You would do anything for your child. It hurts when you see him or her struggling. Maybe there has been a family trauma. Maybe a parental divorce and you want to make sure your children are doing OK. Maybe your child is anxious about school, has bullies they are dealing with, friendship issues or grappling with feelings of self-worth. Maybe they are struggling with issues such as drugs, sex or cutting. There are tons of reasons your child might benefit from counseling. First, give yourself some praise if you are thinking about helping your child with therapy. It might feel as if you failed somehow but you haven’t! Life is difficult for adults and it is sometimes even more so for children and teens.
I believe counseling can be valuable for everyone. I would caution you to consider, that therapy for a child or teen, may look different than for an adult. As an adult, we know why we are going to therapy. We may be looking for someone to clarify and ground us or looking for answers to numerous different questions. At some level, we buy into going to therapy for ourselves, but your child may not have the same buy-in for their therapy, Even though I believe the relationship is always paramount, an adult may find what they are looking for in a few sessions, but this more difficult outcome when working with children. The dynamics are different in child therapy.
Hello! Happy Spring. I’m in completely into my “I am not wearing socks until next winter” season. I don’t care if it 46 degrees out – tomorrow is May and I’m not giving in.
Here is my April MSW online blog post about Social Workers and dealing with clients and loss. The original link is http://mswonlineprograms.org/2016/social-workers-and-professional-grief/
Although social workers often see the very best of people, there is no doubt that the average worker also sees much sadness and struggle. Some social workers practice among poverty and violence. Some work with individuals who are physically ill or dying. It is safe to say that social workers treat an array of people and problems.
This sadness can add up. I supervise a team of care coordinators who work with individuals who have high acuity of physical and/or mental health needs. They are transitioning clients from a long term setting into the community. Although they see lots of success, they encounter loss each day. They listen to people’s stories which are wrought with loss. They watch people relapse into addiction. They watch individuals deteriorate physically and sometimes decompensate mentally. They have clients die under both expected and unexpected circumstances. This can be wearing on workers. When we experience loss we often feel grief. Grief is one of those uncomfortable feelings we often try to avoid.
Most of us understand personal loss. Personal loss includes things like a death of family or a loved one. It may be loss of a pet, a job or of a dream. It may be loss of an idea or transition to another stage of life or a divorce. We deal with personal loss by using our support system and talking about it. We have rituals and memorials. We use self-care. Much of our personal life is seen by people we love so there is support. It can be somewhat different for professional loss.
Professional loss is what we experience in our work lives with clients. It is different from personal loss because the relationships are different and often we don’t stop and take a moment to acknowledge and grieve. Professional losses are often internalized. It is possible we might go home and say we had a rough day or maybe even say a client died but we can’t share much of our experiences with family and friends so we miss out on the support you would get when family and friends are sharing the loss with you.
Some thoughts to remember about professional grief:
Just because you have been doing the job for a while or work in a field where people struggle or die often – doesn’t mean you get used to it. The loss may be expected but it is still a loss. Make time to acknowledge the difficulties of your job and the loss you experience.
Don’t ignore the grief because you are busy. I don’t think there are many employed Social Workers who don’t have much more to do than the time they have to do it. If one of my workers experience a loss with a client, they still are required to keep working with their other clients, make good clinical decisions, keep up on documentation and so on. Even though someone is busy, ignoring the grief isn’t helpful. Just because we push away a feeling for a time doesn’t mean we don’t have to deal with it. Eventually, the grief catches up to you. Not ignoring it now will help you be healthier and less prone to burning out at your job later.
If you are not acknowledging grief and allowing yourself time to feel, your grief may come out in other emotions You might feel snappy, resentful, guilty or helpless. Besides not being fun emotions it may affect your ability to do your job well.
You might judge yourself harshly if your client seems to struggle too much or dies – stop it! Of course, it is a good idea to assess what steps we have taken or missed taking. Recognizing lessons learned is an important part of maintaining and improving our clinical skills. However, remind yourself that you make the best decision you can with the information you have at the time. Social workers aren’t omnipotent and you can’t know every possible outcome.
