how different is it in terms of results than real therapy? Well, I mean, a lot of therapy, you have a real therapist has to deal with defenses and stuff like that. Like I just have people coming up and saying, this is my problem right away. So it's it's a little easier in that way. And then I don't have to pull it out of them or coach them that way.
00:05:29
Speaker
Um, I have had, um, you're asking like, what is, the thing that sticks in my mind the most actually is one incident where I had this guy come on and he was here from, I don't know, he's visiting from London or something. And, um, I'm able to get to things really quickly and people often say that I've gotten more done in like, you know,
00:05:53
Speaker
13 minutes than in like 10 years with the shrink. But this guy wrote me an email saying that when he got back to his wife that I really had like renewed their marriage. I mean it was just shocking and he did, I mean I'm just gonna brag, he's the word genius in the thing.
00:06:14
Speaker
So that really- What did you do? It was really funny. I had him on the couch lying down and he was just talking about his wife and that the marriage wasn't going well and stuff like that and the problems. And I said that I thought they were dealing with a I need you less theory than the syndrome.
00:06:37
Speaker
What is that? And that is like where people are, OK, I'm not going to let you know that I care about you. I'm not going to be vulnerable. I'm going to act like you don't need. I don't need you. And I think that's really, really common. You know, I'm a big fan of it myself. So I kind of help point that out. And I guess it made sense to him. But I also think that he really I mean, he gave me the credit, which I love.
00:07:06
Speaker
But I also think that at the same time, he was probably, you know, on vacation and got a fresh look at his marriage. So it made sense in that way, too. It could have been a combination. But I helped. I helped.
00:07:20
Speaker
It sounds like he might have a tendency to idealize people and possibly some exhibitionistic tendencies. Do you just tell everyone that they're exhibitionists when they volunteer? I'm kidding. No, but you know, it is really funny because I know from experience that the hardest part is getting the first person up to volunteer. And then after that, like people start relaxing and seeing what it's like. And then by the end, people are often like fighting to get on stage. I have three sessions and like,
00:07:52
Speaker
So it is really funny. People are tentative at first, and then after a while they want to give it a shot.
00:07:58
Speaker
Well, it's interesting, it reminds me of, at first I was reminded of Tony Robbins, and he'll help people quickly with marital issues. I remember seeing a guy and he just cuts through the BS, though of course he has this kind of aggressive, almost hostile, kind of est, order error-hardy kind of thing. And then I thought of gurus who were faith healers,
Vulnerability vs Authority
00:08:22
Speaker
right? Like you're healing people, and I wonder if you have any thoughts about
00:08:26
Speaker
What's happening on an emotional level with people? You know, what is it that works? Well, I think I agree, especially like with Tony Robbins, but I think those guys play the role of like heroes and authorities. And I'm very like.
00:08:41
Speaker
I think I'm vulnerable. I think that I'm saying, look, I don't really know. I'm just a self-proclaimed psychotherapist. I show that I have forged credentials. I have a forged diploma and everything. And I think that I come to them saying, I think I can help you, but I'm not right about everything. And I think that that is a very... I tried to be humble. I am humble. I think I'm very humble.
00:09:11
Speaker
I hate myself there. I'm dealing with self-hatred. Self-hatred is as grandiose as you can get. It is as grandiose. So I think there is some of that, like I come at them with humility as opposed to authority. Here's my complaints about shrinks. Yeah, you want to hear that. Yeah. So when I was in the
00:09:35
Speaker
program on depression. I really had a problem with depression. My father inherited it. I'm on medication now. Everything's great. Well, okay, good. It's good. So what happened was after, you know, they had like a, because you're on the medication and they give you a free psychiatrist, right?
00:09:55
Speaker
And I couldn't have afforded it on my own. And so I went to the psychiatrist every month or every week and I got the medication. And then the psychiatrist decided she was going to start on her own, move away from the hospital and start her own practice. And she kind of like talked me and or like, you know, just kind of so we'll be meeting here. And then
00:10:18
Speaker
After then, I found out she wanted to charge me $150 a session instead of like the 40 I was paying and I was outraged that she never told me that. Does that make sense? You guys are shrinks. Don't you think it's fucked up? Sorry, am I allowed to say that?
