Sandra G. Rubin, MD

I have often wondered how medical specialties are influenced by doctors’ personal experiences. In psychiatry, we do not complete physical exams; much of our diagnosis is born out of our observations, interviews, and conversations. Other medical fields, particularly surgery, require manual, technical, and motor skills. In this manner, psychiatry is unique.

I recall the first week of my child fellowship program. I had just completed adult psychiatry training in the US and already had a child psychiatry residency in Buenos Aires, Argentina, under my belt. My new supervisor asked me about my experience working with children. He told me to forget everything I learned and that only during this training would I learn what I needed to be a psychiatrist.

[[{"type":"media","view_mode":"media_crop","fid":"26692","attributes":{"alt":"psychiatry training","class":"media-image","id":"media_crop_9884117584615","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"2518","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","title":"","typeof":"foaf:Image"}}]]My supervisor’s words stayed with me for more than 20 years. How could one sole training program be so pivotal when we bring many experiences to our encounters with patients? My work with adolescents is also inspired by life experience, education, as well as cultural research-reading the sports section; knowledge of dogs, cats, horses, and guinea pigs; learning about PokÃ©mon, texting lingo, and video games. These personal experiences provide us with a better understanding of our patients during therapeutic encounters.

If the patient is a swimmer and I am able to use metaphors from my life as part of the treatment, the patient may gain deeper meaning and insight into what is being addressed. This can change the intellectual context of the session. The ways we relate with patients allow them to open up and to share their pain as well as their accomplishments.

At the same time, we need to keep a distance so we don’t influence the patient. I may have heard specific information about a particular college, or have experiences with a particular school, but I need to listen first and always remain objective and aware of what my patient is trying to convey-apart from personal experience. I try to think of ways to create a therapeutic process that results in effective change. The more our comments resonate with the patients’ internal experiences, the more effective we can be.

Our work requires us to be attentive, and to keep our thoughts and feelings in check so we can effectively interpret our patients’ needs. We should be open every day to what they teach us. As we educate a new generation of psychiatrists, we must include all methods, innovations, strategies-and personal experiences-to treat psychiatric disorders effectively.

Dr Rubin is Assistant Clinical Professor of Psychiatry and Behavioral Sciences at George Washington University, Washington, DC. She is in private practice in Chevy Chase, Maryland. Her Web site is 

She reports no conflicts of interest concerning the subject matter of this article.

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In psychiatry, we do not complete physical exams; much of our diagnosis is born out of our observations, interviews, and conversations. Other medical fields, particularly surgery, require manual, technical, and motor skills. In this manner, psychiatry is unique. More in this commentary.

Author | Sandra G. Rubin, MD

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