When you continuously work with never-ending loss with clients or you work with clients who die – sometimes it will affect your decision-making skills. For example, the care coordinator I had whose client died, assessed another client who presented similarly. When this case was discussed with the multi-disciplinary team she was adamant the member not move out to the community. I asked her, if previous to her experience with the member who died, would she have recommended transition to the community. The care coordinator said yes. Make sure you don’t over or under react to situations based on grief on the job. Talk to your supervisor and colleagues.
Know your limitations and – especially if you are a supervisor – be flexible. In the case above, the care coordinator said that she wasn’t at a place where she could work the case for the new client. I was able to assign to another care coordinator who was at a place to work the case.
Take time off if you need it. None of us or indispensable. No matter how talented and wonderful you are- your job can live without you for a day or two. If you don’t make time when you need it – it is possible you will get to a point you can’t do your job at all.
If you are a supervisor, make your team meetings and yourself a safe place to discuss loss. After I saw the struggle some of my team was having with client deaths, we had an open discussion about our experiences with client loss and a discussion of the feelings and struggles we have. We also talked about our role in client’s lives and how losing the client affected us. I did a follow-up training on professional loss and encouraged discussion as well as checking in during supervision.
Either individually or with colleagues, you might consider have a ritual or memorial when clients die or there is a particularly hard case. Tell your client’s story to each other and tell your story of the client. By telling your story, I mean tell about your experiences and reactions to the client’s life. Talk about how it affected you. Tell about what endeared you to the client and what were the parts with which you had difficulty.
Don’t ever forget self-care. If you don’t care for yourself you will have nothing left to give. Spend time with your family and friends. Read some books, listening to music, go hiking, meditate or pray, exercise or play with your pets (which is a big one on my team.) Self-care makes sure you have the emotional energy to grieve and keep going.
The nature of Social Work is that there will always be loss we are working with. I remind my team (and myself) that it is worth it. We witness and help heal people. That even though there is continuous loss that we listen to people’s stories. We may not be able to fix everything. We may not be able to stop a relapse or stop a client from dying, but we have the opportunity to honor their self-determination and really hear their story. That is the gift we give our clients most of all. Take time to grieve the professional losses so you are able to continue witness and heal those with which we serve.
Happy October! My favorite month of the year and it is coming to close. I struggled with this month’s blog post for MSW online. I have a passion for helping people who help those with mental illness but had trouble with demonstrating that passion in my writing. This is geared to people considering a career in social work or new social workers, but I think it can be used as a nice primer for everyone!
As a social worker, you often work with vulnerable and struggling clients. One such group, you may work with are individuals diagnosed with a mental illness. Mental Illness does not discriminate. Any population you work with, will likely have some people living their life with mental illness. Sometimes because of media portrayals and other misconceptions, working with people diagnosed with mental illness can be scary or daunting.
There are many types of mental illness. The DSM-V (where the criteria for different mental health diagnoses is listed) has about 991 pages.
Below are some basic definitions of common diagnosis you might come across.
One definition of Mental Illness I like is from the Mayo Clinic
Mental illness refers to a wide range of mental health conditions —disorders that affect your mood, thinking and behavior. Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviors. Many people have mental health concerns from time to time.
I like this definition because it normalizes mental health issues. Mental health conditions run on a continuum. Just like people, mental illness is complicated and some people struggle with more difficult issues than others.
Specific Diagnosis Definitions (Also using the definitions from the Mayo Clinic.)
Major depressive disorder — prolonged and persistent periods of extreme sadness
“Schizophreniais a severe brain disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior. Contrary to popular belief, schizophrenia isn’t a split personality or multiple personality. The word “schizophrenia” does mean “split mind,” but it refers to a disruption of the usual balance of emotions and thinking. (http://www.mayoclinic.org/diseases-conditions/schizophrenia/basics/definition/con-20021077)
Those are just some of the diagnoses you may come across in your work. Let me share some tips for a social worker to remember when working with this population.