00:10:36
Speaker
What do you say about that? How are you going to defend your business? Well, I think we're meant to be transparent about arrangements like that and discuss them ahead of time and give people choices and consent.
Therapist Transparency
00:10:50
Speaker
And I know that that doesn't always happen. I know I try to do that in my own practice. But I also think that you're bringing up this really interesting question about self-disclosure on the part of the therapist.
00:11:01
Speaker
I think anytime you see someone and you're looking for treatment for something, they should say, I believe I have expertise to treat this, or they should say, it's not my area of expertise. I mean, there is a power dynamic, and that's one of the ethical responsibilities on the part of any professional caregiver, is to keep that in mind. As a therapist, we're supposed to be aware of our countertransference. If I know I have an issue with a certain person or a certain thing they're doing,
00:11:30
Speaker
You know, you have to include that in the therapy, you know. There are times where, you know, you're saying self-disclosure is important, but it also reminds me of something that you were saying earlier about your show, like you have no responsibility and you make it clear there's a kind of a way where, you know, everyone's talking about like the imposter syndrome nowadays. I don't know if that moment has passed.
00:11:51
Speaker
But the idea of kind of coming out and saying like, I don't really know. I'm happy to try to work with you through that. But coming from my perspective personally, maybe it'll be helpful because I can offer some insight from an outsider's perspective and maybe some things are universal.
00:12:07
Speaker
I get the way that, I don't know about you guys, but the way I work is I check in with my patients a lot. And I try and sense if what I'm saying rings true. And so it's sort of like I may like let them know or if there's some projection I think I'm making, I'll certainly tell them. But it's also like I can sense, and I think you guys must know this, that like when you are making sense to somebody, they're like, oh, uh-huh.
00:12:36
Speaker
I mean, you guys get that, don't you? No. Sometimes I do. A lot of times it takes more than one, you know, go around for me to maybe point something out. I'm probably not as aggressive maybe as I could be or should be. Or as I am.
00:12:55
Speaker
Because I want people to come to it sort of on their own. People are also experts at deception. You know, self-deception, deceiving other people. And I don't mean in a nefarious way, but we're mammals, you know, and we wear plumage. You know, we use behaviors, we dress a certain way, we act a certain way.
00:13:17
Speaker
For example, if I'm wearing my weekday clothing and I'm wearing a suit and tie, people treat me completely differently. If I'm in my at-home weekend hoodie and jeans, people don't even pay attention to me at all. And I think for therapists,
00:13:36
Speaker
There's an ideal which is that we're going to be almost like a perfect mother who kind of reads the baby's minds and is responsive. The idea nowadays is that you kind of have to be good enough from an attachment perspective. You don't have to get it 100% of the time, but you do have to check in and get it enough of the time, which is something like on average for 70%, someone who's not too insecure.
00:14:01
Speaker
Therapists can miss stuff that's in our blind spots. But if it comes up, then we ought to be able to handle it with poise and therapy in a therapeutic way. And patients can kind of keep things to themselves. And sometimes there's nothing the therapist can do about that. And then we can feel blindsided, which is not always comfortable.
00:14:20
Speaker
Yeah, well, you know, it reminds me what you're saying makes so much sense because you guys are really like trying to solve, you guys have the skills set and the training to really solve, you know, long, you know, lifelong issues. Whereas for me, I'm happy if a light bulb goes on and I got a thought starter in there, if I get somebody to think about something new in a new way, perspective wise,
00:14:45
Speaker
I feel like my 13 minute session is a success or my hour podcast radio show is a success. I'm not really, you know, sometimes there is behavior that changes. People will change their behavior and I'll hear about it later or I write them, I have a prescription pad, so I'll write them actionable advice. And I often hear back, I hung that up on my refrigerator and I think about that and stuff like that.
00:15:11
Speaker
So, I do like, I mean, I get so much out
Guidance and Autonomy
00:15:14
Speaker
of that and I never, ever, ever charge for session. So, I do, you know, I do find it rewarding, but my expectations are so much smaller.
