Background Medical identity is formed intrapsychically and intrapersonally during training. Maintaining empathy in students and doctors in senior years is challenging. Empathy loss and use of defences may cause stress and isolation. Palliative care doctors become involved with patients and relatives more than other specialties. Integration of psychotherapy theory with medical knowledge has demonstrable benefits.
Aims To explore the effect of a pre-existing medical identity on the experience of training and working as an integrative psychotherapist and the effect of psychotherapy training on medical practice.
Methods Interpretative phenomenological analysis (IPA) explores daily events given meaning. The hermeneutic uses reflection and cyclical bracketing allowing preconceptions to rise to consciousness. As analysis arises from within the text, it is a robust method for working with identity. IPA has an ideographic base so the method supports small sample size research. Four medical consultants who also worked as integrative therapists, (two palliative medicine, one haematology, one diabetes and endocrinology) gave 90 min semistructured interviews. Ethical code and confidentiality followed the practice of UKCP. Interviews transcribed with prosodic information were analysed line by line demonstrating emergent patterns. Data coding linked themes into super-ordinate groups. Supervision and collegial interaction encouraged reflexivity.
Results Emergent themes were Unpreparedness for medical school experiences and relating with patients prior to a medical identity; vulnerabilities were not discussed and defences against them formed a medical ‘shell’ psychotherapy training permitted expression of vulnerabilities, boundary setting, and personal closeness to patients and family. Transferences, resistances and the archetypal shadow of the medical profession were avoided by suppression of medical qualifications. The emergent true therapist self benefited both medicine and psychotherapy.
Conclusion Psychotherapy training may benefit palliative care doctors retain empathy by limiting the use of unconscious defences, enhancing boundaries and maintaining holistic professionalism.
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