Communication - need to know

There is a clear principle in many different organizations guiding the movement of information: who needs to know?  When that question is considered in life, people often change their communications.  In therapy the issue of boundaries is frequently addressed.  We live in an age when technollogy has created such easy flow of information via telephone, text message, email, facebook, twitter, and whatever comes next.  It has become so easy that we may forget to ask the question: who really needs to know? 

To answer that question, consider another: what is the purpose of this communication?  The process of communication involves a sender, a receiver, and a language.  It appears to me that people are communicating more and more information from themselves (the sender) without careful thought about who it is going to (the sender).  The unconsidered question involves the motivation underlying the communication.  Is this information being provided because it is going to be useful or helpful for the receiver, or does the sender simply want to be heard?  To simplify: whose need is being met?  If we stop and give thought to this question, we may find that some or even much of what we communicate really is unnecessary and may even be inappropriate.

This question relates to the previous post about my wife's cancer.  For me, I have had to (or at least attempt to) clarify my motivations and assess whether or not the information would be useful for someone else to know.  Obviously by posting this information on the web, it is now out there for anyone to view.  We gave careful consideration of this before I embarked upon my writings.

There is much more to be said about this topic, and I am going to try to be diligent about this means of sharing my thoughts.  The focus will be broad, a look at ourselves from a Christian worldview.  Please come along for the ride, and thanks for reading!

Life Changing Events

So often in life it seems that we make plans and begin to move forward, but something happens and these plans go awry. 

Life Happens!

About a week after my last entry, my personal world was turned upside-down.  My wife was diagnosed with a rare and aggressive form of cancer on a routine medical checkup.  One of the first thoughts that I had concerned my clinical practice: what do I do with this?  A bit of explanation may shed a bit more light.

I sometimes refer to myself as a 'dinosaur' as far as practicing psychiatry, due to my background and training as a psychodynamic or psychoanalytic psychotherapist.  This approach has the therapist as a sort of 'blank screen' or 'cardboard cutout' of a human being with little personal detail provided.  The theory is that the patient will "fill in the blanks" with his or her own ideas, fantasies, and projections.  Although there is certainly much to support this approach, over the years I realized that many of the people whom I worked with had experienced a great deal of what I call 'relational deprivation and injury' prior to reaching adulthood.  It became clear that part of the healing process occurred in the context of a real relationship with the therapist.  Actually, that occurs in ALL therapy.  Even Freud was more of a real figure to his patients than is often presented.

So allowing "more of me" into the session has been a part of treatment for years, but how much?  Differentiating between 'being real' and bringing one's own issues into the therapy is something one must be vigilant about.  A few months ago this became an entirely different undertaking.

In therapeutic work, my own emotional reactions to what is occurring in the session can tell a lot.  For example, if I am suddenly having a strong urge to cry at a time when there is nothing going on in me to trigger such a reaction, a bit of internal reflection will usually point out that I am reacting unconsciously to something the patient is feeling, even though he or she may not even be talking about something sad.  I have joked that it is like Mr Spock doing the Vulcan mind meld from across the room.  For the therapist, knowing one's own issues and current emotional state is vital to being able to assess what is going on in the session.  Dealing with my wife's illness was clearly going to impact this balance.

This Must Have Happened to Someone Else Before

My first thought was that there have obviously been many psychiatrists and psychotherapists who have had a spouse with cancer.  What did they do with it?  How did it impact their work?  Unfortunately, I couldn't find anything about this.  I thought I had remembered a paper or two in the past concerning the issue of cancer in the therapist's spouse, but nothing seemed to turn up.  If anyone reading this happens to have any references, please let me know!

How Much to Share?

When I decided that this was going to have an impact on me significant enough to 'leak' over into my clinical work, there was no question that I would share...but how much?  This point is important because my bringing a personal issue into a patient's therapy MUST not become a resistance or distraction to working on the patient's issues.  Being overly vague or evasive could easily become even more of a distraction as the patient inwardly is trying to 'fill in the blanks' and/or outwardly seeking more information.  But too much information obviously carries its own problems.

Another element somewhat unique to my practice is that I am a committed (although highly imperfect) follower of Christ.  Many of my patients are as well.  One of the greatest obligations AND privileges that God gives His people is to pray for one another.  There was no question in my mind that both my wife and I needed prayer from our brothers and sisters in Christ.  As my wife chose to tell our Sunday school class about her cancer, we realized that word would spread.  So after she gave me her permission, I decided to tell some of my patients specific information about her condition.  We have also discussed my writing about this here, and she has been agreeable.  So now I begin.

Cancer

My wife was diagnosed with a poorly differentiated vaginal adenocarcinoma in June, 2011.  Primary vaginal cancers are very rare, and adenocarcinoma (a cancer originating in glandular cells in the lining of the vagina) is only 10-15%.  Her cancer appears to be a 'clear cell' type, which was seen in 1 in 1000 female children born to mothers given DES during pregnancy.  DES was used from the 1940's until 1971 in women who were at high risk of miscarriage.  The drug was taken off the market when girls in their teens and twenties began to manifest clear cell carcinoma.  We don't know if my wife was exposed or not, and appearance in a woman in her 50's would be extremely rare.  But that is what she has.

