Tuesday, May 10, 2011

Breaking Up Is Hard To Do

I’m breaking up with a client. At least that’s what I’m trying to do.

I’ve been seeing her for two and a half years. I picked her up from another program, and she has had case management support since 2002.

She doesn’t need me anymore. She’s said as much herself: she’s got an active life in her community, great family and professional supports, medication that works well for her. But she sticks around because she wants a ride. I drive her twice a month to her trustee, which is a fair way from her house.

This arrangement made sense when she started it with her previous case manager. She needed help not to miss the appointments, and to understand the information she was given when there. But not any more. She’s had time to learn and get used to the process, and she can do it by herself, but doesn’t want to. I can hardly blame her. Why spend money on a taxi when you can get a ride for free? And taking the bus is a pain. That, and the fact that my “support” is tied to her housing makes it difficult for me to disengage.

This is the bigger (systemic) problem. More and more the focus in community mental health services is on “recovery” and this is definitely the right idea. People don’t need to stay sick forever, and support from people like me is supposed to help. This woman has had an incredible recovery, but as it stands our supportive housing program provides no exit as long as she relies on the rent subsidy. I would never say that her subsidy should be removed before she can afford it, as having safe and stable housing is obviously a huge contributing factor to keeping her well. She can afford (IMO) to do without me.

After having explored this issue from every angle with my supervisor for months and months, examining myself for counter-tranference, and trying everything to be sure we were not under-serving her or missing ways that we could connect or provide support, my supervisor told me that I have her backing to start withdrawing transportation support. I have no desire to leave her high and dry, so I will propose that we agree on a timeline in which we can develop a new transportation plan and then I will stop chauffeuring driving her. I began practicing in my head how the conversation would go, and how I will handle her possible reactions.

I went to pick her up yesterday. She was dressed very nice and had a big smile on her face. I wished her a happy belated mother’s day and she thanked me. Then she informed me “and it’s my birthday today!” Oh crap.

I couldn’t do it. I couldn’t rain on her birthday parade with my difficult news. Put plainly, I chickened out.

We meet again in two weeks. I’ll do it then, I swear. Otherwise, I know I’m only prolonging the pain.


  1. I appreciate your point of view. Enabling vs empowerment is not always clear cut. Thats when social work became toxic to me; feeling like I was enabling clients instead of empowering them to do for themselves. Who says life has to be easy to be well? But, then again, if our clients could cope on their own they wouldn't need our help. Tough questions.

  2. Needing social work staff for "a ride" is a big issue I see in my parts as well. I personally very rarely will transport a client in my own vehicle because of the liability, but it's a gap in the system for sure.........a huge reason clients depend on us. We also provide a housing subsidy to many who would not be able to remain in the community without this support, regardless of their level of independence.

  3. I was actually surprised when I came to this job to learn that we did provide transport in our own vehicles for clients. At other jobs I had only provided bus tickets or taxi chits, and sometimes drove in an agency owned vehicle.
    It's tough to tell a client you won't drive them, because their other options really are few.