During the mid-1990s while I was practicing teaching the Inward Outlook in my coaching private practice as well as in my professional life as a public speaker, trainer, and consultant, I was also interning as a psychology doctoral candidate. In the clinic where I worked, my colleagues and I partnered in pairs, co-leading fifteen schizophrenic patients five hours each day, three to five days a week.
Free from the limitations of the past, profoundly present.
The psychiatrist who was the medical director of our clinic for the county’s most challenging persistently mentally ill patients, became quite frustrated with me for being so “idealistic” with my patients. He said I was not reality-based enough to be able to assist them. I replied as respectfully as I could that perhaps he was right, but my perspective was to see the possible best in every patient in order to elicit the same from them, in spite of their presentation. I can see in retrospect that, essentially, this was an expression of my authentic personal purpose, not yet articulated but available for my patients: “Free from the limitations of the past, profoundly present…”
It struck me, after listening to her repetition of this fear for several sessions, that no one who treated her had actually ever validated her concerns or really listened to her.
I had a patient (whom I will call Elaine) who was diagnosed with paranoid schizophrenia, and who had been in a board and care home for some time after her family determined they could not care for her. She was in her late thirties. Her speech was very pressured – intense and staccato – and for the first several sessions she repeated the same litany, intensely staring at the floor during the whole communication, about how people were trying to find her, knowing they would jump out of the bushes on her walk home and feeling terrified they would kill her. She had evidently told this fear to all her previous therapists, including her psychiatrist, who all told her this fear was ungrounded, a fabrication and delusion of her illness. It struck me, after listening to her repetition of this fear for several sessions, that no one who treated her had actually ever validated her concerns or really listened to her.
Now Elaine aspired to finishing high school, getting her GED, and living on her own. Her psychiatrist told her that that would never happen, and that she would never get any better than her current state of mental health.
On my third session with Elaine, I decided to listen to her fears from the stance of possibility. Horrible things do happen to people; people are victims of crime and do get ambushed and harmed sometimes for no reason. So I said to her, “Elaine, I believe you, that this is possible.” This stopped her in her tracks. She looked up at me for the first time in three sessions, mouth open, in wonder. “I believe you,” I repeated. “This type of situation could happen.” I let this sink in.
What if you were to stop paying so much attention to the fear of it happening, and started paying attention to what you are interested in having happen?
For the first time, Elaine stopped telling her story and listened attentively. “But here’s the problem,” I said. “You are thinking about this happening so much that you never let yourself have a moment of peace. And the fact is, it hasn’t happened to you at this point. So what if you were to stop paying so much attention to the fear of it happening, and started paying attention to what you are interested in having happen?” I went on to say that if something frightening did happen, which could happen to any one of us, that she would have to deal with it at the time – but in the meantime, she could actually begin to enjoy her life and start to create the life experience she wanted.
Elaine never brought up that litany again. Over the next six months, we worked together an hour a week; and when our time together was complete, Elaine had moved out of the board and care home, was living on her own, and was once again seeing her father on a weekly basis, going out with him for hamburgers and milkshakes. When I asked about her six months after our work was done, I was told she had begun studying for her GED.
See the possible best in every patient in order to elicit the same from them, in spite of their presentation.
I never read the clinical reports on my patients until after I met with them, because I didn’t want my initial assessment to be contaminated by the previous clinicians’ diagnoses. As a result of allowing myself to “not know,” I was able to perceive possibilities with these patients that very likely wouldn’t have occurred to me had I beforehand assumed the reality of accepted clinical diagnoses and reports. Of course, I read the reports later, but I had by then been able to bring my own fresh perspective to whatever diagnosis was written, thereby achieving some very unusually positive results with patients diagnosed as people who would never improve.
Interestingly enough, my work with these patients was so effective – their mental health, social skills, and community participation so improved – that a year later, the same medical director who had earlier been so frustrated with me, requested supervision from me with his patients on my particular methodology. And he asked for coaching on the IO approach.