Working in your own neighborhood

Although social work has its roots in community development, and being “with” people, with the strengthening of ethics and the discouragement of “dual relationships” many people find it much easier to work in social work outside their own neighborhood, where there is less likelihood of running into their clients in the choir, at the park, at church, at the grocery store, as their children’s teachers, etc.

This is especially true when a person works in a place of authority (child protection, mental health worker who has to certify people against there will) or of confidence (therapist, counsellor).  In these positions you know a lot about people that other neighbors do not that can make interactions awkward and both client and worker may find it difficult to draw clear boundaries between work and home life.

I was recently interviewed for a position working in mental health kitty corner from my house- visual distance.  I am fairly involved in my neighborhood, helping out at a local dinner at a community house and have folks over regularly to my dinner from church who are clients of that team.  If I took that position I would more than likely see clients at the same dinner table often; this could be difficult in mental health if someone already has paranoia that someone is following them.  I loved the idea of working in the neighborhood but in the end I decided not to and chose to stay working just a 15 minute drive away at the organization I currently at, but in a different department. In the end I chose to keep my role as that of a friend and neighbor only; I want to be able to invite people for coffee without worrying that I am somehow breaking a rule by inadvertently inviting in someone who is already on the mental health team and I may work with in filling in for a colleague. I want to be able to fully participate in the community without drawing my curtains in or relaxing in other parts of the city for fear that if I leave my home I will be actually working at not working.

In some ways I want to break this tendency to want to completely separate work and play as it seems kind of artificial.  It perpetuates differentiation in the class and status of worker and client.  For example, if I was in the neighborhood my clients would see my two year-old having a tantrum on the sidewalk; I would feel a little embarrassed, similarly I might see them in the soup line across the street from my house or working as a prostitute at a nearby street corner.  Perhaps this would make all of us a little more real and humble.  Hard to say.




Entering the world of work

This past week I had two interviews, received all of my grades, and was offered and accepted my first job with an MSW. I will be working as a mental health therapist at my former practicum site.

One of the questions that the interviewer asked me was what I felt about safety: both mine and clients’.  At first I thought of this question mainly in terms of my own personal safety; I felt relatively little unease or concern regarding that.  However the interviewer’s wanted to know how I would deal with clients safety,  more specifically how I would deal with the responsibility and the emotional challenges of the dealing with suicide and client self-harm.  As I was studying for this interview I had been madly reading everything I could on suicide risk assessment. As I did so the responsibility of my future role started to weigh on me.  I began to become worried that I would miss something important and then I would lose someone.  It is important to have that sense of responsibility but what the examiner’s wanted to know more than anything (as they could see I had read up and knew suicide risk assessment fairly well) was whether I could handle someone whom I had done everything possible to help and protect them…dying.  The interviewer candidly related how she had experienced this in her career in mental health.  I related how important self-care and seeking good family and social support would be for this job.  However, I have to admit that the thought of someone committing suicide on my caseload scares me- as it probably should- and I think it would be an incredibly difficult thing to deal with as a social worker.  Nonetheless I am determined to plunge into this work and field with courage, skill, and openness to learning.

My question to you, fellow professionals (social workers, counsellors, etc): how have you dealt with risk/difficult situations (whether it be the difficult call to remove a child or not, or to hospitalize someone, or have someone on your caseload die). How have you learned to cope keep strong even with the huge responsibility you carry?

Let me know- help me be prepared for the disappointments and challenges ahead.

Also: how has your faith helped you through such challenges?

Interviewing Anxiety

Last thursday I handed in my final graduating essay to my advisor; with a click of the send button I had finished the last requirement of my MSW degree.

With excitement I called my husband and let him know the good news.  With this newfound freedom I celebrated with a visit to a cafe and more phone calls to my family back home.

The next day while at a massage therapy appointment my cell phone rang; who would be calling me?  I had a few ideas, but relatively few people have my phone number so I was curious.

To my astonishment I got a call for an interview for a casual counsellor position from a local treatment program for women that is unique in providing trauma-informed care to women with multiple barriers.

