Sample Chapter

Part II: Treatment

Chapter 4 
Cultivating Inner Development

“Human beings are not born once and for all on the day their mothers give birth to them, but … life obliges them over and over again to give birth to themselves.”
—Gabriel Garcia Marquez

To move past burnout, we must embark on a journey that has a different focus from what we learned in our training. The essential shift entails changing our focus from studying and healing others to studying and healing ourselves.
    In this chapter, we will begin to study psychological concepts that we can integrate into our awareness to help expand our personal deepening. We will seek psychological and spiritual principles that will permit us to extend ourselves to others in a more healthy and spiritual manner. As we do this, we will begin to rediscover the soul of the healing artist within. What we particularly need to look at is what suppresses and what nurtures that soul.

Spotting Patterns in Others

It is often easy for caregivers to recognize repetitive behaviors in patients: Maybe Mr. Smith has high cholesterol because he overeats, Mrs. Frederick has emphysema because she smokes, and Mr. Peters gets headaches because he works long hours at a computer and rarely sleeps. For a healer, the link between a patient’s behavior and his or her symptoms is frequently painfully obvious. If Mr. Smith, Mrs. Frederick, and Mr. Peters changed a few of their daily habits, their health and their lives would improve significantly. But our power to help them heal is limited by their ability or desire to follow medical advice and help heal themselves.
    The solutions may seem obvious, yet patients often cannot or do not make the necessary changes. With a little psychological spelunking, we might find that Mr. Smith overeats because his mother cooked lavish dinners and made snacks for him when he was a young boy with the hope of consoling him during his parents’ divorce. Food comforts him. Food feels like love. Maybe Mrs. Frederick found social acceptance when she started smoking with other teenagers. Smoking makes her feel confident and accepted. And Mr. Peters may overwork because of his distant father, who rarely showed him any attention except for acknowledging his good work in school. Work makes him feel like a lovable person.
    No one can simply walk away from their patterns because often they have deeply integrated them into their subconscious habits. Patients lack the awareness to recognize the control these habits have over them. While Mr. Smith may remember his mother’s cooking, he might not recognize why she cooked for him. Similarly, Mrs. Frederick and Mr. Peters most likely do not remember the specific events that led them to smoke and overwork. Their behavior patterns were developed so long ago that it’s difficult to remember how they acquired them in the first place. While these patterns are easy to spot in others, they are often less apparent in ourselves.

Repetition Compulsion

Sigmund Freud may be a bit past his prime, but his Theory of Repetition Compulsion is still relevant. Using the idea behind his theory, we will see how patterning from an early age can show up in our work lives. Freud felt that humans are subconsciously drawn to recreate situations based on the most defining and dramatic experiences in their childhood. He believed that we do this time and time again to learn how to heal these traumatic experiences.
    For example, when we find ourselves feeling as if someone is pushing our buttons, it is helpful to remember that, though someone pushed our buttons, they did not install those buttons. Instead, we may be reacting to a pattern set up in childhood. We can develop a better awareness of when this button was installed and a better understanding of the pattern instead of reacting reflexively to the person or situation that pushed it. To do this, we need to become aware of what is buried beneath our reactions, not just externalize the reaction by projecting blame on another.
    Freud’s Theory of Repetition Compulsion can be compared to a computer. Despite all that a computer is capable of doing, if it is stuck continuously printing the first page it was ever programmed to print, not much of its potential can be realized. When we confront a situation similar to the experiences that marked our minds as children, our minds will print the same page, in the form of rote behavioral patterns, over and over again. Deprogramming these patterns requires, first, an awareness of the problem. It is not as easy to see the complex psychological patterns that determine our behavior as it is to open a user’s manual for a computer and change the way it works. According to Freud, the mind will continue to print the same page until we learn to remember, repeat, and work through the experiences that trigger our behaviors.
    Often, these patterns limit our self-expression to a few well-worn reactions that keep us from exploring and revealing ourselves as a whole person. This recurrent superficiality can keep us in the shallow end of life’s pool, causing us to miss the opportunities to heal ourselves while we heal our patients. With some specific techniques, we can learn to recognize our unique behavior patterns and identify their source. Once these issues are uncovered, we can develop a healing awareness, an awareness that can be curative. We can become aware of our own psychological and emotional wounds and learn how they shape, define, and limit our interactions with others. And when we heal these wounds, we become better caregivers to our patients, ourselves, our co-workers, and our workplaces.

