When your therapist makes a mistake

Therapists mess up. We are only human, and so sometimes we make mistakes. Unfortunately those mistakes can cause harm to our clients, a thing we try very hard to avoid. That being said, it does happen. I'll spare you a bunch of academic language about therapeutic rupture and repair. And I'll spare you the times that I've messed up as a therapist–that's for my own supervision. What I really want to explore is what to do when your therapist messes up in session. Therapists are entitled to have bad days or bad moments. The question is, when it happens to you, as the client, what can you do?

There are a few options here. First, you might choose to not return. If it’s someone you’ve only seen once or twice, for instance, and they’ve already made a misstep, you might just want to find someone else. In that case, consider that whatever mistake they’ve made as a gift; you know they’re not the right fit for you.

But if your therapist is one you’ve been seeing for a long time and you don’t want to leave, you can—and should—address the issue.

I know that’s easy for me to say, sitting here at my dining room table and not in the therapy room (virtual or in person). That space is sacred and heavy and sometimes fraught. A power dynamic exists. Therapists are trained to be aware of that dynamic and try to make it an equal partnership but it still exists. So it can be frightening say to your therapist, “I am upset with you. You said something that hurt me. I’m frustrated,” etc. It takes an enormous amount of vulnerability and a little bit of risk.

Let me assure you though, if you have a good therapist, they want to hear it. They don’t want you to silently resent them or just disappear and not return. It can be scary, sure, but ultimately it will make things better and allow you to do the work you came to do. Your therapist is going to mess up sometimes; give them the opportunity to apologize so you can both move on, together.

When does therapy end?

In my very first social work class in college, our professor taught us that termination begins during the first session. It shouldn't be a surprise to anyone when the relationship between social worker and client ends; it should be an ongoing conversation from day one. Sounds reasonable, right? After all, the relationship–whether it’s traditional therapy or case management or some other social worker/client situation–is finite. There is a goal that both parties are trying to achieve together. It’s not going to go on forever.

In real life, I don’t necessarily start talking termination in the first session (with apologies to that favorite professor of mine!). I have my reasons. First, for a lot of my clients, starting therapy is a giant step that they’ve often taken only reluctantly. Before they even start they’re looking for a way out. Talking about termination when they’ve just screwed up the courage to begin therapy may be enough to tip them over the edge into quitting.

Also, endings are hard. Ending a relationship whose major purpose is to dig deep into some very personal, vulnerable, and sometimes scary stuff feels even harder. Some people choose not to terminate in the traditional way (including me! Full disclosure, I have absolutely terminated via voicemail. I just wasn’t ready and I didn’t want to talk about it so I took the easy way out). I’ve also had clients feel really anxious about terminating and instead prefer a slow fadeout: first a session every two weeks, then every month, then… See you later? 

In fact, that’s a way to make termination much less frightening: you can always come back. I’ll be here. And if you’re nervous about starting therapy, maybe knowing there’s a time to end it will help. It’s one session at a time. You can start–and stop–whenever you’re ready. 

Using Emotional Intelligence to Thrive

Earlier this week, I had the pleasure of presenting to a group of professional women about emotional intelligence. They had chosen the topic and while it’s not my typical area of expertise, the idea interests me. At its core, emotional intelligence is about examining how we understand and interpret our feelings, our motivation, our interpersonal interactions. I think this is one of our lifelong jobs as human beings: to grow through self reflection and introspection.

So how does that growth occur? First, we need to have a basic understanding of how much emotional intelligence we already possess. As with all psychological concepts, there’s some debate in the psychological community about how measurable EI is. (There’s debate in the community about literally everything, to be fair). That being said, it’s pretty well accepted that emotional intelligence can be higher or lower depending on a number of factors: empathy, for instance, as well as motivation, social and self awareness, and self regulation. There are tests you can take online to get a feel for where you land in each of those aspects. Or you can take a moment and just consider: how well do you know yourself?

