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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by pegasus on December 10, 2010, at 10:35:51
I'm having this issue with the busyness of my Ts practice. The other day, he told me that he does 30 to 40+ hours of therapy per week. So, that's 30 to 40-ish clients. That seems insane to me.
And more to the point, it means that I can expect only 1/40th of his professional attention. And if I call or email him, I'm probably one of many that day (he encourages check in calls/emails, and his phone is always buzzing away). I feel like there's not room for me in all of that. I don't understand how he could even remember me from one week to the next.
I know this touches in to deep, past family issues. And I know that he does seem to have the capacity to be fully present during my sessions, and reasonably responsive outside of them. And yet, I can't get this thought of a multitude of clients out of my head.
it makes me sad
- p
Posted by sigismund on December 10, 2010, at 12:00:18
In reply to busy, busy therapist, posted by pegasus on December 10, 2010, at 10:35:51
> The other day, he told me that he does 30 to 40+ hours of therapy per week. So, that's 30 to 40-ish clients.
Wouldn't some of his patients be having more than one hour a week?
Posted by pegasus on December 10, 2010, at 12:15:36
In reply to Re: busy, busy therapist, posted by sigismund on December 10, 2010, at 12:00:18
Do you think that's common? I suppose it might be. I've never done it, so I forget that some people do. I guess if I'm his only 1/week client, then I could be one of around 20. I like that ratio better. It seems more humanly possible. But it seems more likely that he has more clients.
Why do I care, though, if he's serving me well? But I do care . . . a lot. Should I not? I'm not sure.
- P
Posted by Annabelle Smith on December 10, 2010, at 13:16:35
In reply to Re: busy, busy therapist, posted by sigismund on December 10, 2010, at 12:00:18
I wonder if what you are feeling is similar to how most clients in therapy feel? I really don't like to admit it, especially aloud, but I can really relate to what you are feeling and describing here. It seems like we all want someone who can unconditionally and totally care for us; that such a person does not exist is distressing to put it mildly. Whether or not there a God, I think this deep desire is underneath a lot of peoples' desires for there to be a personal God who knows, loves, and cares for us intimately. At least I am aware that is the case for me. Do you think that all clients want their therapists to care for them as we are talking or do you think this is more prominent and distressing for people with particular backgrounds and "issues" like perhaps me, you, and others on this board? I hope I have not projected anything onto you and that I am following you correctly.
It is funny timing that you post this now, because I have been feeling distressed about the same thing. The therapeutic relationship is so strange, unlike any other in life. Sometimes I feel exploited and hurt, because I share so much and then it's like, that's it. I become so connected, almost merged, and don't know how to deal with this. My therapist is not like even a beloved professor or mentor whom I know that I could theoretically call or email even 10 years from now. I want him to be something that he cannot be. I know that he literally cannot care for clients in the way that I want him to care, because to do so would drive him insane and make him be of no use to anyone, broken down by everyone's pain. I wonder to what extend his care is real. Sometimes the therapeutic relationship seems so fake to me. It's more real than any other and also more fake.
Posted by Annabelle Smith on December 10, 2010, at 13:25:43
In reply to Re: busy, busy therapist, posted by Annabelle Smith on December 10, 2010, at 13:16:35
p.s.
Do you think it is good to share these feeling with our therapists or to keep them secret?
Posted by Solstice on December 10, 2010, at 13:32:50
In reply to Re: busy, busy therapist » sigismund, posted by pegasus on December 10, 2010, at 12:15:36
> Do you think that's common? I suppose it might be. I've never done it, so I forget that some people do. I guess if I'm his only 1/week client, then I could be one of around 20. I like that ratio better. It seems more humanly possible. But it seems more likely that he has more clients.
>
> Why do I care, though, if he's serving me well? But I do care . . . a lot. Should I not? I'm not sure.
>
> - P
I'd just ask him, Peg. I think your concern is valid. Sometimes I think my therapist is prone to having too full of a plate - and I have very plainly said that I don't want to get lost in a sea of too much stuff. So I'd ask him how many clients he has - and if it's a lot, whether he thinks he is big enough to handle what he's taking on. He might be impressed that you're looking out for yourself :-)Solstice
Posted by sigismund on December 10, 2010, at 15:10:38
In reply to Re: busy, busy therapist » sigismund, posted by pegasus on December 10, 2010, at 12:15:36
>Do you think that's common?
