Meeting the Moment

Meeting the Moment

The Importance of Risk in Therapy

By Daniela Gitlin

July/August 2020

When people find out I’m a psychiatrist, they often react in these ways:

One (while leaning back and holding up crossed index fingers): “Don’t analyze me!” To which I smile and say, “Relax. I’m off duty.”

Two (with a shudder): “I couldn’t listen to all that misery, day after day. How can you stand it?” Are you kidding? It’s real and compelling, and I can’t believe my good fortune to do this work.

Three (with furrowed brow): “What is it you actually do? You’re just sitting there.” I’m listening and thinking about what I’m hearing. I’m problem-solving.

What people don’t realize is how unpredictable the work can be. If the patient and I are two circles, where we overlap—the relationship—is a zone of unpredictability. This is where therapy work is done. This is where chance is either my enemy or my friend, depending on my attitude. No amount of practice will ever make perfect. No amount of planning fully protects against the chaos that’s intrinsic to as complex an organism as the treatment relationship.

What kind of person voluntarily takes on the challenge? No one, least of all me, would have predicted I’d go to medical school and become a shrink. As a physician therapist, carrying life-and-death responsibility heightened my fear of making a mistake. What if—I missed something?…

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