Can I get a cup of shut the hell up & common sense in pill form!

In all my years as a therapist, there have been some strange patients on the “couch”. But there is one patient in particular that came to mind today. It happened as I was in my car, waiting for the stop light to turn green. A little, old, fragile looking grandma in a sky blue Cadillac pulled up next to me, sipping on a cup of coffee.

Patient 372 – Session: 103 –  Diagnoses: Narcissistic personality disorder (NPD)

As I recall it was a warm day, middle of spring, flowers were in bloom, birds chirping their lovely songs… yada, yada, yada. I was sitting having my morning coffee, reading the paper, you know, catching up of the so called news that everyone seems to get so worked up over. To me, it seemed like it was going to be a good day.

Then it happened, as I was in the middle of reading how the Octo-Mom was doing  wrong, yet again. In a high pitched, almost shrieking voice, “Is Dr. Siglov in? I have to see him NOW! It is a matter of up most emergency!”

My faithful receptionist and psycho bodyguard,  Tanya tries her best to calm the situation. Me, I open my desk drawer and pull out the trusty bottle of Jack Daniels and proceed to fill up my almost empty cup of coffee. There goes the day.

As the war between Tanya and Patient 372 comes to a shouting match about having an appointment or not, I chug down my spiked cup of courage and head to the door. As I walk to the door I am thinking to myself what the hell is going on to get p.372 so worked up, it’s only 7:09 a.m. for god’s sake! I take one last deep breathe of normalcy and slowly open the door.

“See I told you the Doctor will see me, he knows who I am!” Patient 372 screams in a condescending voice to Tanya. “Now get me a cup of coffee, 1 cream and 2 sugars. Do you think that you can do that or do I need to show you how?”

“Come on in Patient 372, the couch is all yours.” Not exactly what I wanted to say, would rather of said what really came to my mind, but that damn professional demeanor is a bitch sometimes.

As Patient 372 storms past me into my office to lay claim to the couch for the next hour that she fought so vigorously for, I turn to Tanya and say, “Two cups of coffee please and that will be all for now thank you.”

Tanya grabs my courage cup, rolls her eyes, gives me that look and walks towards the break room muttering every dirty word that nuns would condemn you to the fiery place below for.

“What seems to be the problem this morning? You seem a bit worked up.”

“Why can’t people just realize who I am? Why is it that everyone in the world is in complete denial and obviously unaware of my needs? My husband, the kids and especially that damn old q-tip driving the sky blue Cadillac in the left lane going 2 miles an hour on I-95. She kept me  from getting my morning venti, sugar-free, non-fat, vanilla soy, double shot, decaf, no foam, extra hot, peppermint, white chocolate, mocha with light whip and extra syrup. And as for your receptionist, I think you need to find one that is better equipped for handling people who need help when they are in a crisis! Maybe she needs to take a few hours on the couch and fix her anger issues.”

As my head spins from the coffee order that she just rattled off or the effects of my friend Jack is finally starting to kick in, I vaguely hear her ramble on about how the world is against her and that she deserves everything, never does anything wrong. Typical NPD issues, same story different, day for Patient 372. But I start to notice that she continually comes back to the “Ole’-Wanna-Be Rich, Q-tip” (as she so eloquently calls her), that kept her from her coffee. I start to wonder to myself what she is like if she never gets her coffee or any form of caffeine, With that in mind, I quickly jot down in my notebook “Note to self: Always have coffee on hand in the office.”

I ask her if she has been working on the Schema Therapy that I have went over with her. (You know the same old bullshit remedies that every therapist uses, start a diary to write your emotions down to get them out of you, meditation, chairwork.) As she starts to riffle through the shoulder suitcase that she call a purse, I get up to go get the coffee that Tanya has made for us. She places her diary on the table in front of my chair. Then goes right back into the woe is me routine. I think to myself, “Game on, diary here I come!”

Ok let me stop right there, the diary thing is just something that we, therapists, use to see how messed up and blind our patients REALLY are. We hope that they, the patients, will take a day to read it back to themselves and realize that they are their own problem, but that day never comes. Some people just can’t’ read between the lines. Oh well, job security!

Alright, back to where I was,  I placed her cup of joe on the table in front of her, I sit back down in my chair with her “Therapy” in hand, I take a quick sip of my coffee, aaahhh, Tanya my wonderful receptionist, invited Jack back to the session. I jot another note to self: “Give Tanya a raise.” Then I wonder if and what she spiked Patient 372’s coffee with, well… maybe I don’t want to know.

Patient 372 takes a big gulp of her “questionable?” cup of coffee and goes back to rambling on and on about the lady in the sky blue caddy. I thumb through her diary that she handed me, page after page in her diary, “Sky blue caddy!”, “Damn sky blue caddy!”, “Was behind the F$#&*@$ Sky Blue Caddy again today!” Over and over, throughout the pages in her pink, leather bound diary, there it was, the trigger of her NPD issues.

Now mind you, I have been treating Patient 372 for a good while. She does have issues… A LOT of issues, but normally her sessions are pretty normal. “Life is so bad because people don’t know who she is.”