Doorknob Bombshells in Therapy: The Deadline, the Brain, and Why It Is Important to End on Time

by Daniela V. Gitlin

What should a therapist do when a patient reveals critical information at the end of a session?

It’s a near-universal experience among mental health practitioners: a patient drops a bombshell—a critical disclosure that moves the treatment forward—on their way out, with a hand on the doorknob. This “doorknob moment” creates a stressful dilemma for clinicians, especially when the patient is distraught. Should the clinician end the session on time, or run over and be late for the next patient?

Here, seasoned psychiatrist Daniela V. Gitlin provides clinicians with a clear, evidence-based answer. By conceptualizing the functional differences between patient and therapist in the treatment relationship as a metaphor for the functional differences between right and left cerebral hemispheres, Gitlin’s argument yields a comprehensive explanation for why doorknob moments occur, why they are necessary to prevent treatment stagnation, and why ending on time makes patients feel safer to deliver them.

Genres: Psychology

240 pages, Paperback

Published September 17, 2024

About the author

Daniela V. Gitlin MD is a rural psychiatrist in private practice for over twenty five years. It's amazing how much trouble she gets into with patients and still manages to be helpful.

Reviews

[Suzette Standring · Rating 5 out of 5]

Doorknob Bombshells in Therapy was an insightful read on many levels, both for clinicians and lay people. I am not a clinician or medical practitioner. I am a professional writer with a great interest in mind-body dynamics. The book focuses on sudden revelations made by a patient at the very end of a session, and whether it is best to end a session on time. However, from my viewpoint as a lay person and a writer, I learned about the role of deadlines and the importance of structure in the creative process. Author Dr. Daniela Gitlin dives into the right and left brain hemispheres and their separate roles. The right produces new information and new ideas. The left brain searches for the familiar and can be the source of inner criticism and naysaying. To make both sides cooperate is the goal, and her research guided me to a higher understanding of how better to manage self-criticism and creative paralysis. It gave me valuable insights into sudden bombshells people will drop in every day life, and how best to manage such episodes.
I found Doorknob Bombshells in Therapy to hold fascinating and solid information written in easy-to-understand language. It’s proven to be a powerful tool.

Suzette Martinez Standring
Author, The Art of Opinion Writing and The Art of Column Writing

[C · Rating 3 out of 5]

3.5 stars. This book was clearly expanded from an essay and has many of the telltale symptoms (a lot of repetition, a secondary argument line that feels forced). However, Gitlin addresses a fascinating topic with clarity and likability; I dog-eared many of these pages and will return to them!

[Claire Crilly · Rating 3 out of 5]

I enjoyed the case studies and the practical hints and tips towards the end of the book. Some of comparative stuff to creative work and left/right hemisphere dragged on a bit. But I am glad I read it and it has given me some new perspective of time boundaries and managing end of session distress

[Terry Boyarsky · Rating 5 out of 5]

This book begins with a necessary review of the literature, and guess what? The doorknob moment is recognizable - even outside psychiatry - but hardly studied and poorly understood. Dr. Gitlin provides a delicate, nuanced blend of professional, personal, homey and downright practical evidence to support the claim that ending a session on time is not only important, it determines whether the therapeutic process will progress or not. Dr. Gitlin discusses attention, consciousness and the therapeutic relationship.

The accumulated information from the first 3 chapters coalesce in chapter 4 with a juxtaposition of science and art. The disparate collection of images and examples come together before the reader's very eyes and brains - she reveals, dissects, and interprets her own experience as a creative - and ties it to the art of being a psychiatrist. There is a section on modeling patience that is impactful, carefully reasoned, and touching.

Dr. Gitlin enters into an honest dialogue with the reader, inviting him/her to reflect on his/her own experiences. This book appears low key and is subtle, but the material is important and well-presented, both for the experienced therapist and the lay reader.