Workplace Interactions

The workplace is a wonderful place to confront our patterns and heal our wounds. In fact, our workplace interactions can be viewed as a form of social meditation, a form of contemplative practice with applications for healing both ourselves and our relationships. We do not want to overlook this opportunity.
    The following story illustrates one healthcare worker’s experience in confronting recurrent behavior patterns.

Relating in a New Way

Nurse Kathy was the consummate caregiver. In addition to her work as a Pediatric ICU nurse, she took foster children into her home. When a new teenage foster son, Ben, was placed with her, she moved him in, got him feeling comfortable, helped him get used to his new school, and hired tutors to help him with his schoolwork. Ben did better in school once he was in an environment where he could study. He made friends and seemed to enjoy his new home. But just as things settled into a peaceful routine, Ben started acting out. He got into trouble at school and started to turn minor situations into raging arguments at home. Kathy couldn’t understand why Ben was suddenly so hard to get along with.

Her caseworker reminded her that Ben had a severely alcoholic father and recommended that Kathy read some of the literature on children of alcoholics. She learned that because Ben was raised in an alcoholic home, he spent his youth unable to predict which days would be good and which would be awful. When his father came home, he never knew if he would get a hug or a slug. Kathy realized that on a deep, unconscious level, this was the connection Ben was familiar with. The feeling of peace Kathy provided was unfamiliar and out of his comfort zone.

Ben needed drama and chaos to feel connected. Ben only knew what he knew. His sense of comfort, his sense of connection, was based on conflict and that’s how he thought of love. Once Kathy realized this, it made sense that at first, when there was a lot of drama around a new home and new school, Ben was fine. But as soon as things got to where most people would feel comfortable, Ben couldn’t feel connected, or at least the type of connection he was used to. Once Kathy understood that Ben’s behavior was fairly stereotypic of a child of an alcoholic, this new awareness allowed her to help him learn to connect with people in a different way.

    On a similar note, a few years back, a researcher found that about 60 percent of ICU and emergency-room nurses identified themselves as adult children of alcoholics. Certainly many of these nurses, like Ben, bring unconscious dynamics to the workplace. We may be drawn into certain fields for various unconscious reasons. The chaos in the ICU and ER may be quite familiar and comfortable. One physician was overheard saying, “In our neonatal unit, the nurses are great when it is busy. They are so competent and thorough. But when it is slow, they nickel and dime the doctors for minor orders and sometimes even create drama between themselves or with the relatives of their patients.”
    But, as Nurse Kathy did with Ben, we need to occasionally ask: Is all the chaos experienced in these units intrinsic to the work setting? Or could some of that drama be created out of a need to feel connected?
    If so, perhaps these nurses are unconsciously drawn into a field like intensive care because of the satisfaction they get from working in a chaotic environment. In other words, maybe they need/create chaos to experience the feeling of belonging. Freud would say they are drawn into this energy to revisit patterns from their childhood.

Dr. Dan’s Drama

Dr. Dan was a busy obstetrician. He enjoyed his job and developed positive relationships with his co-workers and patients. However, his patients wondered why the delivery-room experience always was so chaotic; nurses running around, everyone yelling “PUSH” all the time. Several patients mentioned that their experiences in other deliveries weren’t like that. Dr. Dan was like a different person in the delivery room. One patient noted that by the time the baby was delivered, Dr. Dan and his nurses were more exhausted than the mother and often screaming louder than the baby.

At a physician’s workshop when discussing repetitive patterns, Dr. Dan had an epiphany. He said, “Now I get it. I grew up in a Jewish household with the stereotypical intrusive mother, the father that was never around, and three sisters that were classic Jewish-American princesses. We had unending drama in our home. A broken fingernail seemed to elicit the same response as a death in the family. Now I see that with all the female nurses running around the delivery room yelling, ‘PUSH,’ I feel perfectly at home with the drama.”