It was once, I don't know about now.
Posted by sigismund on December 10, 2010, at 15:12:33
In reply to Re: busy, busy therapist, posted by Solstice on December 10, 2010, at 13:32:50
Just personally (because I find the injunction to disclose so satisfying), I would tell him how you feel ASAP
Posted by pegasus on December 10, 2010, at 17:25:15
In reply to busy, busy therapist, posted by pegasus on December 10, 2010, at 10:35:51
Yeah, I'm planning to bring it up with him. But, frankly, I don't really want to hear what he'll have to say about it. I'm sure he'll have some explanation for why it works for him. But I don't really want to hear about that. I can tell that it works for him. I don't see anything slipping through the cracks or anything. I'm just not sure that it works so well for me.
Which is hard to really understand. Because if he can handle it, and I see no effects of it, then what's it to me? Maybe it's not really any of my business.
Maybe what I'll do is tell him how I responded to that disclosure, but then ask him not to comment. At least that way he knows, and I wouldn't have to listen to explanations that I'm not really interested in.
I sound like a jerk to myself here. I guess this is all part of why I'm in therapy.
- p
Posted by emmanuel98 on December 10, 2010, at 20:07:34
In reply to Re: busy, busy therapist, posted by pegasus on December 10, 2010, at 17:25:15
Of course it matters to you and of course you should talk about it to him. My p-doc says most therapists see about 20-25 clients a week. 30-40 is a lot, so maybe there are people he sees twice a week. But my p-doc (who said, when I raised this that (1) he couldn't pay his rent if I was his only patients and (2) that maybe in time I would feel like I could share him) pointed out that having 20-25 patients who you see regularly and talk to every week is very different from teaching (which I did for many years). When you teach you have maybe 75-100 students and don't interact with them personally on a regular basis.
I raised this because I always forget what students want. If someone says they need to reschedule an exam because they are going away that week and then they come up to me and ask me when they can take the exam at a later date, I completely forget that they asked in the first place. I have too many students and lose track of them.
Therapy is different. He's talking to patients for 50 minutes at a time, carefully listening, keeping track from week to week of each one.
It's really hard to imagine that your T has other patients who feel as intensely toward him as you do, but he does. Bringing it up and talking it out will help you feel better about it.
Posted by pegasus on December 13, 2010, at 11:53:53
In reply to Re: busy, busy therapist, posted by emmanuel98 on December 10, 2010, at 20:07:34
> Bringing it up and talking it out will help you feel better about it.
Thanks for your perspective. I'm sure you're right. But I'm not at all convinced that talking it out will help me feel better about it. More likely, I think, is that I'll end up annoyed by him wanting to explain how he handles the volume, and then I'll feel like I ruined the session by bringing it up. And in the long term it will be just one of those uncomfortable things that I have to learn to live with if I want therapy. But I'll probably find some way to mention it anyway.
I mentioned it to a friend who is a T over the weekend, and she agreed that it seemed like a lot of clients. But then she said, "But, it's not really any of your business, as long as it doesn't affect your therapy." Ouch. I should stop bringing up therapy issues with her. She's always defensive and insensitive like that. Or maybe that's me.
- P
Posted by Dinah on December 13, 2010, at 16:36:26
In reply to Re: busy, busy therapist » emmanuel98, posted by pegasus on December 13, 2010, at 11:53:53
> I mentioned it to a friend who is a T over the weekend, and she agreed that it seemed like a lot of clients. But then she said, "But, it's not really any of your business, as long as it doesn't affect your therapy." Ouch. I should stop bringing up therapy issues with her. She's always defensive and insensitive like that. Or maybe that's me.
Ouch indeed. And perhaps she missed the point. You say that he seems on top of things (far more than my therapist does), so maybe the issue is the one that crops up over and over again in therapy? Does my therapist care about me? Am I more to him than a number (and a larger number than expected)? He may seem to be juggling his responsibilities well, but does he have room to care for all of us in a special way? If he's split into so many pieces, and equally, how much is left for me? 1/40 of his caring and attention and time will seem like less than 1/25.
But maybe it's not like a piece of pie. Maybe it isn't something that has to be split. Your therapist does sound more attentive than mine, no matter how many or few mine has.
