I have a small antique sign that I bought long ago at a Goodwill store. Beside a whimsical illustration, it reads, “it’s nice to be important but it’s more important to be nice.” Medical doctors are important, there is no denying that. We rely on them to keep us healthy. But, at times, a purely clinical nature can cloud their ability to provide the empathy patients often require. Please understand that what you are about to read does not apply to every single doctor, specialist, and practitioner.

This is not intended to be an indictment of the medical profession or a blanket statement of its shortcomings. Rather, this is an examination of how, in my experience, medical practitioners can fall short of fully recognizing and understanding the connection between physical health and emotional health, and how mental health practitioners can support clients in the aftermath of what they experience as invalidation.  

The Necessity of Clinical Empathy

Clinical empathy, more than anything, means remembering what it’s like not only to be a patient but also, to be a human. While this concept is drilled into those of us in fields like social work and psychology, perhaps a little further drilling is needed for some in the medical field. Years ago, I visited a cardiologist following a short hospital stay for what ended up being anxiety and panic. At the time, though, I was advised to follow up with a specialist to check on self-reported symptoms, including racing heartbeat and palpitations. At that visit, the cardiologist, becoming visibly frustrated with me, sighed and said brusquely, “look, I can’t tell you what every little sensation you’re feeling in your chest is.” I felt in that moment as if he saw me as a neurotic hypochondriac. In retrospect, I wasn’t being crazy; I was simply frightened and seeking answers. The doctor, though, had failed to recognize — or acknowledge — my fear, showed frustration rather than empathy, and left me feeling misunderstood and invalidated.

In his book, Clinical Empathy, David M. Berger writes that empathy is “the capacity to know emotionally what another is experiencing from within the frame of reference of that other person, the capacity to sample the feelings of another or to put oneself in another’s shoes.” I don’t think this doctor tried to do this; to be fair, many others I’ve seen have. 

Here is what that doctor could have discovered about my frame of reference: I’d been witness to a lot of illness in my family when I was growing up, I was prone to anxiety and struggled with panic attacks, I’d been a caregiver for my mother as she went through multiple bouts of cancer. Any or all this information might have helped this doctor decide to take a softer touch with me. And that empathic curiosity is all it would have taken for me to have felt validated rather than silly.

I will never forget a very different experience. A doctor told me something I will never, ever forget. But first, he allowed me to explain what I was feeling. He listened openly, non-judgmentally, and empathetically. He never once caused me to feel I was being silly or neurotic. In our field, we call it “holding space,” but we have a fancy name for everything. He listened —that’s the long and short of it. After he heard my story, my past experiences, and my worries, he left me with a thought that has sustained me and allowed me to heal from persistent health-related anxiety.

He said, “some of these sensations you’re feeling are your body remembering the pain from the past.” He understood. When the emotional imprints of the past manifested through frightening physical symptoms, I could remind myself that my body has a memory, just as my brain does. The same way an uncomfortable thought doesn’t mean something bad is happening, I could reassure myself that an uncomfortable physical sensation doesn’t mean something catastrophic is happening.

It was only then that I began to heal from my chronic somatization and worry. This individual, by the way, was not a therapist, counselor, psychologist, or mental health professional. He was, of all things, an oral surgeon. But, more importantly, he was a human being and he allowed himself to be vulnerable and it made all the difference.

This doctor modeled what we as therapists hope to do for our clients: first and foremost, he listened empathically, non-judgmentally, and compassionately. Next, he offered psychoeducation that helped me understand what I was experiencing, and lastly, he made sure I knew not only that he cared but also that he didn’t view me as a neurotic.

In another life, perhaps he had been a therapist. As an oral surgeon, his bedside manner, no doubt, served his patients very well. I was lucky to start working with a truly wonderful therapist following this experience, but my layman’s understanding of the importance of clinical empathy truly began with the oral surgeon. My therapist built on that initial foundation of understanding and empathy and, gradually, I healed and became less anxious about my health.

As a psychotherapist, my role is to help clients rebuild trust following invalidating parenting, abuse, or trauma. But I can also help clients rebuild trust and safety following experiences of clinical and medical invalidation. Just as I could not heal in an environment where I did not feel safe and accepted, neither could my own clients. I have the opportunity to do the honorable and important work of restoring safety for those whose sense of it has been shattered.

Even a brick at a time, I can help my clients build a fortress in which they feel validated. For me, it started with a medical practitioner who took the time to listen and understand. It continued with therapists and other medical professionals who have supported me and been understanding of my life experience. I now feel safe, supported, understood, and validated.  

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Sometimes, my job is to help clients pick up and reorganize the remains of an invalidating and shattering experience and to reorganize them into a meaningful and restorative whole. What an honor that I can help clean up the mess that’s left from past invalidations and assaults on their sense of safety and well-being. My hope is that, as you read this, you consider expanding your own fortress-building and safety-expanding capacity with clients who have been subjected to traumas, both great and small, including medical invalidation.


File under: The Art of Psychotherapy, Musings and Reflections