Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Speaking From my Heart


When deeply worried about the mental health of patients, make sure they feel heard, validated, and empowered.  

As I gain clinical experience over the years, I find myself reflecting more often on patient experiences. I spend time before sessions thinking about how I’ll approach a particular visit with both the patient and family. Sometimes the approach is the same and sometimes what resonates with a parent is not the same as for the teen. 


Recently I was preparing for a session with a teenager and parent. I’ve been providing psychiatric care for this teen for several years. This teen has made great strides and by the end of middle school, they excelled at academics and were a model student.  


For high school they switched to a different school environment and struggled. The therapist and I talked between sessions, and she had relayed newer unsafe behaviors the patient was engaging in. I’d thought about what I would suggest as a plan when we next met.  


I was very concerned about this recent change and worried they were at risk for considerable harm. I directly expressed my concern for their safety and well-being. I let them know that not only were their parents worried about these behaviors but so were their long-time therapist and myself. I also felt given the course my patient was on that we needed a treatment change. I knew the parent was equally concerned but wasn’t sure if the teen fully grasped the dangers or thought we were overreacting. 


I suspected the teen wouldn’t be keen on the change I proposed, though it had been helpful in the past. I empathized with the patient and acknowledged they may be disappointed with my suggestion. Then, I spoke from the heart expressing my hope that this change would enable them to graduate high school, a goal they wanted to achieve.   


To their credit the patient said that it wasn’t what they wanted to hear but agreed with the plan. In preparing ahead of time I planned to directly express my concern, empathize with the teenager’s feelings, and discuss the big picture plan I knew the patient had for themselves, which aligned with what their family also wanted.  


By recognizing the teen’s goals and how this change would help them, the patient felt validated and empowered. As healthcare professionals it’s helpful to remember that sometimes speaking from your heart can help in a difficult situation. 








This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.