Is there anything in your past that would contribute to worries about the sheer number of clients he has? Many siblings, or a large school with overstretched teachers? Or the opposite perhaps?
At one time my therapist had numbered invoices and I'd calculate it myself. I think he's got more clients now than then, and I think it's just as well that I have no way to discover how many other clients he has.
I think it's perfectly normal to worry about those things. Even if it's just to worry about how long he can continue at full tilt. Maybe it would help to learn that he is actively taking care of himself?
Posted by pegasus on December 13, 2010, at 17:33:03
In reply to Re: busy, busy therapist » pegasus, posted by Dinah on December 13, 2010, at 16:36:26
> I think it's perfectly normal to worry about those things. Even if it's just to worry about how long he can continue at full tilt. Maybe it would help to learn that he is actively taking care of himself?
Ah, I think that's it. I'm worried that some day he'll have a heart attack, or a nervous breakdown (what are those called these days?), or just suddenly be unable to keep going, and then he'll be gone. I had thought that I didn't want to hear about his "self care", because clearly he's taking enough care for things to work well now. But maybe you're right. Maybe that's exactly what I need to hear about. In terms of how this pace can be maintained over the course of my therapy.
Yes, it's all about me. I know. I've already called myself the appropriate names over being so self absorbed. And I know it's allowed when one is trying to suss out the viability of one's own therapy.
- p
Posted by Dinah on December 13, 2010, at 19:24:00
In reply to Re: busy, busy therapist, posted by pegasus on December 13, 2010, at 17:33:03
Well, if you can't think about things from your own perspective in therapy, where can you?
I don't think it's ever wrong, or ever not your business, to talk about your feelings or concerns in therapy.
Posted by Daisym on December 14, 2010, at 18:54:15
In reply to busy, busy therapist, posted by pegasus on December 10, 2010, at 10:35:51
"his phone is always buzzing away"
I think this would bother me A LOT. The therapy space is supposed to safe from intrusions and reminders of the "real" world - cell phones going off are a reminder that you are taking up space and time and someone else needs him. No matter how present he seems to be, it has to make you flicker a bit to hear the buzzing. How can you completely let go and sink into your feelings?
I think the worry about his ability to sustain the pace probably has some merit. But I would pose the question to you, "How can you be special if he has 40 more just like you?" And if this strikes a cord, then maybe allowing yourself to look at the need to be special is where the work needs to go. If not, then I'm off base and it is my issue (it is totally!) and not yours.
Therapy is just darn hard, isn't it?!
Posted by pegasus on December 16, 2010, at 11:59:59
In reply to busy, busy therapist, posted by pegasus on December 10, 2010, at 10:35:51
I brought it up in the last 10 minutes of the session, and it opened this whole big can of worms. As soon as I tried to mention it at all, I got all emotional, and had to choke it out through tears. So, obviously, this is triggering something big in me. I explained how I was afraid there wouldn't be room for me among all those clients, and that he would forget me, or my story, or just burn out and go away.
He asked whether it would be helpful to hear how he manages it. I told him no, because I was afraid that I would hear it as him explaining how I get 1/40th of his professional attention.
T: Well, I don't think I'd explain it like that.
me: Yes, but I might hear it like that.
T: That's good to know, for both of us.
me: Well, it's not really any of my business either, unless it affects my work with you.
T: And here it is, affecting our work.
He gently stayed with it a bit more, and was very generally reassuring and encouraging. He mentioned that he's been doing this a long time, and does a lot of things to take care of himself and make sure it works for him to have a full practice, and is really fascinated by his work and loves it, and is in no danger of burning out.
It's obvious to both of us that this is triggering stuff from my past, and we talked about how we can maybe talk about it more in the future.
There was one part where he was saying something about how it was valid to want to be important, and to matter, and be remembered. It was so incredibly painful for me to hear him say those things, that I couldn't even listen. I managed to choke out that it hurt to hear him talk about that, and he said, "It hurts to talk about you mattering?" But he said it like he got how important that is. So, I felt heard.
