Bearing Witness Is Our Greatest Offering

I woke up recently to ash raining down outside my home. Wind-whipped fires in the Napa/Sonoma wine country  sadly had destroyed so many homes, businesses, and farms overnight. Even 60 miles to the south, smoke choked the air of what would otherwise have been a golden fall day in San Francisco.

It seemed that disaster and peril reigned everywhere we turned in recent weeks. Hurricanes lined up in the Caribbean. Earthquakes in Mexico. Bullets raining down on concertgoers in Las Vegas. Threats of war on the Korean Peninsula.

If your practice is like mine, the anxiety that goes along with these events is affecting your patients. I’m seeing more anxiety on my couch, and it’s not just the  garden-variety Generalized Anxiety Disorder or panic that I am used to. What I am seeing in the microcosm of my patients’ psyches reflects a deep uneasiness in the macrocosm of the world.

While most people struggle with a certain measure of anxiety as part of their inheritance of being human, it is easier, as a clinician, to distance oneself from these microcosmic anxieties, or even to offer some wisdom, or cognitive behavioral therapy (CBT) techniques for managing the worry. Sometimes, these offerings are even helpful.

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However, it is these macrocosmic anxieties about the uncertain state of the world that are shared by my patients and me. For these worries, there are no easy platitudes. CBT offers little solace against the fears of a warming planet or a world that sometimes feels like it is coming apart at the seams.

It is in these moments that I am reminded that our greatest gift we bring to our patients as therapists is not fixing the troubles that are brought to us, but merely bearing witness to them. It is easy, in a time of brief therapy and outcome-driven health care, to want to bypass the most important thing we offer our patients—to allow them to be fully seen and witnessed. Once we are seen by another, and given the opportunity to fully express the inner experience of our worlds, we are more than halfway to making the changes we must make. Sometimes, those changes are external. But often, they reflect a quiet shift within us, an openness to changing what we can, a willingness to accept what we cannot, and, in the words of 12-step programs around the world, “the wisdom to know the difference.”

Andrew Penn was trained as an adult nurse practitioner and psychiatric clinical nurse specialist at the University of California, San Francisco. He is board certified as an adult nurse practitioner and psychiatric nurse practitioner by the American Nurses Credentialing Center. Currently, he serves as an Associate Clinical Professor at the University of California-San Francisco School of Nursing. Mr. Penn is a psychiatric nurse practitioner with Kaiser Permanente in Redwood City, California, where he provides psychopharmacological treatment for adult patients and specializes in the treatment of affective disorders and PTSD. He is a former board member of the American Psychiatric Nurses Association, California Chapter, and has presented nationally on improving medication adherence, emerging drugs of abuse, treatment-resistant depression, diagnosis and treatment of bipolar disorder, and the art and science of psychopharmacologic practice. 

The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors. Blog entries are not medical advice.