Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.
Monday, February 28, 2011
Like Looking in a Mirror
Sometimes, I treat people who have the same problems I have in my personal life. It's hard. Oh, it's really hard. If I'm really distraught about something and a patient calls seeking treatment with a similar life circumstance, I will sometimes turn them away and recommend another shrink. But I don't always screen so carefully on the phone, and often "I'd like to make an appointment," will simply get a time and date.
The feelings get really complicated here.
If I feel I've had a role in creating my circumstances, then I wonder as my patients seek my counsel, Who am I to be making any suggestions, much less giving advice? Why are you looking to me, I've screwed up the same situations. Oh, you say, Dr. Jeff said on KevinMD that Psychiatrist's Shouldn't Give Advice, but you know, some of us do, and even when we don't, our feelings are often relayed through the questions we ask or the comments we make or don't make, or perhaps by the expressions on our faces, even if we don't say "You should do X." I told a friend once that I feel uneasy, guilty even, in these situations, and he replied, "How do you think I feel?" Did I mention he does family work and was in the midst of a stressful divorce? And I have yet to ask a colleague who also does family work how he managed during the years his own children wouldn't speak to him. Oy, life can be tough, for shrinks just like everyone else.
So perhaps I listen to someone talking about his most personal feelings about a situation, and you know, if I've been there before, perhaps it's good that I can empathize. If I'm in the middle of it, sometimes I listen and the patient's words seem so unreasonable, so unjustified, and yet I recognize them as being exactly my own--it's like having my own anxieties bounced off a wall only to ricochet straight back into my face.
Do I tell the patient that I've been in the same place before? Generally, no. Therapy is about his problems, not mine, and I think in these situations my empathy is clear. I say things that are more poignant and resonant than I might in circumstances where I feel removed. And patients never ask if I've been in the exact same place. On some of the harder things-- things that have no precise quick and easy answer-- I've taken to saying, "Not only don't I know what will fix this, I don't know anyone else who does have the answer." This I can say because I've done my own searching.
I hope I'm reassuring and comforting to people who find themselves in the same places I dwell. Certainly, tripping over a few stones on the path makes one walk a little more gingerly and judge a little less harshly those who walk more slowly. Mostly, though, I worry that I'm a little bit of a fraud just for being in the room.
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I WANT my mental health professional to have walked in my shoes at least to a degree. That is why I value a therapist's age, because hopefully the older they are, the more life experiences.
If our field had published, evidence-based guidelines for handling every possible psychosocial stressor, or if our medications worked somewhat predictably in relieving a wide range of physical, emotional, and cognitive symptoms, then, sure, I'll leave my experiences at the door and give objective, authoritative treatment recommendations.
Until that happens, though, I'll take pride in the fact that I've overcome certain obstacles that few of my colleagues have faced, and use these experiences to guide the care I provide to others.
"sometimes I listen and the patient's words seem so unreasonable, so unjustified, and yet I recognize them as being exactly my own--it's like having my own anxieties bounced off a wall only to ricochet straight back into my face."
So it seems, in this case, that the shrink is gaining insight into their own situation via the patient's story. On the one hand this seems like an inversion of the exchange that should be happening, seeing as the patient is showing up and paying with the intention of improving their lives, not helping out their shrink. It would be fairer if the shrink's personal experience could offer the patients a reciprocal kind of insight but there are obvious reasons why this might not always be possible or desirable.
On the other hand, any growth that the shrink experiences will likely pay back to patients, even if it is a different patient in the future. It seems thoroughly human and not something to crack too much angst over, like, did you ever really believe that you had advice to give that was completely untainted by your own experiences? Probably not.
It's probably unfair if, during a session, the shrink sits tongue-tied because they are processing their own stuff and having some sort of identity quake about their role. But if you believe you can help the patient and not screw yourself up at the same time then things are probably ok and ethically sound. Nobody is equally awesome at counselling on every topic.
It would be a good idea to disable that anonymous button, right about now.
TAKE ME TO THE FAT DR!!!!!!!!!!!!!!!!!
We ALL have problems. Sad but true. No one escapes this Earth without going through some trials in life. I like to pretend that my therapist and psychiatrist have no problems... ;-) Although I know that realistically they do. However, if I knew of their issues, it would probably stress me out, because my nature is to try and help or fix other people, and I would obsess about it.
