Holding Clinical Space for People to Feel Safe
In health care, the concepts “safe” and “clinical” are often confounded.
Clinical most commonly refers to processes and methodologies used in the treatment of patients. These methods are held to be scientifically rigorous having been substantiated through careful study or examination.
That same notion is carried over in how we enculturate health care professionals (HCPs) to practice with clients; we encourage a clinical rigor, which necessarily includes the maintenance of objectivity – a hallmark of clinical and scientific inquiry. We conclude that in practicing in these clinically informed ways that we are also ensuring a quality of safety, those methods having proven to be effective and thus “safe”.
These clinical measures can be effective when trying to control for confounding variables, including the subjectivity of the practitioner themselves. The great scientific hope is to see things as they are, not as we wish them to be.
The problem with this is that we forget that objectivity or clinical rigor is its own kind of bias or way of seeing, grounded in a set of assumptions, among which is the debunked idea that one can extract the subject from the act of looking. So, working from that assumption, we continue to pursue the ideal that clinical objectivity creates the greatest conditions for safety because it eliminates unwanted variables. Cue the archetype of the all-knowing, authoritative, and distant clinician.
If health care was a discrete vocation that could be reduced to a collection of diagnosis and treatments (objective ITS), this assumption may well serve us – 1+1=2. There are instances where this may be truer (like reading a scan), but this is far from the whole truth (like in most complex care situations).
When health care assumes that clinical and safety are synonymous it cuts itself off from dealing with the complexities that arise in the experience of human suffering. This includes all the interior (subjective) realities that are shaping that experience; an array of complex variables, constantly rising and falling.
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Despite conventional thinking, safety doesn’t arise from distanced objectivity in the form of subjective denial, it grows from radical subjectivity. As in, the person feels safe to explore their ideas, feelings, and concerns in an environment that can safely hold those experiences. In seeing my whole self, I make it easier to for you to see yourself - an “I for an I” or, as the Hindus so reverently say, “Namaste” - I see in you the divinity that is also in me. ?
What happens when we make “clinical” synonymous with “safe” is that we inadvertently encourage clinicians to cut themselves off from their interior experience, having given them few if any tools to mitigate and be with what is arising in their thinking, feeling and sensing selves. That sense-making in tow, they assume the same of the people they are serving – I need to treat this person as an object of my attention, which overlooks their subjectivity. When we cut ourselves off from our interiors and those of our clients, we aren’t creating safety, we are creating the conditions for self-suppression or self-denial. We are overlooking a whole universe of experiences playing out right through our very eyes. The contents of that self seep into practice whether we hold firm to our intended objectivity or not. The only antidote to that is the deep awareness of the self, not its denial. I can only be aware of that which I am aware.
We need to contemplate a new paradigm in health care that can simultaneously hold the rigor of scientific and clinical inquiry and practice while also not denying or actively suppressing the qualities of the subject. This history of self suppression is one of the most significant contributing factors to delayed development, trauma, and the resistance to change we see across the health care continuum, including the redundancy we see in people who feel trapped in patterns of hurtful behaviours, or in the dwindling morale we see across the health care professional community. Fearing the self, we deny the self, and we feel unsafe to share what is not deemed to be clinically significant. And in that fracturing, we feel undone, partial, and, ultimately, unsafe.
Trust breeds safety. I want to trust that you know what you’re saying. I also want to trust you know why you’re saying it. I also want to trust that you are aware of what you don’t yet know, about this, about me, and about our shared experience. And more so, I want to trust that we are in a learning experience together. When we open to practice in that spirit, we invite someone to step into their own discovery, and that can be the safest space to hold for those who are feeling most vulnerable.
Questions for health care professional reflection arising through this piece: