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Thoughts on how we celebrate with our patients when they achieve a milestone in their work or convey a more finely tuned awareness of themselves.
PORTRAIT OF A PSYCHIATRIST
– Series Editor, H. Steven Moffic, MD
Driving to my office early one morning, a classical music radio station played a celebratory piece of music, filled with the rousing sound of trumpets. An uncle had requested this piece for his young niece, recently honored at a school graduation. He knew she was an avid listener of the station. He hoped the music would make her smile. We will never know if she heard the piece or smiled with surprise, although we can appreciate the uncle’s unique way of celebrating a member of his family.
In my clinical practice of psychiatry and psychotherapy, signs of favorable progress are clearly important to recognize and affirm. I have been wondering lately how we celebrate with our patients when they achieve a milestone in their work or convey a more finely tuned awareness of themselves with others as well as awareness within their inner and outer lives. These developments might take the form of some manageable risk, a life-serving decision, a breakthrough to forgiveness, or a coming to terms with an excruciating loss.
It is unlikely we would play celebration music, or by contrast sit stone-faced in primeval silence. More likely, we might convey in affirming words, or a simple non-verbal gesture, a shared sense of its meaning for the person. Nor would we ignore the ways in which our relational work together, our collaboration has borne fruit.
I recall during a time of crisis in my life, I gave a fresh persimmon to my personal psychiatrist. I had stopped at a market in San Francisco on the way to my analytical therapy session and bought a bag of these small orange treasures. I fully expected him to plunge into some commentary on gift giving, boundaries, and interpretive meanings. To my surprise, he took the small fruit in hand, looked at its shape and color, felt its texture, sniffed its aroma and placed it on his desk. I felt so respected by this gesture of receiving.
Later, I came to realize within the offering was a way of coming to terms with the end of a difficult part of my life, a kind of acceptance that went beyond words or knowing at the time.
The art of sharing, whether it be in the form of celebrating, or of disclosing oneself within the frame of intimacy and the integrity of the therapeutic relationship, the complex issue of self-disclosure arises. As psychiatric physicians and psychotherapists, we must always question when our modes of sharing are self-serving as opposed to furthering the process and progress of relational learning and personal evolution. In 2018, Irvin Yalon, MD, esteemed for his work in group and existential psychotherapy as well as for his literary contributions, spoke to me of the importance of conveying to patients our genuine, warm appreciation for their courage in facing something difficult in themselves or having reached beyond their isolation to connect with others, including their therapist.
A young woman in her mid-20s is expecting her first child. As her pregnancy proceeds, she becomes tormented by obsessive ruminations. She fears emerging catastrophe. In psychotherapy she speaks of a sense of dread-dark companion from earlier times in her life. Will she be able to meet and fulfill the tasks of motherhood? Would her marriage survive? Was she vulnerable to postpartum depression or worse, psychosis?
Despite social support, reassurance, encouraging her efforts to cope, she struggles to find a center of calmness in herself, some way to meet the challenge. Ultimately, she resigns herself. She cannot control what will happen. She goes into labor and delivery with a mixture of relief, terror, and surrender. Her husband is with her, holding her hand, reminding her of the breathing exercises they had practices together. She delivers a healthy, robust baby. Everyone is ecstatic, with and for her.
In the months that follow, she discovers how much she delights in caring for her newborn and growing infant. All the tasks she had been dreading, all the mishaps she feared fall away.
To my surprise, in our psychotherapy work together, she has become more courageous, more ready to explore the developmental and experiential aspects of her peril in life. We celebrate this shift together and share in the wonder of how much more present she is now with a new confidence in her capacity to meet the natural uncertainties of life head on.
Returning to the act of celebrating a young person’s accomplishment through a special request for her on a favorite radio station; or honoring patients’ ways of sharing an ineffable quality of themselves through an art form; or finding in our own life experience an equivalent for attuning to another person’s emotional upheaval-the key is to find ways to fulfill our human gift for relating to others. Celebrating is a life affirming act within and outside of therapy.
Dr Weingarten is Adjunct Clinical Professor of Psychiatry, Stanford Medical Center and Clinics, Department of Psychiatry and Behavioral Sciences. He has no conflicts of interest concerning the subject matter of this article.