What do you do to help your patients get better? Prescribe medications? Conduct psychotherapy? Fill out forms? Provide advice? Intervene with family and friends?

Yes. I think we all do those things. Today I want to suggest that there is one more tool in your armamentarium, one more powerful than all the others. That thing that can lead to healing is YOU.

Let me start with sharing three short scenes from my work as a psychiatrist that illustrate my point.

Scene 1: As second year residents in my training program, my classmates and I were assigned our first psychotherapy cases. They were few in number because most of our time was spent on the inpatient units. One day, maybe in October or November of that second post-graduate year, after seeing a particular patient for about two months she said, “I was thinking about you and what you said to me last week…” She went on to explain what impacted her but I don’t remember a word of it. I stopped listening and was instead busy freaking out in my head, “Wow, there are people walking around this planet thinking about me and I don’t even know it!”

Silly? Perhaps, but I was discombobulated by the idea that I existed in my patient’s head even when I wasn’t there, as if my patient’s thinking about me somehow exerted some sort of control over me or invaded my privacy. I won’t say I had low self-esteem growing up; it would be more accurate to say that I never experienced, thought about, or expected that I would or could influence others. Thus, those patient’s words were a shock to me. It made me “grow up” as a person and as a psychiatrist.

Scene 2: About a decade later, in my career of training my fellow psychiatrists to pass their oral board exams, I had a particular course participant have a break-down when presenting a case to me as her mock-examiner. She had spent 30 minutes interviewing a patient with increasing distress as was evident to me and the handful of viewers in that room. When the patient left and it was time for her to present the case to me the “examiner,” she broke down in sobs, clearly overcome with strong emotion. It wasn’t so much an expression of sadness but one of releasing the overflow of tension and stress. I moved my chair closer to hers and said, “Janice, look at me,” as I pointed at my eyes. “Look at me,” I repeated, and, “Listen. It’s ok. It’s just the tension. You’ll be alright. This is what I need you to do right now.” As soon as Janice looked away, descending again into her internal monologue, I’d repeat, “Janice, no. Look at me. Listen to me now: place your hand on your abdomen and breathe to make your hand move back and forth. Pay attention to your breathing and the movement of your hand.” After a few minutes, when she got her breathing and emotional equilibrium back, I went on, “You know what to do now. Just start at the beginning of the case like we all practiced….” And on it went and she got through it. I don’t know, but I would guess that that experience with the patient and then with me has stayed with Janice over all these intervening years. I bet she’s a stronger, more resilient individual now.

Scene 3: A couple years after my experience with Janice I was treating a patient with powerful suicidal thoughts and a history of suicide attempts. One day, the patient came in and said, “Dr. Jack, I had a setback this week and had really strong thoughts to kill myself. But I thought about you. I didn’t do anything because I didn’t want to disappoint you.”

I still get tears in my eyes whenever I think about this last scene I described – really. Now I’m mature enough in my role to accept that this is my role and to use it for others’ benefit. Yes, I want people to internalize me! Yes, I want them to think about me, and what I have said to them, and how I would react emotionally to some behavior they’re engaging in or about to engage in. I want to be in their heads between appointments and for the rest of their lives.

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Yes, it’s scary. It’s scary because I’m a flawed individual and I don’t want to harm anyone by having them internalize a harmful or simply counter-therapeutic part of me. But what is the alternative? To not influence people? To leave all the therapeutic heavy lifting to a medication only? Or to some really clever psychotherapeutic intervention? First, it’s impossible not to influence another person or to act in ways to avoid them internalizing you. It’s happening whether we want it to or not. So, I say, why not use it in a thoughtful and therapeutic way. And second, since I think that it is the power of us, the power of the relationship that patients form with us – and we with them – that can be the most powerful intervention. I would not want to leave it off the table.

Since we all have such a remarkable influence on our patients – and others – we carry a burden of responsibility. My motto is we need to be “clear of mind and pure of heart.” By that I mean, we need to keep learning about pertinent areas of knowledge that impact our interpersonal functioning and how non-conscious processes can affect our behaviors. (I’ll cover some resources in upcoming posts.) And, we need to monitor ourselves to ensure we’re acting in the patient’s best interests; not in our best interests; and not to get back at annoying patients – and many patients do act in ways that would annoy most anyone, and it’s ok to admit that to yourself. We just don’t want to respond in ways to vent our annoyance at the patient’s expense.

So, I leave you with these queries. Think back at the ways you have influenced others, for good or ill. How did it happen; what were the mechanisms? What did you learn from these experiences? In what ways, if any, do you seek with conscious intent to influence your patients now? How do you deploy the power of you? What can you share with me to help me continue to better use my “self” to help others? Thanks.

Until next time,

Dr. Jack


Today’s Quotes

“I hold that a strongly marked personality can influence descendants for generations.”
– Beatrix Potter
“Don’t walk in my head with your dirty feet.”
– Leo Buscaglia
“Once in a while it really hits people that they don’t have to experience the world in the way they have been told to.”
– Alan Keightley