00:15:24
Speaker
Right, there's a long-term relationship oftentimes in therapy, and you see things evolve over time. And as therapists, I think, you know, I don't know about you, Farrah, but every once in a while, you know, someone will come in, a patient will come in and say, you know, my yoga teacher said this to me, like, how come you didn't say that, you know? Oh, yeah. And then it's like, well, let's see, how defensive should I get now? And it's like, we did kind of talk about that. Actually, we did directly talk about that. Or maybe it's like, you know, that's a good point. I didn't, we haven't talked about it. How long have you been thinking about that?
00:15:54
Speaker
Or sometimes things will get like slapped down that, you know, and I'll say, OK, I guess I was really off base. And then a month or two or a year later, it will come back up again in a different way. Right. So because you're dealing with people's defenses and you could be right.
00:16:14
Speaker
You might know, you might feel like you're the person's resistance, but you don't really know, right? And it might just not be the right time to hear that. Well, how do you handle defenses and stuff like that? For some reason, that reminds me of one of the things we were talking about preparing for this interview.
00:16:35
Speaker
Lisa, you were talking about like creating art as well. And there's something about sort of the art of therapy, but also the art of art and how our defenses can get in the way of being as creative as we want. I don't know, that comes to mind as well. Though we could keep therapy bashing, you know, if you want.
00:16:54
Speaker
No, I mean, you know, like the whole thing about making art is, you know, it's funny because as the therapist, I do like I've always had personal issues about authority and I still have them like working with curators or galleries. I get really nervous more than I need to.
00:17:10
Speaker
But I do feel like sort of in control as the shrink, you know, a little bit. But I was gonna say, also, what must be frustrating, this is where I get pleasure, which must be frustrating for you, is just I call out what I think. So if I think somebody's in denial about it, like I won't do it in a mean way, and I may kind of not be as direct as I could as I'm thinking, but I can,
00:17:38
Speaker
I can say this stuff because I don't have the responsibility that you guys have. You really have to massage defenses, right? Well, I'm not sure about the word massage there.
00:17:57
Speaker
I prefer to be direct and I'm sort of relatively, I'm sort of evasively direct by nature. And when I want to be more direct with someone, you know, I will want to get their consent to do that. And I'll usually say something like, I have some thoughts about it but it might
00:18:18
Speaker
might be triggering for you, or I don't usually use it. Really? But how do you feel about me sharing it? And how do you feel about me asking you for permission to share it? You don't want to get too self-referential.
Measuring Therapy Success
00:18:32
Speaker
But there's a way where you can be tactful and cautious and make room for being direct, rather than expecting the therapist to have
00:18:43
Speaker
is some sort of, like, special ability to read people, which, well, that'll come up too, you know, not always being direct as well. Now, that's a really, that sounds like a great way to handle it. I have not seen that in years. That's great, Grant. Good for you. See, that's another thing that bothers me. There's no yelp. The whole diet
00:19:03
Speaker
The whole like the whole way that therapy is, you know, the whole culture of it bothers me. There's no Yelp for therapists. Therapists are not supposed to advertise, but they need the patients, right? I mean, they need they need all every therapist I've ever really spoken to. You guys need clients, but you're not really supposed to advertise.
00:19:24
Speaker
And then and on top of that, there's no like Yelp for it. And there's no like it's and it's also really expensive to like find a good therapist. So say I wanted to try three different therapists if I was going to have a big operation that was going to take up years of my life, I would go to three opinions.
00:19:42
Speaker
But, I mean, you know, I'd have to spend, you know, hundreds of dollars, and that's part of what bothers me too. Why don't you do free consultations? First consultation should be free. What about that, you guys? I think that, I mean, though I don't usually invite people into my office and tell them that they don't have to pay, I'll talk to anyone on the phone who wants to talk and get a sense of exactly what they're looking for. And if I don't feel that it's a good fit,
00:20:10
Speaker
then I will kind of refer them to someone who might have more expertise in that area, or might be in the right neighborhood, or might have a different fee that works better for them. And I think most people do that, though I'm not sure. I don't know about that, but that sounds great. See, no, that's good. You guys have real ethics and responsibility behind this. I wish all your colleagues did. I'm not sure everything is so black and white.
00:20:43
Speaker
about like how the therapy is regulated. Like if I want to get a heart transplant, I can look up how many heart transplants, successful heart transplants done at this hospital by this doctor. So how am I supposed to know if you guys are any good or not?
