Perspectives
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Second Opinions
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Here’s how to maintain your composure when patients have differing views
by
Dana Dorfman, PhD
October 13, 2024
Dorfman is a psychotherapist and author.
In 2020, I crossed a professional line expected within the sanctity of a therapeutic relationship: that of non-judgment. Quite simply, I lost it on a patient. It’s a moment in my 30 years as a psychotherapist that I look back on with regret and disappointment.
The context: several months into the pandemic, my fifth patient of the day expressed their strong opinions about the upcoming election. Rather than “holding space” for their perspectives and thoughtfully responding, I reacted strongly. In a flash, I reduced myself from the role of compassionate listener to an argumentative pundit, challenging their perceptions and insulting their preferred candidate’s character. In hindsight, the real culprit was less about our differing political views and more about burnout-fueled anxiety.
Who wasn’t feeling fried that first COVID summer? My family of four (and the dog) was stuck inside our New York City apartment. The protests against police brutality were literally right outside my door, joining the chorus of my recurring internal cacophony of anxiety. Even if you tried to go outside — masked, of course — or just opened your windows to get some fresh air, there it was. Noise. Unrest. There was no respite — even within our tension-filled home.
Even when we’re in a supportive environment, surrounded by people we love, our nervous systems can be activated. And that summer, in the midst of a burgeoning global pandemic and civil unrest, everyone’s nerves were depleted.
But it taught me new and valuable insights about caring for patients in a time of great anxiety, especially for those whose politics differ greatly from ours. My patients have a wide range of professions — including healthcare — and political beliefs. Now more than ever, as we quickly approach another tension-filled election, I have been especially conscious of putting my learnings into practice, as challenging as that may be.
It’s no surprise that compassion fatigue and burnout disproportionately impact healthcare workers. For those of us who work in mental health, it manifests in a unique kind of emotional depletion. The frequency, depth of intimacy, and quality of the relationship that we experience with our patients has its own occupational hazards — one of them being when the personal collides with the political.
Since emotions are behind everything we say and do, even “reasoned” political arguments and opinions touch us emotionally. This is why it feels so “personal” when someone supports a politician or political view you find reprehensible. (Often, I feel we — especially us women — say something is “personal” when what we’re really describing is “emotional.”)
Nevertheless, there are practices every healthcare practitioner can adopt to manage our anxiety and improve our effectiveness in patient care. Acknowledging our limitations and seeking help when needed not only benefits us, but ultimately leads to better outcomes for our patients. Navigating anxiety is crucial, and one fundamental strategy is to establish and maintain healthy boundaries while fostering self-awareness.
Mental healthcare providers in particular are trained to maintain boundaries that prevent us from projecting our personal issues onto our patients. This boundary-setting is vital; it enables us to remain emotionally available without losing ourselves in the process. The challenge arises when we find ourselves in emotionally charged situations, when we feel threatened or confronted. Physical sensations can emerge, clouding our ability to be supportive or listen. This is true for pretty much everyone, mental healthcare professionals, other clinicians, and patients alike.
Recognizing what triggers our anxiety or defensive reactions is essential. This can range from certain patient behaviors to specific themes in conversations. For instance, you might feel a tightness in your stomach or a rush of heat. Understanding these bodily sensations can serve as early warning signs, prompting you to take a step back, pause, and regain composure.
Self-awareness is key. And this requires time, which we don’t often have to spare. When I notice my stomach churning or my body tensing, I take a moment to pause. I may ask for a simple break, like taking a deep breath and planting my feet on the floor to recalibrate myself. Giving myself permission to have a moment of reflection can help ground me before I further engage with patients. I might even identify words or phrases that trigger this self-protective state, allowing me to prepare mentally and emotionally.
Finding moments of quiet, even just for a minute, can be a transformative practice. If you have a brief break between patients, use that time intentionally. Instead of mindlessly scrolling through your phone, check in with your body and emotions. Whether it’s a few deep breaths, eating a piece of chocolate, or a chat with a colleague, these small acts can restore your emotional inventory.
It’s inevitable that there will be times when we mismanage our emotions in front of patients. Perhaps you’ve experienced a moment of frustration where you unleashed your feelings on a patient, followed by shame and self-recrimination. Or, maybe you’ve ignored or dismissed them to avoid dealing with those feelings. It’s vital to approach these moments with self-compassion. Acknowledging that you’ve violated a boundary and reaching out to repair the relationship can be healing — for both you and the patient. You don’t need to over-explain; simply acknowledging your actions can make a significant difference.
In situations where communication has faltered, it’s important to give space for the patient to express their feelings. We cannot control how they will interpret our intentions, but we can control our response. This process can be uncomfortable, and the residual shame may linger, but it offers a powerful opportunity for growth and improvement as a healthcare professional. Acknowledging our limitations and seeking help when needed not only benefits us, but ultimately leads to better outcomes for our patients. (I offered amends to the aforementioned patient who left our session, but I accept that they didn’t accept them. I don’t like it, but I accept that it’s a consequence of my response.)
From treating many healthcare providers over the years, I know that we often feel the pressure to be the helpers, which can make some of us reluctant to seek help. Therapy can provide a safe space to unpack these feelings, identify triggers, and develop coping strategies.
Mitigating compassion fatigue and burnout is hard, but we can do it step by step, until the practice becomes a habit. By enhancing self-awareness, we can better prioritize self-care. Healthcare professionals can and should acknowledge our anxiety, whether during an election year or not, and not just to improve our effectiveness in patient care but for our own well-being and advocacy. I believe society — and our country — will be healthier for it.
Dana Dorfman, PhD, is a psychotherapist, and the author of When Worry Works and the free monthly newsletter Demystifying Anxiety . She is also the creator of the Anxiety Reaction Types, based on her 30 years of clinical experience.
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