October 29, 2011

If You Don't Understand, Ask

Therapy Policy: If you don't know what your client is talking about, ask.

I learned this lesson during my first doctoral internship, which was my first experience conducting therapy in French. Over the course of eight years living in Quebec, I've achieved considerable fluency in the French language, as well as in the nuances of Quebec slang, politics, and culture. However, everyday French conversation and conducting therapy in French are not comparable, and the learning curve during that first internship was steep. 

At the beginning, wanting to prove myself as an Anglo therapist in a Francophone environment, I opted for the "it's no big deal" approach and ignored the language issue. To avoid drawing attention to my Anglo-ness, I didn't ask clients to repeat unfamiliar terms or to explain comments that weren’t clear to me. This strategy was not effective. In supervision, I learned that my comédien client was not a comedian but, rather, an actor. When I expressed surprise in supervision over a client’s shocked response to a rude, but not out of character, comment from her partner, I learned that choqué means angry, not shocked. When I asked a colleague what my client might have meant when she said that her mother was "the kind of person who watches Occupation Double” (a Quebec reality TV show), my colleague wondered why I hadn’t simply asked the client.

In discussion with my supervisor, I realized that I was worried my clients would reject me for being an Anglo imposter who could never understand them. But my solution--pretending to understand when I didn't--was hindering therapy. When I consciously shifted to a more open and curious approach, my clients responded positively. They appreciated my acknowledgement of our differences and enjoyed the opportunity to explain their cultural references. Who knew!

Now I'm in a new steep-learning-curve internship--at a chronic pain centre. I'm not used to working at a non-psychiatric hospital; I hear unfamiliar terminology used every day to describe pain, medical procedures, medications, etc. What's more, I've never worked with pain patients before and many of their experiences are unfamiliar. 

I'm doing much less pretending this time around. One thing that helps is seeing my superiors--physicians and psychologists alike--do things like Google a medication they've never heard of, right in front of patients! They don't seem worried that patients will think they're incompetent because they admit to not knowing everything. A second thing that helps is noticing that patients want me to really understand their experience; they're not annoyed when I say "I'm not quite sure I understand; what do you mean by...?" Rather, they appreciate it.

This time, my policy is "If you don't understand, ask" (and, where medical terminology is concerned, "if you don't know, look it up"). 

So far, so good.

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