00:20:59
Speaker
Yeah, I'm kind of on your side here. I think it should be, in some ways, more regulated. But it's kind of the wild, wild west. And not only that, but within the field, there's all this kind of arbitrary infighting. And there's some research, and then people are like, this is the best evidence-based therapy. And then other people are like, yeah, but our therapy has evidence too. But what I've seen amongst therapists is that kind of,
00:21:26
Speaker
My feeling is that people don't really want to clarify what's happening in that way. You mean the therapists don't? Well, as a profession, yeah. I have a sense that people don't really want to kind of pin it down. They don't really want to track outcomes and stats. And I don't think it's nefarious, though. You could say there's some economic motives as well or some guild-based motives.
00:21:48
Speaker
When people practice therapy, they're not necessarily coming from as clinical and orientation, and there's something about it which is presented as like a literary inquiry.
00:22:00
Speaker
There's like a famous quote from Eric Fromm who said, I can't, I'm paraphrasing, I can't guarantee that this will help you, but I can guarantee it will be an interesting conversation. So it's a different orientation. I think it depends what people are coming into therapy for. If they want to enact some sort of change in their life, you know, there are certain things that are possible. Like how motivated they are?
00:22:23
Speaker
how motivated, but also is this just like a journey of self-discovery, or is what they really need to figure out what they want to do and get a job? And so I'll... Or treat clinical depression. Right. Or treat clinical depression, or work out relationship issues. So it's kind of like, what can we do and what can we not do? And so a lot of times,
00:22:45
Speaker
I'll say like, oh, it sounds like you're kind of looking for a life coach or, you know, I'm not going to tell someone what to do. I'm not going to give them assignments. I'm not going to be like, send me three cover letters to proofread. It's just, you know, right. I think that goes back to my thought about consent. It's like that's fine if you're not.
00:23:04
Speaker
purporting to treat clinical depression. If you're going to have like an elucidating conversation with someone over years so they have a deeper sense of who they are in the world, then that's the procedure you should consent them for, not like I need help with depression. Okay, let's talk for 10 years, which is what you're sort of critiquing.
00:23:23
Speaker
So how do you figure that out just from what they're saying in the beginning or like kind of what is bringing them in but also where it starts to go because if you think about it like oh well you're on this path and you just picking up a stone and turning it over seeing what's there and then after a little while the patterns sort of start to emerge and sometimes they're problematic for the patient and sometimes they're not. So just because
00:23:51
Speaker
And that's another issue, right, to not put my own values onto someone else. Like, I might think it would be great for them to go back to school. But if that's not what they want, then, you know, I have to sort of act in their best interest and also be aware of like, why do I want this person to go back to school?
00:24:11
Speaker
You want to go back to school. Right, right, right. Yeah, counter-trans. Yeah, I always point that out. Is this me or is this my counter-trans or I have some counter-trans friends? I'm always calling that out. Yeah, but that's really like your obligation as a therapist to keep it in check and to have supervisors so you don't get totally derailed. Well, not everyone is trained to do that. And also as psychiatrists, we're trained to think diagnostically.
00:24:38
Speaker
Yeah, you guys are giving out drugs. I'm giving out coffee or candy. Well, I mean, aside from being able to give out drugs or prescribe medications as we sometimes call it.
00:24:48
Speaker
We're actually in New York state. You're not allowed to give out drugs. You have to go to a pharmacy. There are some states where physicians can dispense. Yeah, pharmacists are the new bartenders. That's one of my paintings, right? Yeah, and cannabis pharmacy in New York, too. But what I was going to say is- Oh, can you guys get prescriptions for that? I'm not certified to do that. But doctors can get trained. It's about a two-hour online training from the state. But we're trained diagnostically. I'll pay for that for you, Grant. No problem.
00:25:19
Speaker
Sorry, I didn't mean to derail you, which I did, but I didn't mean to. Well, I was just going to say we're trained as physicians first. So we're trained to think diagnostically. So usually if you go to see a therapist who's a physician, more often than not, we'll do an evaluation period first, even if it's not as explicit. So we're thinking diagnostically. Whereas if you talk to someone who's trained in talk therapy, they may or may not conduct a diagnostic interview.
