Doing Social Work

[doingsocialwork]

Can therapists cry?

I’ve been thinking a lot this week about managing affect in session. (That is, my own affect, not the client’s.) I have some who remain coolly detached from their emotions, others who can show every emotion on their faces and cry openly throughout. Both are ok, both are normal and understandable and where they are at this moment in recovery. 

But what happens when I’m sitting with someone, hearing stories of unfathomable pain and brutality, and my natural human instinct kicks in? I found myself fighting back tears in one session as a client recounted her childhood of constant physical, verbal, and emotional abuse. I felt my throat tighten and the tears pool in my eyes. I didn’t cry, but I know she heard my voice crack slightly the next time I spoke. 

I don’t just detach from this content. At least at this point in my career, I can’t. And I’m not sure I want to. I’m not sure what that ability would mean. 

My mentors and peers have shared similar stories, and some have cried outright in session. The reason I’ve been fighting that- because most of the time, I really do want to cry- is because I don’t want to shift the dynamic. I don’t want the client, who is with me to do the incredibly difficult work of telling her story in the hope of reclaiming or re-assembling certain aspects of her life, to feel the need to comfort or reassure me. 

However, I do believe that being a non-reactive blank slate is equally useless. It’s important to me to show that I am moved and affected by my clients’ stories, while always making sure the focus stays on them. 

[doingsocialwork]

Sometimes, a hug is just a hug

We spent a great deal of time in seminar today discussing touch, when (if ever) it is appropriate to touch clients, and other ways to make them feel “held” without physically touching them. The general consensus was that it should be avoided.

To me, this seems like an awfully white, Western, formal medical perspective. I think we need to trust our clients to demonstrate what they want and be open to the idea that a hug does not necessarily mean boundary violation or unhealthy transference.

Our attitudes toward touch are so culturally bound, and so incredibly dependent on where we grew up and who we were born to. In Bangladesh, my American friend marveled at the men who walked in public holding hands with their platonic friends. In France, one kisses people on the cheeks the way Americans would shake hands. In some cultures, it’s not polite to make direct eye contact. And so on. 

I trust clients to make their boundaries and needs clear, and I trust myself and my therapist colleagues to be able to pick up on subtleties and meanings. I would never be the one to initiate touch with a trauma survivor, for example. But if a client wants to greet me with a hug or a touch on the shoulder or arm as a way of formally beginning a session, or hug as a way of closing a session, and there’s nothing about that which might be harmful or connected to a problematic ulterior motive, and it’s not for my own personal gratification, who am I to say no? When I terminated with my caseload of adolescents last year, each one of them automatically reached out for a hug. When I went into some of their homes to thank families and provide future treatment recommendations, I was embraced by caregivers. 

I want to work in a way that says this is ok. Especially if the client is from a culture that normalizes and values more intimate touch than we are used to here. Sometimes, it’s just a way of saying “hello. I’m here. Let’s begin. I’m happy to be working together.” 

[doingsocialwork]

On liberation psychology/psciologia de la liberacion

One of the modes of therapeutic thinking I am most drawn to is the liberation approach. In essence, liberation psychology seeks to actively understand the psychology of oppressed and impoverished individuals within the context of their cultures and communities, first by naming and then by addressing the oppressive sociopolitical structures which marginalize and traumatize them. 

This perspective was first formalized in the 1970s by Latin American psychologists and educators, Ignacio Martín-Baró chief among them. Influences include Jesuit liberation theology and Paulo Freire’s concept of concientización.

The point is, a person’s context matters. And “traditional” or “classic” modes of psychotherapy tend to understand mental illness or psychological distress as located within the individual, a personal pathology. Liberation psychology believes that psychological distress must be contextualized in the oppressive environment, or legacy of oppression carried in the individual’s DNA and communal memory.

It opens a whole new world of how one practices and experiences therapy. If the clinical encounter can be a space in which the client is the teacher and the therapist is the student, and where speaking the truth of one’s story, one’s community, and one’s ancestors can lead to the creation of a new consciousness, then our field’s opportunities to do good, healing work are limitless.

Slavery. Anti-Blackness. Colonialism. Genocide. Exploitation. Economic imperialism. Xenophobia... These broad, painful social legacies cannot be erased from an individual, a family, or a community.

The challenge for me is, working within a very “traditional” white-dominant/supremacist, hetero/cisnormative, Euro/Western, secular medical institution, how do I make this framework standard practice while still adhering to the norms and regulations of my position? I have so much more to learn as I form my own practice and my own therapeutic style. 

[doingsocialwork]

Motivation

We’ve all had those jobs: the all-day cubicle, the headache-inducing computer monitor, the thankless customer service. These are honorable and important ways of working, but sometimes, in these positions, it’s hard to step out of yourself on those blue and gloomy days and find the motivation to work well. 

For me (and I’ve had those jobs, including telemarketer), social work is different. The motivation is built in. Even when the work involves hearing stories of loss, betrayal, illness, and unspeakable pain. Perhaps especially then.

Because when I go in to work, I have the privilege of sitting with another person. I get to listen, and share, and reflect, and contain. I get to engage in a way that might make their week, or just their afternoon, a little better, or a little more manageable. 

This built-in motivation is a powerful force; even when I’ve felt depressed, under the weather, and tired, all of that gets magically left behind. Nothing could drag me out of bed on a pitch-black below-zero winter morning, except the thought of the clients I’d be meeting that day, and what they might want to discuss.

This thought provides immediate clarity and cuts through all the self-pity, the tendency to procrastinate, the desire to stay home and do nothing.

It may be my greatest professional asset. 

[doingsocialwork]

25%

Ruling in Compton Schools Case: Trauma Could Cause Disability

This is great news. For anyone who works with children or adolescents with trauma histories, this is old hat. Trauma literally changes the brain. It impairs one’s ability to concentrate, make decisions, and even adhere to simple behavioural norms such as “holding still.” It does cause a disability and deserves to be understood, worked with, and accommodated. 

I’ll tell you right now, my career goal is to develop and implement a curriculum called “The Trauma-Informed School,” with training and interventions for every level of the school ecosystem. I’d start with one school, then the entire district, then it would sweep the nation. Pipe dream? Perhaps. I know there’s a school in Walla Walla already doing it and seeing incredible results.

[doingsocialwork]

“close of a long day” (Beckett)

I signed up to present a case to twenty colleagues at a psychiatry department case conference. In two weeks. 

WHAT AM I DOING

Quick idea that I want to write about in greater detail someday:

Being a therapist is like being an improv comedian.

I should search the databases to see how many articles have been written about using skills of improvisational acting and comedy in social work. You’ve got to be really agile in the brain to be able to respond to some of the things clients come up with. 

[doingsocialwork]

Introductions.

Me: A 27-year-old 2nd-year MSW student and clinical social work trainee graduating this May. Convinced that social work is the best profession and that enrolling in social work school was the best decision I ever made.

My placement: On a multidisciplinary treatment team in an outpatient psychiatry department of an urban hospital system in the Northeast.

I dig: Trauma-informed and trauma-sensitive care, narrative therapies, believing that psychodynamic theories are fluid and flexible, Critical Race Theory, intersectionality, understanding systems, mindfulness.

What it’s like: Four days a week of seminars, case presentations, grand rounds, supervisions, and best of all, sitting with clients. Four classes a week at social work school. Sleepless nights, rattled days, constant intellectual and emotional stimulation. Constant awe and gratitude throughout. 

What I will be posting: Reflections on all of the above and much more. The goal is to give readers a taste of what goes through the mind of a young, zealous social work trainee and student, and what life is like in the field.