Just the Right Response

Last week during a therapy session with a patient, I said something in response to a comment she had made. She looked startled and laughed when she recognized the applicability to her; I was startled and joined her in laughing. It seems I had said the exact right thing to her comment and had no idea I was going to say it. Then we went on to discuss the meat of the exchange. 

As I near the end of my 40+ years as an advanced practice psych nurse, I actually now have time to reflect on the dynamics behind the scene as it were. I was reminded of Patricia Benner who adopted the Dreyfus Model of skill acquisition and wrote the book, From Novice to Expert. 

In the model, which is a continuum, the novice and the advanced beginner have increasing levels of exposure to actual situations from which to generalize and require fewer and fewer supportive cues. However, they are still intensely aware of “the rules” and keep a mental file of them against which to measure new situations. 

The competent clinician, on the other hand, has had enough experience to approach situations more confidently with increasingly abstract, analytic responses but is still conscious and deliberate in new situations. 

The proficient clinician perceives situations as “wholes” rather than parts; decision-making has become less labored, and thinking about “the rules” drops out of conscious decision-making. 

Finally, the expert clinician seems to have an intuitive grasp of each situation and zeroes in on the relevant area of the problem without needing to mentally scroll through a range of solutions. However, there is no magic, since to get to this place the expert has gone through ALL the stages of clinical development.  

So, the response that surprised both the patient and me,  was the culmination of all the training, continuing education, and hearing others’ stories over many, many years of practice.

The take-away for those of you somewhere on the novice-to-expert continuum:  

• There is no magic – those clinicians you watch through the two-way mirror have been doing therapy a lot longer than you. You will get there in time. 
• Some say that the best teacher is the proficient rather than expert clinician—the former still remembers the rules, even as she moves away from needing to catalog them for practice. Find a mentor who can still explain things well. 
• When you get experienced enough to surprise yourself and your patient with just the right response, and do it with some humor to boot, enjoy it. You’re not doing something wrong. After all, research supports that it’s the genuine, empathic relationship between patient and therapist that makes a difference, not some magic formula. 

Have you ever surprised yourself and found that it was just what the situation called for?

Leslie Durr, PhD, RN, PMHCNS-BC is an advanced practice psychiatric-mental health nurse with a private psychotherapy practice in Charlottesville, Virginia.

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.