As someone who teaches, supervises and works with fellow colleagues, analytic candidates, psychology graduate students and members of other healing professions I have found that often, many of us entered a healing profession because of a personal wound. Or perhaps not because of it, but because such wounds alerted us early on to the need for healing and set us on a path in its search.
Recently The New York Times published a thoughtful article regarding oncologists’ and the feelings of grief which inevitably accompany their work (“When Doctors Grieve“). The article described a research study led by health psychologist Leeat Granek in Toronto, who found that grief is considered a shameful emotion among medical professionals and is thus kept to oneself, often affecting the decisions and interactions of doctors with their patients. Specifically, this article points to the fact that many physicians suffer from an accumulation of grief that may lead them to recommend more aggressive treatments when palliative care may be more appropriate. Medical competence is not the issue here, but rather, the fact that unacknowledged emotions and feelings can have a deleterious effect on our lives AND the lives of others. This is also an issue for those of us who work in the mental health field and offer direct client services.
Many of those who work in the healing professions came to them because of personal interest, and much of the time that personal interest may have been spurred by a history of pain and trauma. This notion has led some psychoanalysts to suggest that working in mental health is not just a vocation but an avocation – a calling towards this particular profession in lieu of another. Psychotherapeutic work is interpersonally demanding and challenging and requires an attunement and sensitivity that reaches beyond words and language to a vast reservoir of memory, emotion, feeling and experience while remaining in relationship to another. It demands that the therapist be present in his or her own experience and be willing to understand it and use it to inform his or her intervention. To that end, one’s personal analysis has been considered the bedrock of psychoanalytic training. It is intended to help to navigate the roadmap of our life experience while attending to areas which may cause us pain and conflict and might interfere with our ability to treat another, particularly if that other touches upon our pain or conflict. Supervision of our work is another way to think through why we have chosen one intervention over another, as well as to consider the impact of our patients’ lives on us. As one of my early supervisors said “It is not that you have to have everything worked out about yourself, but you have to know your own conflicts and the way that they affect you, so that you can recognize them when they come up, and if you work with people who are in pain, they will come up.” My supervisor was talking about the experiential areas which connect patients and doctors – she was addressing the business of being human and staying human.
To my mind this is one of the issues that Dr. Granek speaks to in her research: the need to remain in touch with our humanity in all its personal and particular elaborations and to create a space in the healing professions where healers can attend to their own feelings and emotions so that they do not interfere with their work, but rather, so that they can continue to work meaningfully and in an engaged manner. Being a physician, or a psychoanalyst does not remove us from being human, in fact, it connects us to our humanity daily. As healers, we have studied particular paths to helping others through their suffering, and if we are to continue to help, we need to recognize our own humanity and how it manifests in our lives and in our work. Failure to do this can blur the boundaries between patient and doctor, and lead to treatment ruptures and interpersonal collisions, as well as potential boundary violations.
Physician heal thyself! This phrase captures the ability of physicians and healers to treat disease in others while perhaps not attending to themselves and their own personal healing. It captures the need for all of us to recognize why we are the way we are and how who we are influences the way we live our lives and practice our medicine. How much we may be able to help our patients may very well depend on how far we are willing to go on the basis of what we know of ourselves and how we know it and use it in relationship to another. Personal analysis and supervision are certainly not the only way to self knowledge, but they offer an opportunity to create a space within a relationship where it is possible to speak and think about what ails us and its impact on others.
First published on Dr. Ceccoli’s blog, Out of My Mind, on June 18, 2012.