00:25:47
Speaker
depending on how they were trained and how they choose to practice. But we tend to be, you know, it's a double-edged sword, it's medicalized. So we can give out drugs. Here's another thing that really bothers me about you people. I like where this is going. Bring it on, bring it on. This is the day of reckoning. We're on trial. Oh, I feel so good. You guys, I should be paying you. Dr. White are here to be hung in effigy.
00:26:16
Speaker
No, so okay now now I came across this in group I've been I was in a group therapy group for a long time With that I love and I love everyone in and I love the therapist I'm not saying anything bad about it, but there was like somebody in the group who was really narcissistic and
00:26:40
Speaker
I felt like this person was really languishing in the group and dominating the group.
00:26:50
Speaker
And it was very frustrating for me. And I also I respected the therapist a lot, but I also got frustrated that no one, you know, when I'm saying that, like, like that it was just taking up our time and that that person wasn't getting help and they were fucking getting in my nerves. OK, so what would you how do you how do you guys respond to that? What do you guys got to say about that, huh? Are you saying that the therapist was derelict in some way? I kind of do. I don't know. What do you think the therapist should have done?
00:27:18
Speaker
I don't. If you were a therapist, what would you do? I would have just been like, listen, kid, you are like so up your own, you know, you are so and you're not realizing this is your problem. This keeps happening because you think you
00:27:37
Speaker
Should get this and life isn't like that. Why don't you wake up? But but I wouldn't say that either I might if I was on stage if it was okay because then it would be okay It would be very different, but I don't know what I would do I think it's a problem asking you guys you guys are trained you have the fucking degree Here's my trained degree derived question for you The next one is did you say something to him in the group?
00:28:01
Speaker
Oh, and so I thought it was a guy? Assumed it was a man. Or her. Well, you said narcissist, so I assumed it was a guy. You know what? In the group, I felt like I was the loud mouth a lot, and I felt like a lot of pushback, and I wound up getting mad and feeling that I wasn't going to do... I mean, I didn't know how. I kind of tried to, but I don't... I actually feel like I did try to, but I didn't feel like I got enough support in the group, and I often felt like... And from the leader too, probably.
00:28:31
Speaker
Yeah, but I'm also like really obviously outspoken and I'm not saying that's, you know, like my idea of getting support isn't necessarily reasonable. Was the group therapist a man or a woman? I don't want to even say. I don't want to say. I love her. Oh, God. Jesus. Wow. That was so stupid. Oh, God. All right. Was the narcissist, we can edit this if it's really a problem. I don't care. Okay. Was the narcissistic patient, were her initials LL?
00:28:59
Speaker
I don't want to. No, no, no. I mean, I have no, I have my own narcissism. No, I have my own. Probably maybe. I don't know. I don't know. It's like that. It's like that Netflix show. You know what? I know I have a lot of narcissism, but I am like, I tried to really stay on top of it so I can see like I pay for it. You know, I mean, it hurts me. I pay for it, but I try to like,
00:29:27
Speaker
I try to mitigate it or apologize for it when I can. I try to take responsibility for my own narcissism. I try to do that too for my narcissism as well. Yeah, it's good. At least makes you tolerable to be around, right? Yeah, you have to manage it. My motto is make your crazy work for you. I don't have any crazy.
00:29:49
Speaker
No, you don't seem like you do. I bet you do, though. Thank you. You don't seem like it. She seems a lot more well-adjusted than you, Granddad. Farrah seems a lot more well-adjusted. Is she, you think? I'm going to take the fifth. She can speak for herself. I'm going to come to your next show. You can just really come to next show. Why don't you ask her directly? Do you think you are? Do you think you are?
00:30:11
Speaker
I don't know. I'm still kind of working it out. So therapists, like you guys can seem really like in control in the therapy office and really together, but you could be a disaster in your own real life,
Therapist Self-Awareness
00:30:23
Speaker
right? Absolutely. And do you see a lot of that? Are a lot of shrinks disasters in your... Do you see them as a particularly together group of people? I wouldn't know. I don't know. I just know you guys. I don't know a whole lot.
00:30:35
Speaker
I don't think any worse than other professions and on average, if anything, kind of on the path, you know, working on things, which I think is the process you want to be in as a therapist. But, you know, I think with every profession there's some people who are, you know, who have kind of a double life, you know. But I think that there's an expectation of more self-awareness.