The reality is, honest self assessment can be tough. We all want to believe we’re naturally empathetic and intuitive, etc. But actually looking inward takes a little more work and a lot more humility than a standard, “how nice a person do you think you are?”. It takes effort to honestly face yourself and ask, how empathetic am I? How much do I let my emotions dictate my actions? What would others say about me?

A lot of my work as a therapist is encouraging people not to be so hard on themselves for having difficult feelings. So don’t get me wrong: this shouldn’t be an exercise in self flagellation. Rather, I want to encourage you to consider measuring your EI as one more way to grow. It’s all grist for the mill, as my brilliant clinical supervisor told me recently. How we understand and manage our emotions impacts our lives in numerous ways, big and small.

And if you aren’t ready to look further right this minute, you have permission to leave it alone until you are. Part of being emotionally intelligent is setting limits, even (especially) with yourself. When you are ready, I encourage you to investigate with curiosity and empathy. The path to growth doesn’t need to be all thorns. Celebrate the parts of yourself that bring and spread joy and tend to the parts that want to grow with love and compassion.

What if I want to know about my therapist?

Once, during a job interview, the interviewer asked to describe my boundaries with clients. A pretty vague question, right? Like, it depends! But seeing as how I was in an interview for a job I wanted (and eventually got, thank you very much), I played along and responded: I answer the questions my clients ask me (within reason).

Because here is the thing: when you are sitting across from me in that first session, I want to know some pretty deep stuff right off the bat. For instance, do you drink alcohol? Use drugs? Are you religious? Have you ever tried to hurt yourself or someone else? Not exactly cocktail party conversation. So if a client has a question for me (like how old am I or how many kids do I have, etc.), I’m more than willing to answer.

Some things about me are already clear: I wear a wedding ring, for instance. I’m fairly young. I’m a woman. I’m white. For some therapists, this is about as much information as clients are allowed to know. There are different schools of thought and none of them are wrong; in some ways, it’s a personal preference. There are good reasons for a therapist to not spend a lot of time talking about herself. For one thing, that’s not why you’re paying me; we’re here to talk about you, my friend. For another, some clients use this tactic to deflect and avoid the stuff they need to talk about. But I think, especially in the rapport building phase of therapy, it’s normal for a client to wonder, who is this person I’m telling all my secrets to?

So ask away! If I don’t want to answer, I won’t. Part of this process is developing a relationship and setting boundaries within it. I’m happy to tell you that I have two kids and a little dog and a husband. I’m happy to tell you that I’m in therapy myself, and that it helps me be a better therapist for you. I’m happy too, to talk about why you want to know about me instead of telling me about you. Like I said last time, almost nothing is off limits. This is a road we walk together. So tell me, what do you want to know?

In defense of the six minute visit

This is in defense of the six minute visit.

There is a kind of cold call aspect to my job that has taken years for me to accept with grace and poise. When I explain to patients and families that I’m calling to offer emotional support, some people are immediately hesitant. I’m sure this is partly because of the way we view mental health in this country but that’s not the point of this particular post; suffice it to say, people are on guard when I explain why a hospice social worker is offering them a visit. The nurse, the home health aide, even the chaplain: their roles are very clear to patients and their families. But when I say that I just want to talk, that makes some people feel weird.

So over the years, I’ve become practiced in how to get people to talk to me, a stranger. (And, since the pandemic, a stranger wearing a mask, which really hinders the non-verbal cues. But again, I digress).  When I see a new patient, which I do once or twice a week, I have a kind of game plan: I start with an informal list of questions that I offer to my patients and their families. They range from the mundane (where are you from originally?) to the thorny (what are you afraid of?). Sometimes those questions lead to a lovely, rapport building visit and I feel I’ve done something useful. Other times though, I’m not welcomed to stay. I don’t mean I’m unceremoniously kicked out; it’s more that it becomes clear to me that the patient or the family do not want to talk to me. I am, after all, a stranger, if a well-meaning one.