I am fat. I’ve been told this my whole life by both friends and society. Sometimes I will look at a photo of myself from when I was young and will wonder why everyone thought I was so fat. Maybe it was a self-fulfilling prophesy but I am fat and that has been part of my identity as long as I can remember. At times it has determined what risks I have been willing to take and what experiences I participated in. I would blame it for relationship troubles or truly believe it was one of the reasons for general unhappiness at different times in my life. As I’ve gotten older I am able to more often recognize that I am not just a fat person and my weight doesn’t determine my happiness. Also – and this important for people to remember about themselves too – what I weigh does not determine my worthiness as a person. I am going to repeat that. Our weight does not determine our worth as a person. The value I have as a human and my happiness are not dependent on numbers on a scale. Each of us is worthy of love, happiness and kindness, regardless of how much or how little we weigh or our physical appearance.
Right now I am doing the whole30 challenge. I get accolades about how great it is that I am doing this. If I lose weight, I will get praise for losing weight. People will say “You look so good.” Or “It is so great you are hanging in there.” I soak up any praise and it it is a motivator to keep eating healthy. However, when it comes down to it, if I choose to live healthier, if I lose 40 pounds or if I end up gaining 40 pounds – it makes no difference in who I am. I am a not better person if I weigh 40 pounds less. I will not be less worthy if I gain 40 pounds more.
In my private practice both women and men come in and virtually with each and every person there will come a time where there is a discussion about weight and negative feelings surrounding it. I have worked with so many teenage girls who have issues around their weight. They tell me “My mom (or my grandma) told me I need to lose weight.” These are teens who are active and within the norm of weight for their age and they will cry and ask why their parents can’t accept them if they don’t weigh the right amount.
Then I have adult women come in and tell me the same stories of family members and friends telling them they needed to lose weight. They are told they will be all alone in life because they are fat or if they didn’t lose weight they would never find happiness. Generally, these messages are well-intended. You want the people you love to be happy. Only, the feelings these messages induce don’t go away. It sends a subtle implication that you are not quite good enough because of your weight. You might not even notice you are saying these things to others or yourself because it is such a part of our culture. It is difficult to step away from thoughts about weight because American society is filled with the messages everywhere telling us that thinner is better.
When I started first grade there was a girl who told me she wished she could be my friend but she couldn’t because I was too fat to have friends. I wasn’t even six years old. Now, almost 40 years later I remember this and I know it became part of my identity. I don’t remember the girl’s name or face but I remember the conversation. Probably one of my brain’s first lessons on starting to believe “don’t be fat or you will be all alone.” How much more will words about heaviness stay with someone when it is a family or friend saying them. You might say “I worry about their health, I want them around for the grandkids” or a hundred other very valid reasons why someone would be better off losing weight. You are just trying to help. I would argue that if the person is an adult – they are very aware of how much they weigh. It only amplifies the shame to be reminded that your fat bothers others and you are not quite good enough because you don’t lose it. There are ways to be encouraging and supportive without adding to pain. It is up to the person to decide how they want to tackle their weight. People have very complicated relationships with food and weight. You can be pithy and say “just don’t put it in your mouth” but there are often many factors at play. It is not necessary for you to let someone know they need to lose weight. Even disguising it with “I worry about you” is still saying “you are not good enough because of your weight.”
I’m not saying you shouldn’t help your children be active and maintain a healthy weight. I would just say consider how you promote it with your children. Eat healthy and be active yourself. Don’t hold others to expectations you aren’t able to sustain. Live by example. Which also means recognize that each time you put yourself down for your weight or your eating or exercise habits you are teaching your children and others that your importance has something to do with your physical looks. You are even reinforcing your own beliefs. “See I’m not good enough because my body isn’t perfect.” Stop yourself when you find yourself putting yourself down. Stop comparing yourself to others. I bet virtually everyone who reads this has thought at one time or another “at least I’m not as fat as that person.” I have thought it. Unfortunately it just reinforces the idea that if I weigh less I am better. Being a little healthier than someone else does not give us the moral high ground.
