Think Like A Shrink: Proof


I thought I’d start an occasional series called “Think Like A Shrink” that teaches the lay public how to listen to people the way a practicing psychotherapist does (that practicing psychotherapist being me.)

I won’t be giving you anything obscure to think about. This will be straight-up-the-middle stuff. And as reassurance, you should know I meet that Malcolm Gladwell criteria for expertise – that whole 10,000 hours thing. I hope that doesn’t sound like boasting – it’s just the facts. But there’s a huge difference between getting advice about psychotherapy from someone who practices full time and someone who’s an academic only (let alone someone who writes pop psychology), and one concern that I have about the profusion of psychological advice on the internet is that there’s very little downside to anybody saying anything they want. But do you really want relationship advice from a college intern trying to pump out posts for US Weekly? Probably not. So here’s what on Reddit they call proof: I’ve seen an average of 25 patients a week for 45 weeks a year for the past 10 years (I am sparing you the calculations; I saw 20 a week when I worked as a neuroimager, and see 40 a week now). This calculates out to 25 x 45 x 10 = 11,25o. Hopefully this makes you feel comfortable that I meet the Gladwell mark.

Here’s what I hope is a second reassuring fact: everything I talk about will be off the top of my head. No notes, no websites, no open books, no outside sources. Nothing. That’s less arrogant than it sounds – hopefully a lot less. I am avoiding references for a practical reason: it’s so that you can really see how a shrink thinks. If I were looking things up in sources I’d be giving you a distorted view of how therapists think in real life – which is on the fly.  I can’t very well pull out books and turn on the internet when a patient says something; I have to respond (or choose not to); what’s in my head is all I’ve got.  What I’ll put out there in this series are the ideas I turn to in sessions. You’re getting, that is, an inside view of what’s available to a more or less typical practicing New York City psychotherapist.

Finally, please know this: I won’t use any real people in my examples, but will make up scenarios that are similar in their clinical feel – but totally dissimilar in their clinical details – to the kind of thing I see every day. Nobody’s privacy is going to come even close to being violated – promise. But you’ll still get a feel for the kind of thing shrinks see.

So here we go, on what will probably a long, drawn out excursion: the tools of my trade. If I were a dentist, what I’d be describing would be my picks and drills. If I were a basketball player these would be my moves. If I were a photographer these would be my camera settings and lenses.  In psychiatry they just happen to be words. Which just happen to be the easiest kind of thing to distribute across the internet. Enjoy!

Click here for Think Like A Shrink #1: Don’t Psychoanalyze Your Family and Friends!

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About Peter Freed, M.D.

I am a psychiatrist (psychopharmacology and psychotherapy) specializing in the so-called "personality disorders," particularly narcissistic and borderline personality disorders. I was a Fellow and then an Assistant Professor of Clinical Psychiatry at Columbia from 2004- 2011. I am currently in private practice in NYC.