You may still be answering pages, writing notes, and reassuring families. You may even be performing well. Competence can hide a great deal from the people around you and from you.
Medicine asks people to make consequential decisions while tired and move quickly after loss. You are expected to absorb other people’s fear without becoming defensive and remain teachable inside a hierarchy that is always evaluating you. Then the distress produced by these conditions can be handed back to you as an individual failure of resilience.
I work with physicians at different stages of practice, including residents and fellows trying to get through training without losing themselves inside it. I am not a physician. I have spent years teaching, supervising, and working alongside physicians in academic medical settings. I know something about what the system asks of the people within it, and I will still need to learn what it has been like for you.
Competence can become a hiding place
The qualities that help someone survive medical training can include intellectual discipline, self-sufficiency, and an extraordinary ability to compartmentalize. Psychodynamic therapy calls some of these capacities defenses. I do not use that word as an insult. It describes the ways a mind protects itself from an experience that feels impossible to hold all at once.
You may have needed to compartmentalize. I would want to know whether you can still choose when to do it, or whether the wall now comes up automatically with your partner, your children, or your own body. Being able to function is important. It can also make the rest of you very hard to find.
Therapy can give us time for the feelings that efficiency has postponed. A patient dies and the next patient is already waiting. An impossible workload makes you angry, then ashamed of the anger. You fear making a mistake and hate how exposed it feels not to know. These experiences do not become less powerful because you can formulate them elegantly.
The system comes into the room
Medical hierarchy will follow us into the room. You may wonder whether I am another person assessing you, whether honesty will have professional consequences, or whether I will offer a generic wellness solution to a structural problem. Residents and fellows are especially accustomed to relationships in which support and evaluation come from the same person.
Psychodynamic therapy gives us a way to talk about those expectations. Your experiences with authority, care, and evaluation will shape what you anticipate from me. Some of those expectations were learned accurately. I would rather we examine them than dismiss them as irrational.
I will explain confidentiality and its limits directly. You can ask what is documented, what stays private, and what would happen if I became concerned about safety. I want you to know what I am thinking instead of having to read my face as though it were another evaluation.
Care should not become another performance
Physicians can become very good therapy patients in the same way they became good trainees. You can arrive prepared, insightful, and determined to improve. Insight matters. It can also help you remain impressive while the messier experience stays at a safe distance.
I want to know what you feel when you are not busy proving that you understand it. You can be uncertain, competitive, frightened, or tired without immediately converting the feeling into a plan.
My style is active and transparent. I may ask a direct question or point out that an explanation makes perfect intellectual sense but does not seem to touch what you feel. You can tell me that I am wrong.
What I would want to understand
When did medicine begin to feel different from what you imagined? What happens inside you when you make a mistake or receive criticism? Who are you when you are not being useful? What has the work asked you to stop noticing?
I would also want to understand the relationships around the work. Does your partner feel shut out? Has training delayed parts of life you wanted? Do you feel guilty needing anything from people who already accommodate the demands of medicine?
People come to this work because of anxiety, depression, trauma, burnout, grief, or the effect medicine has had on their relationships. Sometimes the work is about getting through a punishing stage of training. Sometimes it is about deciding what you will no longer sacrifice to keep going.
Therapy cannot repair a healthcare system by changing the individual inside it. We can figure out what the system has done to you, what belongs to your own history, and where the two have become difficult to separate. That understanding may give you more choice about how you want to keep working and living.