Detached

The relationship between a client and a social worker is one that is highly professional and can be intensely personal at the same time.  Navigating the boundaries of this relationship can be challenging as a result, but that's not really what I want to get into in this post.

In our involvement with clients, we are sometimes witness to or even participants in some of the most intensely personal moments in a client's life.  And while we may be clear on our role (let's hope we're all up to date on our ethical practices) what can be less clear is how to feel about being a part of these moments.

Today I took a client and his cat to the vet.  He was having the cat put down.  It would have been better if he had a friend or family member to give him a ride and offer support, but there was no one else but me.  The client was very accepting of the fact that this was the right thing to do for his pet who has been sick and suffering, but was obviously still heartbroken to have to go through it.

On the trips to and from, we talked about how he was feeling, his plans for getting through the rest of the day, who he could call for support.  We joked about things to lighten the mood, and he told me happy stories about when he first got the kitten.

I was happy that I was able to support him today, and he didn't have to go through this difficult experience alone.  At the same time, I felt really - weird about being a part of this event.

I love animals, but this was not my cat.  I'm not much of the weepy type, so I wasn't personally upset that the cat had to go.  I like and respect my client, but we're not friends.  I'm not personally invested in how he feels about this loss.  I care and I sincerely hope to see him come through this experience okay, but that's it.  What was upsetting to me was that my presence at this occasion meant a lot more to the client than it did to me.  He deserved to have real love and support today, and all he had was my empathy.

These are the limits of our engagement with clients. If I had cared more, if I had become personally affected, that would be a whole other problem.  So this is one of the challenges, especially if providing long term support to clients, that we inevitably face.  How can we encourage and support clients to develop real loving caring relationships which are not so lopsided?  Which don't involve someone who is being paid to care (that sounds cold, but hey)?  And how do we as workers debrief when we feel too little as opposed to too much?

Thursday Morning Interrupted

I start most of my Thursdays in the same way.  I have a standing appointment with a long time client at 9:00.  Since my work day actually starts at 8:30, I usually pull up into a local parking lot, and drink tea from my thermos while I remotely check my voicemail and read emails on my blackberry.  At about 5 to 9 I drive on over to the client's building and we usually meet for the full hour.  This particular client likes to share, and always has lots to talk about.

The other day I followed said routine.  At about 5 to 9 I realized that I kinda needed to pee, but didn't have time to get to the McDonalds down the street (my preferred pit-stop location.  I won't eat there, but their bathrooms sure are nice and clean!) so not thinking much of it I went on to my meeting. 

As my client is launching into his weekly update, all I can think about is my need for the loo.  It's getting worse by the minute.  I've never used the toilet in a client's home (just my personal philosophy) and I'm not about to start in this particular one.  My client is extremely nice, but not the best housekeeper.  And let's just say that over the years this client has related many a charming tale about various bathroom "misses" (I'll leave that to the imagination).  Only 20 minutes into our appointment as I'm trying desperately not to wriggle and fidget, I had to make some really lame excuse - I'm sorry I have to cut this short today, I've over booked myself - and got out of there! 

Waiting for the elevator was agony.  As I got to the ground and dashed for my car, I quickly tried to come up with my best plan considering urgency/need to avoid any embarrassment.  In full on wiggle mode in the car, I drove down the street to my mother's house, as it's mercifully nearby.  I totally made it, and basked in the glory of this success for a few minutes before carrying on with my day.

This is remarkable only because how is this the first time ever this has happened?  I do the same bloody thing every week?!?  I guess I should be grateful, and just hope it never happens again.

Helloooo Nurse (is there anybody in there???)

Me (on the intercom/phone thingy outside Local Hospital Mental Health Unit) : Hi, I'm Nectarine from Community Mental Health. I called earlier and one of my clients is here. Could you buzz me in so I can see her?


Nurse: Uh, I'm sorry ma'am, visiting hours begin at 4:30.

Me: I only work until 4:30. I'm not here to visit.

Nurse: I'm sorry, we don't allow visitors until 4:30.

Me: I understand that.

Nurse: I can't let you in here.

Me: Can I speak to my client?!?

Nurse: Who did you say you were again?

Me: I'm her case manager. From Community Mental Health.

Nurse: Well, I guess I can let you in.



*the magic door finally opens to admit Nectarine, and she approaches the fishbowl impenetrable force field nursing station and waits patiently outside the plexiglass for about an hour 4 minutes before Nurse emerges.*



Nurse: Uh, can I help you?

Me: Can you direct me to my client Janey Sad?

Nurse (looking me up and down): Where's your ID badge?

Me: We don't have ID badges, I can show you my business card. This is not my first time here.

Nurse scans my business card.

Me: So can you show me where to find my client?

Nurse: Don't you know? I thought you said you'd been here before?

Me: Uh, yeah, many times to see different people. My client just got here, I don't know which room she's in.

Nurse: I guuueeess I can show you.



*Nectarine follows Nurse down the hall where she opens the door to a patient room*



Nurse: Yeah, this lady is so confused. She's naked, you can come in.

Me: I think I should let her get dressed first...

Nurse (to patient): Helloooo! This worker is here to see you. THIS LADY IS HERE TO SEE YOU. (to me) Come on in...

Me: Uh, are you sure this is my client? That doesn't sound like her.

Nurse: Who?

Me: Ms. Janey Sad.

Nurse: Ohhh, this is Janey Nothere. She's sooo confused.



*another staff member kindly interrupts*



Staff: Did you say you were looking for Janey Sad? She's right here in the activity room, I'll get her for you.



