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

Finding Balance

"Wheat Field with Cypresses," Vincent van Gogh, 1889. Metropolitan Museum of Art.


Small gestures while supporting patients through trauma and grief can make a big difference.

Beyond Freudian origins

During psychiatry residency, I was trained to not disclose personal information to patients to maintain boundaries and manage transference and countertransference. With time and experience, I have recognized that these emotions are not always negative and have evolved beyond their Freudian origins. I worked very hard to maintain strict boundaries during my residency training and this continued when I became an attending.


Supporting pregnant and postpartum women

While beginning my work with pregnant and postpartum women, I found discomfort in maintaining strict boundaries. I worried that I appeared detached. Cold. Unfeeling. It is reasonable to not disclose personal information to a patient with psychosis or certain personality disorders. However, many patients who see psychiatrists are not unstable, are high-functioning, and would not use the information inappropriately.


Helping new mothers feel safe

One of the obstacles to diagnosis and treatment of perinatal mood and anxiety disorders is fear of being judged. When a mother has the courage to come see me, she needs to know she is in a safe space. When she feels she is the only mother who can’t sleep when her baby sleeps, finds breastfeeding difficult, or even sometimes wants to run away, the mother needs to know she won’t be criticized.


Thankfully, I did not experience postpartum depression, but I remember my struggles with the “baby blues” and the challenges that came with being a new mother while being a psychiatry resident. Although I might not share the exact experience of the mother sitting in front of me, there is a sigh of relief for her to know I am also a mother and I am aware that motherhood is not always sunshine and rainbows.


Acknowledging grief and trauma 

Other patient encounters that compelled me to let my guard down include those involving trauma and grief. When my patient with a severe trauma history finally felt comfortable enough with me to recount the details of her horrific abuse, I teared up. I acknowledged my teary eyes to my patient. I expressed sorrow for what she had been through and admiration that she was able to recount something so painful that it impacts those just listening to it, not living it. Another patient lost her her child tragically and violently and sobbed in my office. I moved to a chair closer to her and simply put my hand on her shoulder while her tears flowed.


These small gestures bring trust, honesty, and reassurance of being heard and understood. I have never had these small interactions negatively impact the physician-patient relationship. I am not suggesting that we should disclose everything to all patients or always show the same emotion and vulnerability they do. I am aware that they need to see us as strong, calm, competent and can tolerate their emotions.  But sometimes, we must remember that we’re human.