Detachment

Last January I wrote about boundaries.  I think the sister to boundaries is detachment.  Healthy emotional detachment allows a social worker to engage empathetically and authentically with a client while not being overwhelmed by their emotional state. It also allows the client to be distinctly in relationship with you while giving them the dignity and respect to be their own person. It is critical to good work and yet perhaps harder for a social worker than you might expect.  Let’s talk about why detachment is a challenge and what you should stay aware of.

1.  Social workers are good at hard conversations

Social workers may be particularly prone to struggling with detachment.  Social workers have hard conversations every day.  We examine emotions, we reflect, we are insight oriented.  We are also surrounded by peers who are good at having hard conversations.  When you ask us how we are doing, we don’t say fine.  We tell you.  We aren’t shocked.  We aren’t uncomfortable.  We don’t pretend everything is okay.  My colleagues can take one look at me, call me out, and an hour later we have processed.  I happen to think this makes us wonderful, insightful people.  It can also distort our expectations of others.  Most of the people we work with have not had the same experiences with difficult conversations as we have.  Both their skill level at dealing with emotional content and their comfort level will likely be less than ours. Detachment allows us to accept where our client is at, to accurately assess the pace of introspection, and to allow the time necessary for the client to gain the skills they need to build emotional intelligence.

2.  You care

This may seem simple, but you became a social worker because you care.  You genuinely want to see people achieve their goals and do well.  Your passion and love for others can make detachment difficult.  Progress takes time and it doesn’t go in a straight line.  You will watch clients sabotage their happiness.  You will watch them withdraw and isolate.  You will watch them return to hurtful situations and continue to do things that don’t work.  This is okay.  This is part of the process.  In order for you to allow them to be human and allow the process to work, you will have to detach.  It’s not your journey.  It is theirs.  Watching someone suffer hurts, but your job is often to sit with them during the suffering, not to fix it.

3.  You’ve overcome obstacles

This is a big one.  Social workers are advocates, we are social justice warriors, we are change makers.  We are risk takers.  If you are like the social workers I know, you have a story, and it is a good one.  You have overcome obstacles to get where you are.  That is what we do with clients and that is often what we have done for ourselves.  You have taken a struggle and turned it into a triumph. So you know it can be done.  You know how it feels to be empowered, to reach a goal, to not survive but to thrive.  And you want that for everyone else.  You are likely a doer.  You see a challenge and you conquer it.  It is part of your resilience and part of your gift.

4.  You’ve seen miracles

I have been asked many times about how I can work in a career where I see so much human suffering.  That is true, social workers see pain.  We also see miracles.  Every day we get to see the impossible become possible.  We know nothing is impossible, because we have seen it.  We want that miracle for our clients.  It can be hard for us when people limit themselves because we know there aren’t really limits.  We know you can do anything and we really want you to know that to.   

These are all beautiful traits, but you can’t walk someone’s journey for them.  And…you shouldn’t.  When you fail to have healthy detachment with a client (or anyone for that matter) here is what happens.  If they achieve their goal, it won’t be theirs.  They will credit you and they will lose gifts that come with doing hard stuff.  If they don’t achieve their goal, they are likely to feel both shame and judgement.  Why aren’t they good enough?  Why can’t they make a decision when the answer seems so obvious?  Why did they backslide?  What is wrong with them?  We all know that intellectual knowledge doesn’t directly relate to behavior change.  Client’s often know intellectually what is working and not working about their behavior, but they just can’t do it differently YET….that is so okay.  That has to be okay in order for them to have a healthy relationship with you.  And the trick is that can only be okay if you are able to have healthy emotional detachment.  Detachment is part of love.  It is about loving someone exactly where they are and allowing them the dignity to own their journey. You are merely a guide.  Detachment allows you to be patient and respectful while honoring someone’s journey. 

The Next Right Thing: Self-Care is an Inside Job

The Next Right Thing: Self-Care is an Inside Job: So three things happened in the last months.   First, a colleague made a comment about how much they loved my blog (mental reaction:   What...

Self-Care is an Inside Job

So three things happened in the last month.  First, a colleague made a comment about how much they loved my blog (mental reaction:  What?  Someone actually reads that?).  Second, a friend told me I was the most positive and optimistic person they know (mental reaction:  Me?  Wow, that’s cool!). Third, on a particularly stressful day a mentor checked in on my self-care.  On this third one I responded by quickly going through my check list (Physical, spiritual, emotionally, intellectual).  They all checked off.  Daily workouts and nutrition – Check!  Daily prayer, reading, and meditation – Check! Plenty of processing with supportive friends –check, check!  And intellectual, well my month has been full of hanging out with brilliant colleagues and students so again –check. 

