How I Learnt Self-Compassion and How I Help Other Doctors to do the Same

Image by Gráinne Schäfer

by Dr Ira van der Steenstraten

Going through medical school in the late 1980’s in The Netherlands meant that I was taught the medical model and the focus of my training was illness- based. We were continually trained in new evidence-based treatments, which gave me a toolkit with a wide variety of treatments for my patients. I trained as a psychiatrist and psychotherapist, but nowhere in my training was I taught self-compassion, something I only discovered relatively recently. Fortunately, I am now a more self-compassionate person, and I am passing my knowledge onto other doctors.

I have always been very interested in strength-based approaches; how could I help my patients to improve the quality of their lives whilst becoming independent from me. I think this approach was influenced by my own experience as a chronic patient, being born with a severe bleeding disorder. I was missing a blood clotting factor that caused spontaneous internal bleeds, mostly in the joints, leading to pain and immobility. From the moment I could speak, I had to learn to read my physical symptoms and react to it appropriately; a skill I now recognise as mindfulness. Treatment meant intravenous administration of the missing clotting factor, which was done at the hospital until I was 11 years old. After that, I leaned to administer it myself which allowed me to become more independent.

I dealt with my condition in a mixed way, on the one hand I did not talk about it much, trying to ensure it would not prevent me from doing things. Of course, this would not always work out and often I had to admit my ‘defeat’ when a joint bleed prevented me from doing what I wanted to do. On the other hand, I learned to appreciate the moments when I was not in pain so much more; I experienced gratitude. Now I realise how important this gratitude has been for my mental wellbeing, and in making me a person with a very positive mindset.

My bleeding disorder has led to severe osteoarthrosis and arthritis. In my twenties I had the painful knees of a ninety-year-old and I was considered a chronic pain patient. But during my medical training, like so many other junior doctors, I found it hard to speak up when physical complaints were bothering me, I would rather just battle on. Like many other doctors I exhibited a personality style that is prone to having little self-compassion: hardworking, conscientious, reliable, self-critical, and perfectionistic. These characteristics can make you a good doctor when focusing on patients, but not on yourself. Working in a hierarchy for years under, sometimes, very critical and uncompassionate supervisors, ensured that taking care of myself was not high on my list of priorities.

However, after finishing my training and becoming a consultant psychiatrist, overcoming medical obstacles getting a double knee replacement and becoming a mother helped me to accept my vulnerabilities better, as Brené Brown would say. David Roland interviewed me a couple of years ago for his book “The Power of Suffering” and this made me reflect on the coping skills I had developed over the years. I think accepting our vulnerabilities also means becoming more self-compassionate, it might be a big part of the same process.

In 2008, I came to Brisbane, thinking it would be for a sabbatical of one year after which I would go back to my psychiatry practice in The Netherlands. But now, 13 years later, my family and I are still here, and I have focussed on the prevention and early intervention of mental health problems. I started a Life Coaching company, Breeze Life Coaching. The Australian Medical Association Queensland (AMAQ) asked me to develop a wellbeing program for junior doctors in response to the 2013 report by Beyondblue that showed the absolute shocking numbers of mental health problems in medical students and doctors. I knew immediately that this suited me. We did a systematic review to see what components should be in such a program, but I knew it would also be valuable to incorporate my personal and professional experiences into the program.

Queensland Health decided to make it available and mandatory for all Queensland interns from 2017 to complete the program. To date, I have presented the program ‘Wellbeing at Work’ (previously called ‘Resilience on the Run’) to over 4000 interns across Queensland. The feedback has shown how important it is to the interns that I understand from my experience what can be perceived as obstacles to selfcare. There is evidence that mindfulness is very helpful but over the years I have also included other practical, evidence-based strategies and I think cultivating self-compassion is one of the most important of these. I find that Professor Paul Gilbert’s Compassion Focussed Therapy model works well to explain the importance of self-compassion to analytical and self-critical minds.

My first real encounter with the self-compassion movement was when I attended a University of Queensland Compassion Symposium. I was excited to present the details of my program at the symposium a year later. I also jumped at the opportunity to attend a masterclass by Professor Paul Gilbert. All I could think was, how much I wished he had written his books 30 years earlier. Thinking back, I realise that most of my patients, especially those in psychotherapy, had suffered from low self-compassion. I wish I could have had the tools then, to help them more effectively.

I am excited for the future and I hope the ongoing research into self-compassion will equip us with greater understanding and tools. In my current role as President of the Queensland Medical Women’s Society (QMWS) I recently arranged a Self-Compassion Masterclass for medical women by Dr Marga Gooren. I plan for my next project to help young people to become more self-compassionate. Finally, being part of the management committee of Doctors’ Health in Queensland (DHQ) enables me to ensure that fostering more self-compassion in all doctors will be high on our list of priorities.

Thank you all for your interest in this important field and I hope to maybe work with you some day!

This article originally appeared in the CMA newsletter. You can subscribe to the newsletter here.