Heart Speaking to Heart: the Psycho-spiritual Formation of Compassionate Attention and its Destruction (Precis)
Kathryn Mead
This paper began with an account of a medical student’s ward experience and an examination of what that could teach us about the complexities and systemic vulnerabilities of delivering compassionate care in healthcare settings. A key factor is the clinician’s capacity to stay in touch with their imaginative ability to identify with their patient. This in turn needs environmental support, so workloads, time pressures and the psychological acuity of fellow practitioners all influence environment for better or worse. Ethical complexities in the work mean that there are differing and sometimes conflicting aspects to compassionate care. What militates against the fostering of compassion is lack of time and overwhelming work pressures; clinicians feel guilty even taking out time to reflect on what might be happening, and there is often a reluctance to challenge hierarchies.Perhaps the single most important factor is a clinician’s own psychological self-awareness: losing contact with this can lead to a denial that becomes systemic and at worst is the prelude to abuse of staff and patients alike. It is nothing less than tragic that some doctors, exhausted from overwork and a growing sense of helplessness, abandon early aspirations and dreams about medical practice and resign themselves to perfunctory work; they often become vulnerable to depression.
The paper then turned to an examination of safeguards that are in place in counselling practice that foster the clinician’s ability to respond compassionately to patients. These safeguards consist primarily in recognized boundaries that are established in the interest of both therapist and client. In contrast to medical and particularly hospital practice, the importance of consistency and stability are recognised: client and therapist meet at the same time and for the same allotted length of time each week, and there is a generous allocation of time that allows for the development of relationship, exploration and exposition. The client’s need to have certain dependency needs met by the clinician is acknowledged and valued. Time is taken to gain understanding and not rush to a premature determination of what the client might be trying to express and the subtle business of allowing the client to shape their own healing and come in time to an authentic sense of what is meaningful to them is enabled. This was illustrated by an account of Donald Winnicott’s ‘Squiggle Game’ and the paper then turned to a brief description of early psychological needs and how whether they are met shapes our ability to hold both ourselves and others compassionately.
Compassionate sensibilities are maintained or destroyed by many factors and how they interact with each other. There is evidence that some genes play a role in our capacity for empathy, but what matters is how that genetic inheritance is played out in environments. Devoted and emotionally sensitive care in infancy is the environment that most enables us to develop compassionate feelings although even here, this is not the whole story– there are some psychopaths who have had competent parents. Simon Baron-Cohen’s work in developing a scale of empathetic capacity was referenced. If a loving parent hands us the ability to understand ourselves and to look compassionately upon ourselves in childhood, they have given us an infinite resource to hand on to others, and this foundational security can be powerfully re-enforced later in life by compassionate spiritual and religious beliefs. Our ability to maintain compassionate feelings, however, can equally be undermined by environments later in life that at best do not foster, and at worst, actively destroy our need for security and care, leading to feelings of powerlessness, frustration, anger and despair – and, defensively – indifference and even cruelty to those who are most vulnerable.