Case Example: Nancy is a registered nurse who has worked in a Metropolitan hospital for the past fifteen years. She primarily works in the unit where patients are “prepped” for surgery. She is admired by other nurses, doctors and administrative staff for her caring attitude. Nancy is always there to sit beside an anxious patient waiting for their operation. The only problem is that Nancy can be too “caring” at times and can fall far behind in her duties. Furthermore, she is often complaining about hospital policy and about the understaffing of her unit. “No one seems to give a damned and I am running around putting my thumb in our leaky medical service dike!” In sum, Nancy is a frustrating mixture of care and contention. She is beloved and belated.
How might the New Johari Window help us make sense of the dynamics operating in Nancy’s professional life. First, she is operating in an anxiety-saturated environment. As Isabel Menzies-Lyth has noted, hospitals are places where patients face existential challenges. The staff are not immune to the anxiety evoked by these challenges. Nancy can absorb the anxiety herself; however, she chooses instead to assign it out (with some justification) to her patients that are waiting for surgery.
Nancy “metabolizes” her own anxiety by taking care of her patients’ emotional needs. Her own anxiety is likely to decline if she can help someone else. By doing “something” rather than sitting there passively doing nothing. Nancy is able to confront her own traumatizing “tiger” and tame it (or at least get it to lie down and not bother her for a while). For Nancy, the priority is not getting to all of the patients for whom she is responsible. Rather, her priority is to spend some quality time with one patient—to the extent that her own anxiety and that of her patient is reduced.
Nancy may be aware that she is neglecting other patients assigned to her. However, she has a great excuse. There is insufficient staffing!! This is probably a legitimate complaint given the shortage of qualified health care workers in most hospital systems. There is more to the story here, for Nancy’s complaints about understaffing also enables her to transform her anxiety into anger. She can project the source of her anxiety outward and assign it to hospital leaders and various funding agencies. It might go something like this in Nancy’s head and heart (though this is an internal conversation that usually is not recognized let alone acknowledged by Nancy):
“I am anxious about having to set priorities regarding my work with patients. I don’t like being the source of my own anxiety. I can move the source outside and blame the “%$*^&*$*^” idiots who supposedly are “running” this hospital. I can complain openly about this matter because I will never be fired: I am “’ndispensable.’”
Nancy might even get other people working in the hospital to agree with her. Their agreement serves as wonderful, confirming feedback that Nancy can store in her second quad. She can interpret this agreement as feedback to her that she is smart and accurate in her assessment of the medical world in which she operates. A perfect, affirming storm for Nancy produces self-confirming hypotheses about herself while reducing her personal anxiety.