*Nectarine meets with Janey (Sad) who is relieved to see her. Nectarine then waits twice as long outside the fishbowl nursing station, loudly but politely saying "Excuse me" before someone finally buzzes her out the door. She decides right then and there that she will personally drive all clients to Nearby Hospital in future as she is swears she is never coming back to Local again.*

NOTICE

Please put underwear on before your case manager comes over.  Please!

15) Staying at a job for two years is a ‘long time’*

It’s hard to believe I’ve been at this job for almost two years now. I’ve worked that long (and longer) elsewhere before, but this is the first job I ever had providing long-term support to clients. Most of my caseload now has been with me for the entire time I’ve been here.

In the last two months especially, I’ve started to notice things in my working relationship with my clients which I think are the result of being able to have this on-going support. Clients sharing personal information because they finally feel comfortable. New insights being gained through reflecting together on the past two years of their life. For me, know what times of year are hard for a particular person, and anticipating triggering events. It’s kind of cool, and weird.

Not having done this before, I’m always learning as I go how to balance the intensity of my professional relationship with clients and my personal boundaries. “Relationship” doesn’t even seem like the right word. I’m more keenly aware as I work with individuals longer that the whole thing is so one sided. I’m uncomfortable with the unbalanced power dynamic, and yet it’s so necessary. I admit, I resent my clients sometimes for how much energy it takes to support them. But I know it takes a lot of their energy too to do the hard emotional work I put them up to.

In a few months the intake part of my job will end, and I’ll be back to full-time housing worker. I’m curious/anxious to start fresh with several new clients all at once. In that case, it’s a bit of a comfort knowing I’ll still have my old stand-bys to give me some (unconventional) predictability and a feeling of (sometimes) stable progress. Assuming I’m still here for them.

*See here

Pause for Thought

Check this out --> Feminist Activists Find Peace in Thailand

I wanted to link to this article for a couple of reasons.  For one, feminism and VAW (violence against women) work are very important to me.  My training background is actually in assaulted women’s counselling, not mental health, although the two have obvious intersections.  I love learning about what feminist activism looks like around the world.

The other reason is that I found as I read this, I was contrasting the “retreat” experience they describe with the professional trainings and workshops I attend here in Canada.  The focus on “self-love and self-worth as an essential part of their work in the world” sounds really in line with my philosophy, but not my practice.  I certainly haven’t had many experiences in my professional life where there is such an emphasis on this sort of thing.  The perks offered to us at trainings usually max out at a free lunch, and possibly getting to go home a bit early. 

I don’t know much about Thai society or the culture of social service work there, so I can’t really comment on whether the needs of these workers would be different than where I am, and what they might make of their retreat experience.  But as the writer says, seeing “15 women grown napping together on the floor of a conference room after a lively plenary” would be “odd” to see in the U.S. (and I’m considering the U.S. and Canada to be more or less the same in this respect). 

It sounds nice.  But would it work?  Would anyone go for it?  I can imagine the mixed reactions of my co-workers – divided between feeling uncomfortable, and griping about how they could be making phone calls or getting assessments done instead.

Is this because we really don’t value self-care?  We talk a lot about avoiding compassion fatigue, but the general consensus seems to often be that we are responsible for this on our own time. 

On the other hand, is it because sleeping or meditating would be considered a private activity, and we would be asked to let our guard down to such a degree in a very public and shared space?  A lot of what they describe would be strikingly different from our typical professional activities and behaviours, and would (I think) demand a lot of openness to the experience.  Would this cross my boundaries?

I don’t know.  But I’m curious.

Has anyone experienced something like this?

Please, just go pt. 2

The housing transfer saga continues.
I met with the client. She had yet to make up her mind. She was highly anxious, and unfocussed and I could barely get a word in. I haven’t seen her like this in several months, although it used to be constant.

She wanted to know what I thought she should do. I wanted to tell her, but I didn’t. I reinforced that it was her decision, and tried to outline some pro’s and con’s.

Eventually, I ended the meeting since we were talking in circles. I suggested she call her worker at the housing agency and discuss it with her to figure out a final decision. We only have so much time.

Today, another message from her in the wee hours of the morning. She still hasn’t decided. I have a lot of thoughts and theories and hunches about this and about what I think she should do. But I’m getting too personally involved. This is counter-transference baby. I haven’t been able to connect with my supervisor for the past two days and I know I need to debrief with her, so I haven’t called the client back yet. I feel guilty about that.

This is rare for me. I’m usually pretty consistent about my boundaries, and I generally find it pretty easy to keep a healthy sense of detachment between me and my clients. But it’s bound to happen sometime, right?

Aarrgh! I really thought she was going to go for it.

True Confessions of a Sappy Housing Worker

Confession: I am in love with my client’s dog.

It got dumped on him by his brother. He is doing his best to care for it, but really has no experience looking after a dog. It appears to be some kind of Sheppard-X, and is about 1 year old, so he’s a good size.

This dog is crying out for structure and attention! When I walk in the door, he doesn’t jump on me, which apparently he does to everyone else. He listens if I give him commands, and while I visit with my client the dog curls around behind me on the couch with his head in my lap.

I know for a lot of my co-workers, they would consider this a workplace hazard, and likely would not meet the client in his apartment while the dog is there, but I love it. He has big, wet, sad looking eyes…

Is this crossing some kind of boundary? I am usually very good at enforcing limits and not forming emotional attachments in my work but I seriously want to take this puppy home with me! Apparently the brother keeps saying he is coming back for the dog when he “gets his new place” or when he “gets the right kind of transportation”. I’ll believe that when I see it. In the meantime, I will collect all the snuggles I can while trying to concentrate on what my client is saying.