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Anesthesiologist and psychotherapist Maire Daugharty discusses her article, “Why real therapy isn’t just about crisis.” She challenges the common misconception that therapy is only necessary or effective during acute crises (“crisis-hopping”), explaining that this view can lead to premature termination—a “flight to health”—when underlying work remains. Maire emphasizes that periods of calm in therapy are essential for integrating positive changes, processing accomplishments, and solidifying shifts in perspective and self-structure. The conversation also explores the critical importance of respecting patient autonomy and boundaries in both therapeutic and medical settings, acknowledging that clinicians cannot fully know a patient’s inner world. Furthermore, Maire clearly distinguishes the deep, exploratory work of psychotherapy, which often involves confronting difficult truths (“approaching the shattered mirror”) and altering implicit assumptions, from the explicit skill-building and goal-oriented approach of coaching, which works with the existing self-structure.
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Maura Daugharty; she’s an anesthesiologist and psychotherapist. Today’s KevinMD article is “Why real therapy isn’t just about crisis.” Maura, welcome to the show.
Maura Daugharty: Thank you. I appreciate being here.
Kevin Pho: All right, so tell us a little bit about your story and then the KevinMD article that you shared with us today.
Maura Daugharty: Yeah, so I am an anesthesiologist. I finished training in 2000 and was very much engaged in my profession until about 2014, 2015. And then I found myself feeling very, very tired and unhappy without really understanding why. And I started to explore that and ultimately, in that exploration, returned to my early adult interests.
In mental health, I went back to graduate school and did a degree in clinical mental health counseling and then did some additional coursework so that I could be licensed in both addiction counseling and marriage and family therapy.
And that’s where I find myself today. I’ve been very fortunate in being able to negotiate with my group a call schema that one worked for me to get through graduate school and then worked for me to begin to open and build my practice and now works both for me and them in working part-time as an anesthesiologist and full-time as a psychotherapist. At this point I do work predominantly, not only, with physicians, I think mostly because I really understand the environments that we struggle with in today’s practice, which is so very different from 25 years ago.
Kevin Pho: So your KevinMD article, you talk more about psychotherapy, “Why real therapy isn’t just about crisis.” What’s this article about?
Maura Daugharty: Yeah, so it really culminates my thinking around a handful of things, particularly working with physicians in the last handful of years. And this is true for everyone in general, not just physicians, but there are some issues that are unique to our environments that come into play in a lot of the work that I find myself doing with people.
So people come into therapy typically because of an event. Often they’ve been thinking about it for a long time, but they’ve been reluctant for a number of reasons. There’s a real stigma associated with going to see a therapist. Sometimes there’s a sense of, “I’m not strong enough; I can’t handle it on my own.” So it’s a quote, admission of weakness. And so people come in because they’re absolutely desperate over a particular circumstance.
And as it turns out, working through that circumstance is actually building the foundation for doing the work of psychotherapy. So in other words, how people come to find themselves in the crises that they are in is very much about the work that we do. So moving through that initial crisis is partly gaining trust of the client, helping them understand that we are working on a process; it is not a sign of weakness. And there are some things that you bring to the table in the horrible environments that we face that you have control over. And it’s learning to identify those things that we do have control over, that we do have some agency, and then the work really begins.
And so once that initial crisis is resolved, sometimes people feel like, “Well, I feel better now. I feel happy. Now I’m coming into therapy and I’m talking about how life is so much better. I must be done.” Where in fact, the reality is this is where we really begin the work. And people who stick with that learn over time as they start to make connections between the way they see things, the way they have learned to see things, and that things actually aren’t necessarily what they assume.
And so what it looks like—and I think I use this example in my article because it’s a nice, simple, straightforward illustration—is it looks like somebody coming in who struggled with, for example, a drinking problem. Or marijuana for a long, long time. And they get sober for a few weeks or a few months and they feel really good and they decide, “I’m done. Therapy’s done.” Well, you know, no, you’ve only just begun.
And particularly in that instance—and there’s a formal term for that called flight to health. And often what that reflects is: “I’m afraid to engage the change associated with this. The thinking that’s happening right now is really threatening to me because I’ve lived my life in this particular way for decades”—because I work with adults. And the idea that this isn’t actually functional, it is a real state of disequilibrium that some people aren’t ready to tolerate. So we call that a flight to health. I call it crisis hopping. In the sense that people come in, they resolve a crisis, they say, “I’m done,” and then they come back, say a month later or two months later saying, “Wow, I find myself in a similar position.”
Kevin Pho: So from your experience, what are some of the common reasons why people come to you? What examples of crises do you see people initially come in with?
Maura Daugharty: So I work with adult individuals and couples. Couples will always come in with, “We’re struggling with communication.” OK. And that phrase captures an enormous amount of what’s happening in terms of that relationship. But it’s always, “We really, we’re growing apart. We are struggling with communication. We can’t—we don’t seem to be able to connect or talk with each other.”
