3,181 Comments Posted by Lynne

It's kind of like in a classroom when you are assessing a student's abilities. You start out with the "lesson" verbally and gauge how everyone is doing. Are people watching you, can they follow what you are saying, can they tell what day it is, can they tell what year it is, are they reading the board versus listening to you read it, are they even paying attention, if you say that it is snowing out and ask what kind of clothes you should wear, do they know to wear cold vs. warm weather clothes, etc. You learn a ton of info by asking simple questions and gauging peoples' reactions, depth of knowledge, ability to string a sentence together, stay on topic, listen to the rhythm and "prosody" of their voice, see how close they sit to others, how much eye contact they are able to make and for how long, whether they have any possible movement disorders from their medications - as I said, you check out how they are reacting and interacting, how they are processing, and how they are learning from the situation.

It's a great way to learn about people without staring at them or making them take a test. :-)

Surely, Shirley. ;-)

I personally feel a good therapist should have enough empathy to be able to get at least a faint sensation of what their people are going through to be any good at what they do. That way they can answer the questions that the person may be unable to articulate. The majority of folks I currently work with are nonverbal. so you REALLY have to try to figure out what they are doing, thinking, and feeling so you can best assist them in increasing their independence.

A lot of other therapists (probably ones who are much better than I am, to be honest) believe that you need to build up a pretty stiff wall between yourself and the people you see. That is the case for many patient populations, but that's why I love working with folks with intellectual disabilities. I don't have to be all formal and business-like and fake - I can be myself and they can be themselves and we all slob around and get dirty together, but we have a good time. We are on each others' level and it's a lot more truthful. They don't like something you did, they hit you in the face. Lesson quickly learned - don't do it that way next time. They do something you think is fantastic, you give them plenty of attention and reinforcement and pretty soon you'll each be members of the others' "biggest fan" club.

Best job in the world, and they actually pay me money to do it! :-)

The majority of cases of schizophrenia are first seen when people are teenagers/young adults. It is very rare that someone exhibits any signs of schizophrenia in middle age or later if they haven't already done so when younger. If someone starts to look "psychotic" anywhere after 30 or so and with NO history of psychosis, you have to rule out other factors, like brain trauma, medication, tumor, alcoholism, electrolyte imbalance, etc.

But again, the pattern of signs and symptoms of schizophrenia are fairly consistent, and even if someone faked it as a younger person, a good clinician should be able to tease it out, especially if there were good reasons why the person would have wanted to malinger.

As far as being unnerved, I'll have to think about it. I've done this so long and seen so many things that I can't think of any specific time I was particularly unnerved, but that may be due to the fact that after all this time the events seem natural, like having lived through a natural disaster makes you forget that rough times aren't necessarily part and parcel of everyone else's world.

Dang, surly girl, do you know me or what? :-)

However, it IS true that we are always "madder" than the people with whom we work. :-)

Sorry - surveyors are in town and we've been working early and staying late last week and this.

It's possible, but it's difficult. There are a lot of tests that are specifically designed to detect "malingering," as it is called. There are a lot of things you do naturally if you have depression, bipolar disorder, schizophrenia, etc., many of them involuntary, and there needs to be a consistent pattern before someone gets the diagnosis. A good mental health expert should be able to detect the fakes most of the time. However, I am sure there are a handful of people out there who have gotten away with it, probably under the circumstances in which the person is exceptionally good at faking PLUS the mental "expert" isn't that good.

If you have lots of time to observe someone (months) it would be very, very, very difficult for someone with any skills NOT to figure it out. Ironically, with the way insurance is going these days they try to make you prove 1,000 times over the person has a true problem or they won't pay you and/or the courts won't allow the person to remain in a mental health facility.

When you are trying to reorient people who have reality/perceptual issues, a good place to start is with concrete things, like what day is it, what's the weather like, etc. You can both check to see whether the person is oriented to date and time (a quick mini mental status exam) and assist the folks who don't currently have this concept.

=8-o

Amen! ;-)

Now THAT'S funny! 8`-)

Smurfy,

I think you are just marvy! 8`-)

They aren't supposed to and never were supposed to leave this information unsecured. Patient information has always been supposed to be confidential, even before HIPAA - HIPAA just put some teeth into the concept. However, given that we have now seen this at multiple sites I am saddened by it.

My best guess has to do with timing and ignorance. As a psych I am supposed to keep all records for anyone I have seen in therapy for at least 5 to 7 years (the length depends on the state psych laws). I have moved 5 times in the past 7 years and each time I have moved I have made my poor spousal unit pick up and move multiple (15+) metal file cabinets full of therapy records. Luckily last year was my time limit expiration for maintaining records and I was able to shred and/or burn 15 filing cabinets worth of records. I think that's why I get so irritable when I see that other people don't follow the same guidelines.

I am guessing that the information was kept for a number of years per state statutes, and then as the years dragged by the information was forgotten as new people came in and took over the state record systems and somehow lost the fact that all this was still sitting somewhere.

Well, that's me being kind. I know that if MY name was in any of those records (either as therapist or as client) I would be a little peevish about now.

Oh my dear Lord! =8-o After all this time my little sister turns out to be my little brother! =8-o Well, I'll be hanged, son, I shoulda looked at you a little closer, huh? ;-)

P.S. I did the same thing to Grifpops once!

Well, actually I was writing to isabeats, but if you want to hop in, feel free. :-)