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Reflections on communicating


The chief editor asked me to share some personal experiences, so here it goes – reflections by an experienced clinician, but still a simple mind.

“Are they a he or she?”, I asked the young man in front of me. We were meeting for the first time in his GP’s office. He was referred for assessment of possible ADHD, and I was just checking up on his social situation. He mentioned that he lived with his darling, and I routinely ask this question, having learned that there could be at least two possibilities, to keep it simple.

“He”, he replied with only a little hesitation. “I did not know that”, said my colleague, “he’s been my patient for 10 years”. The young man told us this was one reason he liked life in Norway – back in his home country he would not survive if this was known. “I would be pushed from some roof, beaten to death or kidnapped”. I was actually surprised, though not really shocked by this. But I was impressed with his stoic calmness when he told us this. As a matter of fact, a matter of life – and death.

Communicating must have a purpose, and it must have its means. For a psychiatrist the purpose is to prepare a secure ground. A ground where the patient has never roamed. A place he might be afraid to enter. There he is able to explore aspects of himself and his life, not least the unknown forces operating within him, out of his reach and control. But he can also convey to his helper a sense of the context his life is immersed in. What his closest kin are allowed to know about him and whether they are a real support or a threat to his existence.

The doctor can behave in many ways during a consultation. There are general rules of respect to be observed, also specific psychiatric rules, I guess. But in order to establish a safe space for the patient to use, the doctor has to offer a bit of himself. A straight vision in the patient’s eyes at important stages in the conversation. A friendly, even surprised laugh when it is not offending. An anecdote from other patient histories to show this one is not alone in his experiences and troubles.

A clear willingness to take responsibility for one’s actions is indispensable. But there are borders, without clear signposts. What do you do when you feel that you are in a state that you cannot present yourself – or “your self” – to your patients? At the time of writing I sit with bruises over my nose and lips, and one little finger in plaster. The plaster thing has happened before, and does not bother me. But showing myself with bruises, that is a “no”. Why? Is it because it steals the attention from the patient’s story into the therapist’s? Or is it because it would reveal that the therapist is also a vulnerable being, only a human? Anyway, it stops me from my video meetings for some days. Should I tell what happened? No, I only state that I have been hindered from attending the sessions the next days and that we will meet next week as scheduled. It really feels like a compromise, somewhere between silently dropping out and stealing the show with my story, a behavior which also feels like begging for pity. I realize this is a tale of an unresolved puzzle.

Where do I want these stories to lead? To here: Trust the patient and trust yourself, that you have something that the patient needs. Maybe he even knows that – and he should not be disappointed. □


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