What psychotherapists can learn from district nursing: Takeaways from “Call the Midwife”

“Call the Midwife,” beginning in impoverished London in 1957, deals with challenging issues such as illegal abortions, thalidomide, and spousal abuse. And yet, when watching it, I (JS) felt a great longing to be part of the caregiving community living at Nonnatus House, the nurses and nuns who cared for those in the district.

What appealed so much to me? These professionals lived and worked in a supportive community of colleagues. They cared deeply, both with skillful competency and emotional concern, for those in their charge, while maintaining professional boundaries. They did not routinely bring young women and children to live with them. They recognized the limits of their roles. They held space for the strong emotions of their patients without allowing those emotions to overwhelm them or take over a patient visit. Instead they used the support of their colleagues to manage intense feelings and maintained the most caring and professional demeanor with the patients.

While we are not providing nursing care, nor are we delivering babies in people’s homes, we psychotherapists do care for people who are struggling with very difficult circumstances. How can we, as mental health professionals, in clinics, hospitals, and private practices, use those lessons?

• First and foremost, we can care deeply about the people with whom we work, while still maintaining appropriate boundaries. Our clients come, willing to share their stories and their hopes for positive change with us, initially strangers. We owe them the benefit of holding them in our hearts. There is not an episode of the show in which the sisters and nurse midwives do not demonstrate this inspiring charge.

  
  

• Be able to hold space for strong emotions. One way that we can be helpful for our clients is by letting them know that we can handle what they bring to us emotionally. We will not be undone by it. Season 1, set in 1957, has us meeting young nurse midwives who must learn to hold their own, as well as their patients’ feelings.

  
  

• While caring for our clients, we must also recognize what is within our scope of practice and what is not, where are the boundaries and limits of our roles. That is one tool to help keep us from crossing boundaries or getting overwhelmed and burned out. Be keenly aware of what we can do as practitioners and what we cannot. To that end, if we know what other services are available we can refer to those and know that there is someone who can help with the things that are not within our skill set or purview. Despite the desperate situations of many of their patients, the residents do not bring people in to eat or to stay at Nonnatus House, the home of the nuns and nurse midwives on the show.

  
  

• We must surround ourselves with a community of skilled and supportive colleagues. Perhaps the most appealing aspect of “Call the Midwife” is the community both within Nonnatus House and surrounding it. While we are unlikely to mirror that in our own lives and work, there are steps we can take to build community. For your practice, think about those colleagues you respect, who do good work, who share a way of caring about their clients in a way that jives with your approach. Keep in touch. Have regular consultations and/or regular social gatherings. Know that they are your community and you are part of theirs. Be available to them and call on them when you need to. Community comes in many forms. When one of the nuns determines that she is ready to leave the order, she receives loving support and remains a critical member of the community. Joyce, one of the nurses, has her career threatened by a racist patient and her co-workers rally to back her.

  
  

• Be creative and dynamic. If you see a need, can you think of a way to fulfill it? Is there a program that can be developed? A grant that can help? Someone using a model in another geographic region that is worth looking at? A treatment to get trained in that will serve your population well? For many of us, these calls to action are not realistic in our everyday practice but they may serve to get the creatively clinical ideas flowing. Maybe a new therapeutic group or a different intake method is needed. The issue of homeless men struggling with alcoholism comes to the fore and the local mayor determines to create a facility for those dealing with alcoholism in the community. The season set in 1961 brings the reality of the relatively new medication, thalidomide. Pregnant women took thalidomide to ameliorate nausea. However, it was later discovered that it caused severe birth defects. Dr. Turner and three of the nurse midwives develop a system to correlate the use of the drug with those affected.

  
  

• (And the bonus 6th lesson: Sometimes our clients will surprise us in the most wonderful ways. An early episode depicted a woman desperately upset about her pregnancy. The reason for this upset is that the child is the product of an affair, which will become obvious when the baby is born as the biological father was Black while the mother and her husband are White. Her husband is joyous at the coming expansion of the family and loves this child as his own!)

  
  

We are unlikely to move in with a number of our colleagues. We are also unlikely to show up at our clients’ homes on bicycles or be well known service providers among the folks walking down the street. We are likely to care for people, at times when it is hard for them, and at times when it is hard for us. However, there is joy in the work we do and in the community within which we do it.