Fake it ’till you make it? Reflections on “Finding Normal”

Over Labor Day weekend, a small group of acupuncturists, acupuncture students and our community clinic volunteers gathered at my house to view the documentary Finding Normal and to have a discussion about it as well as Lisa Rohleder’s blog posts on the movie. If you haven’t seen the movie yet, it is highly recommended, as are Lisa’s insightful writings about it.  In this post I would like to share a bit of what was discussed and some insights that came up for me as a result, and hope for some provocative conversation.

As our discussion began, some folks commented on how the mentors in the movie are able to easily empathize and connect with their clients’ suffering because they have been through the same experience of struggling with addiction. The observation was that empathy like that cannot be taught or learned, that as acupuncturists we deal with a much broader variety of  suffering, much of which we may not be able to identify with in the same way the Finding Normal mentors do. Another point was made – that perhaps the approach to connecting with patients Lisa describes / recommends in her blogs is “too narrow” and “too formulaic”. Someone in the room directed the question to me: “You teach this stuff to acupuncture students – how do you do it?”

My response (some of what I said at the moment, some fleshed out later on):  I actually do not know of a way to teach this, as I am still figuring this out for myself. But something helpful happened when we decided to hire a new practitioner at our clinic: we realized that we needed to train our new acupunk to do stuff the way we do it. We agreed that it was vital to make sure that the patients have a consistent experience at our clinic, that it was really important for survival of our business. So we created a “Guidelines” document, a lot of which is essentially a script instructing what a practitioner needs to do and say, how to communicate with patients when working in our clinic. The detailed instructions are helpful because when the basic structure is already given, the punk can relax into it and better hold the space, like a nice vessel. They are meant to assist the practitioner in making space for her patients’ suffering inside her while remaining continuously functional and supportive and doing this as work, meaning systematically and for many hours on end with many people. Its purpose is to help the new punk develop that “functional practitioner persona” Lisa talked about in her blog.

(After completing this document, I realized that I could adapt it to the acupuncture school setting to use it with my CA students, so I did.)

So the truth is that I do not teach anyone how to empathize with their patients, because I can’t – each practitioner needs to make their own journey with that. It’s like trying to teach someone to fall in love – can’t be done. I only try to provide a set of clear framework that will help ease that journey within a community acupuncture clinic setting. It is “formulaic” because it is pretty much a basic blueprint, and it is pretty narrow because we have narrowly defined systems in CA (for a good reason – see Noodles, part 3). But narrow and formulaic is not a negative thing in this case – it is liberating and supportive. When you think of it, Chinese Medicine is actually very fond of patterns and formulas.

In Finding Normal, we hear David Fitzgerald repeat to his clients, like a mantra (or a formula): “Don’t get high, don’t steal anything, don’t hurt anybody, go to a meeting, show up for your appointment tomorrow morning. That’s all you got to worry about today.” (I am paraphrasing) He is giving the newbie a basic prescription for survival, a system to help him connect with his inner self without having to think of what to do next. By clearly defining the formula and its boundaries, the mentor is creating a safety net where the changes can begin to take place. No energy need to be expanded to re-invent the wheel, just follow the steps, be sincere, and see what happens. It also helps the client plug into the community experience of recovery, as everyone else is given a similar formula and everyone is in this together.

In AA they use this expression “Fake it ‘till you make it” This suggestion “implies that if the newcomer acts according to the steps and teachings of the program, then the program will begin to work and the anxiety will fall away” (from AA to Z; An Addictionary of the 12-Step Culture ). I think we can apply it to learning to practice CA. I am not suggesting faking empathy (not possible? not needed), but that trust in following the basic process of the CA clinic systems is perhaps enough to benefit our patients. It is enough because acupuncture has a huge role to play and the systems are set up to make more acupuncture happen. It is enough because the systems are set up to involve the community in the process and encourage opening of hearts on all sides automatically; because the systems are set up to give us many opportunities to stand in others’ shoes, all kinds of shoes, which is pretty much the only way I have found to “learn” empathy. As Lisa said, the context is community as opposed to individual. Hearing David Fitzgerald’s “formula” I thought of Lisa’s, stated in her Installment 4 of Finding Normal blogs: “This is what an acupuncturist needs to do: be present, be respectful, communicate the treatment plan clearly, hold the space, give a fuck, put the sharp end in the patient, and get out of the way. And then let go of the outcome.” Now I am seriously thinking of replacing our long “Guidelines” document with a small slip of paper that says just that.

