You Don’t Know,Keep Asking,Keep Understanding

“You never know how it is going to turn out “

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Living With The Uncertainty

                                            Recently, a clinician that I know told me about a patient who had been seen. The young man, in his 30’s, had served as an Infantry Marine and was deployed for two combat tours to Afghanistan and Iraq.  The young man now is back at home, not working, terrified to go outside, isolates at home, and added, with embarrassment, that he cannot takes showers, that he cleans himself by taking sponge baths.   This has been going on since the deployments.

                                         Initially, the clinician working with this patient thought that what was being presented was consistent with symptoms that would be associated with combat trauma Post-Traumatic Stress Disorder and Panic Disorder with Agoraphobia.  One could have developed a reasonable treatment plan from that perspective.
                                       However, as time went on, the patient disclosed to the clinician that on several occasions he was sexually assaulted by another male Marine in the barracks showers in the middle of the night.    The patient was afraid to disclose the abuse to his superiors because the other Marine threatened to kill him if there was a disclosure.

                                       You never really know what another person is carrying in their lives. We make the mistake, as clinicians, thinking that what we conceptualize as a present problem can be as easy as a paint by numbers canvas.

                                      People are more complex. Collaborative-Dialogic practice (Anderson) reminds us that the patient/client is the expert of their own lives.  Our job, as clinicians, is to listen to walk with and provide support using a not-knowing stance (Anderson) in allowing the patient/client to do the work that will be most beneficial for them.

                                     Working with people, especially those from different socio-economic, demographic and cultural perspectives demand a neutral perspective, one that is free of distinct lens being over-layered upon the patient/client.

                                    Our work comprises translation, Interpretation and explanation (the abbreviation being TIE). We are learning the language of the people that we treat as well as those that we supervise.  We need to be aware how race, gender, sexual orientation biases effect the care that we are trying to provide our patient/clients.  We need to accept the uncomfortable reality and recognize our fear and sensitivity to criticism and be as clear as possible when we are wearing different hats in our work be, they clinical or administrative issues.

                                 Again, the goal is to be open to what the patient/client or supervisee can teach us as clinicians, while being conscious of what we can teach them.

                                There is also the challenge to being attuned to what patients/clients/supervisees are not sharing with us and why?     What can contribute to a freer environment that will facilitate more open and receptive communication for all?

                                 These are the “pearls of wisdom “(Anderson) that we continue to unearth. As one therapist recently noted:

                                 “You never know how it is going to turn out “

                                 There is freedom in this realization and yet, there maybe some fear of not getting it right, of hopefully not doing any harm.

                                  Here again, the need to return to “you don’t know it all “and therefore the continued emphasis to ask more and understand more. The Collaborative-Dialogic process demands this type of reciprocity and fluid exchange of observations, cues and information.

                                Our work is never done, but the continued dialogue can be mutually enriching for both therapist, patient/client and supervisee.

                               May it be so.

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