I had applied to this job with little expectation that I would get an interview; I simply applied because I have long wanted to work with women in addiction using a trauma informed approach.  I do not have particular employment experience specifically with women so I was surprised to get this call.

At first I felt elation then later anxiety.  Anxiety for a number of compounding reasons.  I was worried that I would be stumped by difficult questions.  I was worried as it is coming up within a matter of days without much time to prepare, let alone buy a few new clothes, hair cut.  More than anything I need some new glasses and contact lenses; for the past few months I have been wearing broken glasses taped together with black electrical tape.  I have been so busy being a mom and a student that I haven’t even had time to buy things for “me”!

I was also worried strangely enough because the future was now much more uncertain- with me perhaps having to make difficult choices. It was hinted that I would be interviewed for a casual position in counselling at my mental health practicum that I had applied for two weeks earlier.  I had already set my course on that potential job, excited to see old colleagues when this possibility came up. Now I felt quite anxious not only about a difficult interview but potentially having to choose between this new position and the opportunity to work somewhere that I had grown to feel comfortable and would have the opportunity to  learn more about providing therapy to people with a variety of conditions.

Writing about my anxieties makes them feel trivial- likely I will get a job, the bills will be paid and I will continue to learn and grow in social work/therapy.  However, nonetheless these thoughts have dominated my head over the last day and a half as I have dwelt on the repercussions of one choice or another.

What helped with the anxiety?  Strangely enough not mindfulness but reading: reading about women, substance abuse and trauma brought me a lot of excitement which made me feel encouraged to study and put my best foot forward for this upcoming interview. And now my anxiety is at a record low.  Now just to care of the essentials: hair cut, interview outfit, contact lenses, and interview prep (ok that one still causes me a little bit of anxiety).

So if you were a therapist, what was the technique I used?  What helped me get through this?

In a concluding note: I am extremely grateful and blessed to have made it through this journey through my MSW.  As many of you know, midway through my first year of the program I found out that I was expecting a baby- surprise!  God’s planning, I call it.  I took one year off from studies- missed graduating with my original cohort.  However, God has provided, finances, work, everything I needed, and learning opportunities.  With his strength I have completed the finances and engaged in the learning gradually taking the courage to integrate my faith into my understanding.  It has been a wild journey, not without bumps but I’m glad I’ve made it through this leg of the journey intact (and thriving, and happy- with a healthy dose of anxiety here and there).

Approaching the finish line

I am  writing a short post to let you know it is that time of the year.  I’m at the end of the semester and working hard to finish my last graduating essay of my MSW program. 

It’s been a journey; the practical hands-on learning has opened new doors for me to work in an area that I’m passionate about: mental health and addiction, as well as counselling. 

Unfortunately, I do not think this program has been “enough”.  I want to learn so much more and gain more clinical skills.  That’s one reason I’m going to keep learning via workshops, books, colleagues- and through the discussion of this blog.  I appreciate the role many of you have paid in my learning as I endeavored to integrate my faith and understanding of social work.

But for now I have to hit the books and keep going!!

Structural Social Work and Clinical Practice

Over the past few weeks I have been absent from blogging because I am in the last month of my masters program, meaning that rightfully I am (trying to) spend more time doing school work than other things like checking e-mail and blogging.

However, I have not ceased entertaining new ideas for posts. 

As those of you who are in the field of social work may know our educational institutions have largely shifted the philosophy of education to that of a philosophy of structural social work.  This means that our level of analysis is to always include the impacts of unjust societal arrangements on people’s problems.  In The Structural Approach to Direct Practice in Social Work (Goldberg Wood and Tully, 2006)  it emphasizes the importance of trying to change an oppressive situation before engaging in clinical work with an individual.   For example, a depressed elderly person fearful to leave the home may need increased protection from police to decrease gang violence or a change of home to a safer neighborhood, not simply therapy to deal with fear.  In this type of example the author explains that it would likely be futile to engage in therapy without first addressing her environment or larger systemic problems contributing to her individual problem.