Not making your weight be such a huge factor in your identity doesn’t mean someone can’t make changes and be healthier. I want to live healthier. I want to lose weight. I want a better relationship with food. These are reasons why I am doing the Whole30 challenge. However, this is my journey. If I don’t succeed I will be disappointed with myself but it doesn’t make me a failure at life. Conversely, if I complete the challenge it won’t make me a better person. Happiness, love, money and opportunity won’t just fall out of the sky to me because I shed a few pounds. My life will still be my life. If you are working on changing your weight do it for you and not because you think it will make others accept or love you more.
I want to note that it is OK to accept yourself at whatever weight you are. You don’t owe anyone explanations on how much you weigh. You are allowed to be happy and enjoy life and it is not dependent on your size. You are worthy of love and joy and you will find the people who really matter don’t care how much you weigh.
I know as someone who is heavy that it is easy to forget to live life because you are waiting to lose weight. Just don’t do that. I am working hard at living the life I choose, embracing opportunities and not letting my weight stop me from living. Whatever we are on the outside does not determine our happiness unless we let it. I know that it is easier said than done, but my hope is that instead of focusing on our perceived shortcomings that we instead embrace life. You are worthy because you are alive. Instead of feeling shame over your weight focus on embracing experiences, loving those dear to you and being kind to all.
This is a little different from what I normally write but I noticed I was having an emotional reaction to people’s opinions regarding the movie American Sniper. One of the best ways to process an emotional response is to express it – so here I am.
I read several blogs and watched a couple of video segments on critiques of the movie. Mostly negative and scathing. I kept wondering – “What movie did you all see?” Then I realized many of the segments started with “I didn’t see the movie and I don’t intend to…” Oh. Random Pet Peeve: Shredding apart a movie you have never seen. Go see it and then shred apart to your heart’s delight.
It dawned on me that of course everyone takes something different from the movie. What we get out of a movie or music or art or a book is really about us and who we are. It isn’t about the movie at all, so in essence we all did watch a different movie.
As an overview, I do not believe we should have been fighting in Iraq. At the same time I respect and honor the military and their families that sacrificed to do as their country asked. I am proud of my brother who served in Iraq and won’t diminish the soldiers sacrifice by indicating that military members are all blood hungry, glory hounds incapable of seeing ambiguity. Before I saw the movie I had no idea Chris Kyle even ever existed. I only went because I had the day off and my Aunt said “I have to go pick up tickets at the movie theater – want to see a movie.” A movie – as in entertainment. A movie that I’m pretty sure wasn’t supposed to be an end all/be all documentary of snipers in the Iraq war. I actually laughed out loud when I saw the quote about Americans going to the movie as a patriotic act. What? The writer might be over-thinking it some. I’m pretty sure people aren’t sitting around thinking “I could donate to a veteran’s clothing drive but hey – going to see American Sniper is the same thing. Boy aren’t I patriotic.”
I will say out loud that I actually liked the movie. I was a bit dismayed to see that Clint Eastwood directed it because in the political belief world I’m pretty sure Mr. Eastwood and I are not only at opposite ends of the Spectrum, I suspect we are on different spectrums entirely. Of course – it doesn’t matter who created the movie – I often say if our beliefs won’t stand up when people question them – how solid are they to begin with.
What did I get out of the movie? War is fucked up. Yep. That is it. War is fucked up. People are placed in fucked up situations. People are expected to do Fucked up things. Sometimes in the situation people will say and do even more Fucked up things. After they are done and go home – people are expected to go on with their lives and their families as if none of the Fuckedupness happened. That is what I got out of the movie.
One complaint I have read several times is that the movie is too black and white. (Ironically actually, since many of the critiques of the movies were very black and white!) Complaints of the movie said it depicted that all Iraqis were evil and the Americans all good. Definitely a bit of that. One thing the movie did do was show how the one Iraqi had been an Olympic athlete, hinting that hey – these are just people too. Again – it is a movie. No movie no matter how excellent can cover each and every nuance of a situation.
