Category: Grief

Caretaker versus Doctor

It is not unusual for me to deliver a particular admonishment to family and patients.  Sometimes people need a simple reminder; others need a figurative beating about the head and shoulders.  This warning is critical to the care of the people we love.  The essence of the advice is this-function as a caretaker rather than as a doctor when treating a loved one.

The definition of a human being invariably dwells on our fragile and temporary existence.  The most primitive of tribal cultures always includes a medicine man to counter this fragility.  Whether the setting is composed of desert nomads or slick urbanites, people consult specialists that smooth and extend their existence.  Once the specialist is consulted, patients arrive at their own decisions regarding treatment.  The specialist consulted may be termed an internist or shaman, yet both are healers that direct our behavior in pursuit of health.  The mission of all health specialists is to provide specific directions for others to follow.  Whether the treatment is eagle feathers or a new drug, the aim is to cure sickness and extend human life.  Neither the shaman or internist provide day-to-day physical or emotional care.

Most family members of ailing patients want to be as helpful as possible, and this is where the trouble begins.  Caregivers may cajole or force a loved one to comply with the directions of the health specialist, and find themselves ostracized by the one they are seeking to help.  There is no guarantee that the behaviors proscribed by the health specialist may cure or even be helpful.  Most long-term follow-up studies of actual patient compliance hover around five percent after one year.  Stated another way, ninety-five percent of people do not follow doctor’s orders.  Most people take more or less drugs than proscribed, and rarely comply with non-drug behaviors suggested by the physician.  The caretaker who is frustrated with their loved one’s lack of compliance are very likely to be poorly compliant themselves.  It’s good advice for the other guy.
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All doctors can be replaced, though all caretakers are not replaceable.  Parents often comment that “I’m just a mother or father” when confronting disease in their children.  This often gives voice to the parent’s sense of helplessness and feelings of inferiority to the specialist.  The response I frequently employ is, “There are many doctors, but you are the only mother there will ever be.”  The emotional support of a mother, father, husband and wife are indispensable and irreplaceable.  Strangers may provide excellent physical care, but their actions do not have the emotional importance of close relations.  Occasionally I will turn the phrase around, stating to the parent, “I’m just the doctor, you’re the parent.”  It is an effort to reinforce the importance of the caregiver’s emotional support.

Even if you are a health care provider, do not fulfill that role with your loved ones.  There is no shortage of opinions regarding our health, but there is always a shortage of love and support when the chips are down.  Nagging a loved one into compliance with the doctor is more likely to result in bitter feelings than better health.  Such nagging may be taken as a need to control, rather than the need to see the patient regain their health.  As a parent, best friend or spouse, remember that the relations built over a lifetime cannot be replaced by a stranger-no matter how educated and skilled.  The non-specific factor in all forms of recovery is love and support.  Leave the specifics to the specialists.

Psychotherapy Revisited

Perhaps you have read my last post “Psychotherapy 101.”  The post “Psychotherapy 101” is an introduction  into fundamental aspects of psychotherapy.  It also attempts to dispel common myths regarding psychotherapy.  I am satisfied with the post’s information, but a bit unhappy with its tone.  Perhaps in my rush to dispel the “fruit and nut” aspects of psychotherapy, I did not give an accurate description of its softer side.

Even though most people seek psychotherapy to solve particular problems, there are those whose mission is to grow as a person.  It is easy to categorize these people under the “problem” label, since a desire to grow as a person assumes a certain degree of dissatisfaction with one’s life.  Perceived in another way, one may regard these seekers of growth to be satisfied with their lives, yet eager to exceed the boundaries of their current existence.  It is less improving a bad thing than making a good thing even better.

Personal growth through psychotherapy is not problem oriented or solution focused.  There is no mountain of empirical literature to guide the psychologist’s movements.  It is a free style exploration of one’s existence.  Psychodynamic therapists have an interesting perspective on this form of exploration.  They maintain psychotherapy is the construction of a story that both the patient and therapist agree upon.  It is a simple sounding phrase, yet its meaning tends to enlarge as it is turned over in the mind.

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Many growth-oriented therapies eschew goals as an unnecessary stifling of personal exploration.  Perhaps this is based upon the assumption that the goals of an incomplete person will be incomplete as well.  It may be true that one has to reach a certain level of psychological sophistication to formulate reasonable goals.  While this concept rings true for many high functioning people, it is not very applicable to those with more fundamental problems.  Working with victims of head injury, the formulation of any goal may be a great victory for the patient.  Lacking awareness into their deficits, the psychologist must maintain the privilege of  controlling the nature and extent of the treatment.  Growth-oriented psychotherapy assumes good cognitive functioning.

Growth-oriented psychotherapy is likely most beneficial to those whose work and home-life are generally satisfactory.  Personal growth work is easily derailed by current emergencies and old traumas.  Personal growth as a goal is certainly noble and worthwhile.  The time and expense are considerable, and the commitment is extraordinary.  The shared experience of building an autobiography is very powerful.  One cannot help but be altered by the experience.  The person emerging from this process has yet to be revealed.  It is hoped that greater awareness will bring greater clarity, and the clarity will strength our purpose.  Please leave comments regarding this post in the section below.