This seems logical for this particular situation, but for social workers the tools and ability to change a situation of a barrier for a client are out of reach or take too much time to truly benefit an individual.  In seeing the picture we have the burden (my our profession and our education) to change the bigger picture to benefit our clients; few other professions have this within their aims or purposes.

The reality is that many social workers (myself included) choose to practice on and individual level using clinical skills borrowed and developed from the field of psychology.  However, in being a social worker we have the added layer of assessing for the role of social and environment and then working for change within that realm as well as on the individual level.  This is helpful, but also challenging and can go outside of the framework of evidence based practice models that we may be using to mix it with an advocate role.  One complication of using a structural model is that in theory it is quite black and white (fight injustice!), but in practice people and situations are far more complicated; the oppressed are oppressors, we are both holding power and without power, resisting and engaging. 

In some cases in my work I have found it is not very applicable.  For example in counselling a middle-aged women with depression reporting a satisfactory marriage and middle-income status I am building a relationship and targeting symptoms of depression with various counselling techniques; I’m not working on an issues of injustice as she did not bring that forward after careful assessment.

However, at other times the knowledge of the effect of injustice, the barriers faced by those who are discriminated against can be used in therapy to help people normalize their experience and understand that our system is not just a meritocracy and that their not “making it” in life is not just an effect of a character flaw. Looking first to understand who is disadvantaged and discriminated against is also a good guide to research.  For example if I am doing research and find out that those with lower-income consistently die more after having cardiac surgery I would not just accept this fact but want to examine the structures that contribute to this injustice and lobby to change this.

So there are advantages to having a grounding in structural theory, but also limitations in practice.

As a social worker do you use structural theory as a basis for your work?  How well does it go work within the context of your agency/practice?  What alternative models do you find useful?

Prayers for helping professionals: St. Theresa of Avila’s “Let Nothing Disturb Thee”

Many years ago I came across this prayer by St. Theresa of Avila, a mystic and nun of the 16th century.

Let nothing disturb thee

Nothing affright thee

All things are passing

God never changeth

Patient endurance

Attaineth to all things

Who God possesseth

In nothing is wanting

Alone God sufficeth

I have recited this prayer in times of stress and anxiety during my life. Let nothing disturb thee herald’s back to countless biblical passages where God’s people are exhorted to fear God, not men ( eg Psalm 56:4: God, whose word I praise, in God I trust; I will not be afraid. What can mortal man do to me?). 

As a social worker working with people experiencing profound mental confusion, crises, and chaos in their lives it is essential to have a firm anchor in God.  Especially when it seems like even the best therapies fail, medications only provide minimal relief, and support is refused.  Ultimately, God is present and I will trust and pray for him to be with this client and myself in this mess we call life.  

It seems so simple, just trust in God, He never changes He’s always there. But we are afraid, we are disturbed by what we see. That is why we get into the work we do- because the state of the world disturbs us and we want to do something about it. 

And it seems at first glance that this prayer provides no recourse, no action to take about that which disturbs us.  Are we left retreat to our personal prayer with God away from these disturbances or claim that these disturbances are perceptions of reality that create suffering (a more Buddhist viewpoint)?

I think this prayer could be interpreted this way but one line challenges me toward engagement: “Patient endurance attaineth all things”.  Patient endurance is an active choice, not a passive observer stance.  It’s like seeing a rushing river that you need to cross and instead of sitting on one side and fretting about it to instead decide to get in up to your waist in rushing water, hold on to whatever you can to get you across and endure the cold water as long as you have to until you reach the other side. 

This is what our life is like, but to patiently endure we must be “possessed” by God.  When we think of the word possessed we often have images of demon possession and exorcism by Catholic priests.  Very rarely do we hear of being possessed by God. Being possessed implies being owned or filled in its entirety. In being possessed by God Saint Theresa rightly says that nothing is wanting.  There is no need if God lives fully in us and through us.

