Friday, July 31, 2009

Coaching Yourself.

I tell the people I coach that my job is to teach them that they don't need me. By suggesting the short-term and long-term merits of learning to "coach one's self," selectively soliciting and incorporating incoming stimuli along the way, I pride myself on my ability to empower people to make their own training choices... and to observe how the skills they build through their athletic training can be applied to the rest of their lives.

I write frequently about how readily this approach lends itself to medicine. The single mom who struggles to quit smoking. The isolated widow who can't bear to leave her home. The dairy farmer who can't seem to change his diet enough to get his blood sugar under control. All of them learning to make choices consistent with the pursuit of a goal that means something to them, and why. All of them learning to direct their self-dialogue. Learning to direct their lives.

This morning I had the unique opportunity of observing an EMDR (eye movement desensitization and reprocessing) treatment session where I was able to not only see this very concept play out -- but to actually contribute to its synthesis. EMDR is an evidence-based treatment for Post-Traumatic Stress Disorder (PTSD) that has been in my archives of "stuff I know that exists without actually understanding how it works" from my psychology training. The basic concept is bilateral brain stimulation (through tactile stimulation of the fingers and visual stimulation by eye-tracking back and forth) in a safe, present-moment construct that allows complete processing of a re-experience of a traumatic memory. The idea is that PTSD results from incomplete processing of a distressing event -- and so, here, that processing can be brought to completion while attaching to it new, adaptive neural pathways.

The woman who graciously allowed me into her world to experience this technique likely did not appreciate how rare of an opportunity she was affording me. What I crave more than ANYTHING is the opportunity to observe management of emotional symptoms besides drugs. I want to see people who are brilliant at it; I want to see people who suck at it (that's how I trained myself as a coach, and that's how I'm training myself as a medical student -- abstracting things to emulate, and things to be on the lookout to avoid). The trouble is that, understandably, nobody wants an "observer" (medical student or not) during visits where they plan to discuss emotional symptoms with their doctors.

In the basement of the clinic where I'm training, tucked away in a dark little corner, is one of the only EMDR specialists in Vermont. Very few people know what she does; very few people seem to even care. So I decided to introduce myself, tell her that I'm fascinated by what I think she does, and that I'm frustrated that my medical education doesn't teach me anything about her world -- so, could I observe? The therapist gave me a hug and called a ton of abused, traumatized women and asked if a stranger could be brought into their worlds and hear their deepest, darkest secrets that they've barely processed. And some of them actually said yes.

So there I was, in this tiny dark corner room, as a participating audience member in the theater of a human being's life. 45 year old single mother, six years clean from all sorts of substances (IV drugs, alcohol, and who knows what else?) still struggling with her recovery, while experiencing PTSD from a 15-year history of physical, sexual, and emotional abuse by men in her life. And there I was, breathing in the privilege that was this woman trusting me with more pain than I've ever seen before.

How the EMDR protocol played out was to process a given issue (like would be expected in a psychotherapy session), wherein the therapist targeted a specific theme and message for self-dialogue and engaged these brain-stimulating techniques to more "deeply encode" the thought. Then, the patient was prompted to describe the emotional and physiological experiences that resulted from the newly processed thought. I imagined that, in a former life, this woman had probably not been so expressive -- that what I was observing must have been the result of a LOT of work.

After an hour, I saw a woman who was empowered by her own thoughts. So when it was my turn to speak, I called her on it.

I told her that I deeply admired her strength in "coaching herself" through her adversity, and how impressed I was by how far she's come and how committed she is to seeing herself through the challenges that lay before her. She started to cry.

"Nobody's ever told me that before. I guess I really am coaching myself."

We said goodbye. After the door closed behind her, I started to cry, too.

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