INTRODUCTION

by Jacquelyn Small, LMSW

From the beginning of the ‘60’s through the early ‘80’s, countless research and journal articles appeared in the field of counseling and psychotherapy indicating that regardless of your role in life — be it therapist, physician, other health provider, parent, or boss — there are 10 personality variables that determine high effectiveness as a therapeutic person in the life of another. These 10 personality traits correlate with helping as opposed to harming another person regardless of one’s theoretical orientation, or the extent of your helper relationship.

In professional health care, these personal traits have been found to correlate with a wide variety of criteria of patient improvement, including psychological tests, time out of hospitals or institutions, clients’ or patients’ self reports, and therapist or supervisor ratings.

These 10 personality variables hold constant regardless of the diagnostic nature of your patient’s problem. They have been tested with all sorts of people suffering from physical, emotional, or mental illness. (1) Those who habitually remember to use these traits in their conversations with others are considered “naturally therapeutic.” And the professionals who measured high in these 10 traits were found to be “high functioning” and highly sought after as therapists, doctors, mentors, and guides. Even independently, people will list these characteristics in some form when describing the type of person they would seek out when they need help.

Emerging now from this lengthy body of research, these natural “people helper” characteristics can serve as a useful guide for physicians as they start to look at themselves as therapeutic agents in the life of those they serve. They can be rapidly acquired or enhanced simply by giving them attention and practice.

Medical providers in today’s world are more aware than ever that their style of relating to their patients and clients is even more vital than usual. For today, there is another body of research that correlates with these findings, specifically targeting the medical professions. (2) In a research study by Dr. Howard Beckman, from Rochester Independent Practice Association* reported in the New York Times, June 1, 2004, primarily only those doctors who are perceived by the patient as being arrogant, non-caring, in a hurry, or rude are hit with lawsuits when something goes wrong in their treatment of a patient. This article summarized some of these findings, with many interesting insights, such as: A psychologist at Harvard University compared the mannerisms of surgeons who had been sued multiple times with those who had never been sued and found that those with more warmth in their voices, rather than speaking with a dominant tone, were the ones never sued. (3) Something even as simple as your tone of voice can make the difference in your doctor/patient relationships! The references from the popular press illustrate that these concerns are of common interest and knowledge to patients. Many practicing physicians are also paying attention.

Every physician makes mistakes, some bad enough to be considered of negligence or improper diagnostics. Unfortunately, some of this just naturally “goes with the territory” when required to be an expert on someone else’s disease or critical trauma process. And, in fact, it’s just human to be imperfect at anything we do. However, it has been found that patients don’t file lawsuits based on the one and only criteria of medical mistakes. Most patients who suffer from serious medical errors acknowledged the mistake, but don't sue. However, those who do litigate file lawsuits because they felt rushed, ignored, or not treated like a human being by their provider who they often refer to as arrogant or cold.

Often, when more than one doctor is found to be at fault concerning a negative medical outcome, the patients don’t want to sue the doctor they liked, but attempt to punish the one who was considered rude and uninterested in them. It’s been found that doctors who have a caring and compassionate relationship with their patients, who actually spend 18.3 minutes versus 15 minutes with each patient during office visits, virtually never get sued! (4)

Correlating with these insights, there was an article in the Austin American-Statesman, Austin, in November, 2005, entitled “In patient care, empathy is the RX for ill manners, doctors learn,” by New York Times journalist, Gina Kolata, which speaks for itself. (5) Lawsuits are indeed prompted by emotional issues where the litigator is feeling betrayed or seriously harmed. And for this reason, the human side of medicine has become a major theme in today’s medical journals and conventions. And it’s no wonder, really, when we remember that it’s humans that we serve!

I believe we all know that when we’re in a life crisis of any kind, being in the presence of someone who is empathic, who listens and really cares, we feel better afterward. And even perhaps our health improves. As a long-time psychotherapist and teacher of therapeutic processes, I’ve found this to be consistently the truth, sometimes almost to a miraculous degree. As Dr. Candace Pert’s research concerning the biochemical links between consciousness, mind and body, indicates so poignantly, there is no way we can separate emotional well-being from physical health: they go hand-in-hand to bring us health or illness. (6) The mind/body medicine field is replete today with facts proving that our emotional life feeds our physical health to a dramatic degree, noted especially in cancer and heart attack survivors.

So if you are a physician or other medical provider reading this book, you may be hoping to improve your relationships with your patients. And if so, you will benefit very quickly from a thorough examination and understanding of these traits-in-action. And the good news is: You already have these natural human qualities built within your psyche, so you don’t have to go out seeking them in long hours of study and training. With only a few hours of focus, and a willingness to practice with your patients, you can learn to bring forth that which is already within you in a highly therapeutic manner. And you can do this, not in some awkward or uncomfortable “pretend” manner, but by still just naturally being yourself.

I know how valuable every minute of your time is. In today’s medical morass of managed care, where you are needing to increase the numbers of patients you see each day to bill for insurance, it’s crucial that you learn to improve your bedside manner to its ultimate capability — and as quickly and easily as possible, not only for your patients’ well-being, but also to ease your mind from lawsuit threats.

