This study, dealing with cardiac and cancer surgeons' reactions to treatment failure (i.e., situations where surgeons despite their best efforts were unable to successfully treat their patients) found changes in the surgeons that bore striking resemblance to certain changes in people undergoing psychotherapy. Twenty surgeons participated. Each reported on two of his patients, all of whom had undergone surgery that failed to stem the progress of their disease. The life expectancy of these patients was approximately one year. Each surgeon saw one of his patients only until completion of the customary postoperative care and then referred him/her back to the original physician. The other patient was seen by the surgeon on a once-monthly basis even after postoperative care had been completed. While the surgeons had decided to be part of the study "for the possible good of the patients," many reported experiences of transformations in their own self-understanding. The particular elements of healing and self-understanding included a sense of self-forgiveness and acceptance, a strengthened feeling of human connectedness, an enhanced sense of meaning about what they were doing, and a sense of openness and hope for the future. Perhaps this self-transformative process and the possible mechanisms for change discussed mimic what happens in psychotherapy patients.
Working with Southeast Asian refugees in psychotherapy can teach Western psychotherapists how our culture-impacted notions of health, psychopathology, and psychotherapy influence the way we hear, understand, and respond to our patients. Western conceptions of individual boundaries, family ties, the relationship of mind and body, and ways of knowing are among the issues that arise for the Western psychotherapist who works with Southeast Asian refugees. While we in the West have seen rapid technological advances, we also have suffered dislocations, change, and the loss of traditional bases of meaning. Yet despite the differences, there are also elements within Western culture that resonate with what are usually considered "Asian" ways. These include the self-in-relation concepts described by feminist writers and the attitude of therapist as learner described by some contemporary psychoanalysts as well as by a contemporary Western philosopher. Refugees and Western patients alike want their unique faces "seen" and hope to birth new and expanded meanings in their psychotherapeutic dialogues.
The socio-political context of clients' lives and the interconnectedness between a client's "inner" world and the "outer" world of which they are part are often ignored or denied in Western culture and in psychotherapy. The roots for this exclusion and the lack of context and connectedness generally in psychotherapy are briefly discussed, and some responses from a particular client in psychotherapy are presented and explored.If an American were to turn out a novel or story in the 1980s in which men and women characters consorted together without one mention of physical desire, we would wonder in reviews and at lunch why the author suppressed sexuality. Yet hundreds of novels and stories offer us American characters who live out their lives without any political and ethical anxiety. We ought to be calling it suppression, because we are as much political and moral creatures as we are sexual creatures (Bly, 1986, p. 3)."Homeless women," says a 44-year-old woman client in psychotherapy with me for about a year and one half, "I passed a homeless woman and her daughter on the street. I didn't know what to do. There are more and more of these people around. What is happening here?" These are the comments with which Ms. R begins her session. She works part-time teaching poetry and creative writing to grammar school children in a private school. She is married, with
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