Reflections on the Summer Series

We ended the summer teaching series on last week.  There were six sessions, and each of them was somewhat unique.

Due to a glitch in communication, the first invitations from the Ontario Medical Association went out across the province.  And, well ... no surprise, we received interest from all across Ontario as a result.  It’s no surprise that physicians including psychotherapy in their practice, whatever stage they are at, are searching for opportunities to discuss difficult and challenging cases.  They also, of course, are often seeking to connect with other like-minded colleagues.

Under the kind and expert guidance of my colleague and fellow education committee member, Dr Harold Pupko, small groups of physicians brought many varied cases to these peer consultation groups.  They ranged from the practical: a case where a patient from East Africa presented to a community health clinic requesting, on his first visit, that disability forms were completed (ODSP forms).  He did not want any other care.  We explored how to best go about creating a dialogue in this situation, in a situation where there was general distrust in the medical system.  Other themes covered were more complex, such as how to deal with poorly regulated and highly reactive patients in a full-time psychotherapy practice.

In our last session, the final case presented was of a woman with no friends.  She just seemed to be one of those people that don’t really come off as too unusual or bizarre, but somehow, just don’t attract people.  Her psychotherapist, a highly experienced colleague, had attempted the usual behavioural interventions - go to Meetup groups, seek out social situations, sign up for programs and courses and the like - but her patient continued to be politely brushed off by the people she attempted to befriend.

This led to a poignant discussion on the growing phenomenon of isolation in our Canadian society.  The cost is high and affects patients and caregivers alike.  Ultimately, it may be the biggest causative factor involved in rapidly increasing rates of depression.

The impact of this kind of social isolation is high.  I know it’s possible, with the right skills and training, to help most patients.  Usually, if one is able to work at the level of character structure, or at a more psychodynamic or somatic level, there’s the possibility of creating real change in therapy.  Here, we’re talking at the implicit level, or the dimension of the mind/body.  And that’s a beautiful process, because the patient may never know what they were doing wrong, with their body language or with subtle cues they transmitted to others.  But they change in therapy, and they stop doing whatever is was that they were doing before those attachment- and trauma-based procedural tendencies got in the way of their lives and their happiness.

We agreed that loneliness and isolation were creating the need to go a lot further in therapy, and that this is affecting the length of time we need to see patients and the stress of the work involved.  If it was easy to find community and belonging in the world, we would not have to work so hard, and – for a lot of patients – a little hand-holding and the sense of feeling held and cared for over a period of time, might be enough.  But one needs to leave therapy with a fairly complex skill-set these days to penetrate the social and work barriers that seem to grow by the day.  Sometimes, it does feel daunting.

So, here we are, in this time of shifting social forces.  Participants agreed for the most part that the old cognitive re-frames and interventions just aren’t cutting it any more.  

This is stuff you just won’t hear much in formal teaching any more.  There’s too much politics involved and too much for medical school faculties to lose by telling the full truth about how poorly some of their cherished modalities of mental health care actually work.  But in the real world, these techniques that look and sound so good in our lectures and in our journals are no longer adequate for the needs of our patients and our own lives.

So, we ended a good night on a good theme, I think.  Dr Pupko envisioned this series to create a forum for colleagues to come together and to talk and share.  Ultimately, he saw this as serving physician well-being and as building community in our profession.  And we came to the conclusion, at the last session, that what really matters, and what we most deeply require are these opportunities for sharing and belongings.

In this way, the summer series echoed the two series that will be starting on October 1^st – the Wednesday Night Main Speaker’s Series and the Caring for Self While Caring for Others Series.  We are all about creating community and opportunities to find a place where our personal truths and dreams are welcome.

 

I feel moved to end this post with the words of the famous psychiatrist and writer M. Scott Peck, who – towards the end of his life – thought deeply about community and truth:

“How strange that we should ordinarily feel compelled to hide our wounds when we are all wounded! Community requires the ability to expose our wounds and weaknesses to our fellow creatures. It also requires the ability to be affected by the wounds of others... But even more important is the love that arises among us when we share, both ways, our woundedness.” 

 

What are your feelings about  more opportunities to  access peer supervision and other forums for discussing clinical cases, personal issues in your practice and new ideas in neuroscience and psychotherapy?  Would you like to see more of this?  These kind of endeavours can be created- the summer series proved this.  They can happen, but only with considerable interest and support.