Psychologist and MSC Graduate
May 9, 2019
Several years ago, I hung a painting on the wall in my office. It is a picture of beautiful purple flowers that peek in and out of a white lattice trellis. A butterfly sits on one of the flowers. A family medicine intern painted it for me as a thank you gift. She followed me into my office after our weekly support group one day and bravely shared a painful experience, her doubts about her worthiness to be a doctor, her identity struggle from medical student to doctor, and her humanity. I helped her find self-compassion at a time she needed it.
I work in a primary care clinic, and last month my clinic moved across town. Although I had several months of notice, I remained in denial and avoidant. This move would result in many changes for me. A longer commute. Less flexibility with scheduling patients. Way less personal space.
It was easy to handle the “top layer” stuff. The stuff that I grab on a regular basis to help patients gain insight or family medicine residents gain a broader understanding of human behavior. The books I read to center myself after a particularly challenging encounter. These items would join me in the next chapter. They were packed in boxes with my name and the new office number.
The “middle layer” stuff was more challenging. What do I do with things that I don’t need or use often but reference occasionally or might need in the future? Notes from old conferences, programs I developed but don’t do currently, artwork from patients I no longer see, notes and cards from ex-residents. I evaluated those emotionally, then objectively, then ultimately discarded, photographed or packed in “not sure what do with this yet” boxes.
The “bottom layer” stuff was the most challenging. Some of it was part of my very first therapy office when I started a postdoctoral fellowship in 2000. Bottom-layer stuff evokes a sense of flipping through a high school yearbook or a childhood treasure box. The items themselves serve very little practical purpose to current life except to remind us who we were before we became who we are. I smiled once I got to the bottom layer stuff.
Two highlights of the bottom layer. One was the Candy Land game that I pulled from the filing cabinet. Nine-year-old Ben (not his real name), one of my first therapy patients, gave it to me — the only Hanukkah present I have ever received. Ben had Asperger’s syndrome, which impaired his ability to communicate and connect with people, including me. One day he and his mother were shopping. He pointed to the Candy Land and said “Dr. Ayres doesn’t have that game. She would like it. I think we should get it for her for Hanukkah.”
It was the first time he indicated thinking about anyone else outside of the structured social skills development exercises we did in session. And he was correct. I didn’t have the game and I did like it. So did he. We played it every week until I left that job three years later. By the time I was ready to move to Austin for my current job four years later, the box lid was crumpled by use. I taped it up and moved it across the country. As the box continued to disintegrate, I purchased a newer version to use in therapy sessions and my Hanukkah gift became a treasured museum piece.
I spent a lot of time looking at that box and the replacement version that never became a velveteen rabbit. I put it aside until I had a solution. It was a visual, tactile reminder of a special connection with Ben, and who I was when I was new to the field. I ultimately removed the cards and board from Ben’s game, put them in the 2008 version, and cut the “Candy Land!” box edge from my Hanukkah present. The game pieces and cards are in the new office, waiting for an enthusiastic child to select that activity.
I also found my journal from the intern support groups I led during my first four years. We started every support group with a 10-minute journaling exercise to gently transition from one task to another. I started reading the early entries. I was struck by the simultaneous familiarity of my voice from a decade ago and the foreignness of it.
Neither of us could have predicted how successful she would become over her three years of training, that she would be known for her depths of compassion and honored with a leadership award at her graduation.
As I Iooked at the painting, I reflected on how much more I knew about self-compassion now than I did that day I talked to her. I hadn’t had training in Mindful Self-Compassion. My guidance was more reflective of a therapist’s understanding of the interconnectedness of thoughts, feelings and behaviors than self-kindness, common humanity and mindfulness. But yet, it was the basic tenets of self-compassion that I pulled into that conversation as I helped her consider an alternative perspective to her critical self-talk. I thought about how natural it felt to guide others, particularly vulnerable new doctors, to self-compassionate self-talk and how difficult it is to direct those same reflective questions to myself when I need them the most.
These were the guidelines:
▸ I will make space for whatever feeling arises.
▸ My feelings will take as long as they need.
▸ I will search for common humanity when I feel isolated.
▸ I will remember that others hold a safety net underneath me. If I fall, they will catch me.
▸ I will not choose to carry this burden alone. I will accept help and support by sharing my feelings instead of guarding them.
Fast forward to present day, four weeks later. I did make space for the gamut of emotions. I cried a lot and worried a lot.
I worked through guilt about self-compassionate schedule changes and boundary setting. I was kind to myself during the process and pushed back when the internal critic arose to offer well-intended, but emotionally minimizing, commentary. I attended our Tuesday night CDP meetings and talked about how hard it is to have a self-compassion practice when it is desperately needed.
A colleague asked me last week how long she can play the “my clinic just moved and I’m still adjusting” card. I told her I don’t think adjustment cards have an expiration date. They simply disappear when they are no longer needed. I had several adjustment cards about this move but now I’m down to one – the “not sure what to do with this yet” boxes are still in my living room and on my dining room table. My children, our dog and I navigate around them as I await the “now I know what to do.”
I trust the wisdom of Rainer Maria Rilke in Letters to a Young Poet when he told a young poet to live the questions and trust that the answers will be revealed when they are ready to be lived.
The intern’s painting hangs in the shared office. I look at it often on the two days I inhabit the new space. It is a visual reminder to find self-compassionate grace for the person I am now while I’m developing into the person I am not yet.
Jennifer L. Ayres, PhD is the director of behavioral health services at the Blackstock Family Health Center. She is an assistant professor of population health for Dell Medical School and a clinical assistant professor of psychology at The University of Texas at Austin. She oversees behavioral health education for family medicine residents and psychology trainees, conducts outpatient psychotherapy and does inpatient psychology consultations at Dell Seton Medical Center.
Ayres has a bachelor’s degree from Emory University, a master’s degree from the University of North Texas and a doctorate in clinical psychology from UT Southwestern Medical Center in Dallas. After her graduation, she moved to the Los Angeles area for a postdoctoral fellowship in child abuse and trauma. She worked as a trauma psychologist in Los Angeles for seven years before returning to Texas and settling into her current position.