It was a good session, I think. I'm liking him, despite his huge practice. Maybe it's huge because he's really good. :)
-p
Posted by Solstice on December 16, 2010, at 14:51:33
In reply to we talked about it, posted by pegasus on December 16, 2010, at 11:59:59
Wow Peg. I'm so glad you wrote all this down - if I were you I'd carry it in my pocket - to take it out and read it when well-being falters. As for your comment about it being painful to hear him saying things that clearly indicated that he considers you and your needs to have value.. omg Peg.. I KNOW that experience!For me, it was painful to 'hear' that stuff from my therapist for several different reasons. I think it was painful to feel the neglected little girl in me so tentatively soak it up - for one I was afraid it would be yet another mirage, and for two it put me toe to toe with the painful loss of having been so neglected for so long. More than anything else - I was so very afraid to believe my therapist's care was real enough to rely on. That was really painful. My T kept talking about that attachment thing.. and I worked so hard to avoid allowing myself to feel attached. It was like I had my eyes shut tight with one hand covering them while I looked the other way, grimaced, and let my other hand stay in general proximity to my T. If any attaching was gonna happen - believe me - it was going to happen 'accidentally' :-)
And accidentally it did happen. And I can say the words. I'm attached to my therapist. I'm not afraid of it any longer. I'm not afraid of feeling important. Funny thing.. I got a text from T this morning at 6:45am. I knew T was going on a trip and would be getting back just as I left for my holiday trip - and we'd be going nearly 3 weeks. So I get this text saying "if by chance you need to contact me while I'm in Cartagena [Columbia], call this number xxx-xxx-xxxx, and ask for me. I'll be back in the states on the 20th & you can get me on my phone then." Talk about leaving me feeling like I matter! I know I'm not going to need to make contact - but I feel so cared for to have been left a way to do it if I felt the need.
Reading about your experience just filled me with warmth. I'm so glad you shared it.
Solstice
Posted by annierose on December 16, 2010, at 17:16:59
In reply to we talked about it, posted by pegasus on December 16, 2010, at 11:59:59
I think you're exactly right - his practice is busy because he is good. I love how he spoke gently to you, admitting that this is affecting your work with him - although not in the obvious way. I love how he acknowledged that and validated your feelings.
He sounds passionate about his work. You're so lucky.
Posted by Dinah on December 16, 2010, at 19:39:23
In reply to we talked about it, posted by pegasus on December 16, 2010, at 11:59:59
I really like his responses. :)
Posted by pegasus on December 27, 2010, at 9:40:46
In reply to busy, busy therapist, posted by pegasus on December 10, 2010, at 10:35:51
If anyone is still interested in this, I thought I'd post a response that I got from another T that I know in my personal life. This one I really respect and would totally want to work with, if it wasn't a dual relationship (because I know her from another part of my life).
What she said was that when she hears about these Ts with really big practices, it's always men. She thinks that men tend to have an ability to be more separate from what's going on in the room. Not that they aren't fully present, but that it somehow doesn't affect them as much as it tends to affect women. Women tend to unconsciously (most of the time) take on more responsibility for the emotional environment due to our socialization. So, having a lot of clients is more draining for women.
Also, she pointed out that men tend to have a different attitude about work in general. They tend to be more identified with their jobs, so being able to handle more (and taking on as much as one can handle) can be a path to self-validation, and seeing oneself as a more effective, valuable person. Women tend to identify more with the overall balance of their lives. So putting that much energy into work tends to have more negative connotations.
I found that interesting, and plausible.
I'm feeling better about the whole thing now. But I think I still need to revisit in therapy that fear of being lost in the crowd, and the pain around being told that it's OK to matter.
- p
Posted by Dinah on December 27, 2010, at 9:44:58
In reply to another perspective, posted by pegasus on December 27, 2010, at 9:40:46
It may not be true of all men, but I think that's definitely true of my therapist.
I think we all yearn to be special, to not be part of a crowd. Maybe the best of therapists are able to see each of their clients as special. It may be a gift.
Actually I do know people like that. People who aren't therapists. Imagine what a wonderful thing it would be for someone with those natural gifts to enter the profession.
Posted by pegasus on December 27, 2010, at 10:24:20
In reply to Re: another perspective » pegasus, posted by Dinah on December 27, 2010, at 9:44:58
Yes! Actually, the person that gave me this alternative view is such a person, and she is a T. How much I wish she could be my T! I know her in a different context, and in that context she clearly shows this talent of making everyone she talks to feel so important. The trick, I've come to realize, is that whoever she is talking to really is that important to her. I aspire to one day be able to value each person I talk to in that way.
- Peg
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