Here is the thing about self-care.  We often teach it as a check list.  It boils down to take care of yourself, and make sure your needs get met.  This is true but the external acts we take are really a means to an end.  Sure there are benefits to staying healthy and they certainly are an important part of self-care, but the truth is the most important part of self-care is a mind-set.  It is the difference between happiness and joy.  Happiness is situational.  It is fleeting.  We are happy when life goes our way.  Joy on the other hand is constant.  Joy is related to peace and serenity.  It is a spiritual understanding that in both times of tribulation and times of triumph there is a constant in knowing that you can rest in the assurance that in the end all will be alright. 

That sense of joy, that view of the world is what allows me as a social worker and an educator to walk with people in their vulnerability.  People are people.  They are by definition imperfect.  They will stumble and fall and they will rise and overcome.  As a social worker you will see their fear, their weakness, and their shame.  Working effectively with people (and living with them) is like differentiating between happiness and joy.  You must love them and believe in them in a constant way.  You must know without a doubt that whether at the bottom of a valley or the top of a mountain their value doesn't change.  Their value is constant and whether they know it or not irreplaceable.  The world needs them. 

Self-care as a social worker is more than whether or not you did that run.  It is about protecting your joy and your belief in the “inherent dignity and worth of the person (NASW Code of Ethics)”.  Be mindful to protect this, because the world can never be what we have given up hope on.

                                                                                                                    

My hope as an educator is that we will model and teach our students about the very real and complex work involved in maintaining self-care from the inside.  That we will teach students to articulate who they are well, so that when the world is filled with negatitivity they will guard their joy and love for people. 

 https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English

Boundaries

2016 was a year of redefining boundaries for me.  In truth we constantly redefine boundaries.  Sometimes we do it well and sometimes we struggle, but even not doing it is doing it, so saying 2016 was the year of boundaries is saying something.  Setting boundaries in 2016 was like getting a black belt in boundaries and felt a little bit like being hit by a Mack truck.  Sometimes growth comes in slow and steady progressions and sometimes it comes in giant moments of clarity.  2016 was one of those giant moments of clarity.

Although plenty is written about boundaries and in some ways this feels like a basic concept for social work,  as I reflected on this years growth and took my lessons into my mentoring of social workers, I realized we don't talk about it nearly enough.  It might be simple but it isn't easy and as this year proved, it isn't something we just master and move on.  Setting boundaries is a skill we continue to refine as we grow as humans and as social workers.  The ability to understand, set, and negotiate boundaries is critical to social work practice.

Boundaries are a way that we do the most critical and complex thing I call social workers to do.  I talk to the social workers I mentor about how to "be with" the client.  This is the illustration I use.  "When someone is drowning I want you to be in the water with them.  I want you to be fully with them while being separate enough that you don't get pulled under with them and drown.  You cannot guide someone in the healing process while staying on the shore.  You also cannot guide someone if you allow them to wrap themselves around you and take you under water."  This illustration comes from a very real experience that happened when I was a child.  I was drowning in a river.  My mother instinctively jumped in and in her panic proceeded to try to drag me upstream.  We both were drowning.  A family friend jump in and pushed us to shore.  The friend was fully invested in our well being yet separate enough to be able to do what was needed.  Good social work means being fully present while being fully separate.  It is an art and it isn't easy.  It has everything to do with boundaries.

Boundaries tell you where you end and another begin.  They define your turf.  Emotionally, spiritually, physically..what is yours, mine and ours?  It is a way that you honor both yourself and others in your world.  They allow you and others to speak your truth and to be treated with dignity and respect.

Setting boundaries requires direct and honest communication.  It means that you are taking responsibility for your own needs.  In order to set boundaries you must feel worthy of respect and dignity and you must release shame.  You must also be able to tolerate discomfort.  When you set a boundary it is about defining what is and what is not acceptable in your world.  It dictates your behavior, not the other persons.  Setting a boundary means I will do what is right for me, whether you cooperate or not.  To set a boundary, I must let go of the outcome.  I will speak my truth, what you do with it is up to you.  The important thing is that I spoke it.

Boundaries also require flexibility.  Some violations may require instant "stop signs" to go up, while others allow for graduated responses.  The truth is many behavior patterns are ingrained and  may take practice and repetition to change.  And many boundaries require negotiation, a give and take between two people.  In order to participate in this negotiation without being lost, we must have a clear grounding in where we end and the other begins.  We must also have a clear understanding of what we find acceptable and unacceptable.

