Today's "Ask Amy" column - She blew it!!!!

Here is the column:

NO STRESS HERE: PSYCHOLOGIST SLEEPING ON JOB

By Amy Dickinson

Tribune Media Services

DEAR AMY: I have a stressful job and work long hours.

Because of all the stress, I have begun to see a psychologist. A few weeks ago, I went to a session after work. I was so exhausted that I nodded off during the session. When I woke up a few minutes later, I saw that my psychologist had dozed off too! He jarred himself awake, just as I did, and he tried to act as if nothing had happened.

I didn't say anything and let it go, but last week it happened again.

This time I woke up 30 seconds before he did.

He profusely apologized, and he gave me an excuse about staying up late caring for his infant son.

I'm not sure what I should do about this. He didn't offer to give me the session for free. In fact, I paid his entire $150 rate.

What should I do? Drop him? Report him? Ask for my money back? Do nothing at all?

Is this common with psychologists?

I have no idea of how to handle this. - MK in Studio City, Calif.

DEAR MK: Sometimes people in therapy find that they "shut down" to the extent that they become sleepy during a session - either as an avoidance from talking about difficult things or because they find their therapist's office a safe and comfortable place.

And sometimes, to paraphrase Freud, you're just plain tired.

The ideal place to talk about this is during a therapy session, and your therapist should help you to do that. The fact that he tried to gloss over something that happened in his office during your session, then further explained away his own behavior, means that you need to find a new therapist.

You are obliged to pay for your session no matter what you do during it - including sleeping, crying, checking your BlackBerry or staring silently at the clock.

However, your therapist's first duty to you is to stay awake and alert during your session - even if YOU happen to fall asleep. He owes you a refund and the offer of a referral to another therapist.

Don't give up on therapy. Next time, bring a cup of coffee or tea with you, and don't lie down during your session.

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Re: Ask Amy, February 23, 2007

Dear Amy,

You really missed a chance to give MK in Studio City, CA some good advice. You will recall that MK was seeing a psychologist because he was suffering from stress. At one of the sessions MK and the psychologist both fell asleep.

MK’s problem is almost certainly sleep apnea which causes all kinds of mental health problems including anxiety and depression. Medical schools and medical doctors have historically overlooked this widespread condition. The estimates of the number of sufferers of apnea keep rising. The latest studies say 31% of male adults and 21% of female adults are at risk for this serious condition.

In addition it is believed that more than 50% of people seeing psychiatrists, psychotherapists and psychologists for mental health problems have sleep apnea as the root cause.

The psychologist should learn to screen new patients for referral to medical doctors for evaluation of sleep apnea. Since there are good treatments for sleep apnea, the psychologist would probably see his patient load decline by more than 50%.

Sincerely,

rooster
Georgia, USA

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ATTACHMENT

Are You Sleeping with the Enemy?

By Scott Standage, M.D.
email: drbandage@yahoo.com

viewtopic.php?t=17056&postdays=0&postorder=asc&start=0

GOOD JOB ROOSTER!!!! PAT

When I woke up a few minutes later, I saw that my psychologist had dozed off too!

Perhaps the psychologist needs to be evaluated for Apnea as well!

Rooster:
Over the last 20 years of professional practice, I've had literally thousands of patients in my office for psychotherapy sessions. I cannot think of a single one of them that fell asleep. Not once, not ever. People who come to therapy are there for a reason and are unlikely to fall asleep as they are usually in too much emotional distress and, accordingly, pretty much pumped with adrenaline. Amy's comment that people sometimes "shut-down" in therapy is true, but this is emotional shutting-down, NOT falling asleep, unless, of course, if they have an underlying narcolepsy.

I, however, (and I'm embarrassed to admit this) DID fall asleep on a patient (twice, no less!) Unfortunately for me, this patient was mind-numbingly dull and was, in my opinion, wasting time in therapy. This is not, however, any excuse for my falling asleep -I was suffering the effects of OSA and did not know what was going on with me. This was early in my career but I'm likely to never forget it.

Had she been a paying client, I would absolutely have not charged her for the session and, I would have taken this as a "wake-up" call (forgive me for the pun!) to have my own health checked out. Had I known then what I do now, things would have been different.

I also would have offered to find her a different therapist as I had clearly contaminated our working relationship.

The psychologist should learn to screen new patients for referral to medical doctors for evaluation of sleep apnea. Since there are good treatments for sleep apnea, the psychologist would probably see his patient load decline by more than 50%.

I think the fly in the ointment here is that many people end up seeing a psychotherapist AFTER they have seen their GP. The GP's should be doing a better job of screening for sleep-related mental health issues. Further, but equally as important, any psychotherapist worth his/her salt DOES do a full screening before they engage in psychodynamic issues looking for medical and/or situational explanations for the the patient's presentation.

I screen every patient for general health issues including quality of sleep, daytime wakefullness, appetite, mood, etc.,

I'm a little hard-pressed to see "50% of people seeing psychiatrists, psychotherapists and psychologists for mental health problems have sleep apnea as the root cause." In my 20 years of experience, I'd say "50%" is way high.

Good job, Rooster.

Actually, I did something similar this last Monday. I was off for Presidents' Day and turned on the TV in the morning to see what was happening. I just caught the last few minutes of the Today show....the subject caught my attention. It was about "Men and Depression". They mentioned the link in their website, so I went there and read the article (I found it easier reading to click on the printable version). Anyway, I was quite upset after reading it and fired off the following e-mail to:

Today@NBC.com

To whom it may concern.

I just caught the last couple of minutes of this portion of your show, so I went to your website and read the article.

http://www.msnbc.msn.com/id/17190411/site/newsweek/

This article says absolutely NOTHING about "sleep apnea". Depression is one of the characteristics/symptoms/effects of sleep apnea. There have been a huge number of people mis-diagnosed and treated for depression when the underlying problem was sleep apnea. Once the sleep apnea was treated, the depression disappeared. Furthermore, many of the "symptoms" that are listed in that article as being attributed to depression are also symptoms of sleep apnea.

http://www.newtechpub.com/sleep/apnea/a ... press.html

I did a search on MSNBC.COM for "apnea" and came up with 357 results.
I realize that this was an article in NEWSWEEK magazine, but I would have hoped that you folks would have "connected those dots", too. I also have a problem with the various medical professions and their attitude of "medicating" the symptoms and not treating the (REAL) causes.

Best wishes,

<name and address>

"MK’s problem is almost certainly sleep apnea which causes all kinds of mental health problems including anxiety and depression. Medical schools and medical doctors have historically overlooked this widespread condition. The estimates of the number of sufferers of apnea keep rising. The latest studies say 31% of male adults and 21% of female adults are at risk for this serious condition. "

Sorry but that is not certainty, it is opinion. It may be a very good opinion but to claim it is certainty is tenuous in the extreme.

But the intent of Roster is good and well meaning

DSM

Hence the "almost" in front of it.

Well, I don't know if anyone from this board contacted her, but here's the followup:
http://www.latimes.com/entertainment/l ... 4523.story

Thanks Mella,

Here is an email I sent in response:

Dear Amy,

You have made a little progress in your education by publishing this statement: "Dear Sheila: Many readers have contacted me to extol the wonders of CPAP machines."

I will be happy if you soon are able to publish a statement something like this:

"Dear Readers: I have recently become aware of the very high prevalence of undiagnosed sleep apnea in our population. I am also now informed of how destructive to the human mind and body this condition is when left untreated."

Best regards,

Rooster
North Carolina

I hope many others will write her.