At a recent visit, this exact thing happened: there were introductions, I explained the purpose of my visit, and the patient’s adult children very kindly thanked me for coming and then said they were fine and I should feel free to hit the road. So, after only six minutes of standing in the living room, I left. The patient was hours from death; the family was all present and all on board with hospice philosophy. They had funeral plans, they were following the medication regiment, they were making jokes about death (a very solid coping mechanism). They really and truly did not need social work intervention.

And yet! My critical inner monologue kicked in as soon as I began the walk back to my car: six minutes! That wasn’t long enough! I did something wrong. Maybe a better social worker would have pressed. Perhaps a better social worker would have explained in greater detail what the visit was for. Was I distracted? Burnt out? Having an off day? I could have asked to stay, I could have insisted on seeing the patient with my own eyes, I could have… completely alienated a lovely family who made their needs known to me the moment I walked in the door.

Because that is the thing about this job: you have to have an innate ability to both read the room and find the places to push. Sometimes there are no places to push. There are no weak spots or cracked open doors to lean against. Sometimes I have to trust my instincts that I am an unwanted guest and get out before I start to cause harm. That family did not need me. Six minutes was plenty of time for them; why shouldn’t it be plenty of time for me too?

The Work of Intrusion

Death is such a private time; it is the only thing we truly do alone. Sure, if we’re lucky, we’re surrounded by people who love us, but the final trip is done solo. I’ve often wondered where the dying are during that in between time: when the body is still here but the soul (or whatever you want to call it) begins to fade away. I guess the answer depends on your own personal belief system.  I’ll spare you mine; it’s private and precious to me but also not the point of this blog post. This post is about feeling like an intruder.

So much of social work is about invading people’s personal space. We ask wildly personal questions of our clients: what kind of sex do you have, and with whom? How much money do you make? What religion do you practice? Where do you want to die? Imagine asking someone those questions in any other setting. I’m a real hit at cocktail parties, let me tell you.

And yet, this is the work: to build rapport and intimacy as quickly as possible so we can help people. It is a skill that we have to cultivate over time, acknowledging our own discomfort and moving through it. I sometimes feel like an intruder in hospice: when I walk into a home and someone is actively dying and I’ve never met the family before, for instance. Who am I, to invade this sacred space? People often come onto hospice very late in their illness—a topic for a whole different post, I can really rant about that one—so we don’t always have the time to provide the quality care that is the goal of hospice: the relationship building, the life review, the exploration of spiritual and existential distress. Often, I walk into a house and the patient is already halfway gone. The body is present but the person is not themselves, exactly. In those moments, I feel like an intruder, a voyeur. What can I do for someone who is mostly gone? What can I do for a family of strangers in their most intimate, private grief? Sometimes I have felt an urge to leave as quickly as possible, to spare everyone the awkwardness of my presence.

And yet, I have been invited to be present; that is the work I’ve agreed to do. That is what we have all agreed to do, as social workers: invite and share vulnerability, create intimacy and trust, sometimes over months and years and sometimes over just minutes. I can tell you that while I love having a patient for a long time—love hearing the stories and meeting all the family members—there is something special and sacred about holding space in the room for a stranger as they exit this mortal plane. I used to want to run out of the room, sure that I was already too late. Now I see the usefulness of my presence; I can be still and quiet and assure the family: you’re doing everything right. Thank you for letting me be here with you. It turns out I am not an intruder after all, but a source of comfort for the journey. Even if it’s only at the very end.

Image by Jose Pereira, Unsplash

White privilege, hospice, and a ton of unanswered questions

It doesn’t feel like the time for me to be talking; there are BIPOC voices that need to be elevated at this moment and I want to be someone who elevates those voices. That being said, it also feels important to interrogate the ways in which social workers work within a system of white supremacy. And it feels important to acknowledge how tricky it can be to balance the work of anti-racism and social justice while also building rapport and offering support to our clients with unconditional positive regard.

