But any improvement I made was incremental at best.My colleague is a bubbly extravert who gets very excited about everything; I worry that to match her results, I would have to somehow copy her entire personality. I found myself doing well with overly emotional patients, the sort who had too many dramatic meltdowns to do therapy with anybody else. A few years ago I had lunch with another psychiatrist-in-training and realized we had totally different experiences with psychotherapy. As per the textbooks, there should be a climactic moment where the patient identifies me with their father, then screams at me that I ruined their childhood, then breaks down crying and realizes that she loved her father all along, then ??? ” or “Maybe you feel like screaming at me right now? So I figured the textbooks were misleading, or that this was some kind of super-advanced technique, or that this was among the approximately 100% of things that Freud just pulled out of his ass. We were both in the same training program, studying under the same teachers. In particular, all her patients had dramatic emotional meltdowns, and all my patients gave calm and considered analyses of their problems, as if they were lecturing on a particularly boring episode from 19th-century Norwegian history. I wish I could get my patients to have dramatic emotional meltdowns. I tried, I even dropped some hints, like “Maybe this reminds you of your father?
Just as there’s a spectrum from smart to dumb, or from introverted to extraverted, so there’s a spectrum in people’s tendencies to interpret ambiguous situations in a positive or negative way.
This means that it is essentially biologically impossible for [them] to distrust.
As Isabelle got older, the negative side of her trusting nature began to play a larger role.
There are a bunch of good stimulant abuse cases in the literature that present as “patient’s boss said she was unusually standoffish and wanted her to get psychiatric evaluation”, show up in the office as “well of course I’m standoffish, everyone in my office excludes me from everything and is rude in a thousand little ways throughout the day”, and end up as “cut your Adderall dosage in half, please”. NPR has a good article, A Life Without Fear, describing some of what they go through: Kids and adults with Williams love people, and they are literally pathologically trusting. Researchers theorize that this is probably because of a problem in their limbic system, the part of the brain that regulates emotion.
(“Why is that psychiatrist telling me to cut my Adderall in half? There appears to be a disregulation in one of the chemicals (oxytocin) that signals when to trust and when to distrust.