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You Can Only Take Patients as Far as You've Gone Yourself

March 08, 2018

By Andrew Penn, RN, MS, NP, CNS, APRN-BC
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The opinions expressed by Psychiatry & Behavioral Health Learning Network bloggers and those providing comments are theirs alone and are not meant to reflect the opinions of the publication.

Of the things that struck me the most at our Elevate conference this year was several presenters sharing their own personal experiences with psychotherapy. This was something I’ve not seen in my 8 years of coming to Psych Congress. I was impressed by the courage with which they were willing to offer vulnerability, and the way their confidence in seeking guidance during difficult times normalized therapy for the early-career professionals in attendance.

In the prebiological days of psychiatry, when psychoanalytic theory was the lighthouse that guided our understanding of patients and many psychiatrists were also trained as analysts, it was de rigeur to be in one’s own analysis (or at the very least, psychotherapy). It was considered important to do so, in order for the therapist-in-training to be able to understand the landscape of their own inner world. Undergoing analysis would allow the therapist to be more effective with patients in therapeutic use of self and more aware of the potential pitfalls of transference and countertransference.

TherapyToday, biological psychiatry holds great sway. The managed care-driven “split model” of care often means that psychiatric medication is prescribed by the NP, MD, or PA and psychotherapy is the domain of the psychologist, professional counselor, or social worker. In this milieu, it may now seem less important for psychotherapy to be an important piece of routine maintenance for a psychiatric clinician. Perhaps this applies less to training programs that are primarily psychotherapy-based, but in psychopharmacology-focused training programs, the interest in the developing clinician’s own psychotherapy and clinical supervision appears to have waned in recent decades.

The Psychiatrist as Patient: Do We Always Get Good Care in Our Hour of Need?

I am troubled by this de-emphasis of personal psychotherapy for psychiatric clinicians.  When we have not done our own psychological work, we are limited in the depths to which we can take our patients.  As the old chestnut reminds us, we can only go as far with our patients as we have gone ourselves. If we are fearful and apprehensive of what we will find if we look within, how can we ask our patients to do the same? We will be more likely to stay on the surface, treating only symptoms, and not diving beneath to do the deeper work of change.

As an aside, the lessons we are learning from the marriage of psychopharmacology and psychotherapy in psychedelic-assisted therapy suggest a therapist having a map of their own inner world helps them to make better choices in both pharmacology and in how to navigate the landscapes of the patient’s inner psychic world.

Sadly, as I and others have discussed in previous blogs, I believe there remains a lot of internalized stigma within psychiatry. Licensing boards may even raise eyebrows about a clinician seeking their own treatment for mental health issues. I have met more than one psychiatric clinician who, only after a long period of friendship, has told me with no small measure of shame, that they take psychiatric medications. Far from being a reason for shame, these shared experiences allow us to better empathize with the concerns and fears our patients may hold when they come to our offices, seeking treatment.

The biggest loss for us, as clinicians, in not seeking our own therapy is that we miss the rich opportunity to understand our own inner worlds. When the vicissitudes of midlife led me onto a therapist’s couch, I began a journey that has infinitely enriched my inner world, helped me make sense out of patterns where I felt stuck, improved my relationships, and ultimately, made me into a far better therapist than I was before. I encourage all of my students to pursue their own therapy as part of their training and to continue on as they begin practice. It’s a small investment in their well-being as well as that of their patients, as being on the couch ourselves allows for a fuller appreciation of the intimate work that we are privileged to do with our patients.

WEIGH IN: Do you agree that personal psychotherapy is important for psychiatric clinicians? Leave your comments below.

Andrew Penn was trained as an adult nurse practitioner and psychiatric clinical nurse specialist at the University of California, San Francisco. He is board certified as an adult nurse practitioner and psychiatric nurse practitioner by the American Nurses Credentialing Center. Currently, he serves as an Associate Clinical Professor at the University of California-San Francisco School of Nursing. Mr. Penn is a psychiatric nurse practitioner with Kaiser Permanente in Redwood City, California, where he provides psychopharmacological treatment for adult patients and specializes in the treatment of affective disorders and PTSD. He is a former board member of the American Psychiatric Nurses Association, California Chapter, and has presented nationally on improving medication adherence, emerging drugs of abuse, treatment-resistant depression, diagnosis and treatment of bipolar disorder, and the art and science of psychopharmacologic practice. 

The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors. Blog entries are not medical advice.

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