The best therapists/psychiatrists I have had, have validated my feelings/moods without dismissing me. I also assume that most Psych. that have been practicing for many, many year, have heard and seen just about everything and are able to draw on the knowledge and what has helped them before, in treating their own patients.
this is such an honest post. thank you very much.
This sounds like something that there's no way you could ever completely avoid; you just do the best you can do, and that's all anyone can ask.
You just do the best in your humanity that you can.
Geez, it'd be good if I could TAKE the words I just gave out, now wouldn't it lol. Really.
Sunny CA: Sometimes people have issues that are very different from my own. It's okay, sometimes that distance is helpful (part of why I wonder when I'm more up close and personal). I think the space is a bit more comfortable.
Anon1: I think I get something out of every story-- sometimes simply the appreciation that all people do not want the same things or feel the way most people would predict. Sometimes when I have my own difficulties, I get reassurance in recalling how patients came through similar problems, sometimes years ago. I've never sent anyone a check for the post-hoc assistance!
Milo: Thank you.
Sarebear: This is EXACTLY how I feel sometimes. And I meant to wish you a happy birthday--I hope it was great and that it involved cake. It's good we have Roy to be more punctual (Ha!--but he did remember on the right day)
i imagined my amazing Psychiatrist/Therapist (in another state) had a "perfect life".
At one appointment, shortly after New Year's, as i lamented the fact that, once again, my husband, son and i stayed home and did nothing and i was certian he did something fun....he told me he spent a good part of the night chasing down his teenager from a party the kid was not supposed to be at!
Guess even Wonderful Psychiatrist had his share of troubles!
One of the best psychiatrists I ever had, and certainly the one I felt the most comfortable with, was the one who told me that he had also suffered from and been treated for serious depression throughout his life. It was following one my "you don't know what it's like" pouts and it definitely made it possible for me to be more open with him in our sessions.
Now your post has made me wonder how difficult it was for him to treat clients with similar issues. How much of his personal experience fed into how he dealt with me, what made him decide to share with me, would he share the same with others, did he risk endangering his own well-being?
Thanks for the insight. :)
Thanks to you both for the bday wishes, and it involved Dutch Apple Caramel Cheesecake at The Cheesecake Factory! Mmmmmmmm. That's a kind of -cake!
I really appreciated such a beautiful and honest post. I think mental health professionals who have experienced the intensity of emotion - whether energy, or sadness, or hopelessness, or hopefulness - that we as patients feel ... or rather, those who acknowledge and are aware, even if only to themselves ... are those who are best suited to help heal and grow. I'm not sure it's helpful for a therapist to confide to a patient what exactly his/her experiences were , even in a general fashion (ie severe depression, etc), though I'm not completely opposed, either; I can see positives adn negatives with both. But, I will tell you that it's the therapists who are able to get across that they are human, that they feel and not just think (or neither!) who are the ones who help the most. We pick up on it, and it lets us help you help us.
And we are very much aware of it.
This is a welcome post Dinah. I frequently wonder about my T and her experiences - I know some things about her (like that she divorced). I once said that it must have been hard as a therapist treating someone contemplating divorce while she was going through her own.
Personally, I think some disclosure is a good thing. It would help to know if your T has experienced something similar and it makes me as a patient feel like less of a freak. One thing I've asked and she's never directly answered is whether she has her own ongoing therapy.
Would be hard to titrate though since the therapy is about the patient and not the therapist.
While I may be wrong, I tend to think that people do get a sense of whether there is a personal connection with their therapist on a particular topic, even when there is no intentional disclosure on the therapist's part. (excepting analysts, of course).
And I tend to be very conscious of this (verbal and nonverbal) when a topic hits home.
What if your patient touches on an issue, that you have, but are not quite aware of,where you have a big blindspot? Do you and your colleagues discuss patients (anonymously - maintaining their privacy) so that this doesn't happen? Have you ever had a patient call you on it?
Pastors go go though exactly the same thing..
Great post. Nice to know I'm not the only one feeling that way..
Is it important for a patient if his surgeon had an appendectomy done? Or if his cardiologist had a heart attack?
I have found all this to be true also. And it happened once or twice that they had a problem I had but I was able to disregard myself and focus on them, to realize after the session that I helped myself too. I don't think it's possible to not be involved at all, not while we're all humans.
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