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Do psychotherapists, doctors and leaders develop "emotional chainmail"? Description of a possible problem.

I've been in a peer "psychotherapy group" residential retreat again recently and I was involved in an interaction that has crystalised a series of thoughts about potential "emotional armouring" in therapists that I've been aware of more vaguely for some time. And in fact these "suspicions" involve not just psychotherapists, but also doctors and leaders more generally as well. Happily there are great advantages of this emotional stability & resilience, but I believe there can also be very genuine personal & interpersonal costs. So what am I talking about here?

I've written often about peer residential groups in this blog - see for example the overview in "Update on website traffic: my own favourite top 15". And this recent meeting I took part in was another in a series that goes back over 20 years. These gatherings are very much about connection - deep emotional connections both with oneself and with others. A couple of days into the group I was involved in a very powerful interaction with an old friend. We had been more distant for a couple of years. There were hurt feelings and misunderstandings that had been very hard to fully work through. Here was an opportunity to revisit this painful territory to see if we could get closer again. My take on what happened was that we did really well, moving a jammed relationship forward despite very strong emotional difficulties.

We talked through what had happened and how we each felt, while we were witnessed by eight others in the group for probably an hour and a half. Afterwards several people gave us feedback, both immediately and over the next day or so. Mixed in amongst the appreciation were other comments to me that seemed to link with each other. Something about a slight emotional "distance" or "control" that they thought they saw in me. One friend put it fascinatingly, talking about a very subtle, fine "chainmail" that seemed to "protect" me in situations of strong emotion ... but that could also leave him feeling like he hadn't fully connected with me or seen me. We talked about the hobbits' "mithril coat" in Tolkien's book "The Lord of the Rings". This very light, valuable, immensely protective form of chainmail saved Frodo's life when he was attacked deep down in the Mines of Moria, but it might also have left him a little harder to hug by his friends!

Doctors may develop different reactions to physical pain compared with the general public - see, for example, the paper "Physicians down-regulate their pain empathy response: an event-related brain potential study" with its abstract reading "Watching or imagining other people experiencing pain activates the central nervous system's pain matrix in the observer. Without emotion regulation skills, repeated exposure to the suffering of others in healthcare professionals may be associated with the adverse consequences of personal distress, burnout and compassion fatigue, which are detrimental to their wellbeing. Here, we recorded event-related potentials (ERP) from physicians and matched controls as they were presented with visual stimuli depicting body parts pricked by a needle (pain) or touched by a Q-tip (no-pain). The results showed early N110 differentiation between pain and no-pain over the frontal area as well as late P3 over the centro-parietal regions were observed in the control participants. In contrast, no such early and late ERP responses were detected in the physicians. Our results indicate that emotion regulation in physicians has very early effects, inhibiting the bottom-up processing of the perception of pain in others. It is suggested that physicians' down-regulation of the pain response dampens their negative arousal in response to the pain of others and thus may have many beneficial consequences including freeing up cognitive resources necessary for being of assistance."

What are the benefits of these adaptations, what are the costs, and are there ways of improving the cost/benefit balance? And are we just talking about doctors & psychotherapists here? What about leaders? If I'm the head of a tribe and I need to send the young men out to protect our village against invaders, how well will I plan the defence if I'm contorted emotionally by the thought of our casualties? But will this make me as a leader emotionally cold and, in some ways, inhuman? There's much work in this field. An example is Lammers & Stapel's recent publication "Power increases dehumanization" with its abstract "The current paper shows that the experience or possession of power increases dehumanization - the process of denying essential elements of "humanness" in other people and perceiving them as objects or animals. A position of power entails making difficult decisions for other people that may cause pain and suffering. Dehumanization helps to downplay this pain and suffering and thus to justify these decisions. Study 1 shows that powerful people dehumanize an outgroup more. Study 2 replicates that powerful people dehumanize an outgroup more and shows that this is especially likely after making a tough decision that is painful for that outgroup. Study 3 replicates this in a medical context. Together, these studies show that dehumanization - although by itself a very negative phenomenon - can also have functional elements: it helps powerful people to make tough decisions in a more distant, cold, and rational manner."

This isn't a straightforward black or white situation at all. There's other work showing very different findings, with psychotherapists, doctors and leaders fully capable of being more empathic and caring than the general population. But there are risks. I have been involved in working with deep emotional pain in myself & others (both individually & in groups) for forty years. What does this do to me? How do I cope, consciously and pre-consciously? How can I help myself to stay open, available, sensitive & compassionate while still being able to keep my feet when emotions are running very high, still be able to be there for a client facing a catastrophic situation, but then recover quickly enough to be deeply present & helpful for the next person in need who walks through the door of my clinic, and the next, and the next, and then be there at the end of the day when my wife or child or friend is facing a tough time too? And if I can do all this, is there then a danger that I get in some ways stuck in this caring, giving role and find it very hard to be vulnerable and ask for care myself. Yes, all of this can be a challenge!

In tomorrow's post I'll write more on the pluses and minuses of developing more familiarity and stability in situations of high emotional distress, and then I'll write a third post on ways that could help us get the best of both worlds - both stability and openness.

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