April 20, 2013

It's Your Call

Mental health tip: Just call.

When you miss a deadline or make a mistake at work, it is better to call or email? If you can't make your friend's dinner party after all, or remembered your sister's birthday only the following day, is it better to call or text?

Often when we're handling a stressful or delicate situation, we opt to email or text instead of calling. We tell ourselves that we're saving time, but usually the decision is motivated by avoidance. That is, we're anxious about the annoyance, anger, or disappointment that our communication may generate, and try to decrease our anxiety by avoiding the recipient's real-time reaction.

Is this a good strategy? Consider this story that a friend told me recently

Last Friday, a colleague missed an important commitment at work--an obligatory weekly meeting that staff in her small office cannot miss without an exceptional reason. She had a good excuse to miss the meeting, but it was personal and she didn't want to discuss the details with our boss. Anxious about his reaction to her absence, she decided to email the day before to say that she would miss the meeting for personal reasons. 

This was the first point where a phone call would have been preferable. My colleague sent the email and waited to feel relief, but none came. Instead, she became more and more nervous as she imagined our boss's angry response. Three hours later, she received a brief reply saying of course she could miss the meeting--if she really felt she needed to. The tone of the email was ambiguous and she felt flustered and panicked. This was the second point when my colleague could have picked up the phone, but the desire to avoid facing our boss was too strong. She didn't call and instead treated herself to a weekend of lingering stress.

How would calling have helped in this situation? First, my colleague would have been able to explain herself clearly, assuaging her concerns about being perceived as a slacker or malingerer. Second, she would have been able to gauge our boss's reaction, which is difficult over email. Third, the issue would have been resolved in minutes. Instead, she fretted all weekend--only to learn on Monday that our boss had been entirely unconcerned!

The question of calling versus texting or emailing is not limited to work situations, but is equally relevant in the social realm. When we're running late or have to miss a social occasion altogether, or don't want to tell our partner that we forgot to pick up milk--again--we use text messages to avoid directly witnessing negative reactions.

Example: Earlier this week, I had to cancel plans with a friend for the second time in a row. I didn't want to face his hurt or irritation so rather than calling, I texted to say I couldn't get together that evening after all, but how about Friday instead? He responded quickly: "ok." I waited for a further text, but none came, leaving me feeling uneasy and uncertain. Was "ok" equivalent to "No prob, see you Friday! :)" or did it mean something closer to "WTF?! :(" Remembering my patient's story, I called my friend instead of texting back. It turned out that he was at work--which explained the brevity of his response--and had to work late and was happy to postpone our plans.

How did calling help in this situation? First, I had the chance to fully explain why I had to cancel plans again, preventing my friend from perceiving me as inconsiderate. Second, I was able to assess his reaction, which was impossible from his ambiguous text. Third, rather than fretting about it until Friday, the situation was resolved in minutes.

Text messaging and email are great tools when used appropriately, but problematic when used in the spirit of avoidance. The next time you notice yourself texting or emailing when you know you should call, remember that avoidance maintains anxiety, and ask yourself if you'd feel better if you made the call. Even if your feared outcome comes true--e.g., your sister is hurt about her birthday, or your partner is cranky about the milk--at least you know where you stand and can start making amends. 

April 05, 2013

Friday Post-Mortem

This week I saw an exceptional number of psychotherapy patients in five days, and I noticed a few things:

a) It took a lot of energy and, even though I enjoyed many of the sessions, I was noticeably drained by the end of the week.

b) I joked around in therapy more than usual and told more quasi-personal anecdotes.

c) My patients didn't necessarily like it.

I've been thinking about how the first two observations are related and I think I've cracked the code: Therapy takes a lot of energy because you have to be thoughtful and mindful and helpful and insightful, but an additional element that takes considerable energy--for me, at least--is not being totally myself. It's not that I'm a blank automaton with my patients, but in therapy, I don't make express opinions or preferences, make jokes, seek support, gossip, compliment, or reassure, and I rarely give advice. If a patient is telling an anecdote and I've experienced the exact same thing I don't say "Oh my God, me too!" If a patient is recounting a dilemma, I can't tell him what I'd do if I were in his shoes.

I think the extra jokes and quasi-personal anecdotes this week represent a kind of resistance to the additional hours of personality suppression. When a patient mentioned that the hospital security guard made a weird comment to him, I said "Yeah, he's done that to me too a few times, he's kind of an 'unusual' guy," rather than "What was that like for you?" When a patient reported that she didn't work out this week, I said "Yeah, it's not always easy to get to the gym after work, I've had weeks like that," rather than "What were some of your obstacles?" These responses weren't particularly out of line, but they weren't particularly helpful either. 

Finally, I think that this kind of over-sharing is confusing for the therapy relationship, and here's why: I'm particuarly likely to joke or to reveal glimpses of my personal life in session with patients who are similar to me--patients who have the same sense of humour or the same personal conflicts as me, who live in the same neighbourhood as me and have a similar lifestyle, or who share my cultural or academic background. But although I know that we have a lot in common, patients aren't aware of our similarities. So if I suddenly mention that I too am attending a Passover seder this year or that I too experience daily frustration with the ongoing construction at the subway station nearest both our homes, it comes out of the blue. It's also worth remembering that I've had therapists who shared personal details about themselves with me, and that I disliked it and preferred to maintain our one-way relationship. My own patients may not feel this way, but it's my responsibility to err on the side of reticence.

Reining in your own opinions and preferences and experiences isn't easy and explains why therapists can feel isolated despite interacting with people all day. For the therapist, psychotherapy doesn't meet the need for communication because it's not reciprocal. All the more reason to keep up my usual strategy of calling up a friend or family member for a brief chat when I have a break in my day, and why I like the idea of mixing private psychotherapy practice with other pursuits.