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Key points
- Feeling effective in work is a source of satisfaction.
- For a psychiatrist or mental health professional, taking notes can help clarify what a patient is working on and the direction of treatment.
- It’s important to work together with people and be in sync.
- Happiness at work is contextual. It relates applying what you know to what needs to get done—and learning from it.
As a psychotherapist, I listen to the intimate details of people’s private lives and am expected to reflect on them—sometimes in real time, but always once I have a coherent image of the person’s life. It’s a pointillistic process,since, while not every detail is clear, the ensemble can make sense at a distance.
I make mental notes during a session, and sometimes scribble a few observations on an iPad. Transcribing my notes is a challenge, however, since I invariably stop to think “Where is this going?” If the question seems more rhetorical than answerable, I need a revelation: more light, more notes, more work.
There is a delicate balance between listening, taking notes, and reflecting. Funny how it defies the laws of physics to go in three directions at once but, as a psychotherapist, I do it all the time. We practice a kind of mental gymnastics, defying linearity in the interest of understanding a person. Fortunately, however, I am assisted by technology. I have a computer-based record keeping system that allows me to make cumulative entries, sort of like a bookkeeper would. Maybe it’s surprising that a psychotherapist finds analogies in accounting. But trying to understand someone is just that complicated —you draw analogies from everywhere.
Today, a patient was describing a dream that I wanted to make sure to remember. So, I jotted down some notes as he spoke. He asked what I was doing. I thought to respond by asking, “What do you imagine I’m doing?” or, more candidly, “What does my recording your dream mean to you?” But the former seemed too much like a caricature of Sigmund Freud, and the latter just finessed the importance of the dream itself. So, I just said that I wanted to make note of his dream.
But actually, I don’t like primarily refocusing my discussions with patients on the process of their treatment. While it’s useful, it can also be distracting. That is, note-taking, however inconspicuous, invariably draws attention to me and away from the seamless give-and-take that I prefer. But sometimes it’s hard to avoid. So, I acknowledge that compromise is necessary if I am to remember anything and, finally, begin to figure things out.
Still, the question the patient raised stayed with me. It caused me to reflect on what I take notes about and on how I take notes. What is the split-second decision that favors one detail over another? How do I know what’s important, and will I think so later? Do I take too many notes (unnecessarily distracting the patient), only to stave off remorse when I might wish I to recall something that was now gone? Maybe taking notes is as much about me as it is about the patient, at least in the sense that I need to feel that (as a painter, an accountant, a psychiatrist) I am making progress.
When patients used to lie on a couch, unable to see the psychiatrist, they had less of an idea whether what they said was being reduced to notes. But those day are mostly gone. So why not discuss with the patient why I am taking notes? How about “If I am to develop an in-depth understanding of you, I need to record your dreams. It helps me think about you”? I could bring him into the process, keep him engaged. After all, it’s his treatment, and he has an interest in my doing my job,. Ultimately, all the loose ends will get tied up.
What matters, finally, is that we work together. When I have a sense that the patient and I are in sync, I experience a kind of professional satisfaction, apart from the feeling that I am actually helping someone deal with their concerns. I focus on note-taking here because it’s an element of how I go about reaching a place where I can say, “Well, I am making progress. This is coming together.” Notice the “-ing” form of the verb, the sense that my achievement (insofar as something that is never finished can be an achievement) is an unfolding. Psychotherapists do not expect miracles of understanding. But we do hope for some continuous elaboration born out of collaboration with the patient. When it occurs, i.e., when it is sustained, we feel good about ourselves.
Feeling effective in one’s profession is a source of happiness. It implies that we have made the right choice of work—or at least a good, practicable choice—and that we are pursuing it towards a socially useful end. We tend to choose some indicia over others, often those that are personal to us rather than those that are external. Thus, if a colleague pays me a compliment, I’m happy—but not as happy if, by my own lights and according to my own measure, I am performing up to the standards that I’ve set for myself. Note-taking, and the gradual understanding that it entails, has come to seem valuable to me as a constant, almost metronome-like feature of my keeping up with the dialogue that I have with a patient over weeks, months, and even years. It is mark of our progress together.
So, when I think about “happiness” in a professional context, it is not something that equates with the type of elation that occurs in a relationship or when some sought-after promotion finally comes through. If it is an ah-ha moment of understanding or, more generally, the feeling that I’m getting somewhere; it is more like a reassurance. It’s like I can tell myself that I know what I’m doing.
We all worry about whether we’re good problem-solvers, and whether we’ve learned enough to make the right moves. That’s way before we become concerned about making some lasting contribution. It’s the basic stuff —am I doing this right? Am I using my time in ways that make sense? When I see the notes begin to cohere, however indefinite the portrait/account/knitted-up stocking, I think “Okay, I am doing good work. I’m pleased.” I’m on the road towards happiness.
