Clinical psychologist and therapy Counseling in san Diego

Total Context Therapy Group BBB Business Review

Total Context Therapy group

On-Call Psychology


     Should Psychologists Make House Calls? In the Middle of the Night?


  • Check “Yes” if you’ve ever felt like you really wanted a therapist to magically appear where you are at 3 in the morning after a long few hours of feeling absolutely batshit.


  • Check “No” if you think that such a person should go to an ER doctor or call a long-lost friend maybe from high school or that weekend in Toledo at the Dada Fest


     Either way, the era of the concierge psychologist is upon us. It may only be me right now, but I’m busy down here in San Diego, California.


     The model of my practice is simple. People in a phase of life, or an evening of life where things are rough, up-in-the-air or so messed up that they can’t even talk to their best friends about it all are, well, everywhere. Multiplying, perhaps. And I am here to help them. At 3 a.m.


     What, “help”? You know me as the psychologist who doesn’t “help”! So what gives? What it boils down to is that crisis often happens when a person has suffered alone with their feelings for a while, and then an upsetting event occurs on top, which throws them into the can’t-handle-it-alone zone. And if this person has a relationship with a clinician already, this clinician has the critical skills to get this person through the worst of it better than a parent, a lover, a buddy or a bartender.


     What do people want in the moment of emergency, when it seems their ability to cope with the facts is painfully inadequate? Mind you, these people are probably perfectly great copers-with-fact 99% of the time. And they would give anything to be able to do it for themselves right now. But right now, they are scared, shocked, hopeless, enraged or a balled-up mess of all of the above, and the usual strategies are not working.


     If you are with other people right now, or in a coffee place or on the train, look around you. Know that with unbelievably little exception, everyone near you has been in a situation like this. They desperately needed someone to call, but they didn’t have the right person.


     Maybe you are that person, or have recently been, or fear you are on the edge of being. If that is the case, wouldn’t it be safe and smart to develop a relationship with someone who could take on the part of the job that you won’t be able to do, when you need it the most? All you would have to do is press, at the most, 10 times on your phone pad. Unless you were on vacation when you really needed me, in which case a country code or maybe a “1” before the area code would be required. So, just a few presses. Or even just one if you had me on speed dial. Or! Maybe none—just tell Siri and she does the dialing. Hey, wait. I’m kind of like a Siri, but more.


     What are some typical situations where you or someone you know might need a concierge psychologist? Here are some examples. The situations have been significantly altered to protect the identities of the people involved, but you will get the idea.


     Recently a situation occurred with a teenage son or daughter, I’m not saying, who arrived home pretty darn toasted, for about the fourth time. And this person is 16. The parents are terrified, but this youth has done a yooie on them—he or she has never been irresponsible; has always been good as gold. The whole family wants to talk, but it’s impossible for everyone to get to my office during regular office hours. Plus they want complete privacy and don’t want to be known in their little beach community as “those people”. Whether they would or not is beside the point. The point is they needed a meeting at 11:20 at night, and were willing to establish some rapport with me before this happened (knowing unconsciously perhaps what they did not acknowledge consciously) such that I knew the players and they knew me. Before the meeting, I had face-to-face meetings with the parents as a couple (in their home), a few sessions on the phone with each parent alone, and had met with the teen and the teen’s sibling each a time or two, and emailed and texted a bit. Being that the ethics of my profession assure confidentiality unless someone is severely threatened (it’s more complicated than that; see my website), they already had the satisfying feeling that someone could deal with the situation professionally and yet no one (but me) would be made to get out of their jammies to meet me downtown at my office in the wee hours.


     Everyone got his or her say, but no one was permanently marred by vicious argument. The teenager received consequences that even he or she felt were appropriate and would have a severely dampening effect on life if getting wasted like this ever occurred again (statute of limitations in place, yes). Lots of good things came out of it. When you can say, “what started out bad turned out really well”, you know you’re onto something.


     Which is not to say that all my concierge patients know me this well and I them before they need me in a pinch. I’ve met a couple of people on the job, very near to the time when they need me. Luckily for all of us, each of these people knew someone who knew me.


     One of these people, an attorney and entrepreneur, has a devilish brother whom he adores but who causes fights between him and their aging, depressed mother all the time. It’s not that he does it on purpose, but the brothers see the situation with Mom very differently. Another problem is, the brothers are both attorneys. One is here and one is afar, and one of them took care of Dad in his last years while the other went through cancer, divorce, and his house burning down. So the brothers want to get along and yet they can’t because they are both so exasperated. This I found out on a Sunday night when Mom had an ischemic attack and one of the brothers was away, having taken his daughter back East to move into her first dorm room. Meanwhile the other brother was called by Mom’s neighbor when Mom didn’t seem to recognize her own house and brought her cat over to play. Quite seriously. I couldn’t make this up. The neighbor works at a hospital where I worked a few years ago and we stay in touch. She knew everybody needed some separation from the scene and yet also some how-to’s for getting Mom some immediate care and a playbook for the brothers to use so they can get through this without suing each other or worse. Pretty soon after this, we drafted a mini-Constitution, and for now, the guys are sticking to it. The Constitution says how they will listen to each other, what their respective Feeling Rights* are; what they each should do to help the other out; how they want to be as brothers after the worst is over; who will deal with medical, who deals with psychological, and who cancels the newspaper and waters the plants and that kind of thing. And they decided to hire a caregiver for the cat. I’m a trained mediator and so are they, so we followed some assumptions to hammer all this out in a three-hour session that along with the emergency care cost them about $1000 including my travel time, administrative time, and some quick phone check-in time. They can call me or email me with questions, musings, or updates, and I respond.


     The duties of a concierge psychologist, or an emergency psychologist, or a psychologist who makes house calls—whatever you want to call it—include everything from hospitalizing a suicidal patient to settling arguments to backing someone about to take the biggest risk of their lives to talking someone down from the ledge after a breakup to parsing the ‘to be or not to be’ question to getting someone through the first twenty-four hours of sobriety. And sometimes these moments come at odd times of the day or night. It’s not that a concierge psychologist is all things to all people, but a certain skill set does obtain. A decided willingness  to be there with a person during these painful or scary times most definitely obtains.


     Concierge psychology is, actually, something like and a lot unlike what you see on Royal Pains. For one thing, he has an agent. But I have what he does not have, which is Mary. Mary is my secret weapon.  Mary takes the place of all the schmancy stuff that those denizens of privilege have.  For another thing, he is an M.D. And while some of what he does crosses the line into the psychological (which is mostly fine and makes for good TV), it is not the point of what he does, and people don’t necessarily get good enough resolution of their emotional crises from their M.D., no matter how debonair. Now I’m certainly not oppugning any M.D.s; my respect for them is vast. Yet add psychological emergency services to your contingency kit and you’ve really got something. In other words, you’d be a lot more prepared for crisis. When you can put a face to the person on the other end of the phone, or you know for sure that the person has your best interests in mind, you will get through your crisis that much better and faster, with less nerve damage, as it were.


* Feeling Rights is like an interpersonal Bill of Rights. See the blog, “Feeling Rights”.



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