Clinical Intersections: What It Really Feels Like To Be a Social Worker
by Dr. Danna Bodenheimer, LCSW, author of Real World Clinical Social Work: Find Your Voice and Find Your Way and On Clinical Social Work: Meditations and Truths From the Field
We spend a lot of time talking, to be sure; whether it’s supervision, informally amongst peers, on the way to the bathroom. But I wonder how much of the time we really say, aloud and to each other, what it feels like to do this work. Of course, there is no universal feeling that defines being a social worker. However, I do believe there are some unifying, unsaid themes that might be relieving to connect around. I am going to try to give voice to some of them.
1. We maintain a myth about where our clients reside in our minds.
We are all confused about where our clients are supposed to live in our minds.
Every single boundary that we hold with our clients is a challenge to the instinct to connect on a human and personal level. Yes, we are real with our clients, but we are also reserved in a way that can get exhausting. When a client asks us how we are doing, we really want to answer with the truth. When a client has a wedding, there is a part of us that wants to go. When a client has a huge exam coming up, we get nervous, too. Our clients are stored inside of us in a way that we must constantly regulate in order to stay boundaried and ethical and to keep their psyches at the center of our work. This is a part of our labor that is both taxing and can feel shaming, because we are so frequently told, both implicitly and explicitly, that we are not supposed to feel these things. The fact is that we have all the same vulnerabilities as everyone else, so when a client no shows, yes, our feelings get hurt. When a client comments on what we are wearing, yes, it hits a nerve. We are real people doing this work while constantly engaging in the labor of de-centering our own psychological needs; yet relying on our own minds to do this well and thoughtfully.
2. Social workers yawn.
All people yawn. Social workers yawn in particular, and it is from multi-layered levels of exhaustion. There is the simple tiredness of not having slept well last night. There is the next level of exhaustion of knowing that at the end of the day, all of our notes are not done and if they are done, they are likely mediocre. There is an exhaustion linked to how much we want to get done and how much healing we want to achieve in the short span of time we have with our clients, as we are up against the backdrop of the complex traumas that have occurred over the years of their lives. There is a yawn coming from knowing that we are often sending our clients right back into the circumstances that trigger all of the feelings they are coming to see us with. There is a yawn coming from knowing that most of the systems that our clients exist in can only serve them inadequately and that we are deeply linked to and entrenched in those exact systems. A yawn, by definition, is the body's effort to collect more oxygen, to fill our lungs more deeply. There is a lack of deeper resources and our bodies act this out as we try to cover the yawns up, literally, from our clients as we raise our hands over our mouths.
3. We are traumatized, too.
Everything we learn about trauma speaks to how the past makes itself known in relational patterns that exist in the present. This is the knowledge that we try to guide our clients toward in order to empower them to live fuller lives. While we are trying to guide our clients with our deep understanding of the fatalistic ways in which trauma can wreak havoc, we are also trying to manage our own histories and to protect our clients from the ways in which we act out. So, when a client is in an abusive relationship and we are trying to guide them out of it, the whole time, we are questioning our motives: are we trying to save ourselves, our mothers, our sisters, or our clients? The truth is that we are always trying to do all of these things, and it gets really confusing to know our limits and to deeply understand our motives as our own psyches show up for every appointment that we have.
4. No one has figured out an adequate level of self-care to manage burnout.
I have read a lot about burnout and self-care. I have also worked extremely hard to create and maintain a rigorous system of self-care that involves exercise, downtime, supervision, and therapy. And it helps - it really does. But it does not even scratch the surface of what it feels like to wake up every morning and face another day of hearing material that breaks my heart, makes me question my faith in humanity, confuses and disorients me about how the world really works; or if it really works. The fact is that, as social workers, we are asked to do too much and to hold too much. We all have differing levels of capacity for it all, but there is no self-care routine that can keep our hearts from hurting in the way that they do. The real relief comes only, I think, from speaking the truth of heartbreak that we feel and the self-doubt that inevitably accompanies it as we try to have a huge impact on the lives of our clients with minimal time, resources, and support to make this impact possible.
5. The whole money thing is scary. It never stops being scary.
While we bear witness to the extreme poverty of many of our clients, this doesn’t prevent us from feeling as if we are ever on solid financial footing. As social workers, in this current economy, we are basically being asked to use our salaries to cover three things: the past (which is debt, largely educational debt that is likely tied to credit card debt, because of what we needed to do to survive school), the present (rent, mortgage, car payments, food, clothing, therapy, health care, utilities, continuing ed, and so forth), and the future (the possibility of ever retiring or creating the opportunity for our families to live differently and with less debt). Yes, we often have better salaries than many of our clients, particularly those of us who work in communities with lower socioeconomic statuses. At the same time, our salaries can never adequately cover the past, present, and future. And every day we are making decisions about which one of those three domains to invest in, knowing that we are sabotaging the other two in the service of whatever choice we are currently making.
6. We are constantly terrified of doing harm.
There is not a supervisee or social worker I know who is not afraid that they are somehow harming their clients. We do everything we can to affirm and validate our clients, while we sense the risk that we might be enabling them by doing this. We challenge our clients and live with the fear that we might alienate them by pushing too hard. We have treatment plans, goal setting, symptom checklists, and rating scales - none of which we can truly ever be using in the presence of another human being. We feel as if we are either abandoning our clients or the systems we work within. This feels true with every treatment decision we make. We build discharge plans that look okay on paper but never properly address the breadth of needs that our clients have. We set goals to assuage insurance companies while we sit with the reality of knowing that the achievement of these goals is neither possible nor sustainable. We try to adhere to as much truth as we can in a system that perverts the possibility of ever really saying everything authentically.
7. There is nothing else we would rather do. We are the resistance.
At the same time that everything that I have spoken about has referenced the deep and paradoxical pain that doing social work evokes, most of us wouldn’t have it any other way. In a world where polarization is increasing, mechanization of processes is accelerating, and measurement and quantification are points of obsession, we are sitting down with people and trying to have real, emotional conversations based within a safe attachment that can help rewrite the scripts that so many of our clients feel tethered toward living out.
No other work can compare with what that can offer us, and despite all of the struggle, that is what we keeping coming back for.
Dr. Danna Bodenheimer, LCSW, is the founder of Walnut Psychotherapy Center, and the executive director of the Walnut Wellness Fund. She is the author of Real World Clinical Social Work: Find Your Voice and Find Your Way and On Clinical Social Work: Meditations and Truths From the Field (The New Social Worker Press).