Caring for a patient on a precipice?
People on a precipice often face insidious victim-shaming, and some more information about how this occurs can be found here. As providers, we can work to combat this tendency. In the mental health field, we recognize the importance of therapeutic boundaries, yet healthy boundaries are not mutually exclusive with vulnerability. I would encourage providers to examine their thoughts about their own mortality and vulnerability so that they can identify and process any subtle ways that biases may be creeping into their therapy sessions. Better awareness of personal existential struggles and anxiety about aging, mortality, illness, loss, and other such topics can help to prevent problematic countertransference and can help strengthen the capacity for empathy and connection. Falling back on basics like open-ended questions and reflections can allow clients the space to share without feeling judged or misunderstood. Suspending our desire to help actively alleviate suffering and simply be present may be all that’s needed for the client in that moment. Sometimes simply not echoing the judgment the client may be feeling is therapeutic work in itself. If you find this challenging, therapy, life-coaching, or a professional supervision group may be helpful. Also, Dr. Mark Epstein has written an excellent book, Going to Pieces Without Falling Apart: A Buddhist Perspective on Wholeness, that shares a psychiatrist’s perspective about letting go of control in order to achieve peace.
In the medical field, the patient-physician relationship also relies on boundaries. Yet compassion and empathy are often important variables in the patient’s comfort with the provider and in improving communication and compliance. Medical providers struggle with the delicate balance between providing hope and being realistic, making treatment recommendations and allowing the patient to make decisions, and the science and the art of medicine. In the cancer world, we hear things like, “you caught your cancer earlier, and you’ll be fine,” and a statement like that not only becomes the words of encouragement we would offer a friend, but also becomes the “research” that supports our hypothesis that negative outcomes can be avoided with proper surveillance or care. The caveat, of course, is that those who don’t fare as well had a level of control in their outcome, or that perhaps it was the fault of the doctor. Physicians certainly feel pressure to actively confront whatever the presenting problem is. What leads many to medicine is to help: to cure and heal. So when you’re left with uncertainty or no definitive course of action, that helplessness or ineffectual feelings can take a mental and emotional toll, as well as impact your treatment choices. One common example that illustrates this occurs when a patient goes to the doctor with a virus yet leaves with antibiotics because of the expectation that the doctor “do” something. Physicians can utilize self-reflection, peer support, or even therapy to examine their thoughts about their own vulnerability, mortality, and expectations about medical interventions. Not only will these insights help them treat those on a precipice, but physicians can also benefit personally, if they find themselves or a loved one on a precipice.
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