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Supporting a Safe Balance

Posted By Lindsey Lawson, Tuesday, March 18, 2014

In December, I defended my dissertation research - a qualitative study in which I interviewed medical, nursing, and medical family therapy (MedFT) students on how their personal experiences with illness impact their work, and particularly their ways of relating to patients’ families – to a roomful of people. In the weeks leading up to this defense, I wracked my brain trying to think of anything and everything my committee might ask me in the question-and-answer portion after my presentation, and I believed I’d thought of everything - I was wrong. The question that gave me pause was one that should have stood out to me as being important some time ago – my committee wondered, “Do you think you’re asking too much of your non-MedFT colleagues? Are you asking them to be therapists in addition to their other jobs?” 

I could see where they were coming from. Maybe I was asking them to be too soft and sensitive; to relate to patients in exactly the way that I would. I wondered if, in wanting to emphasize the unique contributions that I believed MedFTs could offer, I was inadvertently adding to an “us versus them” mentality. In the struggle to feel like my work was legitimate in the medical world, how easy it was for me to find the places where others weren’t being the type of providers I thought they should be. Systemic thinkers versus medical model followers? Sensitive caregivers versus prescription writers? With this in mind, I set out to add one final chapter to my dissertation through which I wanted to better understand the challenges that providers face in balancing the needs of patients and self. Here’s what I found: 
 

Maintaining a "Safe Balance"

There are a number of reasons that most healthcare providers maintain a “safe balance” approach to connecting emotionally with patients and families. 
Burks and Kobus (2012) state: 

The tendency to view and discuss patients in objective, technical, detached and non-humanistic ways often occurs in the culture of medicine.  This does not imply unkindness, but, rather, has developed for beneficent purposes, such as the provision of scientific expertise and efficient communication.

So in order to meet the demands of the system and preserve sound judgment, many providers have to find ways to protect themselves. Some of the most common work demands that healthcare providers face include long working hours, feeling a lack of autonomy in decision-making within the larger medical system, and imbalances between time and effort spent at work and home, which may additionally result in poorer social support systems (Burks & Kobus, 2012). They are asked to repeatedly attend to the needs of those seeking care, which often involves the heavy emotional work of delivering bad news, dealing with frustrated or angry patients, and witnessing prolonged suffering.

At the same time, they try to attend to their own needs: compartmentalizing or practicing other acts of self-care that keep patients’ experiences from overwhelming them. If this balance shifts too much in one direction or another, healthcare providers can face a number of serious problems, including emotional fatigue and burnout. Considering this, expecting providers to demonstrate high levels of empathy for patients and families may be too overwhelming. 

Clinical Implications

So what are the implications for me as a behavioral health professional? Instead of shifting towards what others need to be doing differently, I’m working on understanding the additional stressors that so many healthcare providers are under and supporting my colleagues as people: acknowledging the pull of different obligations that are being managed, offering a compassionate ear when I know someone’s having a bad day, and emphasizing the positive impact that providers have on their patients’ lives.

What does that support look like in my day-to-day work? Some time ago, I ran into one of our residents in the break room. I asked her how her day was going, and she sighed and said that it was “as usual:” busy and frustrating. One patient in particular was causing her stress, but she said that it was easier just to compartmentalize and “let it go.” We chatted briefly about how it’s both fulfilling and challenging at different times to have patients who affect us personally in some way, and how taking time off to decompress, talk to someone else who understands, or spend some time alone can be helpful. Having a better understanding of the conflict between self and other that she was experiencing gave me more compassion, and helped me to support her in finding her own “safe balance.”

Reference

Burks, D. & Kobus, A. (2012). The legacy of altruism in health care: The promotion of empathy, prosociality, and humanism. Medical Education, 46, 317-235. 

 
Lindsey will graduate in June 2014 from Loma Linda University with a PhD in Marital & Family Therapy, and is currently an Assistant Professor in the Marriage and Family Therapy department at Pacific Lutheran University. Before beginning teaching, Lindsey worked as a nurse and additionally spent 2 ½ years as a medical family therapist at the Loma Linda Medical Center. 
 


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