Easy stuff!

I’ve worked in hospice for six years in a city that is racially and ethnically diverse but also often clearly segregated. The neighborhoods I visit vary wildly, both socio-economically and racially. And the demographics have changed over the years, as all neighborhoods change. In fact, that’s the racism I encounter from my patients and their families. It’s not racial slurs or explicit hatred; that would maybe be easier to address. Instead, it’s the insidious, widespread, casual stuff. For instance, the white family who says, “We moved because the neighborhood started changing, you know.” The white patients and families I see feel safe using coded phrases like that because I’m also white. And in those moments, as an ally, as a social worker, as someone who wants to be Helpful and Brave, what am I supposed to do?

With a friend or a family member, perhaps I would be brave. Hopefully I would be brave and address those statements. But with a patient or their caregiver, I must confess: I am not brave. Instead, I am complicit. In six years I have not figured out how to manage the twin asks of doing my job and doing the bigger work of anti-racism. At best in those moments, I make my face go stone and change the subject. I don’t think that’s enough. But I honestly don’t know what else to do.

One of my supervisees and I spent a solid amount of time talking about this and we didn’t end up with the Big Answer. The closest I can get is that we have to work in the role we choose. Which is not to say there’s never an opportunity to push back in a therapeutic relationship. The questions are when and how to do it. As my supervisee wisely pointed out, is it fair or reasonable to ask a person to examine their racism and their prejudice as they are dying? Will it do any good? Further, do I do my Black patients a disservice by not acknowledging the racism they face in the healthcare system I represent? How do I start that conversation? And when? Will it be welcomed or will it also be considered harmful?

Lots of questions I don’t have any answers for. There’s more for me to learn, clearly: more reading to be done, more discussion with others, more self-reflection. One place I’ve started is with this Medium post by H. C. Dawes; I hope you’ll check it out: https://elemental.medium.com/an-invitation-to-white-therapists-a04cc93b1917

Thanks for reading.

Not a rupture, but a tear

Over the years, I have grown comfortable with what I can and cannot do for my patients. I think often of my early hospice career, when I once called my dad after leaving a visit, sobbing because my very young patient was going to die. (I’m sure I’ve written about this before but it has shaped my practice so much in the past six years, I feel compelled to mention it again). The short story is, I told my dad that I couldn’t do anything for her because I couldn’t stop her from dying. And my dad kindly reminded me that I could do something: I could be with her.

It’s a lesson I carry with me into the saddest cases as well as the most mundane days. It’s how I do my work without being drowned by the suffering of others. Also, it’s true! I can’t stop people from dying but I can bear witness and be still and that is mostly enough.

But then, there’s this patient.

I’ve been seeing this lady every two weeks since July. She and her family were told by the doctor, in July, that she had hours to days to live. Another wise thing my dad has told me my whole life is that doctors don’t know everything and they definitely cannot accurately predict when death will come. Here, case in point: she’s still alive in November. And she’s not exactly thrilled about it. I can’t blame her: she’s mostly confined to her bed, she barely eats, and she feels like a burden on her children. When I visit, we talk about those things, but also about her life and her accomplishments and her family. We have a good rapport and I think she enjoys my visits.

Last time I saw her, she was having a particularly bad day. I used all my active listening and therapeutic presence skills and I thought, when I left, that I had been at least a little helpful. When I called this week to schedule our normal visit, she declined. This happens, don’t get me wrong; sometimes people aren’t up for a visit, especially if it’s “just to talk.” But there’s a little nagging voice in my head that is telling me she said no because I can’t do anything for her.

This isn’t a therapeutic rupture exactly but it does feel like a little tear, or a crack maybe. And again, I may be projecting, but I heard in something in her voice when she said “not today.” I heard, “you can’t do anything for me, so why bother?” And that’s the part of the job that scratches away at my confidence and my resolve. I can’t change things for her. What I can offer, she doesn’t want right now.