We learned one month ago that it had spread into both of her lungs.  She had external beam radiation + chemo for six weeks during the summer, then had radiation implant treatment (brachytherapy) in September.  The primary lesion showed some response, but she has now begun an aggressive regimen of Taxol combined with cis-platin due to the pulmonary metastases.  As this cancer is so rare, there really is no research nor established protocols to determine the best approach.  She had her second round yesterday (it is given every three weeks), and after another couple of rounds, she will undergo scans to assess whether or not it is working on her particular cancer.

I will close for now, but will resume writing about both these issues as well as other topics.  Thanks for reading.

On the Radio!

This morning at about 8:20 I was on air with Michael Hart on his call-in radio program on WYDE 101.1FM in the Birmigham and Huntsville Metro markets.  I had previously called in to talk about the tornadoes and psychological trauma.  Given the impact of the tornadoes, Michael and his producer Crystal had asked me to come in studio to talk about these issues.  We had an excellent conversation although the time went far too fast.  There are a great number of issues that I would like to discuss to a diverse radio audience, so I look forward to being able to return to the show again.

If you have not listened to Michael's show, I would strongly recommend that you give it a listen.  He is on from 6-9am weekdays.  They have an online link on their homepage (http://www.101wyde.com) in the lower right corner.

Stay tuned and we will see what comes of this!

An Opportunity

As a psychiatrist who believes that psychotherapy is an integral part of treatment of virtually all patients, there are practical limitations on the number of people I can treat.  When I was serving in the U S Navy, much treatment was provided in group therapy settings, as there are more people who can be treated in a given period of time.  But beyond that, is there any other way to have an impact on my community?

Certainly by writing, teaching, and giving presentations, there is an opportunity to reach more people.  That still tends to be a select audience, however.  Many people might be able to benefit but simply not be aware of information that was available.  So what about more general approaches?

I have been offered an opportunity that appears to give me such a chance.  Here in Birmingham a talk radio host and his producer met with me to explore my possible involvement as a guest on his show.  As a psychiatrist who also happens to be a commited Christian, a man who believes that a Scriptural view of the world and our problems is TRUTH, I am going to have the chance to speak about some of these issues to a broad ranging audience.  It is a conservative talk program, but I'm sure that there are many who listen but are neither conservative nor Christian.  To be able to shed some light into darkness...isn't that what Jesus has called us to do?

Stay tuned for more specific information (hopefully soon!) as we want to move forward with this in the next week.  A hint: the show airs from 6-8am locally!

Alabama Tornadoes

The past three weeks have been a disruptive experience as we all seek to recover from the impact of the tornadoes that struck Alabama on April 27.  This past Sunday after church, my wife and I drove through Pleasant Grove and Concord.  The devastation is hard to fathom.  We are used to seeing amazing special effects in movies, but this is REAL.  The impact on both individuals, families, and their communities will be long lasting.  Seeing the number of people, particularly from the Christian community, jump in to help out is quite encouraging, though.  I thought I would write a bit about some of the issues raised in events such as this.

The emotional harm that can be brought on by such events cannot be overlooked.  The physical damage is obvious, but the unseen impact on some people can be just as devastating.  I will write at some length in the days ahead about the psychological impact that can come.  In the short term, it is important for people to be able to talk about their experiences as well as the emotional impact.  It is helpful to realize that others are suffering as well, and that you are not alone in how you are responding.  It also helps to have the community rally together in mutual support.  On the other hand, people need to be able to get away from it.  In this day of the internet, it is easy to be overwhelmed with information.  Even someone who was not directly impacted by the storm needs to be wary of spending too much time focused on it.  Children can be overwhelmed by over-exposure to images and discussion about the tornadoes.

From a Christian perspective, one can often hear "why did God allow such a thing to happen"?  As I look around at the overwhelming force of the winds, I find myself thinking how grateful I am that it wasn't much worse.  When I see individuals giving of their time, abilities, and resources to help others recover, I see the hands of God in action.  Harder to acknowledge is the conviction that it is also just as easy to ask "why shouldn't this happen" as Scripture is quite clear that in our fallen state, we are in rebellion from Him and have no right to bring any complaints before Him.  We don't like that answer, and this is why much of the world seeks to deny the truth of Scripture, that we are sinners in need of a Savior.

The book of Job is appropriate reading at times such as these.  Job's friends try to say that it is the sin in his life that has brought the calamities upon him.  Job resists this interpretation and wants to bring his complaints before God.  He gets his moment, but God's response is to ask Job some questions.  We do well to review this passage and understand that God is sovereign and it may be difficult to always see His plan...

...but do not miss the point: God DOES have a plan.  He works all things out in accordance with His will.  It is our job to look to Him, seek His forgiveness, protection, and care, and desire obedience which includes taking care of one another.  I see so much love being poured out by people as we try to lift each other up through the aftermath of this tragedy.