Perspectives
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Second Opinions
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We’ve come a long way from the “blank slate” model
by
Hannah S. Szlyk, PhD, LCSW
July 16, 2024
Szlyk is an assistant professor of research in psychiatry.
When I was a newly minted clinical social worker working at a psychiatric hospital, I was taught to be a blank slate. I was not to share details about myself, I was not to react to provocative stories or statements directed at me by my clients. That blank slate even extended to my own health history while at work: I was to be the picture-perfect image of a very young, healthy, and hyper-accomplished woman. I was to know how to handle any life challenge with flawless coping skills. No anxiety here. There needed to be a very clear distinction between who was the provider and who was the patient.
At the same time, there seemed to be this non-verbalized model for the ideal researcher and provider. Attainment of this ideal seemed to be most achievable for individuals who identified as healthy, white, cisgender, heterosexual males of the upper middle class. And so, again, many peers and I had to become blank slates — washed of what made us unique, hoping that this trade off would help us be “good” providers and researchers and “trusted” colleagues. For a while, I just wanted to feel that I belonged within academic medicine and pretend I was not a person with lived experience.
Fast forward many years, and I find myself again working in a department of psychiatry, this time as an assistant professor of research. Within the field, there is now an emphasis on person-centered and trauma-informed care, which encourages providers to employ some use of “the self” in patient interactions.
The field acknowledges, to an extent, that representation matters. People with lived experience can be engaged to help improve practice guidelines or intervention development. There is a push to have peer navigators on treatment teams and to have community advisory boards contribute to research. Providers and patients still must stay in their lane and stick to their assigned role, but they are now encouraged to work together.
Don’t get me wrong — I am very happy about this progress and for the greater appreciation of the patient’s voice in care decisions. But there is still a power dynamic of “us versus them,” “the providers with advanced degrees versus the community.” Even, “the mentally sound experts versus the compromised patients.” I still have a knot in my stomach because many of “us” are “them.” We have been here along.
We are people with lived experience of being patients within the psychiatric healthcare system, and who care for loved ones who also experience psychiatric issues. We are people with identities that do not fit the traditional model of how a psychiatric provider should act and appear.
I finally realize now that my authentic self was never a liability in becoming an impactful psychiatric social worker and researcher. It has helped me foster intuition about clients’ presenting issues, and to have appreciation for a research participant’s hesitance to share their story during a recorded interview. Acceptance of my own experience has helped me become a better researcher, as I feel more comfortable showing more sides of myself with the communities and individuals I work with.
For example, at times, some self-disclosure (e.g., sharing that I have experience being a patient in the mental health care system, and that I have loved ones with mental illnesses and substance use disorders) demonstrates my long-term commitment to a certain project or effort. If I am going to invite communities and individuals to share aspects of their lives with me, I need to be ready to share aspects of myself as well. I am also addressing my own internalized stigma – something I had recommended to past clients but never practiced myself.
I truly hope that psychiatric residency programs can embrace the power of their trainees’ authenticity. If so, other professions within psychiatry will likely follow suit.
A trainee’s experiences, or how they look, speak, or wear their hair does not detract from their impact — in fact, their identity and experiences are invaluable qualities that will likely help to bridge the ever-growing chasm between the U.S. public and the healthcare system. Authenticity encourages provider-patient trust, something that many healthcare systems are in short supply of today. In these unprecedented times for public health, it is critical that the profession move outside of its comfort zone and allow for its members to fully realize the knowledge and wisdom that has been there all along.
Hannah S. Szlyk, PhD, LCSW, is an assistant professor of research in the Department of Psychiatry in the Division of Addiction Science, Prevention and Treatment at the Washington University School of Medicine in St. Louis.
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