It’s taking everything in me to type the following: THAT’S OKAY! It is okay that she declined one visit, one time. It’s okay that she’s depressed. It’s okay that I have no magic wand. (Maybe if I write these words enough, they’ll come true). It’s okay to not be all things to all people.

This is mostly my stuff because I’ve been having a hard time getting people to agree to visits, especially new patients. That’s a thing that happens in this job; after six years, you would think I could sit comfortably with it. But at this moment, I’m struggling with it. And honestly, that’s okay too. It’s not a rupture in my work, just a stumble. Carry on, my grandfather used to say, and so: I will.

Photo by Namnso Ukpanah on Unsplash

Who's in charge here?

I never know what I’m walking into when I have a new hospice admission. Likewise, my patients and their families don’t always understand why I’m there. The nurse and the home health aide, even the chaplain, have very clearly defined roles. When I tell people I just want to talk, it can make them nervous.

At that first visit, death doesn’t always come up in the conversation. It’s a delicate balance: building rapport and offering education and being present without pushing too hard on the door to deeper issues. However, sometimes the patient opens the door for me. Take, for instance, the other day: I visited with a new patient who almost immediately wanted to talk about her impending death. She wanted to know how much time she had left (can’t tell you, sorry); how involved she could be in her funeral planning (as involved as you want!); and how it was possible to feel physically ok and somehow still be dying (take that one as a gift, my friend). We had a difficult but very nice conversation and I think I was helpful.

The next day, the nurse called me to tell me that the patient’s sister didn’t want me to talk to the patient about end of life issues. (Imagine me rolling my eyes).

Luckily, the nurse is no shrinking violet; she informed the sister that the patient is alert and oriented times 72 and gets to be a part of her care planning. In fact, the regulations (if you, like me, are a rule-follower) insist upon the patient being involved in her own care.

But families don’t care about the regulations; they care about their loved ones not being sad, or scared, or “losing hope.” I can’t tell you how many times a (well-meaning) family member has said to me, “We don’t want him to know he’s on hospice” or “we didn’t tell her that she’s dying.” (Spoiler alert: people typically know that they’re dying). And truly, I get it: we don’t want the people we love to be afraid or feel sad or suffer. But, as I always remind those family members, we don’t get to make decisions for other people as long as they’re capable of making their own. We can be tactful; we can be kind. But I will not lie to a patient who asks me a direct question. I will not change the subject when a patient wants to talk about her death. It’s easier sometimes, as I tell my patients and their family members, to bear one’s soul to a stranger, if only because they don’t have to be careful. I won’t start crying or tell them it’s going to be ok; they don’t have to protect me the way they want to protect their loved ones.

In my most gracious moments, I can acknowledge that protection is what people like the afore-mentioned sister are after. In my more annoyed moments, I start crabbing about how it’s all about control and who wants it and who has it. Both can be true! What’s important is to focus, once again, on the person we are serving and to (kindly, firmly, lovingly) set boundaries with everyone else. Advocating for patient choice is foundational to this work; what a joy when it is so easily done.

Living in the village

The other day, I just about ran out of a joint visit. It was a tough one: the patient’s caregiver is struggling, to put it mildly. His anger is palpable. He is hyper-focused on a story he tells every time I see him, of how the hospital and the doctors wronged him and his partner, and how he will get revenge (his words). It is a difficult house to be in, so the nurse and I have made a couple of joint visits.

As a rule, I love joint visits. This work can be isolating and lonely and it’s helpful to have someone else with you sometimes, if only to cut your eyes at when the family leaves the room. I’ve been lucky over my career to work with a lot of wonderful nurses who relied on me for my expertise just as I relied on them for theirs. I think of hospice—of all interdisciplinary work, really—as a village. At its best, the team functions as a mini village where each person has their own role to fulfill: the nurse, medical care; the home health aide, physical care; the social worker, emotional care; the chaplain, spiritual care. Beautiful, right? Everyone has their own set of skills in the village, which complement each other and serve the patient.