    Taking responsibility for the workplace dynamic places us in a unique and liberating position of power. Identifying the origin of the story and seeing how the past is brought into the present is similar to Freud’s insights about repetition compulsions. The dysfunctional workplace is reminiscent of the dysfunctional family in many ways. The workplace becomes a place of acting out the unresolved pieces of our personal histories.
    Dr. Dan realized that it wasn’t the delivery that required this drama. He said that once he started to think about it, the word “push,” never really needs to be used in a delivery room. He said it was probably quite obvious to a woman what to do. He wondered if he wasn’t really just fulfilling some need he, and his staff, might have from past patterns.
Rose’s story is another example.

Rose’s Reflection

One evening, Rose, an emergency room nurse, was floated from the emergency room to the medical floor. Accustomed to the demands and intense drama of the ER, Rose found herself checking her patients every half hour. She checked vital signs, adjusted pillows, and re-read charts. She spent the entire night bustling around. In the morning, one elderly patient noticed Rose in his room once more and asked,

“Nurse, am I really that sick?" Rose paused, looked at the patient and replied, “No, I am.”

    Rose needed to feel busy and involved in order to feel like she was fulfilling her role as a healer. When she could not feel the energy of the fast-paced emergency room, she recreated the dynamic by hovering around her patients all night. In turn, a patient sensed the energy that Rose exuded and became worried that his condition was much worse that it really was. Where did that type of functioning come from? Did the patient need this chaos, or did Rose?
    When Rose was a young girl, she had to give her diabetic mother insulin injections twice a day. Rose’s mother was quite irresponsible with her medical management and so, after several physician visits, Rose decided to take over checking her blood-sugar levels and giving her insulin. Rose felt needed because of her mother’s disease and because the doctors praised her when her mother’s blood-sugar levels stabilized due to Rose’s attentiveness.
    After years of working in the same hospital, on the same floor, or in the same office, co-workers know each other like family; often like dysfunctional families.
    Following is another example of how past energies can affect this workplace environment.

The Ties That Blind

Dr. Brown was raised in a strict military family. His father was a disciplinarian who demanded that the children follow rules and stay within tight boundaries. Most of Dr. Brown’s interactions with his father involved some form of discipline. Later, as a physician, Dr. Brown found himself frequently being disciplined at work for inappropriate interactions. After a particularly tense meeting with the directing physician and another series of reprimands, he found himself again asking, “Why are they always picking on me?” He felt like everyone at work was against him. That night, he began to think about all of the unpleasant meetings he had endured with his director.

Suddenly, a realization emerged from his self-pity. Dr. Brown discovered that his behavior followed a clear, repetitive pattern. Whenever he didn’t feel appreciated or acknowledged at work, he created a conflict that usually led to disciplinary action from his director. He realized he was unconsciously recreating the father/son dynamic of his childhood because strict boundaries and discipline gave him a familiar sense of belonging.

    Although Dr. Brown was not raised in an alcoholic home, his upbringing still made a powerful impact on his behavior. At first, Dr. Brown felt like his directing physician was intentionally pushing his buttons. He felt he was personally targeted by the director when, actually, Dr. Brown was investing his directing physician with qualities that turned him into a father/authority figure. This allowed him to continue playing an unconscious role that was familiar. Once he recognized this, he had the power to change his unconscious behavior patterns.

Revealing Patterns 

Let’s dig a little deeper by paying close attention to how we move, consciously or unconsciously, through our workdays. Because healthcare is a narrative field, the unhealed patterns that bind us are often revealed through the stories we tell. We create relationships with our co-workers and patients by telling stories. No one in healthcare needs to read romance novels or watch soap operas—it’s the material of our day. We even tell stories to ourselves as our own inner dialogue arranges and narrates the events of the workday.
    These stories can tell us a lot about who we are, what we value, and why we behave as we do. We may think that we are just talking, but often we are repeating ourselves ad nauseum because we are stuck in a psychological holding pattern. Our computer is endlessly printing the same page. We will keep telling the same tired story until we do the human homework necessary to release ourselves from the pattern.
    It is said that when creative and spiritual energies are unused, they are expressed in less constructive and more destructive ways. Interpersonal tension, gossip, and negative blaming patterns keep us from maximizing our full collective potential at the workplace.
    Finding our patterns and making them conscious builds our awareness muscle. This becomes challenging because when we unconsciously use drama, negativity, or neediness from our past to deal with people in the present, we are often left with the same depletion we experienced in childhood. As outlined in Freud’s theory, situations repeated themselves so that Rose and Dr. Brown could eventually rememberwhy they behaved the way they did.