I suspect that the troops in country would necessarily have to have some type of black and white belief. Don’t tell me that people who choose the military are sociopaths. There are likely sociopaths at your work, in your neighborhood and even in the military. However, all the military people I have met are people who love their families, their lives and their countries. How would someone who has a conscience and empathy justify killing people if there wasn’t some distancing and some extreme good vs. evil thinking? Could you do it?
It reminded me that as a society we often forget why soldiers struggle so much when they come home. Trauma and PTSD are real and prevalent and it seems like one of our society’s tenets is that “bygones should be bygones” It is over and done with so people can get over it already and move on. Unfortunately, life doesn’t work like that. Often, members in the military do not seek assistance because it seems weak and there is such stigma for a soldier to see help. A movie like this can remind people that the experiences for military individuals doesn’t end when they come home. It many times never ends. The movie showed the main character even talk to what I presume is a therapist at the VA. How awesome is it to give permission to a soldier that talking to a therapist might actually be helpful (gasp!) It would be so easy or neat in real life but the thought was there.
The movie spotlighted the struggles families have. Not just the soldier dedicates their life and time to the military – their family is connected too and often not by their choice. The movie showed how even when the military member returns home – life doesn’t just go back to what the family considers normal.
As much as I – with my peace sign tattoo and all – want a world where human rights are protected and we see everyone as part of one human world and there is no war – we aren’t there yet. I will continue to work and advocate for better lives for people but as many of the critiques said – Life is not black and white. American Sniper as well was not all good or bad. Life is ambiguous and full of both pain and joy. Keep writing and speaking about the things that are important to you and as I will also try – work on being OK with ambiguity and that there can be value in ideas and beliefs that may not be congruent with your own.
I’ve heard that most of us need 4 positives for each negative we hear. I wonder why it is difficult for so many of us to hear the good things. I think we often just disregard the positive things. For example let’s look at two different emails I’ve received from clients. The first email was after meeting someone one time. The email basically said that she wanted to cancel her next appointment. She said she didn’t think I was kind. She thought I didn’t know what I was doing and that I shouldn’t be a therapist.
I read this and I take it to heart. (Which is against one of my main principles for all of us – “Don’t personalize anything.”) Although, in my role of a therapist, it is helpful and necessary to self-evaluate and have self-awareness. Ideally I would read an email like this, process the feedback. Keep and learn from what is valuable and discard what is not helpful. I would not obsess or take it to heart, affecting how I feel about myself.
The second email I received was from a client that I saw several times and had not seen at the time of the email for a few months. This email said that the client felt like our counseling sessions were extremely helpful. She was able to change her thinking patterns. She had accepted some situations in her life and completely opened up other doors. It was a very positive email thanking me for the help.
I read it. Most people like to hear that people like them or they did a good job and I am no exception. I took a moment or two to preen. Then, I found myself discounting the praise.
Interesting. How often do I discard the positives and take to heart the negatives. How often do you do that. Many of us have some negative messages running around our brain a lot of the time. Negatives we hear fit right into those messages so we grab on to them. Positives challenge those negative messages and we discard them. I’m going to try to make an effort to believe the positives I get and not take negatives as the absolute truth. Maybe try to believe the positives and see how your feelings about yourself shift.
In my meanderings around the web I came across this story and fell in love with it. (Directly taken from Here Also, I only skimmed over the transcript so I have no real idea what point the author was trying to convey.)
“Back in the days when pots and pans could talk, which indeed they still do, there lived a man. And in order to have water, every day he had to walk down the hill and fill two pots and walk them home. One day, it was discovered one of the pots had a crack, and as time went on, the crack widened. Finally, the pot turned to the man and said, “You know, every day you take me to the river, and by the time you get home, half of the water’s leaked out. Please replace me with a better pot.” And the man said, “You don’t understand. As you spill, you water the wild flowers by the side of the path.” And sure enough, on the side of the path where the cracked pot was carried, beautiful flowers grew, while other side was barren. “I think I’ll keep you,” said the man.”
