it’s nothing personal…

If there’s one thing all therapists universally strive for, it has to be rapport.  Rapport with patients, with doctors, with staff, and with other therapists.  After all, bickering our way through a day or a session doesn’t sound like much fun, does it? Sadly though, it happens.  We’ve all been there.

Last Friday one of my less manageable patients had a progress check with our doctor.  She’s 16, full of attitude, and as of our last session hates me, she hates Vision Therapy, and she hates our office. Full of anger, her parents divorced a few years ago. Her dad was an alcoholic whose love for the bottle was superseded only by his love for adulterous behavior.  As a 13 year old, she finally figured out what her dad was doing and what her mom had been sweeping under the rug for years, and her parents divorced.  She’s mad at her dad for cheating, and mad at her mom for pretending he wasn’t.  She’s been in and out of counseling, been in and out of illicit drug experiments, and has been all but arrested in her attempts to fight the system.  Vision Therapy has been but one small piece of her growth.  Whether it’s because I remind her of her dad, because I am in an authority role, or perhaps just because I am a male, I bring out her ill behaviors.  She doesn’t like what I have to say, she doesn’t like when I ask her to do things, she doesn’t even seem to like me.  Often when she’s been in I’ve thought to myself “if I even pretended to behave that way in a doctor’s office, my mom would have knocked me into next week!”  True story. We have battled our way through her first eight visits, me trying to motivate her, and her physically refusing to participate and calling me every name she can get away with. Progress checks are usually a step that I look forward to in a patient’s care.  Aside from measuring visual progress, they are also an opportunity for the doctor to brag on the patient’s gains, and the parents to share their thoughts with the doctor.  My nerves were frayed though as my teenage friend entered the exam room because I was pretty sure some serious “Robert bashing” was about to occur.  As my doctor emerged from the exam room 20 minutes later, and my teenage patient turned and said goodbye to me with a snide smirk on her face, I just smiled and waived. My doctor later pulled me aside to inform me this patient doesn’t like working with me – DUH!!! – and we were going to make a change.  She will be working with a female for the rest of her VT sessions.

Hearing your doctor say that a patient doesn’t like you – or doesn’t like working with you – can be a tough pill to swallow.  Did we do something wrong?  Are we pushing too hard?  Is it a personality conflict?  The key to this situation, for me anyway, is remembering that it is not personal.  The patients are on a journey of change, and their lashing out is not directed at us, although it can seem that way some days. Considering the level of vulnerability some patients feel, their journey requires comfort with their surroundings, including the people in them.  My presence is somehow disrupting or threatening that comfort, and if changing therapists will help to better achieve her goals, I am all for it.  After all, I take her concerns seriously, but not personally, knowing that sometimes the best thing we can do for our patients is to take a step back. They’re acting out at the situation or at their frustration, not at us.  We just happen to be standing there.

A change of scenery can be the best medicine.

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Posted on August 4, 2013, in From My Perspective.... Bookmark the permalink. 6 Comments.

  1. well written and so true!

    _____

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  2. Robert, I admire your honesty and courage in writing this article. Although difficult and hard on the ego, I have sometimes had to admit that I was not the best therapist for a particular patient (remember Chip C?). You are truly a role model for those of us in the profession.
    Sending a big hug,
    L.

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  3. Well done Robert – It truly wasn’t you – she just did not want to be there under any circustances! I’ve had this happen a couple of times and my approach was to sit down with the patient and ask them what they would like to do and it could be many things as long as they were related to vision. That usually brought about some really exotic answers and we tried 2 or 3. By that time is was obvious to the patient that these were not fun. So, I suggested a couple of things that I thought would be more “fun” and carefully chose tasks in which I knew she would succeed. After a good taste of success, we ended the session and she said, “O.K., do I come back day after tomorrow?????” From then on we had a good relationship even when the procedures became more demanding. I guess the answer is, every patient comes with different needs and fears and our job in part is to figure out the best way to meet the need and calm the fear. Have a great day.
    Diana

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    • Thanks, Diana. Your sound advice is always appreciated. I tried everything I could with this girl, but she hated me from Day 1. She is going through a tough stretch between home life, high school, and those awkward teenage years. As a male, it became doubtful there was anything I could do. I’m hopeful that the change of pace works out well for her. Hope to see you in Florida come October 🙂

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