Back in my psychiatry residency training, one fundamental teaching of becoming a doctor was the need to be a blank screen for patients to project their deepest thoughts, fears, and desires onto. It is a tenet that is held very closely by many clinicians – don’t disclose a lot of personal information about yourself so that your patient doesn’t get encumbered or influenced by those details. This in turn allows a clean slate for the therapeutic process to enfold. That is why you might not know if your therapist is partnered or single, has children, or likes punk rock or rock climbing. I, for one, never put any personal photos in my office.
I recall in residency, because I was so naive and unsure, I felt ill-prepared to bend any of these rules. I remember sitting uncomfortably in an office, 8 months pregnant with my belly protruding out over my lap, hemming and hawing about whether to admit if I was pregnant when my patient asked me directly about it. Did I say that I just had a really big lunch? I don’t think so but my pregnancy brain may have affected my memory at the time.
Another teaching was the need to hold a consistent “frame” of the therapeutic relationship. These were a set of ground rules for therapy. Start on time and end on time. Don’t encourage messages and contact between sessions. Keeping a solid frame helped create a safe and secure environment for the patient and for the therapist.
Although very important in the therapeutic process, I find myself grappling to come to terms with how the world has changed in the meantime. We are now in a world where patients expect on-demand services, where healthcare companies are rolling out “unlimited text your therapist” services in between sessions, and where social media allows everyone to find out lots of personal details about their therapists if they want to.
More recently a few years ago, I experienced a time when I was surprised that one of my patients who had the day off from work preferred to be seen by another psychiatrist who happened to have availability that day instead. And I am their long term psychiatrist with an opening the very next day! Now, of course it makes sense to me that people want to be helped when they find it convenient for them – not convenient for us as the medical provider.
There is a lot of complexity, opaqueness and stigma in mental health issues today. I find that as my experiences of being a psychiatrist have grown, my comfort level has increased. I desire to communicate differently about mental health. Could I contribute to reducing the stigma about mental health issues if I openly talked about my experiences with panic attacks? What about if I shared my challenges of maintaining work life balance juggling a busy professional life while raising 3 young daughters?
When I’m true to myself, I realize that this type of conversation is exactly what people are wanting and desiring. So is it still wrong to talk honestly?
With rising rates of mental health burden, increasing rates of suicide, and a shortage of mental health clinicians, I feel deep in my bones that talking more openly can’t be the wrong thing to do. I feel privileged to be able to do the work that I do every day. I am honored to be trusted and am inspired by the people that allow me into their lives when they come see me for care. Because of that, I also desire to give back and push the boundaries just a bit and share more of what I have learned. And instead of being just a blank screen, perhaps being a bit more of a transparent one as well.
And that’s why I started LuvLuk and now Moon Mental Health, to have a more open conversation about mental health, and to try to address emotional health in a different way.