As a social worker this is not easily done.  My place of work, like many of you, does not have its sole purpose in serving and loving God but is there to control and fix situations.  Very rarely can we offer people God’s solace and grace as a salve to their problems.  Mostly we can offer the accepted wisdom of our profession. 

This makes it difficult to be wholly possessed by God.  Maybe St. Theresa had it right in setting up convents and encouraging people to pray and seek God after all. 

How do you manage to keep centred and “possessed” by God as you engage in a secular helping system?

How do I become an effective therapist?

In entering the field of therapy I feel a sense of smallness.

Around me I am surrounded by people who have years of experience, mountains of knowledge, and more training than I. 

I look on internet sites for counsellors advertising their services and I see that they are trained in a dozen different methods and treat clients with a myriad of problems and issues.

I could spend a fortune attending training after training, but should I?

Maybe, maybe not.

I want to become an effective therapist. What does that mean?  I want to be as skillful as possible in doing what therapists do.  As one of practicum supervisors says, what little we do.  In the right time and place I want to be ready to assist someone in making the changes in their life they need, or gaining the perspective that they are seeking.

People say that therapy is part science and part art- many argue for more or less of one or the other.  I tend to agree with the mixture theory.  I do not just want to do what feels like the right thing to do but what has worked positively in the past for others in similar circumstances.  However, I do not believe in a cookie cutter approach and believe in miracles, and intuition and want to think outside of the box with imagination. 

My first obstacle in becoming a therapist is simply experience and supervision.  In my practicums I have had the chance to do general counselling but am only beginning to feel more confident or even versed in few therapeutic approaches (e.g. CBT). 

I originally felt trepidation in pursuing a counselling practicum as i did not feel wise enough; or that I was ready to take on the intimate details of people’s painful lives at this point in my life.  Knowing myself I know I always pull towards working with the most marginalize but realize this must come from a firm place of readiness.

So instead I have had practicums specializing in mental health and addictions, but without intensely supervised counselling experience.  In some ways I regret this, but I also trust that God will open up doors if this is to be a path that I am to pursue and that it will happen at the right time in the right place with the right supervisor.

Now I am beginning to develop the curiosity and passion for therapy that makes me want to learn everything I can.  I take this as a good sign.  I still have my doubts about pursuing this vocation, but I am grateful for my times of self-doubt as they show me my weaknesses.

There are many different roads I could take to become a therapist, currently my road is finishing my masters of social work, continuing to learn and process on my own, and to keep my eyes open for opportunities to apply this learning, and look out for good mentors and supervisors.  I would love to take a bazillion courses, but I just don’t have the money right now.  Also the idea of taking course after course makes me feel increasingly confused.  I think I need to digest what I learn fully before going to the next course.  I cannot expect myself to take lots of training and then magically practice all that I have learned.  I want to carefully learn and ruminate on what approaches are not only supported by evidence, but would jive with my personal style, and fit with the type of problems that are coming up with clients I see.

For example, after taking a theory course in counselling I developed an overview of different theories but I’m still on the fence as to what I think of them and how I could apply them.

Ultimately I want to use this vocation to serve God- if it becomes an idol, a way to self-agrandize, or a pure pursuit of money- that I don’t want it, I’m better off-putting my energies into being a true friend to ll those around me  instead.  Ultimately love has to be the centre of this practice, otherwise I’m just a clanging gong (1 Corinthians 13).

This is supported by research in literature that shows more effective counsellors and more affirming and nurturing. However this is not the only element cited, but as well offering a new schema or rationale offered with confidence by the therapist as well as techniques that match the client’s expectations.  Techniques account for only 12-15% of success, more can be attributable to counsellor characteristics than a particular approach. Techniques really rest on the sense of positive alliance with a counsellor. 

In many ways this puts me somewhat at ease as these are aspects I’ve been working at for some time.  Now it is time to learn the details of techniques and theoretical orientations and figure out where I fit in and what I agree with.

Will I learn to be an effective counsellors? With perseverance, I believe and hope.  However, more importantly will God be able to use me as a counsellor through my strengths and weaknesses that I have?  That I am truly hoping and praying for.