Finally, boundaries must be enforced.  If you set a boundary, keep it.  Remember good old systems theory.  All components of a system strive for equilibrium.  When equilibrium is disrupted the system attempts to correct.  When you redefine a boundary you disrupt the equilibrium of the system.  Just because you change, does not means that others in the system are ready to change.  This is a fancy way of saying, when you redefine boundaries expect that you might feel like you were hit by a Mack truck.  When you set a boundary it may be respected but it may also face resistance.  An attempt to get things back to "normal".  And if pushing on your boundary works, well people are smart creatures, we will do what works. 

All of these concepts are critical to a therapeutic relationship.  This isn't because we talk and teach about boundaries.  Yes we do that and yes that is important, but in the therapeutic alliance we have with clients we also model it.  Here is a simple example I used with the social workers I mentor.  When you are scheduled to meet with a client for 50 minutes and instead you meet with them for 80 minutes, what messages do you send them?  Do you believe that they are competent and capable of holding their feelings between sessions?  Do you have faith in them and their ability to handle life?  Many clients are currently maneuvering some sort of life disruption.  By setting structure and routine in the session, you are modeling this for their life.  When they see you set boundaries they are empowered to practice this as well.  The therapeutic environment is intended to be a safe place for them to learn to both set and respect boundaries.  Boundaries are a critical component of creating a safe environment.

So bumps, bruises, and growing pains... I am very grateful for 2016 and the growth spurt that allows me to be a better social worker, mentor, supervisor, colleague, friend, mother...

So ouch and thank you..

Tis the Season...

By many accounts I am a super fan of Christmas.  I love everything about the season.  I celebrate all the way down to the matching pajamas, dogs included.  As we began approaching Thanksgiving, I gave the social workers I work with their annual talk.  I reminded them that the holidays are a time of struggle and grief for many and that this can include ourselves and our clients.  Below are two of my key holiday reminders.

1.  Remember self-care.  You will be extra busy.  You will also have your own grief and losses that surface.  This is a time to put self-care first.  As your clients present with increased need and your workplace becomes increasingly stressed, you need to maintain your inner serenity.  So despite the social engagements mounting and the to do list tripling, do not cut your self-care routine.  You need it now more than ever.

2.  Remember that your clients may be struggling to maintain their balance.  The added obligations that occur during the holiday season can make it hard for clients to keep their appointments. Add to that school breaks, emotional stress, and family stress, and you can anticipate that when the need is the highest they may struggle to engage you.  Give them frequent reminders, be a good role model (number 1), and remind them that in order to take care of others they must be healthy.  Most importantly remind them to give themselves grace.  The holidays can be hard.  They also won't last forever.

Returning from Thanksgiving, I began the annual routine of filling every room with a Christmas tree, hanging stockings, setting out nativities, and essentially transforming my space into a winter wonderland.  As I began this process that I  love so much I also meditated on the importance of tradition, remembrance, and expectations.  The holidays can be a painful time for those who have experienced a loss.  Some of the points below may help.

1.  Remember you don't have to be happy over the holidays.  In fact, you should feel exactly as you do.  You should also remember that you aren't alone, there are others that feel as you do.  Whatever you do, don't "should yourself".

2.  The holidays are not forever.  Whether you are having the best time of your life or feel at your lowest low, this too shall pass.

3.  Drop your expectations.  Each Christmas will be special in it's own way.  No Christmas will be exactly as you pictured it.

4.  Traditions can be helpful to processing grief and loss.  As I hang stockings, I recall memories of my grandmother who is now passed and lovingly made them each by hand.  As I hang ornaments, I share memories with my children.  Some ornaments remind me of people I miss, some of Christmas' that were painful, some make us laugh, and some make us cry.  As we decorate, we also take in our collective history.  We share it, each supporting each other.

5.  #4 above is beautiful and it works for me, BUT don't forget that traditions were made to be broken.  You may find that your previous traditions don't work for you.  The only thing guaranteed by a choice is the opportunity to make a new one.  So if something isn't working for you, change it.

6.  It is often helpful to remember people.  Perhaps you will make a dish that reminds you of someone who is no longer with you, play their favorite game, or share stories about them.  All of these are helpful and healing.  It is also important to remember that the holidays can be overwhelming.  Avoid isolating, but also build in some time to decompress.

What you Don't Say Speaks Volumes: Spirituality in Social Work

As many of you know, I am not an expert in spirituality.  Maybe it is because I am not an expert that I clearly see the need to write this, because it is not facts or answers that we need but questions and discussions.  It seems that openness and inquisitiveness may be what is called for.

I was meeting with a group of Social Workers recently and I had an interesting experience that stuck with me.  We were processing several difficult topics including, sexual trauma, abuse, and addictions.  We discussed these topics clearly, comfortably, and professionally.  Then something happened that I just couldn’t forget.  A Social Worker leaned forward in her chair, dropped her voice, apologized and asked permission to discuss spirituality as it related to how she viewed her work with clients.

