Funder by the Department of Human Services Auspiced by Our Community

COMMUNICATION WITH CLINICIANS

Communicating with mental health professionals can be challenging. Here are 10 common challenges and some thoughts about making the situation work better for you.


1. Communication is bound to feel weird sometimes

Of course there may be communication difficulties - you are (probably) in their space, they are probing your mind, and they may have the power to lock you up involuntarily.

Many of us don't want to offend or "provoke" professionals, and negative emotions (including a "lack of gratitude" on our part) are too often pathologised.

Sometimes it is hard to get heard because what we have to say is too complex and/or too deep or we experience it as a feeling rather than a thought. Sometimes we self-censor because what we were just about to say seems too presumptuous, too stupid or too unimportant.

Many of us who have experienced childhood abuse and trauma can find it extremely difficult to talk about it and often we come out very slowly over a considerable amount of time. Honest, comfortable communication can be difficult under such circumstances.

Don't take all the responsibility for communication that feels weird. When you're not used to it, sitting in a space that belongs to another person who you do not know and who has the power to interpret your mind can be a challenging experience.


2. The communication is uneven and non-reciprocal

Few of us want to be always the takers and never the givers. Firstly, giving is a delight for many and secondly, giving is empowering.

But when we know the relationship has special rules (that we often aren't entirely clear about), we can be afraid to demonstrate everyday reciprocal kindness.

For some of us it's a good idea to be up front and simply ask for an explanation of the clinician's boundary rules. Perhaps this is at the cost of a little adult dignity but for some it is worth it.


3. "They know more"

It's easy to believe that a clinician's many years of training means that they know more than you do. However, the training of both psychiatrists and psychologists tends to lack input from those of us with personal experience. Also, their education tends to be elitist, hyper-competitive and narrow (excluding social context insights from sociology, history, politics and anthropology).

This doesn't mean that they have nothing to say, but they don't know everything!


4. "What should I call you?" Dealing with titles and names

This is a big issue for some and a non-issue for others. You can either avoid using anything until you figure out what to do, or you can just ask what title/name is preferred.

If you are uncomfortable with addressing someone as 'professor', for example, you can choose to make a game of it (if the relationship is worth it) and call her 'professor' to her face and use some good old nutcase humour behind her back.


5. Not understanding the terminology

For many of us, being with a clinician is a bit like being in a foreign country. This means that first we have to work out what people are talking about and then we have to decide whether it really does apply to us.

The language - 'psych. speak' or 'psychobabble', as some of us call it - can be seen as a sort of special mental health dialect that few people outside those narrow professional fields can speak. For example, what do we say when we are confronted by someone asking whether we're 'hearing voices'? What does this mean? If we don't have a base line - not much. If we get it wrong it can have huge consequences.

In a hospital situation, other patients are usually the best interpreters.


6. Projection, transference & counter-transference

Some therapists/clinicians will talk about psychological 'projection', which describes a defence mechanism in which 'we' and 'they' unconsciously give to each other the attributes in ourselves that we don't like.

However, our observations are that often the therapist/clinician is more likely to interpret projection from 'patients'/'clients' but far less likely to locate it in themselves. They are also unlikely to call it when they see it, leaving us totally in the dark.

'Transference' is another term clinicians use. Transference is characterised by unconscious redirection of feelings of one person to another. For instance, you might instinctively mistrust somebody who resembles an ex-spouse in manners, voice or external appearance; or you might be overly compliant to someone who resembles a much-loved childhood friend.

Like projection, we need to know about this concept because it is one of the understandings that drive some clinical practice.

'Counter-transference', meanwhile, as its name suggests, is where the therapist/clinician begins to transfer her or his own unconscious feelings to the 'patient'/'client'. For many of us this comes across as hardly surprising. The difference is that it is the responsibility of the therapist/clinician to be constantly aware of counter-transference because they are the paid professionals. We do not have this responsibility.


7. Power differential

No matter how 'nice' our therapist/clinician/counsellor is, the relationship involves unequal power. This is because of the unequal status of the social role of 'clinician' and the social role of a 'patient' or 'client'.

To some extent, at least, each player knows it is a game. But games create poor communication.

Keeping notes as our counsellor/clinician is talking, bringing in notes to guide us, showing we have read about our diagnosis, and asking about our medication without just accepting it are ways that some of us have tried (mostly unsuccessfully) to even up these relationships.

Other strategies include asking the clinician about his/her theoretical assumptions and approaches and even asking to swap seats with the clinician (literally - she sits in your chair, you sit in hers; it can feel weird but it does send a message that the clinician's authority should not be taken for granted).

However, be warned: some (hopefully a minority) of clinicians will perceive our assertiveness as unhealthy. Don't worry. It's probably got more to do with their loss of power or lack of experience than with anything we might or might not have said or done.


8. 'Pathologising' everything

Doctors and psychologists are trained to look through the binoculars of individual pathology. Therefore they are searching for signs of psycho-pathology as they listen and watch us. In a hospital setting, nurses and allied health professionals also get caught up in this way of seeing the world.

The unfortunate result of this is that communication between us all becomes wary as we try and second guess what we need to do and say in order to achieve what we need. Some of us fall silent for fear of what might be construed by what we say, but then we find words like 'passive aggressive' or 'personality disorder traits' may start appearing on our files.

Many people with a mental illness diagnosis describe how they learned to be a 'good patient' because being 'good' led to being treated better by the mental health system. However, these 'good' behaviours - trying to be silent, for example, or saying what you think the clinician wants to hear - are not necessarily in our best interests.

Judi Chamberlin famously wrote in Confessions from a non-compliant patient (2011): "I've been a good patient, and I've been a bad patient, and believe me, being a good patient helps to get you out of the hospital, but being a bad patient helps to get you back to real life."


9. Confidentiality

Confidentiality is important. Because of community prejudice it's important that we remain, as far as possible, in control of who knows what.

This is not as straightforward as it might appear because when services claim your information is confidential they often forget to tell you about the one major exception - everyone on this rather nebulous entity called, 'The Team' is privy to everything you say. Mostly we don't even get to know who is on this 'team'. Sometimes the definition of 'The Team' stretches to include nearly everyone who works in the medical field. Be careful when you divulge very personal information.

On the other side of the coin, clinicians sometimes use confidentiality as an excuse for poor communication with others (even if we have asked them formally in an Advance Directive to communicate with them about us). This is a special problem when we are in same-sex relationships or it is our friends (and not our family) who support us. Even if it feels weird, it's sometimes useful to use the term, 'primary carer' to describe these relationships because this is a term systems-focussed clinicians more readily respond to.


10. Superiority

Many clinicians are quick to tell you that they had to do many years of training before they qualified for their profession. This is true. But that doesn't mean their knowledge and experiences, particularly as they relate to us, are superior to ours.

Sometimes psychiatrists are critical of the training of psychologists because so much of it is "rats and stats" and psychologists are critical of the training of psychiatrists because, "it lacks theoretical underpinnings".

From our point of view, the essential points are rarely put forward by either group. They include: