Shirah Vollmer MD

The Musings of Dr. Vollmer

Defensiveness in Clinical Work

Posted by Dr. Vollmer on October 8, 2015

How do we talk about our work without worrying that we will be seen as fools? Do we only talk about the success stories, with a good dollop of embellishment about how we changed a patient’s life, or do we fall on our sword and admit defeat, that despite years and hours of treatment, the patient is not only not better, but worse? Hearing case presentations, then opening the discussion to feedback, there are two kinds of responses from the audience. There is the “you should have taken this approach” comment, or there is the “you really did and said everything right, but the patient just did not respond.” In the former, the presenter can say “thank you very much for that feedback,” and/or he can say, “you are not in the room with him, so you don’t know how hard it is to take that approach.” Learning psychotherapy is a constant dance of “showing off one’s skill set,” alternating with looking at therapeutic impasse with an open mind, which can easily lapse into a defensive posture. There are no rights and wrongs. There are two people in a room, and when this is discussed amongst professsionals, than there are many minds, but nothing can replicate that experience of the struggling dyad, trying to make sense of their therapeutic relationship, trying to find ways in which the pain and suffering can be alleviated. Teaching involves the same dance. Trying to give feedback without making the student feel humiliated and hence defensive. As a student, the challenge is to feel humiliated as a means to growing as a therapist. Running away from that humiliated feeling, like patients who want to grow emotionally but cannot take the pain of regret, stifles the learning curve. Teaching psychotherapy and doing psychotherapy are a parallel process. Both involve creating pain for the sake of a future gain. The challenge is both the need for diplomacy and emotional maturity. The margins are thin, and the feelings can be explosive. On the other hand, watching someone grow as a therapist, like watching a patient go through the journey of metabolizing their pain, is a fulfilling experience. Like hiking a steep mountain, the path is hard, but the end is glorious.

2 Responses to “Defensiveness in Clinical Work”

  1. Shelly said

    There are ways and then there are WAYS. One can bully people into learning by humiliation and throwing tantrums and demanding perfection, or one can teach through kindness and suggestion without humiliation. The results may be the same. I don’t think it is necessary that the student feel humiliated as a means to growing as a therapist (on the other hand, I’m not training as a therapist). And I’m not really sure why someone needs to ‘take it’ as a sign of emotional maturity. You make it sound like a right of passage.

    • These are gradations. I am talking about subtle responses in which the reaction is one of hostility, instead of the ability to say “maybe.” Considering a new idea goes a lot further than immediate refusal of a new idea. Bullying is a different subject, which, to date, I have spoken too little about. Thanks.

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