Palliative care psychologist Chris MacKinnon on rescuing joy from heartbreak and loss as the great teacher
“Over the years of working with people in bereavement, I have come to discover the lessons that loss has to teach us. For better or for worse, the death of someone important compels us into a deeper engagement with our own lives and sometimes the hardest part is to rise to this challenge. My work as a psychologist is often helping people discover their own unique ways of responding constructively when loss occurs.”
By Devon Phillips. Chris MacKinnon speaks passionately about his role in helping people confront end-of-life challenges, whether this is assisting people in responding to life-threatening illness or providing bereavement psychotherapy. His path to palliative care is the result of a long-held dream, determination, good timing, sharp insight, and amazing mentors. I met with Chris in his office at the McGill University Health Centre (MUHC) in Montreal.
Q: How did you come to palliative care?
A: Originally my background was in chaplaincy. I had trained at the Royal Victoria Hospital in Spiritual Care and I initially thought that was going to be my life-long career. As part of the Spiritual Care training we watched the N.F.B. documentary End Notes by Gary Beitel. It featured prominent figures in palliative care like Dr. Balfour Mount and psychologist Johanne de Montigny. That video made a powerful impression on me. I came away with the idea, “I think I would like to be a palliative care psychologist.” So I went back to school in my mid 20’s and studied psychology at night while working as a chaplain at Pierrefonds Comprehensive High School. I was subsequently accepted into the counselling psychology graduate program in McGill in 2004. I did my master’s internship at Marianopolis College and then applied for a doctorate in the same program. I was very happy to be accepted, but unfortunately the kind of research I was going to be doing was not a good fit for me. I really wanted to work and do research in end-of-life care. I delayed entry into the PhD program and spent the better part of a year going all over the place trying to find a supervisor. I had meetings at every university in Montreal where I encountered many closed doors; no one wanted to take me on as a student doing end-of-life care research. I was getting quite discouraged and was about to throw in the towel when I met with Dr. Robin Cohen at the Jewish General Hospital. She is a professor in the Department of Oncology and the research director of Palliative Care McGill. When she said, “Yes, I think our research interests are aligned and I could see us working well together,” I was elated! When I started training at the MUHC Palliative Care in 2008 it was really the fulfillment of a dream that had been there for many years.
Q: Have you had role models and mentors?
A: Certainly Dr. Robin Cohen and Johanne de Montigny opened up a lot of doors for me and this deepened my confidence and skills. Robin has so much expertise in research; I learned so much working with her. Robin was an exceptionally generous supervisor, creating opportunities to collaborate with researchers internationally. She also helped me develop more profound research skills. I am very proud of the research we have done, and continue to do together. I worked with Johanne de Montigny for about seven years, first as her intern and later as her colleague. Johanne was the first palliative care psychologist in Canada, a real pioneer who deserves high praise. The culmination of 29 years of knowledge from her work is astonishing, as is her capacity to be able to confront extremely difficult topics in productive and inspiring ways. Her warmth, caring, and authenticity have meant the world to me. Personally and professionally, I carry a lasting gratitude to Johanne for being who she is. All this to say, we need role models in our lives. Both Johanne and Robin have made an indelible imprint on me that continue on in my work as a scholar and a clinician.
Q: With your move to the Glen site, what is your role?
A: I am now the senior psychologist for the palliative care team. I am deeply honored to be given this position and plan to continue to honor this tradition of providing psychological services to those facing the end of life. I am also happy to be involved in providing training to the next generation of clinicians. For example, I am working closely with our physician Dr. Stefanie Gingras on a new program to train our medical fellows in developing their communication skills. This has been a really exciting development. We just completed a pilot program and are in the midst of looking at trainees’ feedback and making refinements for the next cohort. In addition, I will continue to work with doctoral level psychology trainees who are interested in completing either a practicum or internship. One of the real advantages of working in a university teaching hospital is the diversity of learning opportunities available to our trainees, all supported by the rich expertise and experience of our faculty.
Q: What is the role of psychologist in palliative care?
A: There is always this mystique around what psychologists do and what happens behind our closed door. In essence our role in palliative care is multifaceted in terms of assessment, diagnosis, and psychotherapy for patients and families. Put another way, psychologists are here to humanize the experience of dying, inviting a deeper engagement with the mystery of our lives. With a psychologist, a person doesn’t have to worry about protecting their family, they don’t have to mask their pain, and they can, in some ways, be more truly themselves. My goal is to find out how the person consulting with me wants to use our time constructively and address any concerns or questions they may have. Psychologists are trained to help clarify priorities. We are engaged in the sometimes difficult business of trying to rescue joy from heartbreak. Sometimes it involves helping people renew their confidence in life and rediscover that despite the inevitable broken dreams, life is still worth it.
Q: What has helped you in your role as a psychologist?
A: Good mentorship, personal psychotherapy, and trusting that a sincere and deep conversation means something. I also happen to really love my job. I have always enjoyed interesting conversations and I try never to forget the immense privilege I have been given to accompany individuals at times of trial and challenge. I often find myself reading the works of some of the great voices in psychology to help support me and my practice. The works of Dr. James Hollis for instance have been a tremendously rich source of learning and wisdom. Hollis grapples with some of the thornier issues of what it means to be human and always finds a way to make me think about something in new and intriguing ways. I have come to discover that the capacity to access our creative sides is a buffer against some of the difficulties that life can throw our way. I don’t think one has to necessarily be an artist or a painter to do this. Expressing our creative side can help us find new options for responding to tragedy.
Q: Tell me about that. You sound inspired.
A: There are some really remarkable stories, even inspiring stories - like the young man who was dying of cancer but was composing a children’s short story. Another moment I will never forget was the woman who wrote a poem to give to the team as a form of gratitude for everything they had done. There are a lot of powerful moments like these that happen in palliative care, a lot of life!
Q: What are some of the things you have learned doing this work?
A: One of the things I have come to learn is to better understand the role of loss in human life. For better or for worse, I have come to see loss as a teacher. My colleague Dr. Robert Neimeyer at the University of Memphis would say loss is a non-optional course in the curriculum of life. While we might not like this very much, we tend to learn and grow the most in life from the rough patches. I think that one of the biggest challenges for those who pass through palliative care is for them to find ways to step back and see how they are choosing to respond to the events that have chosen them. I see that the role for the psychologist is critical in those conversations about choosing our response to choicelessness. The future is looking bright. One of the first palliative care units was at the original Royal Victoria Hospital north of the McGill Campus. It feels like we are returning to our roots at the new Royal Vic, as we begin the next chapter of palliative care. We have a dynamic team with lots of heart, always going the extra mile for patient and family care. We benefit from the stewardship of our great leaders. I am so grateful to have found my way into this setting, to work with this high caliber of people, and to constantly be learning what matters most.