Making a connection

The young woman, we can call her Mary (let me say now she is not a real person), is sitting in the chair opposite me.
‘What is it like, at home?’ I ask.
‘Difficult, no forget I said that.’
I wait a moment, then take a risk and ask, ‘What’s hard about it?’
Mary picks silently at a scab on her left arm. I can see blood beginning to ooze from beneath the hard carapace as she worries away at it with what remains of her fingernails. On both of her forearms are marks where she has scratched herself repeatedly with a razor blade. The newer injuries are still an angry shade of red. The older ones look like the silvery trails a snail leaves on paving stones. She has told me already how she feels a strange sense of relief when she cuts. She doesn’t want to kill herself, but there are times when she needs to have some relief from her inner pain, and this is something which seems to help, albeit for a short while.
‘Can you tell me a little bit about home…?’ I try again.
‘I can’t say I hate it can I? I mean they care about me, I suppose. But I can’t be what they want me to be.’ She sobs and her tears drip onto the arm of the chair.
I push the box of tissues towards her. ‘Do you have to be what they want?’
‘I don’t want to be…different.’
‘So tell me about being different…what does that mean?
‘Maybe…I don’t know… you feel different?’
Silence. No- a shrug. A response.
‘Maybe that’s okay,’ I try again, ‘… to be different. Or maybe it’s not…it can be hard.’
‘Why? Why should it be okay? Not fitting in!’ She sounds angry now.
I find myself backing off a little, ‘I don’t know. Sometimes people just feel different.’
She nods but still looks at her lap.
Encouraged I continue. ‘Sometimes they are, different I mean. That’s OK with me, but how about you?’
Mary looks up. I detect an uncertain, conspiratorial glance and the first flicker of a smile. I sense we have started to make a connection.

Psychological therapy is a topic about which there is a great deal of mystique wrapped up in layers of ever more complex jargon. Each approach comes with its own vocabulary, set of abbreviations and training course. I had some training in my youth in psychodynamic psychotherapy; I’ve been on the receiving end of quite a lot of therapy too. I’ve also spent much of my life trying to help health professionals communicate more effectively with people who are distressed.

From all of this I’ve learned a few lessons:

Asking endless questions about symptoms is not the way to connect with someone.

Being a good listener is essential but not sufficient. You have to show that you are listening, and this means saying or doing things helpful things during the conversation. Not too much, and not too little. You have to be able to pick up on important cues, which may be verbal or visual, and comment on them. These important cues are the ones redolent of emotion.

You cannot fake empathy. If you don’t feel it, don’t pretend.

You have to be ready to hear awful stories about the suffering that people have endured. If you are not ready to do that then you shouldn’t be in a position where a person may need to confide in you.

You need someone to talk to about what you hear. Supervision is essential and many people in the caring professions simply don’t get adequate opportunity to make sense of their experiences with patients and service users with the end result that they emotionally close down and become insensitive to the pain of others.

You don’t have to be trained in psychological therapy to be able to connect with a person, but psychological therapies are useless when no emotional connection is made. Some people who have been trained are still hopeless at connecting.

Having your own experience of emotional distress isn’t enough. It might help you to understand what it feels like, but that won’t necessarily be what this person feels like and your work is to connect with them, not make them connect with you.

Without a connection you won’t feel able to talk about how you feel, develop trust and share your worries. I know this because the professionals who helped me most wanted to find out who I was and made the effort to connect with me. I will never forget them, or those of my patients with whom I was fortunate enough to forge similar bonds.

6 thoughts on “Making a connection”

  1. Some years ago, I was teaching in Uganda. I met a trainee who impressed me with her empathic sensitivity, and we spent time talking together about the importance of personal engagement in our treatment of our patients. I met her again a couple of years later. Her workplace had changed from the equivalent of general hospital psychiatry to an old-fashioned asylum. On her wards, patients were seriously incapacitated with parkinsonian and dyskinetic adverse effects from the first-generation antipsychotics they received, and were nursed with little, if any regard for their personhood or individuality. Despite showing the same qualities of warmth and empathy as when I first met her, these did not extend to the patients on those wards. When I attempted to explore this, she made clear that economic and systemic issues made the beliefs and aspirations for care she continued to hold inapplicable to her workplace. Ever since Zimbardo, we have known that appropriate empathic engagement with people dependent upon us is moderated by the environment in which we engage with them, but we continue, in our training, to speak of this engagement as if it were not more than appropriate application of therapeutic effort to a receptive patient/client. It might be interesting to look at different workplace and service delivery designs, so see which best promoted these vital connections, within a context of effective service delivery. The Staffordshire Inquiry (see paras 77 and 78 in the executive summary) points out just how dangerous it can be human connections are lost.

  2. Fractured speech (no forget), scrap it
    rereading: self erasure of own (true) views. Imagine hostility and rows at home all the time. Mary wants to be nurtured but this requires her to jettison her own independent views and welfare and has to resort to deliberate self injury partly as a way of acquiring relief; partly as an attempt to implore her caregivers to behave differently towards her and moderate their behaviour. My guesses, could be all wrong though. Do you need a psychology degree or just be sensitive and empathic? What would worry me though is what behaviour Mary receives at home. Caregivers/parents can be very powerful people, flying into rages that would terrify 90 per cent of people. Expecting Mary to cope by teaching her skills would be a big mistake, but one commonly made by complacent therapists. In supporting Mary to be ‘assertive’ you assume that caregivers can be modified. Unlikely…may end up getting her hurt even more…but more than being completely abandoned?……
    Nice post, reminds me of my teenage years!

  3. Linda I’ve got to say this blog is both wonderful and powerful. I especially like this entry, it speaks great truth.
    I am glad to hear things are improving for you. I look forward to reading your future posts. Chloe xx

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