The Profound Act of Sitting With Difficult Emotions and the Value of Process in Social Work Practice
by Pamela Szczygiel, DSW, LCSW
Social workers are in the business of supporting and advocating for vulnerable individuals and communities, many of whom have endured unspeakable trauma and oppression. Given this tall order, it makes sense that, as a profession, we’d want to focus on successful outcomes. Which treatment interventions have the highest empirical evidence? What works? At the same time, some argue that our focus on outcomes has diminished the role of process in social work practice (Applegate, 2004; Urdang, 2010).
In considering the value of process, important professional questions emerge: How does the focus on process facilitate self-other awareness, reflection, and our capacity for feeling and understanding emotion? How does the practitioner’s increased capacity for awareness, reflection, and empathy influence the treatment relationship and, therefore, the client?
As a social work educator and practitioner who is sympathetic to both a relational perspective of social work practice and the experiential philosophies of yoga and Buddhism, I’ve had ample opportunities to explore the above questions with other practitioners, students, and clients. Specifically, I’ve considered the value of sitting with, being fully present with, difficult experiences and encounters in the context of clinical practice (Szczygiel, 2016). This article will use a composite case example to explore the value of staying fully present with difficult emotions, as well as the clinical consequences of avoiding them.
Sitting With Sara: A Case Example
Sara experienced chronic pain resulting from a car accident that had occurred years prior. She endured physical abuse and neglect throughout her childhood and had a long history of difficult, combative relationships with loved ones, co-workers, acquaintances, and, as it would turn out, with me. Sometimes Sara would enter therapy in a good mood. A good mood for Sara meant that she would laugh and crack jokes, usually at my expense. But most of the time, Sara presented as irritable, frustrated, and overwhelmed. Her physical pain manifested as generalized body aches, headaches, and/or stomach cramps. Sara’s body was screaming. She pleaded for me to “do something” to help her, “to fix” her pain. She constantly questioned why she needed to be in therapy. When I would attempt to have honest conversations with her about this issue and how she felt about my inability to fix her, she would cling to me, pleading that she wasn’t ready to leave treatment. Following a session like this, Sara often needed to call me before the next session or schedule an extra session. These “in between” sessions typically consisted of Sara crying, yelling, and further pleading for me to fix her.
Even though we continued to explore the importance of Sara acknowledging her emotional pain and suffering, her pleading for me to “do something” or “to fix” her, coupled with her occasional verbal attacks toward me, intermingled with every ounce of insecurity I had, leaving me feeling worthless and ineffective as a therapist. My response, then, was to scramble and push for answers. I found myself making feeble attempts to offer her more suggestions and advice—referring her to other treatment professionals and various alternative therapies, trying desperately to help her. These were all desperate attempts to “stop the bleeding” and, in all honesty, an attempt to provide myself with respite from Sara. Despite my tendency to value sitting with difficult emotional experiences, as well as using the client-clinician relationship as a main source of intervention, I became fixated on stopping Sara’s emotionality, as it became too difficult for me to endure. We were working very hard and getting nowhere.
Sitting With: Resisting the Urge To Fix Everything
As you already see from the case description, this is not an example of my exceptional abilities as a relational and Buddhist-informed therapist. Rather, it’s an acknowledgment of just how chock-full each therapeutic encounter is with emotional exchanges, many of which are missed, because it is so challenging, for clients and clinicians alike, to stay present with emotional pain. My high responsibility reflex often kept me from being able to sit with Sara’s discomfort. Rather than being deeply attentive to the emotional needs beneath Sara’s cries for help, I often bit the hook on the surface and engaged with her in a never-ending charade of “trying this or that technique.” And, Sara tried a lot.
Despite her limited financial means, Sara attended nutritional counseling, experimented with yoga and acupuncture, and tried various other adjunctive treatments. One of her strengths was her openness to trying new things. But as soon as she realized that the new technique was not a cure all, she would panic. “Why can’t you come up with anything else,” she’d ask me.
I’m certainly not devaluing the importance of the various therapies and tools that Sara tried. I’m a fan of yoga and various other holistic therapies. Rather, I’m saying that the focus on tools, techniques, and interventions can come at the expense of being able to fully acknowledge our emotional experiences. This is a phenomenon that Zen teacher and psychoanalyst Barry Magid (2013) refers to as emotional bypass. In other words, in our efforts to feel happier or more effective, we may suppress the emotional experiences that can offer us insight into our functioning and relationships.
