Inpatient Child & Adolescent Psychiatry: Dr. Bender's Journey Through Curiosity and Connection
Sep 22, 2023
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In this podcast, Dr. Bender shares his journey in child and adolescent psychiatry. Topics include a narrative-driven approach, managing patient load, understanding adolescent patients, power struggles in children, connecting with patients and families, the role of temperament, and dealing with powerlessness.
A narrative-driven and curiosity-based approach is invaluable in inpatient child and adolescent psychiatry, allowing for a deep understanding of each patient's unique situation.
Engaging with families and spending time getting to know patients beyond their surface-level behaviors helps make sense of why a child is in crisis and fosters empathy.
Family dynamics and conflicts can significantly contribute to a child's crisis, and addressing them can create a more supportive and empathetic environment.
Understanding the multifaceted factors that shape a child's behavior, such as temperament, genetic predisposition, and social dynamics, leads to a comprehensive understanding and effective support.
Deep dives
Understanding the Inpatient Treatment Approach
Dr. Dan Bender, a child psychiatrist, discusses his unique approach to inpatient adolescent practice. Unlike the standard practice of focusing solely on assessment, diagnosis, and medication treatment, Dr. Bender takes a narrative-based approach. He aims to understand the crisis that led the patient to the hospital and build a realistic narrative by engaging with the patient and their family. This approach involves spending significant time with the patient and their family members, piecing together their experiences and building a formulation based on their individual narratives.
Engaging with Families and Building Empathy
Dr. Bender emphasizes the importance of engaging with families and spending time getting to know the patients beyond their surface level behaviors. By understanding their personal struggles, family dynamics, and major life events, he helps families make sense of why their child is in crisis. He works towards building empathy and challenging perspectives, both from the parents and the child. Dr. Bender believes that by addressing the underlying emotional experiences and forming a more holistic narrative, families can better understand and empathize with each other while addressing the crisis.
Addressing the Impact of Family Dynamics
In many cases, Dr. Bender identifies family dynamics and conflicts as significant factors contributing to a child's crisis. He highlights how custody battles, power struggles, unresolved trauma, or sudden fractures within the family can have a profound impact on a child's mental health. By addressing these family dynamics and helping parents understand their child's experience, Dr. Bender aims to create a more supportive and empathetic environment. He acknowledges the importance of working within the boundaries of his role and shines a light on underlying issues while respecting the complexity of family dynamics.
Navigating the Role of Temperament
Dr. Bender considers temperament as a factor in a child's mental health journey. While acknowledging the influence of temperament, he focuses on understanding the specific experiences, traumas, and dynamics that shape a child's behavior. Dr. Bender avoids simplifying complex issues by solely attributing them to temperament. He emphasizes the need to explore various factors, including genetic predisposition, early childhood experiences, and social dynamics. By examining the multifaceted nature of each child's situation, Dr. Bender aims to provide a comprehensive understanding and effective support.
Embracing Powerlessness and Focusing on Understanding
The speaker emphasizes the importance of embracing the sense of powerlessness in psychiatry and shifting the focus to understanding and empathizing with patients. Instead of trying to fix or save everyone, the speaker highlights the significance of building a human connection and helping patients feel understood. By conveying empathy and making patients and their families feel seen and heard, a sense of gratification and purpose can be achieved in providing effective care.
Shifting Diagnostic Approaches and Building Broader Perspectives
The podcast episode challenges traditional diagnostic approaches in psychiatry, particularly in cases of borderline personality disorder and bipolar disorder. Instead of providing rigid diagnoses, the speaker advocates for adopting a more nuanced perspective. They emphasize the importance of explaining temperament and patterns of development to help families better understand their children and avoid self-blame. By focusing on empowering parents to connect with their children and address human problems in a holistic manner, better outcomes and stronger therapeutic alliances can be achieved.
Finding Gratification in Inpatient Psychiatry
The speaker discusses their decision to pursue a career in inpatient psychiatry and the gratification they find in their work. They share the importance of embracing the powerlessness often experienced in the field and shifting the focus towards understanding patients on a human level. By forming deep connections and conveying empathy, the speaker aims to help families and patients feel supported and contained in times of crisis. They encourage mental health professionals to find their own path and choose settings that align with their unique skills and perspectives.
In the realm of Child and Adolescent Psychiatry, especially within an inpatient psychiatric setting, a narrative-driven and curiosity-based approach has proven invaluable. Each child who is admitted is navigating a crisis, making it imperative to deeply understand their unique situation to chart an effective treatment plan. This goes beyond clinical observations; it's about immersive engagement with both the patient and their family, diving into their lived experiences to piece together a holistic patient narrative. Through collective efforts, the capacity to deeply connect with and understand every patient and their families is enhanced.
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