The Importance of Empathy in a Physician's Life

Mariusz and his wife, Aleksandra, who is also a psychiatrist. Personal Work with Mariusz, Part 2

Mariusz and his wondaful family. Last week, you heard Part 1 of the personal work that Rhonda and I did with Dr. Mariusz Wirga, which included initial T = Testing and E = Empathy. Today, you'll hear the conclusion of our work, including the Assessment of Resistance, Methods, final Testing and follow-up. I am repeating this darling photo Mariusz's beloved cat, with his tail strait up, showing pride and love for Mariusz! Orangina at her favorite scratching post, with tail straight in the air to show pride and love for Mariusz!  A = Assessment of Resistance Once we empathized, we issued a Straightforward Invitation, asking Mariusz if he needed more time to talk and have us listen, or was ready to focus on the problem and see what we might do to help. Mariusz wanted to get to work, and said his goal for the session was to reduce his perfectionism, but when I asked the Magic Button question, he said he would not press it, even if the Magic Button would bring about a sudden and dramatic elimination of all of his negative thoughts and feelings. So, together, we listed the many positives and advantages of his negative thoughts and feelings, including:

• My anxiety keeps me on my toes.
• My feelings of inadequacy keep me humble.
• My hopelessness protects me from disappointment in the session with Rhonda and David isn’t effective.
• My hopelessness and loneliness show how much I care.
• My hopelessness shows how helpless I feel to free myself from the many pressures and heavy weights I have been carrying for many years.
• My negative thoughts and feelings show how much I care for others, including my wife and kids.
• My suffering with depression and anxiety increases my compassion and understanding of my patients who are suffering and frightened.
• My anxiety protects me from danger.
• My anxiety is motivating.
• My self-criticisms show that I have high standards.
• My loneliness shows that I welcome intimacy and close relationships.
• My sadness shows that I am realistic and willing to look at the dark side of life.

As you likely know, this process is called Positive Reframing, which is looking at the positive side of things that appear to be negative. Effective Positive Reframing isn’t just listing positives from a list or book, like Feeling Great,  It’s suddenly “seeing” something that you hadn’t previously realized, and having an “ah-ha” moment. So, I asked Mariusz if he could see any additional positives in his fairly intense feelings of sadness and depression. To help him, I primed the pump a little bit by pointing out that sadness and depression are the feelings you have when you’ve lost something or someone your really cared about, or when you notice that something incredibly important is missing from you life. At this point, Mariusz became tearful and said he’d been very lonely as a child. Saying this gave him a “choking pain.” But he said he always turned away from his pain, and distracted himself, with work and activities. He said “I was an obedient child, and I was an only child. Both of my parents worked. “You say something is missing. I think what is missing is life I’m too busy. I’m always distracting myself. But I’m afraid that if I slow down, I won’t be able to pay my bills. I believe that 95%. Then I’ll be a burden. I’ll lose the respect of my family.” At the end of the Positive Reframing, he set his goals for the session, which you can see if you click on his Daily Mood Log again. As you can see, he did not seem to want to reduce his feelings to super low levels, which was surprising to me. M = Methods Rhonda suggested we could do a Feared Fantasy and asked what he thoughts others would think about him, but never dare to say, if he did slow down and they judged him. They’d think:

• You’re unreliable.
• We won’t include you anymore.
• We hate you.
• We reject you.
• We’ll tell the world about you.

And his worst core fear was ending up in a homeless camp. We did role reversals using the Feared Fantasy Technique until he hit the ball out of the park, and did the same using the Externalization of Voices to defeat the negative thoughts on his Daily Mood Log. When you listen to the session, you’ll see that there was a lot of tenderness at this point, and we discussed our love for cats, and what we can learn from them—the joys of being average and loved and loving your life. We gave Mariusz several homework assignments:

• Finish your Daily Mood Log in writing, completing the Positive Thoughts and make sure you’ve crushed all of you negative thoughts.
• Experiment with being open and vulnerable with loved ones (wife and family) as well as colleagues.
• Practice saying no to colleagues who make requests on your time, and cut down on activities that are not cost-effective.

T = End of Session Testing You can find Mariusz final Daily Mood Log if you click HERE, and his end of Session Brief Mood Survey if you click HERE, and his Patient’s Report of Therapy Session if you click HERE. David, add three links when you get documents. Rhonda and I wish to thank you, Mariusz, for a brave and touching session! You gave me the chance to process some of my own perfectionism, and to express my gratitude once again for the stray cats that my wife and I have adopted who have taught me so much about love, acceptance, and the simple things in life! Follow-Up I emailed Mariusz to find out what happened when he decided to become more open and vulnerable with wife, patients, and colleagues. He wrote back: Right before the Eureka moment, there is this state of dense confusion. So I was hesitant about where to go, but there was no visible path to choose yet. It feels like your brain is not getting it. It feels dense, also in an intellectual way. Like your brain stops working. It is quite dark and heavy. And then suddenly, the tears come and things become clear and light (in the sense of brightness and lifted weight). And that you all for listening today! Last month, January, was our biggest month so far, with more than 182 thousand downloads of Feeling Good Podcasts, and this is due, in large part, to your support of our efforts and sharing the show with friends and colleagues who might benefit from it! Thanks again, Mariusz! You are shooting into orbit! I'm SO proud of you and happy for you, and grateful to have had the chance to get to know you on a deeper and more human level, and to share a little of myself with you, too! Several days later, he sent me three addition al Negative Thoughts for his Daily Mood Log. They are touching, take a look at how he challenged and smashed them! Warmly, Rhonda, Mariusz, and David