Why do I do what I do?

I often get asked why I have chosen (and/or, did the job ‘fall on my lap??’) to focus on psychotherapy, relational/complex trauma and personality disorders in the wide, expansive (and some might say, elusive) specialty that is Psychiatry.

This is a very good question as the work is emotionally and physically taxing and for most part on face value, rather thankless. Additionally, in Psychiatry as a profession we are fortunate in that we have a luxury of other options we can choose to specialise and engage in.

At times, this work can be highly (and I mean HIGHLY) traumatising for the therapist. Risks here include but are not limited to physical and emotional assaults, intrusive unwanted behaviours and stalking, character defamation, litigation, vicarious traumatisation and the spectre of burnout in all its protean forms. Compared to other medical specialties, financial 'reward' also ranks lowly. So why do it?

After some reflection, here are some personal reasons. - Engaging in this work fosters the development and deepening of a complex skill set that one can take pride in. This skill set is not limited to mere technical procedures and strategies; this is the tip of the Iceberg. We develop skills in self/other-understanding, interpersonal communication, emotion awareness and regulation and compassionately 'being with' self and others. Needless to say, skills development is a necessarily lifelong venture.

- From a service perspective, being valued by the team for taking on patients others may not be skilled adequately to help, structuring coherent inter-agency management plans which in turn fosters necessary and regular liaisons with multiple agencies. This develops a keen insight into the complexity of issues both intrapsychic, interpersonal and societal. The world, we learn, is NOT black or white and we develop skills to help sail the seas of Grey uncertainty. And as Samuel Taylor Coleridge advises in 'The Rime of the Ancient Mariner': do not shoot the Albatross. The graceful seabird symbolises precisely those humanist values that are at risk of further erosion within Health Care systems that pride themselves increasingly on machine-like efficiency and practicality.

- The quiet satisfaction in observing less team ‘splitting’ and heated disagreements when there is a plan in place and an organised agreement between and within various agencies. This comes from the silent knowledge that one has contributed positively to a more welcoming and less antagonistic work culture. We all intuitively know that if a treatment team functions humanely and well, patients and their families will benefit all the more. The evidence base from sociological research is supportive of this intuition.

- The joy of seeing patients evolve, adapt and move forward, which can range from gradual and progressive to very sudden ‘aha’ moments. This joy is amplified when improvements are shared with genuine expressions of gratitude and thanks. Such moments serve as magnifying lens to the beauty of human resilience, creativity and potential, while acting as a bridge to meaningful connection. For me, this also allows for feelings of respect and awe regarding the patients whose life stories they have allowed me to hear and perhaps influence. This in itself, is a monumental privilege.

- Not only patients and clients, but also at times their families, counsellors, general practitioners and involved others express genuine gratitude for one’s professional input and genuine contact and concern. See above point for why this is a very, very good and nourishing thing.

- The opportunity to play and ongoing and highly active role in training, teaching and education. One can develop a significant role in societal efforts to reduce stigma, empower patients and families through the peer support movement, humanise our field and model the values of connection, compassion and ethical integrity.

- The provision of and engagement in a role that has the potential to be deeply satisfying and meaningful (In my case, a vehicle for developing the ’Healer’ Archetype). It paves the path for a personal journey that leads one through many different challenging terrains in the service of developing and embedding cherished values. "Find your Bliss", the late great mythologist Joseph Campbell says. And finding bliss is also coloured with necessary hardships and suffering.

- 'Doing' this work, 'Being' the role properly actually forces one to deeply self-reflect, to become more aware of shortcomings, to develop the courage to acknowledge and address them, and hence to engage constantly in self- development (My courage here does falter at times).

- Connecting with like-minded peers from various disciplines, leading to sustained meaningful friendships and intellectually stimulating discussions. Lots of conversations with colleagues over coffee and wine is testament to this fact!

- Opening one’s eyes up to varied and different perspectives on a range of subjects from a range of scientific, artistic and philosophical perspectives. While this is a more intellectual benefit, it can be very sustaining in the light of recent neuroscience findings that even learning new words can stimulate the brain's dopamine reward pathway. This interestingly, is one and the same pathway that is stimulated by substances legal and illicit! Beware the dangers of over-intellectualising the venture....

Word of warning to new therapists though. Do not seek the above in an obsessional, self centred way. Remember that we will never know everything, that there is an inherent power imbalance and that the therapeutic process should always be collaborative and informed by the professional relationship. Our formulations, theories and evidence-based frameworks, important and necessary as they are, remain guides only, playing the role of servant to our patients' lived experiences. Hence another beware note in the form of a quote from psychoanalyst Tom Main: "The sufferer who frustrates a keen therapist by failing to improve is always in danger of meeting primitive human behaviour disguised as treatment".

This is not to mean throw our professional standards and guidelines aside and enmesh oneself within the needs and wants of the patient, as this can be just as, if not more, dangerous. It means seek good supervision, and maintain your commitment in honing in your therapeutic and interpersonal skills throughout your professional life.

Hopefully this may inspire medical students, junior doctors, psychiatric trainees and others to engage in this field. We need young, intelligent and inspiring minds! Other therapists here on the world of the internet please feel free to add your own reasons and begin a discussion.

* The amazing artwork in this Post were primarily found with Google searching. I am unable to find the names of the artists so please contact me if any of you readers do. I would love to credit them.