In individual therapy, it is really the gamut. People come in with, “I’ve been feeling depressed. I’ve been struggling with anxiety,” and particularly in my physician population. “I struggle with imposter syndrome”—which is really a synonym for deep insecurity. “I struggle with perfectionism”—which is also another term for deep insecurity. In other words: “I have to produce a work product that’s perfect in order for it to be good enough.” And in fact, it only really does have to be good enough. But we’re unlearning so much of what we learned in our training, and it synergizes with what so many of us have learned in our early childhood homes and environments and experiences.
So that complaints of burnout: “I’m exhausted. I don’t know what to do. I can’t go part-time because…” or “I can’t navigate differences in my schedule because that will be a jumping off point for…” And then sometimes overt childhood trauma: “I had this happen in my childhood and it’s really haunted me, and I’m at a point where I can’t tolerate how I feel anymore, or it’s impacting my relationships. And I wanna make a change. I really wanna move through this.”
Sometimes people come in for specific events, really processing through grief. Sometimes people come in because: “I’m having a really hard time navigating my work schedule, raising my kids. My teens are really difficult. My parents are elderly. I just have too much on my plate and I just don’t know what to do at this point. I’m at my wit’s end.” Sometimes people come in with as simple a problem as, “I’m not able to connect, talk with my teenage daughter anymore. What do I need to do to make it better?”
So there are lots of things that people come into therapy for that don’t fall into the Diagnostic and Statistical Manual of Mental Disorders (DSM) for psychiatry. It just runs the gamut.
Kevin Pho: So when you talk about the flight to health, you’re saying that once they resolve that initial crisis that brought them in in the first place… they think they’re all better and then they’re, like you said, good for a few weeks to a few months, but then come back to you because the problems recur? Yeah. So as a psychotherapist, what are some of the ways that you try to prevent that scenario?
Maura Daugharty: Oh, so education, education, education. So I’ll start by talking a little bit about what psychotherapy is. Depending on if somebody comes in and they’ve worked with a therapist before and they understand the process, we’re good to go. Typically if somebody comes in saying, “I’ve never seen a therapist before; this is completely brand new to me. I’m so… I have no idea what to expect.” Then I’m introducing information as we’re moving through our first sessions: what psychotherapy is all about, what it is that we’re doing here.
I’m not here, in other words, to give you advice or tell you how to solve this problem. That’s really the realm of coaching, not psychotherapy. Psychotherapy is about you discovering what it is in your perception perspective that integrates with this problem and how you can change that.
And so what that looks like is when somebody says something that they clearly believe is a fundamental truth and clearly is not, there are any number of ways to hold that up. Like: “Oh, you think this thing? I don’t think this thing; the rest of the world doesn’t think this thing. How did it come to be that you conclude that this is a fact where, as a matter of fact, there are any number of different ways we could look at that?”
The other thing that I do is when I see somebody beginning to develop that, “Oh, I feel so good. I’m almost done with therapy,” I will start to talk a little bit about why you feel good, what you came in for in the first place, and how that might present again. So I’m not overtly saying, “You think you’re better and you’re not,” but I’m making connections for them that hopefully they put together and it keeps them in therapy so that we can continue the work rather than blasting out for a while and then potentially coming back.
And having said that, I do wanna emphasize that it is the client’s right to terminate therapy at any time. That is a fundamental aspect of therapy. It is the client’s right; it is their agency. So if somebody says, “I’m done,” or “I can’t tolerate this,” or “I feel better,” then… I wish you the best, honestly and truly. And that is your right. It’s like in a physician’s hands: when I talk to somebody about an anesthetic plan, there are things I’m going to do and not do because they’re safe. But I’m always going to let the patient make their decision about the things that they have agency over.
Kevin Pho: Now when you talk about that continuing therapy after resolving that initial crisis… just to give a ballpark figure and to manage expectations for your clients, how long are we talking about continuing therapy to reduce that bounce back, reduce that flight path?
Maura Daugharty: Yeah. So it depends, like a lot of things. Are we talking about managing a single simple problem? In other words, brief solution-focused therapy? That therapeutic process is contained and short. If we’re talking about somebody who’s pretty healthy but who’s been struggling with a couple of things—not pervasive things, but a couple of things—then therapy can be pretty short. Several months to maybe a year short in a psychodynamic clinician’s hands.
If the problems are deeply rooted, they are manifested in multiple aspects of somebody’s life, then we’re talking a fairly long-term process. And it is sort of a negotiation between client and clinician, where the client always has the right to say, “I’m done.” I will, for example, have some clients ask, “At what point do you think I’m healthy enough to terminate?” And I say, “You’re healthy enough to terminate at any time. If you’re not struggling with acute alcohol use or in the middle of a depression with suicidal ideology, et cetera, you’re healthy to terminate at any time.”
