Impatient You Are
‘Impatient you are; teach you I will...'
Sunday, 29 July 2007
Jedi lessons for psychiatry teaching
By Dr Frigmund Pseud
Yoda knew that there’s only so much you can learn on the job. If Luke Skywalker was to become a Jedi, he was going to need to take time out and get bogged on Dagobah, that swampy, creepy backwater. Luke could only take so much of this pure-training approach; later in The Empire Strikes Back he flees Dagobah to plunge back into the battle with The Empire. Service-provision wins out over training, and Luke loses a limb for it.
I went to Dagobah once a week for a couple of years of my training - the rooms of an analyst who provides dynamic group supervision for basic trainees. There was a creaky floor under ancient carpet, dusty bookshelves pregnant with the thoughts of twentieth century analytic luminaries; crooked piles of College journals. And stillness, while outside the traffic buzzed away. One of us trainees would present a recent session, while our supervisor listened intently, rarely interrupting, frequently jotting away. Only after a lengthy pause (like………..this………long) would our teacher speak. ‘Yes,’ he would say, ‘Quite.’ Then another pause, and then…The Goods:
What your patient was really telling you. What you told them in reply, although perhaps you didn’t realise it. How you might approach a similar exchange in the next session. What the likely underlying motives and priorities were for this patient.
He reminded me less of the yammering Yoda than Tolkien’s Treebeard. ‘Don’t be hasty,’ I could imagine him saying, or ‘anything worth saying is worth taking a long time to say’.
After supervision, the feeling state instilled would last well into the morning’s work; a sense of alertness to the communications in everyday life, not just clinically; a temporary release from the pervasive hurry of registrar jobs. I was never a Morning Person before I started going to psychotherapy supervision, but I made sure to become one – that’s how helpful it was.
Interestingly, I don’t think I would have missed it if I had never had that supervision, if the College hadn’t made me do a long case which required such supervision. I’d still be a pretty good registrar who’ll one day make a pretty good psychiatrist. For a certain sort of treatment. Of a certain sort of patient. Upon this sad fact is based the erosion of psychological training in psychiatry – as long as we can pass cases and exams, and aren’t obviously ethically challenged, then we’ll do.
If fitness to provide the most basic pointy-end public system consultancy is allowed to drive psychiatry training, then that is what we will get, a training which gets you through the assessments and into the workforce ASAFP.
In that case, we will struggle even more to attract bright, caring and curious medics into psychiatry training, because those sorts of doctor want so much more than that. ‘Now I’m doing Child Psychiatry’, a trainee of the aforementioned variety said to me today, ‘I’m getting to do what I signed up for – work with the patient and their systems in a true biopsychosocial way. Why did I have to wait ‘til Child to experience this?’
This from a trainee at one of the most psychologically informed Adult MHSs in Australia!
Indeed, my dynamically-informed supervision came not from within my MHS but from a private practitioner in the community. The MHS has benefited, I think, from his contribution to my training – I work better engaging with and diagnosing patients, negotiating and integrating with teams, and connecting with colleagues, equipped with the heightened interpersonal awareness that my psychotherapy supervision has given me.
Of course, without the case, there would be no supervision – much of what I learned came through the prism of my first truly longitudinal therapeutic encounter. But I think that psychologically-informed supervision has a wealth to contribute to public system training, independent of the clinical material to hand.
We are lucky at present in Australia, to have access to people who trained in strict accordance with pure psychoanalytic (and other 20th century personality theorists’) traditions – just a few degrees of separation from Freud, Klein, Winnicott, and Bowlby. Fewer and fewer psych regs get their own analysis or therapy of any sort these days; in future decades that degree of separation from the original training and expertise will only increase. Psychiatrists trained in the psychological traditions of last century may become like the Jedi Knights, practitioners versed in something different, difficult to master, but powerful. Sadly, the powers that have taken over the mainstream have pushed the older ways to the fringes, and the threat of extinction looms.
So, what can we do? Yoda knows you can’t train a Jedi purely in the thick of battle, however important experience at the coalface is. It takes time, patience, and a breadth of vision that acknowledges all the sources of wisdom, and the many paths to betterment. To help others significantly, you must know your self significantly; it is better to know what you don’t know than to presume of what you do; seek not the right answers, (there are few, if any) but the right questions (there are plenty of those). This all sounds like babbly bullshit to any bean-counter worth their salt. But any six year-old worth theirs will tell you - you can’t let the Jedi die out!