tatyana
Author: tatyana

<p> I grew up in the Soviet Union and immigrated to the United States as a teen, living in New York and Chicago before moving to the Bay Area in 1998. I began as a Yoga instructor and as a practitioner of Ohashiatsu bodywork and have been practicing Acupuncture/Chinese Medicine since 2003. Before switching to community acupuncture practice model I had a sporadic and struggling private practice, worked as an herbal pharmacist, as an instructor and clinical supervisor at an acupuncture school, plus did a two-year stint doing acupuncture at a public health clinic, working with mostly HIV/HCV+ populations in San Francisco. </p> <p> My discovery of Community Acupuncture practice model (via Lisa Rohleder's Acupuncture Today columns) profoundly transformed my life -- not just my work life but many other aspects of it. I gained a vocation, a community of friends and the most stable and rewarding job I have ever had. I see community acupuncture practice model as the most sustainable and most fitting to my values. It makes sense to me from the point of view of healthcare access, social justice, spirituality, and as an antidote to isolation. In 2008, together with another stellar acupunk Pam Chang I...

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Responses

  1. Guidelines

    Hey Tatyana, I looked for your Guidelines document in the forums but couldn’t find it.  Have you posted something juicy in there, or is it perhaps forthcoming?  Or are you really trashing it in lieu of the “just give a fuck” slip…

    “It’s like trying to teach someone to fall in love – can’t be done.”  True that we can’t teach it.  What I appreciate about these blogs and forums is the opportunity to witness so many punks falling in love over and over again with their CAP’s.  Inspiring & uplifting. 

  2. guidelines doc

    i haven’t posted it on CAN, as it is pretty detailed and particular to our clinic in many ways. i can probably send you a copy or i might post it on the hiring forum. i don’t think we are actually going to replace it with Lisa’s succinct summary, but it will be put in the document and perhaps somewhere else on a wall where the patients do not see it, but where we (the punks) can all read it often to remind ourselves aboput the important things to do.

    -tatyana

  3. Tatyana,
    This is such a

    Tatyana,

    This is such a great post, I keep coming back to it…and wondering…where are the dozens of comments? But I have nothing to add either, it’s all just so well said and then clearly tied back both to finding normal and to lisa’s posts.

    So I’ll just say thank you, and tell you that you’ve inspired me to write down on a slip of paper (because the more it’s said, the more it’s ingrained):

    be present, be respectful, communicate the treatment plan clearly, hold the space, give a fuck, put the sharp end in the patient, and get out of the way. And then let go of the outcome.

  4. faking until making

    it’s funny, one of the things that struck me about Finding Normal were all of the scenes in which the newly recovering folks talked about how lost they felt.  Jill, one of the mentors, said that being clean was terrifying because you never know what to expect, it’s like walking around naked. It made me think about what it’s like to be a new acupuncturist. You’re doing this weird thing nobody understands, you’re not sure you can help anybody, you’re not sure if you’re good enough, and yet somehow you have to keep putting yourself out there day after day after day. And lots of people have no support at all in this process. No wonder so many acupuncturists are so crazy.

    Thanks for a great post, Tatyana! (Brian Lindstrom liked it too.)

  5. un-faking

    yep, i still remember that lost feeling, it actually lasted a few years after acupuncture school for me and many other acupuncturists i knew. i felt like an impostor, but i think the main reason i had that feeling was that i believed that i had to charge people $65 for a treatment and i did NOT believe i could help most people enough before they ran out of money to spend on my services. it was so much pressure. i remember the powerful revelation that i was actually an ok acupuncturist and that it was possible for me to be effective and helpful and do a good job first came to me when i began treating in a public health clinic, where i did not have to deal with the money part and most of my patients were lower income folks who really needed the acupuncture. i was treating 3-4 people per hour (a big stretch for me at the time) and walked out of the clinic every week like i had wings. no pressure did wonders for my acupunk self-esteem.

    i think the context of CA clinic structure is such a perfect tool for un-faking, because there is no pressure to get everything “fixed” at once, no pressure to come up with a complex diagnosis or perform complex techniques, no pressure of worrying whether you patient can affford to come back to see you, no pressure to (pretend to) be some kind of an expert.

    everybody is different, all i know is that this is the way i perefer to do my work, the only way i can continue doing it.

    -tatyana