Small Theater of Psychotherapy｜Act 1: Diagnosis and Consultation

Disclaimer: The plot of the characters in this article is purely fictitious and does not involve any real people

"Ms. X, I have another question. Could you please describe your childhood in three sentences?"

After asking this question, the young psychiatrist looked into A's eyes and adjusted his sitting posture with his legs crossed. It is ten o'clock in the morning, and she looks energetic, ready to complete her work of seeing patients today with the best "empathy state".

Sitting opposite to the doctor, A was not surprised when she heard the question, and quickly answered the question:

"My parents are busy, I grew up with my grandparents, and everyone bullied me at school."

After a pause, she continued:

"But it's not that bad."

Our protagonist A is sitting in the office of the resident psychologist at the moment, staring at the transparent round glass table, the sunlight outside the window is shining on a corner of the table, while the rest is quietly lying in the shade. She felt a little tired and didn't want to keep looking into the doctor's eyes. A does not understand the meaning of this dialogue, she has experienced such a scene more than five times. Within an hour, she will tell the other party her life, or all the pain she has encountered, in a compact and calm language. Sometimes, A wanted to talk more, because she saw a gleam in the doctor's eyes, which she thought represented understanding and compassion, but the other party quickly stated that that was not the purpose of this "diagnostic consultation", and she didn't need to say anything. so specific.

Yes, "Diagnostic Consultation", its purpose is the same as filling out those questionnaires, to make a preliminary diagnosis. Psychology proudly declares that "psychological diagnosis" is the greatest achievement of modern psychology. Using sophisticated statistical models, the intricate relationship between symptoms is clarified, and then classified into categories to form the basis for the diagnosis of mental illness. However, even the most sophisticated classification model cannot guarantee that it is suitable for every living individual. Therefore, in order to describe the patient's condition as accurately as possible, "diagnostic consultation" before consultation and treatment is also an essential link.

During this brief 50-minute period, the doctor will ask the patient in detail about his treatment wishes, specific symptoms, course of disease and important life experiences based on the diagnosis results of the preliminary questionnaire. After the diagnosis, the physician will write a report, discuss the treatment plan for the patient with other colleagues, and then give the patient further feedback and recommendations. It is a pity that the physicians who conduct diagnostic consultations are usually not the ones who will accompany the patients for a long time.

Because of this, even if the patient knows, the physician sitting opposite will follow the confidentiality agreement. In order to make a diagnosis as accurate as possible, you should also tell the truth. However, in the face of this stranger who may only see once in a lifetime, how many people are willing to show the scars on their bodies naked to the other party?

Narrating one's own experience in a rational way is like writing an "autobiographical chronicle" for oneself, with each line displaying a major event. When writing a chronicle, the details and the experience of the person concerned are not important, but the important thing is that this thing happened. A feels this way when she narrates her past, even though in the past ten years, trauma has followed one after another, but now she has the ability to turn them into "chronicles" with ease.

"Okay, the next question is, have you ever hurt yourself?"

"What's the matter, I just said that I was bullied at school, isn't this worth asking?" A thought. But she quickly adapted to the style of this conversation, "it is nothing more than turning herself into a third person to state its fate", and she must remember "don't take yourself too seriously, this will be directly recorded in the medical history and sent to It’s better to be cautious when talking about insurance companies.” Thinking about this, A said:

"No, do you mean self-harm? I haven't."

A unconsciously touched the scar on his arm when he was fifteen or sixteen years old because of that crazy love affair. "That's already happened in the last century, and I haven't hurt myself since then, so it's not considered cheating." Feeling the scar that can hardly be felt, A comforted himself, "Actually, it's nothing important things".

"Okay, now I'm going to ask you some questions, you just need to answer yes or no." The doctor's expression relaxed a little, she knew. Self-harm is usually a sign of a serious personality disorder or a sudden exacerbation of the disease, and is often associated with "risk of threatening one's own life". This means that troublesome things such as "contingency plans" and "major responsibilities" are coming.

"Okay." A knows well, at least in the society she lives in. Life is regarded as the most precious thing, and "self-injury" or "suicide" is a serious threat to one's own life. These signals can usually trigger the other party's high vigilance, just like ringing an alarm bell. She didn't want to cause this trouble for the time being. On this point, she reached a consensus with the doctor opposite her.

So she quickly completed the next "differential diagnosis" with short "never", "sometimes", and "no", just like filling out a questionnaire. The purpose of differential diagnosis is to distinguish similar diseases. Many mental illnesses have symptoms of depression, but if the main symptoms occur in a specific area, or are caused by specific things, such as depression and anxiety symptoms caused by eating problems, then the "eating disorder" should be given first. diagnosis.

"So, Ms. A, I've finished asking the questions I wanted to ask. Is there anything else you think I need to know that you want to share with me?"

A looked at his watch, and there were still five minutes until the end of the conversation. She doesn't want the other party's rest time to be shortened because of her. "I cried every day last winter. This should be an important thing, but forget it, it doesn't seem to be that important." A thought.

"No, thank you, we have talked a lot." A smiled and finally chose to say this sentence. This is not lying, she is actually very grateful to the medical system in the society where she can get fifty minutes of attention for free.

"That's great, we're ahead of schedule today, thank you for sharing this with me today."

"Thank you too."

A was about to get up and leave the consulting room, when she saw various books about "traumatic stress disorder" neatly arranged on the doctor's bookshelf. And in the middle of the bookshelf, like a bookstore, there is a beautiful new book booth. The award-winning book, whose front and back covers are exhibited, has a catchy title: Childhood Sexual Violence Trauma and Pain Perception. A thought to herself, "Does trauma experience also affect people's pain perception? I don't know if it will make people more sensitive or insensitive." She soon thought that this should be the new book of this doctor, "Ah, so this The doctor is quite good, it seems that she understands traumatic disorder." A thinks that she may have indeed been understood in the past forty-five minutes. This immediately made A happy, and she happily added to the doctor:

"Thank you for your time today. You have created a relaxing environment for me to talk about my past. I wish you a happy day."

Hearing this, the doctor looked a little surprised, but she quickly accepted the polite compliment. He smiled back and wished A, and walked out of the consultation room with A.

At this moment, A feels relaxed, which is also the feeling she feels after every consultation. It is as if she has thrown all her troubles and difficult problems to the therapist, and she can take a temporary respite and not be entangled in those troubles. Instead, you can focus on what you're doing -- for example, walking right now.

A remembered that a friend of hers once told her, "Many times we walk in the wrong way, such as using only one side of the foot to exert force, which will affect our posture. The correct walking posture should be to heel first. , and then slowly let the soles of the feet be evenly grounded, and then use the toes to exert force at the joint of the forefoot, especially to feel the force under the thumb.” She still remembers this very well, because she had never paid attention to the matter of "walking" before hearing this. Now, A will often pay attention to this "feet touching the ground" feeling, and use it as an important relaxation exercise.

"It feels so good to walk, to feel the support of the earth, so solid and safe!" A is glad that he can focus on his steps again, "This shows that this conversation is still helpful, Maybe today I can finally fall asleep.”

"However, what exactly am I doing? What kind of consultation result will the doctor come up with?" The brief calm was soon interrupted by anxiety and doubts. "I'm really an anxiety machine." A laughed at herself helplessly. Fortunately, she knew that too much worry is usually a waste of energy after going through the battlefield, so she decided to go to the coffee shop to have something to eat and prolong this short period of time as much as possible. calm.