For Clinicians: Suggestions for Working with Individuals and Familes

I’d say the highest job of the clinician is to listen. So much of the therapeutic engagement has to flow from knowing your experience. These are not generic experiences.

That’s what’s so beautiful about this work: the subject is endless variations on themes. Everyone has an individual experience. I could not do my job as a palliative care doctor if I created coping mechanisms in a generic way. What works for one person may be very different for someone else.

My job is to listen to you and reflect with you so you find what works for you. I’m not going to impose a coping mechanism on you. But the idea is for you to find your inner reserve strength.

Therapeutic Exchange between Clinicians and Patients

The job of anyone working in the realm of serious illness — massage therapists, physicians, social workers, nurses, chaplains– is to participate in some form of therapeutic exchange.

So much the job for the therapist is finding a way to hold all of it, and not trying to surgically remove parts of it.

(I mean, if you can surgically remove pain, okay.)

But clipping too many fine things off the sides to stay in your lane can be such a disservice. That doesn’t mean you have to love the circumstances; we don’t have to be happy that delirium or dementia is in the mix.

But your job of acknowledging it will help patients and their families acknowledge and accept, especially when our bodies are falling apart. In this vein, one important role of the therapist is liaising people back to their bodies. This can be as simple as touching while talking. Touch can overcome so much of the fear and repugnance of feeling sick, and can imply acceptance by the very fact of physical contact.

There are exquisite fleeting thoughts and feelings that can be so instructive. I would just encourage you to honor those reflections because I bet they contain a lot of really good expansion. Expansion for you as a practitioner.

Next time you see that person, you can say “Hey I felt X, Y or Z after we spoke, does this line up for you? Does that register with you?”

These moments can be really helpful, but many of them are very subtle. If you can get really good at seeing these cues in yourself and in your clients, it will undoubtedly improve your practice.

When to Use Touch?

Not everyone wants to be touched, and not everyone wants to be touched by their doctor. So it’s very appropriate to say, “You know, Mr Smith. I am tempted to hug you, do you would you like a hug? Is it okay to put my arm on your hand?”

So asking, and then also just deeply paying attention to their response is the way to navigate.

If they tense up, perhaps they aren’t ready for that kind of intimacy.