00:30:57
Speaker
of what's going on with us individually, socially, and emotionally as we do our work, rather than if I were a consultant. Well, also, to be a therapist, you'd have to have a certain amount of humility, right?
00:31:16
Speaker
to see who, I mean, a bad therapist would have no humility. They would be like Tony Robbins, probably. Listen, they're definitely therapists who get into big trouble because they have a variety of different problems, including narcissistic problems. And they sometimes, sadly, end up in the news.
00:31:35
Speaker
And I think that's true with any profession where you are a caregiver and you have a certain kind of power and you're licensed by the state to prescribe and treat people, that can go to people's heads. And it's certainly supposed to be something that we're trained to be able to deal with.
00:31:52
Speaker
And, you know, if you have a blind spot, though, and you have a problem, a lot of times people just hide it, right? Yeah, you hide it. But I think patients have fantasies about their therapist, too. Like, what is your life really like? How well put together are you emotionally and psychologically? Well, they want you to be an authority figure to some degree.
00:32:10
Speaker
But I was going to say, if you look at the two professions, if you call it a profession that I've been active in, which is art direction and advertising and art and maybe performance, you know, performing, I would say that the level of narcissism is
00:32:28
Speaker
can be completely unchecked in a lot of cases. You don't really get graded on how. But I do think to be a really good creative person of any sort and to be a good shrink, you do have to be really on it. The more real you are about who you are and the more real and directly you can communicate that, the better you are at your creative pursuit. So I think that's probably true in therapy as well, right? I think so.
00:32:57
Speaker
But people like pretty paintings and stuff like that, so it doesn't have to be. But you can damage people if you're too narcissistic as a shrink, right? Have you guys seen anybody like fuck it up?
00:33:10
Speaker
Do you have it where you're going to fuck it up? I have seen people who've been in treatment for a very long time, and it's hard to know whether it's been helpful to them or not. And I think that's always the question. Really, we're doing this because we want to be helpful. And if there's any chance that it's not
00:33:32
Speaker
you know, that it's not going to benefit the person or that it may in fact be harmful, then I think there's an obligation to say, this is not right, this is not working for you or for me, right? Because the other thing is,
00:33:48
Speaker
I'm just starting out, I see a lot of patients, but I also have to take care of myself to a degree. So that means sometimes this is not something that comes naturally to me, like setting boundaries about when I can and can't meet, or how long it takes me to get back to people. So there are all those factors at play, and that's tricky to navigate, I think, not only for the therapist,
00:34:16
Speaker
But also for the patient and for the two of us together. So aren't there any standards? I think you guys need to book a standard. You should get back in X time. We should all expect the same thing. What about that? But there are professional ethical standards. And when you talk about fucking things up, people do cross boundaries.
00:34:40
Speaker
That's a particular way of making a mistake or having a narcissistic problem. There are general professional standards and one of them – and this is something a lot of people don't do and it's kind of hard to do in our profession for reasons that we probably can't talk about today. But it makes sense to have a clear treatment agreement.
00:35:01
Speaker
that spells out all the parameters of the care. So even if there's not like everyone has to practice the same way, but at least every therapist can provide a treatment agreement that patients can read that says, this is when you'll get charged for a cancellation. This is how long it'll take me to get back to you. This is what I expect you to do if you have an emergency. This is how you should contact me.
00:35:25
Speaker
So do you use that in your practice? I have a treatment agreement, yeah. And do you guys sign it? Do they sign it, or you just show it to them, or you give it to them? It's reviewed in person, and then you go through it to make sure everything is understood. It's similar to a consent for a surgical procedure, but there's obviously some perils don't fall through. And if there's any questions, you talk about it, then it's signed.
00:35:49
Speaker
And then it's forgotten usually. Yeah, that's the issue is it's forgotten and it also evolves over time. So sometimes it means like coming back to it, you know, let's say things were really crazy for a while. And I don't even, I wouldn't say that this is a boundary crossing, but I'll be more permissive just, you know, I'll say if you need to, let's have a phone call or that type of thing.