It depends on the work that you wanna do. If you wanna make long-term structural changes in the way that you see and negotiate the world, that is a long-term process.
Kevin Pho: You said that some of your clients are physicians and they come to you with burnout, with imposter syndrome. Now of course you are an anesthesiologist, and I can’t think of very many psychotherapists who are also anesthesiologists as well. So how does that inform your psychotherapy sessions when talking to other physicians?
Maura Daugharty: Yeah, so it very much informs my process because I have been in the operating rooms, navigating the personalities, the corporate overlay, the time crunch, the value difference between: my goal is to take care of the patient as safely and comfortably as possible, but I also have to keep in mind that I have to do it within a timeframe that works for the corporate overlay, right? It’s a for-profit system, and I’m a patient management person navigating those variables.
So I very much understand the struggles that we are all navigating. I’ve certainly been in a lot of the positions that people come in and describe, wondering, “How do I navigate this overbearing personality that I have to work with?” “How do I navigate my feelings of insecurity that come up around specific issues in our work environment?” We all have them. We all have insecurities. It’s how you feel about them and how you choose to manage them. What are those feelings telling you about those insecurities? Are they really imbalanced with your level of expertise in the work that you’re doing?
And then of course, when you are involved in a significant patient complication, a whole other set of feelings and self-doubt and your insecurities come roaring to the surface, and I certainly have intimate experience with those things. Having been a physician 25 years post-training, 30 years including training.
We all run into really difficult, grave situations in the work that we do. One thing I will say that is true of… I’m going to say all physicians is: we are bound to the responsibility to come to work knowing that we can cause significant harm. Knowing that every day, knowing that that is the truth, the fact that we have to contain in our work.
Many of the stories that I hear, many of the things that we work through in a clinician-client relationship where both are physicians, resonate, and I have to be very careful not to impose my experience on my client’s experience.
Kevin Pho: You alluded to this earlier: the difference between coaching and psychotherapy. So for those physicians who may be listening to you now… how do they determine what’s the best course of action for them? How do they choose between, “I need a coach,” versus “I need a psychotherapist?”
Maura Daugharty: Yeah. So I would say if you have a very delineated issue that is amenable to a logistical solution, by all means, coaching can help. Right. Coaching is about giving advice. It’s about identifying sometimes how your thought processes get in the way of what you’re doing, but it’s not doing the underlying work of change in terms of, quote, “imposter syndrome” or, quote, “perfectionism.” It is really just helping you handle charting, for example, being more efficient with charting.
So there is a real role for coaching. I would preface that with some of the catchphrases that are indicators that this is not a coach that you necessarily might wanna align with is: “I have a simple solution that’s going to solve all of your problems.” There is no simple solution that’s going to solve all of your problems. So that’s a red flag right there. So if you’re looking for a coach to solve a very delineated problem in your life, I would look for someone who doesn’t claim to solve all of your problems with their very simple $10,000 program.
Difference between coaching and psychotherapy: who should you reach out to? Boy, that’s a really personal question. In my physician forums, I often hear people reaching out saying, “I need a coach for this, this, and this problem.” And I know that that’s not a coaching problem; that’s a psychotherapy problem. But how do I articulate that to somebody who may be not ready to jump into the idea of, “Maybe I need a therapist?” So that’s a delicate question.
Kevin Pho: Now for those who may be hesitant about psychotherapy because they don’t feel like they’re in crisis, right? Because we’ve been talking about the context of something that’s crisis initiated. What’s the benefit or value for psychotherapy for those who may not feel like they’re in crisis as an inciting event?
Maura Daugharty: So I’m going to quote somebody because it took me a long time to really appreciate this. I was talking with another clinician about couples therapy, and his discussion was, “I’m not going to solve all your problems, but I’m going to help you know each other, hopefully much more deeply.” And that’s really the process of psychotherapy.
And in individual therapy, I like to think of it as helping somebody come home to themselves, where they really begin to understand why they think the way they do and does that benefit them or harm them? What is their overarching view of feelings and emotions, which really is so much a part of who we are and which is so denigrated in our medical training? So there’s a lot of work around that, and it ultimately leads to really understanding yourself on a much, much deeper level.
Kevin Pho: We’re talking to Maura Daugharty. She’s an anesthesiologist and psychotherapist, and today’s KevinMD article is “Why real therapy isn’t just about crisis.” Maura, let’s end with some take-home messages that you wanna leave with the KevinMD audience.
Maura Daugharty: Yeah. Seeking therapy is not a sign of weakness. You can quit at any time, so there’s no danger to engaging because you can say, “This isn’t for me.” And I do hear a lot of stories, see a lot of stories, particularly on social media that would be amenable to psychotherapy. And if you’re brave enough, I invite you to try it.
Kevin Pho: Thank you so much for sharing your perspective and insight and thanks again for coming on the show.
Maura Daugharty: Thank you. Thank you. I so appreciate it. Thank you.