This struck me, hard.  As Social Workers we have difficult conversations all the time.  We had just finished having many of them.  The truth is, having difficult conversations is part of the job description for a Social Worker.  If we won’t have the hard conversations then who will? I found it unsettling that the one topic that was too hard to discuss was spirituality. 

In my experience as a Social Worker, teacher, therapist, and clinical supervisor I have found that many Social Workers shy away from examining the role of spirituality in their own lives and practice as well as in their dialogue with their clients.  They are not provided training or guidance in how to do this and they are afraid that they will do it wrong.  They fear offending or alienating a colleague or client, so they hide behind professionalism.  They choose what is safe. 

So following a whispered conversation about spirituality in Social Work, I asked myself what my role was.  What example will I set for my students?  What does it mean to teach Social Work at a religious institution?  How will I prepare students to work with clients and will it involve spirituality?  Who will teach them to ask questions about their own spiritual journey and how it intersects with their practice?  If we are unable to embrace the conversation how will we authentically encourage our clients to share their spiritual journey with us?  Won’t they know by our silence that this part of them doesn’t belong in the conversation?  What are we losing by being quiet?

The reality is that spirituality matters to many of our clients and not being able to talk to them about something important to them limits our work with them.  Research supports this.  Ninety percent of the world recognizes some type of spiritual practice (World Christian Database, 2001).  A large database of research also supports that spirituality is important to mental health (D’Souza, 2002; Konig, 1998; Teppers, Roger, & Coleman, 2001; Russinova, Wewiorski, & Cash, 2002; Zaza, Sellick, & Hillier, 2005).  Clients use it to cope, and identify it as something that sustains them (Konig, 1998).  Religious and spiritual practices reduce isolation and loneliness and support a sense of mean and purpose (Verghese, 2008).

My own work with complex trauma, attachment, and relational disruption also supports this.  When early caregivers are attentive, nurturing and secure; children learn that people can be trusted.  On the contrary when children experience abuse, abandonment, and relational disruption they learn that people cannot be trusted and are not stable.  I have found it impossible and inauthentic to fully restore trust in a child or adult that has experienced this loss.  When you explain to a young adult who was abandoned by their parents that they can count on people; you are telling them something that is fundamentally untrue.  They know in their very core that if their mother and father can leave them that anyone can.  So, how do you encourage them to risk attachment and connection despite the very real possibility that people may disappoint them?  The only way I have seen this occur is when an individual is able to rely on something consistent and steady.  They are able to use their spirituality to identify something larger than themselves that can be a stabilizing force.  The security of this unwavering “being” allows them to take the risks necessary for relationships and connection and allows them to weather the disappointments of human relationships. 

Like I said, I am not an expert in spirituality or a religious scholar.  I don’t have answers. I have questions.  Maybe it is not answers we need but questions?  So I hope that you will examine your work closely.  That you will pay attention to not only what you are saying when working with clients, but also what you are not saying.  I hope that you will embrace a bio-psycho-social-spiritual framework.  When you are doing an assessment I hope that you will not simply check a box on your clients’ religious identification but that you will explore what a higher power means (and doesn’t mean) to them. That you will give them room to share a personal narrative of spirituality, both what it is and what it isn’t to them.  Remember the power of the unspoken dialogue and remember that you are a Social Worker.  If you don’t embrace the uncomfortable conversations, who will?

D’Souza R. Do patients expect psychiatrists to be interested in spiritual issues?  Australasian Psychiatry 2002; 10:44-47

Koenig HG.  Religious beliefs and practices of hospitalized medically ill older adults. Int’l J Geriatr Psychiatry 1998; 13:213-224.

Russinova Z, Wewiorski NJ, Cash D. Use of alternative health care practices by persons with serious mental illness: Perceived benefits. Am J Pub Health 2002; 92: 1600-1603

Tepper L. Rogers SA. Coleman EM, et al. The prevalence of religious coping among persons with persistent mental illness. Psychiatric Services 2001; 52:660-665

Verghese, A. (2008). Spirituality and mental health. Indian Journal of Psychiatry, 50(4), 233–237. doi:10.4103/0019-5545.44742

World Christian Database.  Atheists/Nonreligious by Country. World Christian Trends, Barrett and Johnson (William Carey Library 2001), updated February 2007.  See website: http://worldchristiandatabase.org/wcd/ http://worldchristiandatabase.org/wcd/

Zaza C, Sellick SM, Hillier LM. Coping with cancer: What do patients do? J Psychosoc Oncol 2005; 23:55-73

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