Sky drama

Today was another day filling in at liaison for Waitemata DHB; on loan from my new job at ADHB. The person who occupied most of my morning roused in me a number of responses. The simplest, because the most personal, relate to what some call countertransference.

Many years ago, when I was still a trainee, I read a series of papers discussing various psychoanalytic concepts. The authors considered what Freud probably meant by a term such as countertransference, and then how it had changed with time into something rather different, and then argued for returning to what they believed Freud really meant.

Countertransference began as the equivalent in the analyst to transference in the analysand. That is an unconscious reaction to something in the analysis in which the analysand (or analyst) responds to the other as if they were an important person in the individual's past. That meaning has morphed into describing the emotional reaction a clinician has to a patient, and the patient's situation. I would prefer to see such reactions as human, and normal, and having to be managed if they threaten to interfere with the therapeutic process.

Yesterday, S and I talked about the differences between sympathy, empathy and compassion. She (quite reasonably) was critical of my reference to dictionary definitions, preferring usual usage. We did not reach full agreement, but did both like the proposal that often there are elements of each of these in the way we respond. That was the case this morning.

More complicated, and more troubling was how what has happened for this particular person roused in me intense feelings about the failings in our systems of care. When a patient has a clear cut major mental illness, reframing it as a personality issue with all that goes with that (you [patient] are responsible for the inability of me [clinician] to help you get better), angers me. And when responding to "disagreements" about diagnosis in the past leads a clinician to not offer something to make the distress less, it is actually harmful to the patient.

The afternoon was better, and to see someone who came to the hospital in severe distress blossom with the arrival of his whanau (family and friends) as they offered him their aroha (love and support) and be able to go home again, is heart warming.

This sky reflects all that for me.