How Do I Know My True Motivation to Get Well?
Last week, I had a very interesting conversation with a patient who has been with me for some time. She had just finished reading my book, which had raised for her some questions about components she might add to her program to facilitate healing. What really concerned her, however, was the part in Chapter 26, which discussed the inner motivations that might interfere with healing. As she pondered this question, she began to wonder if previous stressors (emotional and spiritual) could be getting in the way of her getting better.
This is an important issue. Thoughtful, introspective patients will often ponder this question, and those who are prone to self-doubt and worry (the majority of my patients), may unfortunately turn this process of inquiry into self-deprecation. This adds another dimension to the stressors they are already wrestling with.
So how do I try to get a handle on which individual is doing their best to get well, and which ones are, (usually unconsciously), resisting?
First, I look at the effort that my patient is putting out on their own behalf. Do they do all, or most, of what I suggest? Not all of my suggestions will be helpful, but do they at least give it a shot? This particular patient has done virtually everything I have ever asked her to do, which for me is a clear sign of co-operation at a deep level. Other patients will be non-compliant for a wide variety of reasons: they are too busy, it is too expensive, it takes too much time, it is uncomfortable or difficult, or they just don’t feel it is right for them at this time. Regardless of the reason(s), any one of which may be perfectly valid, when there is always, or usually, a problem with compliance, this is a tip-off to me that there may be a problem here. Sometimes it goes beyond this. Occasionally patients actually sabotage their treatment by stopping supplements and medications that have clearly worked.
If a patient examines their behavior and compliance from the simple perspective of: am I doing my best? That is sufficient. I try to communicate to them on a regular basis, that from my perspective, they are, indeed doing their best so that they don’t get down on themselves.
The second area to look at is how open is that individual to even asking this question?
Over the years I have observed that generally, when a patient is questioning their own motivations and intentions, this means that they are working hard at getting better. It is the patients who do not ask this question that are prone to being unaware of their conscious and unconscious attitudes, and are quick to blame me, or their spouse, or their boss, or their children, or their parents, or someone else for their lack of progress in healing. How willing they are to even discuss this topic gives me a clear sense of their underlying motivation.
Thirdly, over many years I have come to trust my own intuition about a patient’s willingness to get better. I cannot explain it, and I readily admit that my intuitions may be wrong, but there is a sense about some patients, even if they are outwardly making no progress, that if I hang in there long enough, they will get well. And there is a sense, for others, that no matter how long we work at it, at least under my care, I come to feel that nothing will change.
I ponder and agitate over these intuitions, sometimes for months (occasionally for years), until I get some sense of clarity.
When patients are not improving, I hate to have them come back for regular visits unless both of us can be convinced that there is still hope that progress can be made. When I reach the point of certainty that I am not the right doctor for that patient, I will communicate this in as compassionate a way that I can. Usually it is accepted in the spirit it is given, but sometimes patients get angry at me for “giving up.” While they may be right, I would not like to think that there is someone else out there who can give them what they need, and in staying with me that they are missing out on that opportunity.
Intention and motivation are important components of the healing process, and these thoughts reflect my attempt to understand them.