There’s a balance to village life: just as I’m able to give to others, I have to do some taking, too. Obviously it’s not always an even split; that’s life. But with this co-worker of mine, the split is so off that something has to change. And I’m struggling with how to set a boundary without derailing a fairly new professional relationship. This visit may be the straw that is breaking my back.

I don’t want to go into too much detail, because the minutiae is not terribly important. The gist is, this co-worker attempted to do some psychosocial interventions in a clumsy, overbearing, awkward way, that only set the caregiver off (I told you he was angry, remember) and took the oxygen out of the room for a few minutes. It’s not her fault that she did the interventions poorly; she didn’t go to social work school. Just as I would never take someone’s blood pressure or tell them how much medication to take, another discipline can’t do social work.

Despite this very large misstep, she had a good rapport with the caregiver so the visit didn’t end in a yelling match. The visit was over shortly thereafter and even though I knew she wanted to debrief, I had to get out of there. I just about ran to my car, angry with her for disrespecting my skillset, frustrated with myself for not cutting the conversation off the moment it began, and overall feeling horrible, about that particular interaction and about how poorly I’d set boundaries with this co-worker.

Luckily, I have good supervision at this job so I called my supervisor for some validation and guidance. She gave me both and helped me find a way to set some solid limits. I want to be helpful; I want to be emotionally present for my colleagues. At the same time, I can’t be all things to all people. I love the village concept but as I said, there is a balance. I hope this co-worker and I have found the right balance so that we can move forward. This job is easier when you’ve got other people on your side.

A (small) ethical question

I’m in the midst of a lot of professional training, both for work and for my side hustle (“clinical supervision” doesn’t roll off the tongue as nicely “side hustle”). I love continuing education: I love being with other social workers; I love reading case studies; I love doing exercises about theoretical framework. (It turns out I kind of miss being in graduate school). Because clinical social workers are required to have ethics training every two years, a lot of my recent continuing ed programming has involved some ethics credits. We start, always, with the most egregious examples of social work ethical dilemmas: stealing from your workplace (BAD); falsifying documentation (PRETTY BAD); having sex with a client (SO VERY BAD). Those ethical questions have straightforward answers: don’t do that shit. It’s the grayer stuff that I like to turn over. And today I’d like to turn a personal one over with you.

Don’t freak out! I am not involved in any egregiously bad activities! It’s definitely one of the gray ones.

I have a patient I really like: she’s bright and funny and interesting. She has a fascinating career. I’m sure that if we met in a different setting, I would strive to be her friend. But we haven’t met in a different setting; I’m offering her counseling, not friendship. And sometimes I find myself forgetting that.

I write often about use of self and counter-transference but I don’t think I’ve yet touched on this: what happens when we really like our clients? Obviously we like most of them; social workers typically like people. I’m talking about the unique problem of liking a client personally, the way you would like a new friend for instance, and how to manage that.

In my current job, I’ve met almost 300 different patients. Of those, there are maybe 3 that I’ve bent the rules for: seen them for a whole hour instead of the usual 30 minutes, provided a few more personal details than I normally do with my patients. See? Nothing egregious. But definitely gray.

I had a colleague once who told me, when I worked in hospice, that if you get attached to one out of every one hundred patients, you’re ok. Any more than that and you should take a good hard look at your practice. I’ve passed that advice along a dozen times, at least; it makes sense to me. I’m not causing any harm here, to my patients or to myself. I won’t overstep any boundaries: we won’t meet for coffee or see each other outside of this professional setting. But I do want to pause and consider what it means that these people get a little more from me than my other patients get. Being mindful of how much of ourselves we give is one of my favorite ethical questions. Do I give less to the patients that make my skin crawl? Do I give more to the ones that are pleasant and friendly? Do I give too much or too little based on my own feelings? And, ethically speaking, is it ok if there are (small) differences in the care I provide?

