None of the specialists at the U. of Chicago medical center could pinpoint the source of Phil’s chronic back pain. Months of appointments, batteries of tests, and several unsuccessful treatments had culminated in a referral to the psychiatry department’s pain management clinic where I was a clinical psychology intern. Sometimes patients were sent to the clinic as an adjunct to their medical care, but Phil’s chart suggested that the doctors suspected something psychosomatic, sustained by some sort of secondary gain. Perhaps Phil was using his “pain” to coerce his wife into caring for him, maybe he wanted medication or to be placed on disability. It was the late 1980’s, and the psychiatry department was still steeped in interpersonal and psychodynamic theories requiring months and sometimes years of talk therapy. Whether interns and residents were treating chronic pain, an eating disorder, or depression, our supervisors encouraged us to delve deep into patients’ past and to detect how shadows cast by early relational patterns shaded current lives. This approach often provided patients with insight and sometimes alleviated suffering, but there was rarely a clear goal or end point.
During Phil’s intake, I was joined by my friend, Kathy, a no no-nonsense, first generation Lithuanian woman who had just started her psychiatry residency in the clinic. The room was cramped and I could sense Phil’s frustration when the conversation turned from back pain to his early relationship with his mother. But here’s where the story shifts, and why I remember this case so vividly after all these years. Rather than picking up on my thread, Kathy asked Phil to stand up and take off his shirt. I know, I was mystified too. “Now” she commanded Phil, “please walk to the door. Ok, walk back. Good, one more time.” Suspense built as a mystified Phil returned to his chair and began buttoning his shirt and Kathy scribbled in his chart. With the authority of detective who had just cracked her big case, she asked, “Has anyone ever told you that your left leg is slightly shorter than your right?” Further tests confirmed Kathy’s suspicion and with the simple fix of a shoe insert, Phil’s pain subsided. She later explained that something seemed off as she watched Phil enter the intake room—a subtle perceptual acuity gained from years of osteopathic training.
Forgive the pun, but sometimes all someone needs is a little lift. The most common, and even laborious, approaches are not always the best. Greater upfront needs assessment can lead to more elegant, effective solutions. The specific need can include anything from providing a “corrective experience” to learning how to complete a college application, but without specificity we risk delivering mismatched interventions. For this reason, volunteers’ toolboxes should include more than just the relationship hammer. It’s an indispensable part of any mentoring, but other tools can also be helpful and give the mentee just the lift they need.