Figuring Out What to Say

A lot of people ask me if my job as a social worker and therapist is hard. They assume I am depressed by the end of the day or am slowly developing a jaded outlook on humanity. They also try and convince me that people never change or want me to tell them stories that prove how degenerate my clients really are.

But in reality, that is not the hardest part. Sure, there are times I come home overwhelmed. When that happens, I vent to my husband, look for empathy in my teammates, or have a totally mindless night (complete with TV and ice cream). Of course I have stories that shock and I've met people I have little hope for. But those things haven't yet phased me.

What gets hard, though, is being a therapist, having aspirations of being a really good one, and wondering if I'll ever be good at my job. In other words, I worry I really suck. As you can guess from the title of this post, I often have a hard time figuring out what to say. For instance, I was talking on the phone this evening to a dad whose son just tested positive for THC. The son is on intensive supervised probation and has some serious consequences (ie Department of Youth Corrections, ie 1-2 years) that become very likely when mess-ups like these happen. Since my job is to help the youth stay in the home by improving family dynamics, I wanted to approach dad with the perspective of 'your son obviously has an addiction, he can't do this on his own, the situation is dire, he needs you...teenagers try to get away with as much as possible...you might be in a position to monitor him a little more closer and prevent another relapse'

But, of course, the conversation didn't go that way. Dad says, "Good, I hope he goes to jail. When he was in jail last time, I slept much easier. I've been so on edge lately, maybe this will help. Everyone should experience jail. He's almost a man. There's nothing I can do."

Well shoot! I got all tongue tied, as I do whenever I have to rebound after my approach is denied. I also get stuck in my client's problems, which, as my supervisor pointed out, is a terrible place for a therapist. I fumbled through the rest of the conversation, tried to not free dad from responsibility like he was wanting. But this dad had already sad it, ranted on about it, and I wasn't confident that I could change his mind. Maybe I am just too sympathetic. "Yeah", I think to myself, "with a kid that has put you through as much stress as you've been through, you actually might sleep better at night if he was in jail. Maybe jail is really what he needs'

A good therapist is on her feet. She can pull out powerful questions at the right time. In hindsight, those powerful questions might have been something like, "How do you think that makes your son feel to hear you say that you want him to go to jail?" or "You're right, your son is practically a man and yet it sounds like you agree that he isn't making very mature decisions. How can you show him how to be a man? He obviously isn't able to do it on his own quite yet" or...actually...I don't know. I still feel tongue tied. Because at the same time, maybe this dad is past helping his son. If so, I can't expect to change that and feel presumptuous making the assumption that this dad should want to be more involved in his son's life.

And I think that's part of the issue--it is hard for me, in the moment, to 1.) trust my instincts 2.) feel confident enough to assert my professional opinion 3.) assess what the clients are actually bringing to the table 4.) know when it is ok to change directions or keep the conversation focused, no matter how badly the client is trying to steer it in a different direction. Yikes.

I need to learn distance, how to not get so wrapped up in what they are telling me. Keep my mind clear and keep a series of questions that will keep things moving forward. It is a balance between respecting their ideas while helping them grow. Ahhh...that is the hard part. Hopefully this will get easier. If it doesn't, the pressure to figure out what to say will wear me down. I don't want it to and they say that it takes practice and experience yet I can't help but wonder...'What if I'm just not cut out for this?' So, please, bear with me as I get past my insecurities and determine the extent of my abilities. The drive is there, no doubt! Hopefully it just takes a while and isn't something that will always be frustrating.

Sharing the Burden

Sometimes a huge barrier in my work with families is what we call 'the mental health piece.' This means that if moms, dads, or kids have a mental health problem like depression, bipolar or schizophrenia, progress is almost impossible because the individual with the mental health problem is essentially creating a roadblock for the rest of the family.

When that happens, we refer family members to a psychiatrist so they can get a mental health assessment. After the assessment, medication may be recommended or the psychiatrist may other treatment recommendations. If it is serious enough, it may be decided that our program will not be able to adequately address the client's needs. More than anything, the psychiatrist helps me share the burden of how to structure treatment with people that have serious mental health problems.

And why am I talking about this? A few weeks ago, a client admits he has been having suicidal and homicidal thoughts within the past month and also has a plan of how he would follow through with these thoughts if 'it ever got bad enough.' He also had a pretty high score on this legit depression inventory we give all clients at intake. Yikes, right? Right. Then within the next week, a whole bunch of other stressors occur; while he doesn't admit that he is thinking about suicide more, his affect is anything but cheery and I'm worried.

I put in a referral for him to see our psychiatrist (a free service) but the client doesn't want to go and is upset (probably an understatement) with me for putting in this referral. The client's dad also thinks I'm blowing things out of proportion and tries to normalize the kids thoughts.

That sort of conversation is actually really stressful. I am a private person so I totally understand not wanting to talk to a stranger about my most serious problems. YET--the burden of being the only who knows that this kid is having fairly active suicidal thoughts is not fun. In fact, it is rather scary. In addition to worrying about the overall safety and welfare of this kid and his family, I can't help but worry about the liability of having a kid die on my watch. Furthermore, if something (heaven forbid) were to happen, how would I handle the guilt, horror, shame, sorrow, etc while continuing to working in this field? That is the sort of thing you think about as you fall asleep at night. I hope it gets easier as I get better at having those conversations.

Needless to say, when my client showed up for his appointment, I did a jump for joy and breathed in some relief. Knowing that another mental health professional is in the picture to share the responsibility of keeping this kid safe is immensely comforting.

Luckily this kid is OK. The psychiatrist agreed that his depression was serious enough to warrant some professional monitoring on his end, but didn't think the kid needed hospitalization, medication, or something more intense than I could provide. In the month that has passed, his moods have improved as his situation has and I no longer worry about suicide. He has his follow -up appointment later this week and of course, he is mad at me for making him go again. At this point, I don't even care about his attitude. Having someone else confirm my instincts or point out something I didn't know is worth more than I ever realized.