The cool and also deeply frustrating thing about ethics is that there are often no clear answers; there are multiple scenarios and variables to walk through. In this case, I lean towards the side of giving myself permission to be a human person who sometimes gives a little less or a little more, depending on the circumstance. Of course I’ll always examine my practice and look closely for signs of trouble. But I also want to allow myself that one in a hundred; it’s part of what makes the work worth doing.

Photo by Dil on Unsplash

Compassion Satisfaction

I’ve started—and subsequently wandered away from—a handful of blogs about secondary trauma and compassion fatigue. I’ve managed to write about the beginnings of burnout and a lot about self-care and self-reflection. But I was having trouble writing about the intense issues of compassion fatigue and vicarious trauma. Let’s face it, these aren’t the cheeriest of topics. But last week I was fortunate to attend a continuing education program that inspired me to finally finish a post about the emotional risks we face as social workers and how to manage those risks.

The event was offered by my hospital for social work month. We watched a deeply moving video about ow to heal caregivers. First responders, firefighters, police officers, nurses, and, of course, social workers spoke about their experiences with secondary trauma. I cried a couple of times, feeling the pain of strangers who joined a helping profession to help and found themselves mired in suffering. They talked about how their bodies reacted to stress over time or how they found themselves unable to sleep. Each of them showed an enormous amount of vulnerability as they shared some of the low points of their careers.

It was riveting. And it also showed me some beautiful interventions for combatting vicarious trauma. What follows are some takeaways from the video that have really changed my perspective; I hope you have a similar reaction.

• Do you have a safety plan for burnout? We use safety plans for our patients all the time: for those who live with abusive partners or those suffering from suicidal thoughts. It never occurred to me that as helpers, as witnesses to that kind of intense suffering, we too could benefit from a safety plan. It doesn’t have to be dramatic: my go-tos have always been long lunches and journaling. The occasional root beer float has also greatly helped me on the hardest days.

• Do you honor your grief? The program’s facilitator pointed out that secondary trauma and compassion fatigue are often grief. We use ourselves in our practice: we open our hearts and humanity to others and share their pain. It only makes sense that over time, the grief begins to pile up. As helpers, we need to honor our losses. I can tell you the names of patients I loved, who touched my heart and changed me; I honor those relationships by holding their memories close, by telling stories about them and smiling.

• Do you celebrate your successes? My favorite part of the program was hearing the phrase “compassion satisfaction.” Of course there is fatigue in caring for others, but we are also drawn to this work for a reason. As social workers, we are trained to constantly reflect on ourselves and our work but I think we tend to reflect on our challenges and our failures. Instead, the facilitator of this presentation encouraged us to focus on our successes. I challenge you to do the same: what have you done well? What joy did you get to take from your work?

I love being a social worker. It is one of the great pleasures of my life to do this work. As we end social work month, I hope you feel honored by your co-workers and by our profession. Share your joy; we are helpers and healers and we deserve to be recognized for our good and useful work.

Stuck in the weeds

There is not enough money in the world for me to ever consider doing couples therapy. Honestly, I’ve always felt that way; I know what’s in my comfort zone and what’s not. The reason I bring it up today though, is because I found myself thrust into that role and it. Was. Tough.

I’m not in love with my current job but there are perks. For one, it’s short-term so even if the patient I’m seeing is incredibly difficult, I have a nice out: we only have to see each other a handful of times and then either we’re done or I’m referring out to a community therapist. Another perk is that although the majority of my referrals are people with anxiety and/or depression, I encounter a variety of situations. I’ve seen someone with a bridge phobia; recently met a woman struggling with her fiance’s infidelity; and have provided education about a possible Bipolar II diagnosis (a few times, actually). For all my complaints about this job, it’s been a good opportunity to enhance and vary my skill set. Hospice had its variations, of course, but I was there for five years and I was pretty comfortable with my role. This job has a whole other set of challenges and even a year and a half in, I’m still facing new and tricky situations.

