Couch Sessions

“I think couches are necessary.”

(They’re optional, and because of that, I would definitely want one in my clinic.)

This was my thought when one of the consultants at the round-table discussion asked if we psychiatrists still had hour-long consults and couches in our clinics…

The senior psychiatrist said that it wasn’t necessary anymore, and that real consults did not take as long. I, being the junior, merely nodded, as the question was addressed to him, but being the idealistic young graduate that I was, I knew in my heart that I definitely wanted to have one. 🙂

Granted I do not know much yet about the nitty gritty of private practice yet, I do know that I wanted a place or a space where someone wanted to stay to talk about their troubles, and express themselves and correspondingly, in the same way, I wanted to have a conducive environment where I was comfortable enough in assessing someone’s case.

The Psychoanalyst's Couch. (not mine).
The Psychoanalyst’s Couch. (not mine).

The image of the couch connoted hours and hours of free association as in the times of Freud, where one could spew forth thoughts and musings while a therapist would listen and take notes. More often than not, this is what people think of when they hear the word “Psychiatry” (or the other thing).

I suppose it’s a matter of choice…if I were to empathize with a troubled individual, and ask myself, “If I were a patient, what would I like?”

Well, for starters, I’d want to be able to talk in a calming atmosphere, somewhere without a lot of fuss and noise, or where I could just sit and talk and not be pressured to talk or behave as “psych patients” would do. I’d like to be able to talk freely, without worrying about whether what I would say to my psychiatrist would be tomorrow’s gossip fodder. Confidentiality was a big thing.

Also, comfort. 🙂

I do recall before, with my table and chairs set-up, talking to someone with a family problem. As he/she was talking more and more about the problem, I noticed that he/she had begun to lean back and then almost lost himself/herself in her narrative. I had to suppress a smile when I noticed that he/she had already started to put her feet up on the chair opposite his/hers. Or, if it was particularly nerve-wracking, or distressing, people would need to feel comfortable enough to hold onto something.


But that’s just me, though. I’ve never been a patient myself, but when I was a sophomore in training, I had a supervisor who had such a comfortable clinic. When we discussed our cases, he’d have me pick my seat on any of the couches, and he would take a different one somewhere else in the room, and we’d talk about the case that way. And, because I could see the books nearby, I felt free to ask him about the titles and to browse about Psychiatry textbooks, handbooks, novels, etc. It was more conducive to learning.

However, I also found learning better when I sat on the table perpendicular to my teacher, so I could see her face to face and talk about the case at close range.

I think I’m going to apply that in my clinic and future practice. There’s the option to use the couch, and there’s also the option to sit comfortably on the chair near the table. Either way, it can be an empowering thing for the patient to be able to decide how the problem will be tackled the problem. I think that having the person choose how he wants to start is one of the steps to achieving an impact with rapport and psychotherapy. Also, I want therapy session to be something they will look forward to because they know that the work they put in of coming to the clinic will help them recover.

I was provided with a nice black corner couch for starters, with throw pillows in black and while and silver accents. I’m getting a full couch soon, but for now, at least these two options (i.e. couch or table) will be available for the patient.

These were my picks for clinic couch when the next time I can get them, though. 🙂

(Photos aren’t mine…got them from random sites online, and Pinterest.)

birmingham-maple-clinic-office-1 black and grey  circle pillows couch  photo8  white

Pro bono day at the Center

When I see patients, I usually like to take my time, especially for first consults. (I enjoy the interview process, and talking to people.)

However, I think there is a need to “tailor” my interviewing to the time constraint factor.

Earlier, I volunteered a local psychiatric facility in my locality. It’s a government facility, so I expected that there would be many patients to see. However, I got more than I had bargained for. 🙂 I’m not complaining about the sheer volume of patients, though. I was more concerned about not being able to give enough time for each one, as much as I’d like to.

This morning’s exercise proved to be a good eye-opener… For one thing, it taught me the basics of budgeting my time, and second, it gave me a first hand experience of the way people in more rural areas viewed Psychiatry. (They kept coming and coming into the room.)

The stigma of mental illness is still very real in the province where I’m from. Even the mention of the place I was volunteering at was enough to connote that image of “locks, cages and hopeless cases”. (It was not so, of course, the staff was competent and they knew what to do, it was just that the way people thought about things for a very long time.)

It was a mix of patients and relatives, with an equally varied number of problems… They ranged from * problems with sleep, up to problems with the government’s not having enough stock in the place (but I think that that man was just having a bad day.)

I was thankful for the time to do some volunteer work, and also to spend some time with the students who were getting their firsthand experience of the interview with a mentally-ill patient. I wish there were more chances to teach.


(I wish I had a car, though. That place was far.)

(I wish I knew how to drive too.)