There are so many meanings that can be found in this vignette. I think about how easy it is to discard that which isn’t shiny and new anymore or even that which doesn’t live up to expectations. Conversely, how often do we not realize our own value?
When you feel like you are at the end of your rope, step back. Maybe your relationship isn’t easy and all consuming as when you began it but perhaps you’ve gained something more like security or spontaneity or wisdom. You can be sad about your relationship not working out the way you thought but that doesn’t mean it is all lost. Instead of living a disposable life, take time to see if there are aspects of a situation or item that you hadn’t considered previously. Maybe there is beauty, or benefit or flowers that you didn’t notice before.
As for your worth – you are much more complicated and awesome than you have taken to heart. It is easy to get caught up in past shame or current problems or perceived shortcomings. It is easy to fall into believing that life has let you down. Take time to remember that you uniquely bring something to all your relationships from casual acquaintances to intimate partners. Look for the flowers by the path that you bring.
When you read this story – what did you think about?
For some reason I am all about speaking up lately. I was playing on Pinterest (you know – instead of doing something productive) and I came across this quote:
“I learned that now that one who speaks about one’s miseries usually hurt, those who keep silence hurt more.” CS Lewis
I have so much love for this quote. It is so easy to not speak about what hurts us. Sometimes it is to avoid. If I don’t talk about something that bothers me then I don’t have to feel as bad. Sometimes we don’t talk because a situation seems hopeless and nothing changes. Sometimes it is because we think other people must be sick and tired of listening to us go on and on about it. Seems like acceptable reasoning.
Only, the aftermath of not sharing can be so much more devastating. Not speaking can lead to isolation. Not speaking up can lead to more feelings of hopelessness and desperation. Not sharing can even lead to feeling shame. Not sharing and speaking can lead to avoiding feelings which oddly enough often make feelings more pronounced.
I’m not suggesting you tell the cashier at Target all your problems but I bet there are some safe people in your life you can speak to. People generally want to help us. People generally are understanding. Talk to a close neighbor, friend or family or even a therapist. (Shout out for therapy from the therapist!) You might be surprised at how speaking up alleviates some of your hurt and helps you feel more centered and whole.
For the past week, every time I try to sit down and write a blog post I get distracted by shiny things. I just can’t get into it. I looked through all my blog ideas and starts (and there must be 50 of them.) There is one on voting I really want to finish soon. There is one on finding a therapist and one on positivity and I’m just indifferent to all of them. I skipped over each blog start thinking, “boring”, “I don’t care,” “not interesting” and just passed them by. I also save articles in my email for the purpose of blogging or Facebook and, no surprise; I was able to avoid writing by reading a bunch of interesting articles. I just didn’t find a spark to write about.
I started to wonder about how my complete block parallels our lives. How often do we have a task we just can’t get around to doing? Sometimes it is not just duty or tasks we don’t like to do, often people can’t even get started on enjoyable activities. I have heard more times than I can count from people that there are things they want to do but just can’t seem to start. I question how much people miss out on just because they can’t get started. So, I decided to write about nothing. It got me started and I already have the urge to finish one of the blog starts.
The advice to just get started might seem basic. It may prompt a “duh!” response but there it is. Just get started. People tend to feel more confident, more purposeful; more accomplished when just doing something. It doesn’t have to be a big, major event. It can be starting your cleaning project by emptying your dishwasher. It can be beginning to write your great novel by typing up a paragraph. It can be starting that new career by updating your resume. It can be starting that hobby you’ve always dreamed about doing by just looking up information on the internet. Just take action. Stop being distracted by shiny things (whoops, that may be just me.)
Blog on improving your mental health, your relationships and your life.
(Or maybe just free flow of random thoughts of Julie Fanning LCSW)
"Let others lead small lives, but not you. Let others argue over small things, but not you. Let others cry over small hurts, but not you. Let others leave their future in someone else's hands, but not you."~ Jim Rohn