Like yesterday, for instance! A woman called to schedule an appointment for her partner (which always puts me on guard because how motivated are you if you aren’t even making your own appointment?) and then they all showed up together: the patient, the partner, and their small child. Which is fine, in theory; a lot of people prefer their loved ones to be with them at doctor’s appointments. But about fifteen minutes in, it became clear to me that my patient and his partner need some serious marital counseling that I cannot provide. First, because my role doesn’t allow for it. Second, it’s very much out of my scope of practice. And third—probably most importantly—the counter-transference was suffocating.

Photo by Hutomo Abrianto on Unsplash

This is not to say that my marriage is in shambles and I didn’t realize until this session; it wasn’t that Freudian. It was more that in my heart, one person was SO wrong and the other was SO right and it made me feel sort of thought-blocked. Like, I knew I couldn’t say that out loud but I also was really having trouble navigating my own feelings. I spent a lot of time saying, “It sounds like you’re saying X and you’re saying Y, and you’re not really in agreement about the basic facts.” It was not my most insightful work, friends. But afterwards, as I’m processing and debriefing and writing this all out, I’m not sure there was anything more I could or should have done.

This many years into my career, I’m comfortable telling people I don’t know the answer. But every so often, a session gets a little bit away from me and before I know it, I’m trying to navigate a situation I don’t really have a handle on. In those sessions, I have to get back to basics: here’s what I can do, here’s what someone else may be able to do, what do you want to do? I’m left with another good reminder to be mindful of what the goal of the work is: to help, whenever and however we can, and to know when we can’t.

The gift of the work

I started off my day already over it. Yesterday only one of my five scheduled patients bothered to show up. This day was starting with a patient I had seen a year ago who told me the exact same story she was telling the first time we met. This was followed by another no-show and yet another frequent flyer patient who never wants to do anything to change. Overall, I was ready to leave the building.

My last scheduled appointment was a lady who didn’t really want to see me. Her son had cajoled her into coming and she went along with it because she’s a mother and sometimes we do things we don’t want to do. Granted, this woman’s son is in his 60s but still: you never stop being a mom. And your kids never stop wanting you to be well.

Still. This lady wanted no part of it. And I really couldn’t blame her. She’s depressed because she’s basically just waiting to die. She’s had a lot of loss, more than her fair share, as she says. And for awhile we just sat there staring at each other because she didn’t know what I could do for her. “Nothing’s going to change,” she kept saying. “What’s the point of talking about it?”

I was mentally cursing her son for not hearing his mother clearly say she didn’t want to come when suddenly something did change: she started to talk. We talked about what it means to get older, how much loss there is and how lonely it is. She talked about how even in her depression, she’s content with her life. She talked about the child and husband she’s had to bury and how she’s kept those losses tucked away in a little box that she hides from the outside world because she doesn’t want to disturb them. Then she talked about climbing trees when she was a little girl. She smiled. I did too. She said she’d think about coming back.

The rest of the day shifted in my mind. It’s been a long week and I was feeling useless and out of my depth and frustrated. I could hear myself being impatient with my other patients, wanting to rush them out of the office because I didn’t know what they wanted from me. I know what burnout looks like and I could see myself gliding towards the flames. This lovely lady brought me back, just by opening up a little bit and allowing me to listen.

Now I’m not saying that we should rely on our patients to keep us engaged and upbeat about our work. But I also can’t deny that success with one patient at the right time can make a world of difference. It is, I think, what keeps us in the work: watching people be helped, even just for a moment, and knowing that we are the helpers.

I’m also not denying that I’m nearing a burnout point; it’s time for a vacation, clearly. But I am relieved to know that I haven’t completely checked out. This is another gift of this work: the reminders that come from the grace of others, in letting us bear witness to their pain, even though we don’t have any magic answers. How lucky for me that this lady came along today, to remind me.

Photo by Leone Venter on Unsplash