Like Sara, I would also panic when a new strategy or technique didn’t work. I fantasized about fixing Sara, in part, because I resisted my developing feelings of responsibility for her. These feelings were very scary to me, and I desperately tried to avoid them. In my attempts to stop Sara’s emotional and physical pain, I was sidestepping some very significant questions: Why was I working so hard to end Sara’s emotionality? Why was I equating Sara’s emotionality with my own lack of effectiveness as a therapist? Why was Sara so afraid of her emotions? Why did she feel so incompetent and angry with herself for having emotions? Why did she both ridicule me and then cling to me? What was the meaning of this “dance” between us?
Sitting With: Building Our Capacity To Feel, Endure, and Be Ourselves
On one hand, Sara had an immeasurable capacity for emotion. She had been walking around with intense emotional and physical pain for years. Yet, as a child, Sara’s sadness, anger, and fear were rarely acknowledged or validated by her caregivers. Sara endured emotional and physical abuse. This was an unbearable situation that resulted in Sara being left alone with terrifying feelings and no support mechanism for acknowledging and coping with them.
As young children, we rely on our primary caregivers to comfort us when we’re afraid, lonely, angry, or sad. In a healthy relational environment, we absorb such comforting interactions, thereby learning how to feel, hold, and regulate our emotions (Schore & Schore, 2008).
I’ve had a few years to reflect on my time with Sara. I wish I had been able to offer her a better holding space for the intense emotional and physical sensations that she was experiencing. Sara never had such a space, a place to fully sit with her experiences, to be herself. When she was ridiculed and abused as a child, her only recourse was to do whatever she could to survive. In her case, this meant burying her rage and sadness and doing whatever she could to disappear. For Sara, being ignored by her parents meant she was safe from ridicule and abuse.
As I look back, I now see that, when Sara was given the space and time to feel in the presence of a supportive other (me), the emotional floodgates opened. Her buried trauma and pain surfaced as attacks against me, which I struggled to hold because my personal narrative included the belief that I had to make others feel good. My conclusion: If I wasn’t providing Sara with a solution or cure for her anger, fear, and sadness, I wasn’t effective.
The grand fallacy of equating effectiveness with the removal of negative emotions is that our emotions aren’t the problem. They are what they are, neither good nor bad. According to Buddhist philosophy, our suffering is made worse by our desperate attempts to get rid of our pain—burying, running away from, and/or punishing ourselves for simply having difficult emotional experiences (Hanh, 1998).
Conclusion
Offering our clients the space and time to fully experience themselves is a profound aspect of social work practice. It signals to the client that we, as practitioners, can tolerate their emotions. This is meaningful to an individual who has survived by burying or denying emotion, for fear that others will not be able to handle them or accept them for how they feel, for who they are. In this process of sitting with difficult experiences, practitioners are also given the opportunity to develop their capacity to fully feel and understand themselves, an integral aspect of clinical work.
References
Applegate, J. S. (2004). Full circle: Returning psychoanalytic theory to social work education. Psychoanalytic Social Work, 11 (1), 23-36.
Hanh, T. N. (1998). The heart of the Buddha’s teaching. New York, NY: Broadway Books.
Magid, B. (2013). Nothing is hidden: The psychology of zen koans. Boston, MA: Wisdom Publications.
Schore, J. R., & Schore, A. N. (2008). Modern attachment theory: The central role of affect regulation in development and treatment. Clinical Social Work Journal, 36 (1), 9-20.
Szczygiel, P. (2006). Maneuvering difficult emotional terrain in psychotherapy: A Buddhist-informed conceptual framework. Clinical Social Work Journal, 44 (1), 241-251.
Urdang, E. (2010). Awareness of self: A critical tool. Social Work Education, 29 (5), 523-538.
Pamela Szczygiel, DSW, LCSW, is an Assistant Professor at the School of Social Work at Bridgewater State University in Massachusetts. She is also a Certified Health Coach and yoga instructor. She maintains a small clinical practice and is engaged in a variety of community organizations.