One of my seniors once told me, that I should not expect myself to be able to help, let alone cure every patient. There will be some who will not respond at all and then there will be some who will respond only that much. I have tried to keep it in my mind ever since but every time a patient comes who I feel just needs a change of perspective to respond and then does not, it becomes difficult to accept. Its not like pulling the plug for a brain dead individual, because for the quintessential optimist, there is always hope; he can't give up and he can't accept others giving up. If a parent asks me whether their son or daughter is going to be fine, I say,"I can't say"; of course I would like to extend all help that I can, except perhaps the positive confirmation. But when a patient asks me I always say,"yes, you can". But I should say ,"I can't make you fine but you can". You can say,"very Diplomatic!", well that was not the intention.
I can recall so many young girls and boys who I have seen over past 2 to 3 years, whose problems were more psychological than biological but no amount of counselling or therapy could change their perspective. I am not a behaviorist so I do not expect to change people by modifying their behaviors. I believe in insight oriented approaches and thus believe that awareness can bring change in perspectives and hence the behavior. Still there are so many who would close their eyes to the half full glass while focusing on the empty half. That implies I am failing in my job of changing people's perspective. But 'change' is the word that causes discomfiture. Can you really change a perspective? A woman is obsessed about her food, she is afraid of having physical discomfort if she takes wrong kind of food. I have been seeing her for 4 months now. Her depression has lifted but her obsession has stayed. She recognizes her symptoms to be the result of shifting her preoccupation from her children onto herself but somehow she cant shift this preoccupation over to her husband who is obese and diabetic and perhaps needs as much attention as her children. Why? Well, he never gave her that, so how can she! I am happy that I was able to bring insight - but change - no, that did not happen. Could Freud have done that - restructured a personality through psychoanalysis!
In hindsight, don't we all resent change, even while seeking it. As objects bound by the Newton's first law of Inertia- we do not want to change unless change hits us with a force.; even if we are in poorest of situations, we go on; well most of us do if not all.
So, what do I do with these children, the girl who would go back to slashing her wrist because she can't get a job that will fulfill her ambitions, or the boy who has multiple backlogs in first year of professional degree course and still would postpone the formulation of a study routine to tomorrow while the examinations await at the end of the month or the person who would not let go of the fear that he might become mentally disturbed tomorrow due to a partially heritable defect so he is just wasting away today.
May be the solution lies in that force that finally moves the object from its state of inertia. Can we learn to find that force or that force comes to us in time, lets wait and watch.