Friday, July 29, 2005

The Small Things

I have a patient with schizophrenia who I take out to lunch about once a month. Seeing as it was his birthday recently and he verbalized a desire for Chinese food, I took him somewhere different for a special treat.

Sitting for the first time with him in a real restaurant---not just a pizza place or delicatessen---I was struck by the normalcy of what we were doing. Here we were, two people talking about our families, making comments about the weather, the food, the Red Sox, passing the soy sauce, pouring tea. Given his somewhat different way of relating to the world (schizophrenia being essentially a personality and thought disorder), this gentleman's conversational skills can be somewhat lacking in the strict sense of social decorum and "normalcy", and his personal brand of logic can sometimes be challenging to follow. That said, our time together was lovely, relatively comfortable, and very satisfying for us both on several different levels.

During the course of the meal, he looked me squarely in the eye and said, "Y'know, I appreciate this more than you could ever imagine. I look forward to our outings (his word) so much, and it's such a breath of fresh air to go out and do this." He added later, "I wish there was a way I could repay you." I responded that he could repay me by taking the best care of himself that he possibly could. We shook hands heartily and he got out of the car.

This interaction reaffirmed for me the therapeutic value of this monthly tradition, as unconventional as it seems. I don't do this with any other patients, although I have been out for coffee with a few here and there. There's a technique in psychological treatment called "therapeutic use of self" which refers to the professional individual disclosing personal information in a nonmanipulative way in order to normalize the patient's experience, perhaps helping the client to see that the clinician can empathize based upon actual personal experience. I've practiced this technique by disclosing the fact that I take antidepressants, for instance, or that, yes, my cholesterol is also high and my reflux is out of control when I forget to take my medication. When convincing a patient to use a weekly pill-box, I'll often comment that I could never remember my meds without using one (a very true statement, indeed).

While I can't afford to pay out of pocket to take all of my patients to lunch every month, the value of my decision to do this regularly with this particular individual is worth much more than the actual cash value of said expense. It has become something that I simply plan on, and today exemplified for me the fact that the benefit is both therapeutically measurable and personally meaningful. The interpersonal connection and trust that's been created in this "clinical" relationship is something that I can see is a valuable tool in the therapeutic kit which I employ with this gentleman.

Today I acknowledge that it is often the small things that pay the largest, most meaningful dividends.

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