00:36:17
Speaker
But if it gets too much, then it's my responsibility as the therapist to say,
00:36:22
Speaker
I want to be there for you, but I can't talk every single day. And maybe if you need someone to talk to every single day, it might not be me. Right, right, right, right. So you have parameters set up. Now is that, do they teach you that in school? It's great that you guys do that. I don't think anyone's ever- There's a lot of different kinds of schooling, and I think another thing about psychiatric
00:36:49
Speaker
training is it's much more structured. So according to the American Psychiatric Association, if you have a doctor-patient relationship with someone, then never
00:37:00
Speaker
Like how long do you have to wait to have a personal relationship with them? The answer is never. You can never have a personal relationship. And I think they're referring to romantic or sexual relationships with a patient ever, if they've ever been your patient. The American Psychological Association, on the other hand, has a two-year statute. So if someone leaves your care as a psychologist,
00:37:21
Speaker
In principle, after two years, you're allowed to have any kind of relationship with them that you want. So medicine tends to be the most rigid about
Ethical Boundaries
00:37:31
Speaker
it. Does everyone adhere to that strictly, you know, no? And as Farah is saying,
00:37:36
Speaker
You use clinical judgment in how you manage the relationship. Now if you're quote unquote permissive and then all of a sudden you tell a patient like why are you calling me all the time and you have fostered that kind of dependency, then that's a therapeutic mistake probably. And that doesn't mean that you can't use it therapeutically if you bring it up with the patient and kind of work through it or it might lead to a rupture in care. It just depends.
00:37:59
Speaker
But I think it's important for the therapist to say, hey, listen, this was my mistake, or to give them a little bit of background about sort of what was going on. So that you made a mistake, right? Yeah, but things happen. They're not usually huge things. It'll be sometimes like a misunderstanding about a prescription change or sort of a scheduling hiccup. Blame the insurance company nowadays.
00:38:25
Speaker
But there are a lot of times where, you know, because everything is sort of like electronic, it's really easy to put, you know, automatic refills. And so I just think that like the best thing for any patient and any therapist is, listen, if we come to this kind of crossroads or they're
00:38:44
Speaker
you know, we have to be able to talk about it freely and openly. So it's set up in the beginning. That's excellent. Okay, here's another one of my pet peeves, you guys. This really makes me mad. You have officially now taken over the podcast. It's the Lisa Levy podcast now.
00:39:01
Speaker
No, I forgot about this because I actually haven't been in real therapy in a while. So you guys won't let us leave. That makes me really mad. To end therapy? Yeah. I mean, I don't want to open up that can of worms, but I definitely am probably more aligned with you. I wonder what Farrah thinks.
00:39:23
Speaker
I think that we have to be really careful because I also do the psychiatry part. So a lot of psychiatrists will only see their patients once a month, but for therapy it's once a week usually. I don't think that most people, and certainly not most of the people that I see, need to see me every single week. So there has to be a conversation about it, but a lot of times
00:39:49
Speaker
if I say to someone, well, how do you think things are going and do you want to continue meeting weekly? You know, that can also be a rejection. So there are more sort of factors that play. So you guys have like an L because you're prescribing drugs.
00:40:08
Speaker
But I certainly let people leave and I encourage people to leave, but I also say my door is open, you know, drop in every once in a while. I think I think you're alluding to therapists who might
00:40:27
Speaker
use their power and their position to keep patients in therapy who are repeatedly expressing questions about whether they should continue, whether it's the right fit for them, whether the therapist is a good therapist, whether they need therapy anymore.
00:40:45
Speaker
And instead of getting like a reasoned conversation where it's seriously considered as an option, there's a response along the lines of, well, you're just not ready to stop therapy. And then maybe the patient is cowed into silence and is thinking something like, is this person keeping me in therapy because they think it's really helpful for me? Or are they just trying to continue to make money from me? And then it becomes a very difficult conversation to have.
00:41:11
Speaker
Well, I think what comes to my mind is a couple of different incidents where a different therapist and I want to quit.
Ending Therapy
00:41:22
Speaker
And then they're like, OK, well, we're going to have to have a month or two months of termination talks.
00:41:28
Speaker
And then that's like, you know, I'm paying them like X dollars to like, what do you guys think about that? Is that? I think it's generally helpful for people to talk for a certain amount of time about stopping and it ought to be part of the therapy. And I would try to tell people at the beginning, you know, when it's time to stop, we should.
00:41:46
Speaker
we should take some time to stop and not stop abruptly. My experience really is that when people stop abruptly, a certain percentage of the time, it would have been helpful to talk about it. On the other hand, if someone like insists, I'm not going to try to force them to come back in anyway. I don't think that's useful personally. Well, it's good to hear. Yeah, but the separation can be really difficult. It really depends on what kind of feelings are there, and so I think
00:42:14
Speaker
that just making sure that you're able to process them together for a little bit. That could be 20 minutes, or that could be five sessions. But it should be mutually agreed upon.
00:42:25
Speaker
Yeah, I think if you're implying that the therapist has an emotional need to take time separating, then that's a different story than if it would actually be helpful to look back over the last five years with some space to talk through it. Well, I wonder about that. I mean, and there's no way of knowing. And if the therapist doesn't know, that's what I'm saying. There's no regulation here. Yeah.
00:42:46
Speaker
Sure. It's a problem in a way. Well, I mean, you know, I guess I'm a consumer advocate now, right? Yeah. No, but also, well, the other thing is I was going to ask you guys is being a shrink. I'm taking over this. No, that's okay. We have time for probably like a couple more questions and then we'll wrap up. I'm afraid we have to stop soon. Oh, shut up.
00:43:09
Speaker
I figured you were the good artist. Go ahead. You can come back again to talk about your art as well. Oh yeah, I was going to talk about my art. I should really be pushing the art, don't you think? I'm in an art fair this week.
00:43:25
Speaker
Yeah, I do want to talk about it. I'm in two different galleries. Where are the galleries? Art on paper. I'm in Art on Paper. I have a piece with Mulholland Gallery, and I also have a piece with VSOP projects at Art on Paper, and that opens on this Thursday.
00:43:46
Speaker
So yeah, you guys should come. Come by. I might be on Thursday night. So I assume people can find out more about you and your art shows coming up on your website, yeah? Yeah, or my Facebook page, really, or my Instagram,
Lisa Levy's Art and Social Media
00:44:03
Speaker
at Dr. Lisa Levy SP. That's probably better. At Dr. Lisa Levy dot SP? No. Oh, no.
00:44:12
Speaker
No, no dots. No dots. At Dr. Lisa Levy SP, Instagram. Okay. Okay. And in case people do want to visit your website, it's www.LisaLevyIndustries.com. That's right. That's a good place to go. And her show again on Radio Free Brooklyn is Dr. Lisa Gives a Shit.
00:44:34
Speaker
That's right. Every Thursday, two to three. I got that one right. On RadioFreeBrooklyn.org. Did I get enough promotion in there, do you think? I did. Thank you so, so much for being here. We need a custom link. This is really great. Okay. We'll work on that. Any final thoughts?
00:44:50
Speaker
Uh, no, you know, um, there was one more thing I was going to say, I was going to ask you guys though, um, if, if you've ever been like, is there any patient that you either screwed, screwed up or didn't help enough? Do you guys have patients that are like ghosts in your mind?
00:45:08
Speaker
No. Yeah, I mean as a physician in general, I always think about people who I wish I could have helped more or where I feel there was a misunderstanding or maybe I made a mistake or I felt misunderstood. I wouldn't say that it haunts me though.
00:45:25
Speaker
I think every profession has that. I think about ads that no one understood that were really great and I didn't sell them right. You get the wrong Instagram handle. Yeah, things like that. Things like that.
00:45:38
Speaker
Well, thanks for having me on. I'm so honored to be able to be so candid with actual doctors, psychiatrists. This is great. Well, thank you for joining us and for your candor. It's good to have these challenging conversations. I'll make our usual disclaimer that although we are psychiatrists, Modern Tricks is not offering psychiatric care.
00:46:01
Speaker
And if you are in need of psychiatric care or have any mental health issues and are concerned, you should seek consultation with a licensed professional.
00:46:11
Speaker
Thank you for listening to doorknob comments. This podcast is for general informational purposes only and does not constitute the practice of psychiatry or any type of medicine. It's not a substitute for professional and individualized treatment services and no doctor patient relationship is formed. If you feel that you may be in crisis, please don't delay in securing mental health treatment. Thanks.