This little book is not a simple recipe book for knowing about these traits. It’s a “knowing in your bones” reminder of what naturally helps rather than hinders others in our verbal exchanges with them. Anyone can memorize by rote a given set of techniques, but the key to any therapeutic relating lies in the mystery of the therapeutic relationship itself. Somewhere within the physician and one’s patient something unites and creates a sense of deep compassion and desire to truly be there for another, resulting in the patient feeling “heard.”

The renowned family therapist, Dr. Nathan Ackerman, claims that, like medicine itself, therapeutic relating is not a skill, but an art — that being a therapeutic helper is a way of being rather than a set of learned techniques. The question then becomes: Can something as artistic, powerful, mysterious, and creative as “therapeutic relating” be taught as skill development? Or are some of us just born with this ability while others are not? If being therapeutic is dependent upon such ill-defined phrases as “a total way of being,” what on earth can we attempt to teach?

In looking over these naturally therapeutic characteristics that have emerged from the much less mystical world of empirical research, we can see quickly that these qualities break down into three categories of relating: five are supportive traits, three are challenging, and two are “total way of being” qualities.

If you feel weak in any of the supportive or challenging traits, reading this book and then practicing the ones you’re less comfortable with will bring them forth more naturally. However, the two most powerful and advanced “total way of being” traits, Potency and Self-actualization, are qualities of your selfhood that must be cultivated through your own healing and personal work on yourself, and might require a total transformation of your familiar way of relating.

Based on my 33 years of training counselors and other health professionals and Dr. Jim's 30 years of medical practice, including 6 years as an assistant professor in a medical school, here’s our answer: Just as an acorn has the one and only innate potential to become an oak tree, just by naturally being ourselves, we all have the inherent ability to be compassionate, creative and authentic in our unique expression. We simply have to remove the blocks in attitude, caused by our own unhealed issues that may be keeping us from being fully ourselves. While some have farther to go, all of us can markedly improve.

When practiced in your relationships with your patients day in and day out, gradually learning when to bring forth each of these therapeutic traits, you will change and grow along with those you serve. And everyone in your intimate life will notice these changes with admiration — and frankly, often with much relief! You probably don’t realize that as physicians, you may have been humorously referred to for years as an “M.Diety” behind your back. Or you will hear the joke: Do you know the difference between God and a doctor? And the answer is, God knows he’s not a doctor.

We do so often blame doctors for being arrogant “know-it-alls.” And yet, isn’t it true that we want our doctors to know everything there is to know about our particular disease and how to cure it? We certainly don’t want to hear “I’m sorry, I just don’t know anything about this” and then be charged $90 for the 15-minute office visit! So I believe we all need to become more compassionate with one another — doctors and patients alike — and honor the medical profession for its undying commitment to our critical life and death issues.

We must all realize that physicians are trained to dis-identify as much as possible with human suffering, to remain objective and keep their hearts defended when dealing with the grief surrounding the seriously ill and dying. The fear is they might become too emotionally overwhelmed to be effective at times when it’s crucial that they be so. However, avoiding the human tendency to paralysis or overreaction to pain has its price when overdone. In fact, the research underlying this material shows quite dramatically that in many of the helping professions — and certainly evident in the medical world — we have had trained out of us our most natural therapeutic skills. One study even revealed that the higher the academic degree, the less therapeutic the helper was. (7) The paradoxical result is that the most therapeutic person in one’s life sometimes turns out to be one’s hairdresser or bartender! Western medicine has made great scientific advances since Hippocrates rejected the mystical origin of disease. Some have carried empiricism too far. So, as a profession, we are now moving from biomedicine to a biopsychosocial model, hoping to become more holistic in our approach.

Dr. Jim notes the high price physicians pay for the drive that allows them to complete an extra decade of schooling and then to work day and night, often without real patient gratitude and recently with decreasing compensation. The denial system that lets physicians do this, he says, results in excessive rates of divorce, suicide, and addiction, suggesting that their self-awareness is not always fully developed. When teaching at the medical school, he participated in one survey that found that at least 40% of the medical students came from troubled, usually alcoholic families, which seemed to have induced self denial and self deception as well as high compensating energy.

As a physician, you know that nearly everyday you are required to be present and totally alert right when a patient or family member is undergoing the most serious, life-threatening issues they may ever face — where fear, grief, broken hearts, disappointment, rage, and bitterness climb to their ultimate feeling states. So naturally, you’ve had to learn to sometimes close your heart in order to maintain objectivity and technical competence. Yet, it’s clearly no wonder that lawsuits are the result when someone has felt ignored, talked down to, or downright insulted by a doctor with a superior attitude. You are the one — and sometimes the only one — who can offer real hope, compassion, and a sense of inner strength for the one sitting on your examining table, or for the family member hearing the devastating news.

It’s time now to bring this simple, clear, and potent knowledge to you, to assist you in your vital work of healing and saving lives, in the least amount of your valuable time possible. In this short handbook, we will quickly define each personality characteristic, and give you examples of how each one sounds in vivo with a patient. We will also offer examples of what I term “toxic relating,” which is the absence of these traits in action. Then, in a brief discussion of each, you can determine for yourself which of these traits you might lack, or fail to use, or those you already naturally use. This is a self-diagnostic, easy way for you to grow and evolve in your profession.