Real World Clinical Social Work Blog: Self-Care During Resolution Season
by Dr. Danna Bodenheimer, LCSW. author of Real World Clinical Social Work: Find Your Voice and Find Your Way
I personally get extremely overwhelmed during the transition to the New Year. I become saturated by the feeling that I should be doing everything differently. I don’t know where to start. The worst part is that as the year winds down, I find myself becoming increasingly complacent with some of my most self destructive ways of being, because I have this strong fantasy of how things will become magically better when the New Year comes.
I know that nothing that I am saying sounds unfamiliar. We are all in this cycle. It is a cycle largely fueled by capitalism, that is bolstered by selling more and more to convince us that betterment can be purchased. It is a large machine that can be nearly abusive to our psyches. It also negates the very real and sustaining truth that we are often in a good enough state that requires very little tweaking.
As clinical social workers, though, the tweaking that we do need to attend to is self-care. This is true throughout the year, and that has nothing to do with new year’s resolutions. It can not be secured through any purchases or subscriptions or memberships, particularly the ones that are on sale starting January 1st.
Self care for us is different than it is for many other professionals. We don’t just need a vacation every 6-8 weeks. A mental health day offers a certain reset, but not a sustainable one. Finding sustainable paths to self care, in our field, takes the effort to recognize our own idiosyncratic needs and the ways in which we are left with the overwhelming residue of our work.
I want to preface this by saying that I don’t feel like an expert at self care in any way. In fact, I feel I am pretty bad at it. That said, I feel there are some ways in which I have come to understand how to maximize support, understand myself professionally, and to talk to others about their cases in a way that provides relief.
You get hurt.
When I started to do dissertation research, I was interviewing experienced therapists about their experience of loving their clients. I learned a tremendous amount, but there is something that someone said to me that stuck. He said: “Before we end the interview, I want to tell you one thing: it’s that you get hurt. You get hurt by your clients, and no one tells you that.” Nearly 10 years later, I cannot believe how true these words are. We are frequently armed with the powerful reminder to “do no harm.” Problematically, though, we spend less time learning about and preparing for the ways in which we get harmed.
We meet with clients who have strongly avoidant attachment styles, complex trauma histories, inconsistent patterns of relating, and often regulate their own self esteem through the diminishing of others. We ourselves get diminished. We get hurt. We are abandoned (often without explanation). I once had a client tell me that I was talking about myself too much when she asked me how I was doing and I said that I was getting over a cold. I had another client make fun of the place where I went on my honeymoon (though she didn’t know that I had gone there) because it didn’t compare to an island she had been to in Hawaii. I had a client who was at a meeting where I was being discussed, and he told me how some of the people there didn’t like me.
It gets complicated. We can’t just tell our clients that they hurt us. It’s not that simple. We need to give them the space to interact in ways that are authentic to who they are, and this is often sloppy. But we can’t just disappear, either. Part of our work, in terms of self-care, is honoring the part of us that gets hurt by our clients. Sometimes we find ways to say something to our clients that is productive; a lot of times we don’t.
So what do we do with the hurt parts of ourselves? A key part of self-care on the part of the clinical social worker is to surrender the shame that comes from having feelings induced by our clients. There is so much written about the professional stance, objectivity, and clearing ourselves of countertransference. But that makes it very hard to just admit that we are hurt. Admitting that we are hurt is a huge piece of taking care of ourselves. We can admit it to a friend, a co-worker, or a supervisor. Those are huge steps. But those steps don’t compare to how essential it is to remain open to the truth of our vulnerability in this work. Without recognizing that utter vulnerability, our capacity for woundedness, abandonment, and disappointment, we cannot properly care for ourselves.
You aren’t talking about your work too much.
I am sure that most of you, if not all, feel as if when you are talking about your work, you are talking about it too much. You aren’t. I say that having no idea how much you are talking about it, and I am still sure that I am right. To do clinical social work well, your brain is probably working overtime to process the multitude of complex dynamics that you see on a daily basis. We are always walking the tightrope that hovers right above micro and macro, intrapsychic and interpersonal, theoretical orientations, agency politics, ethical decision-making.
The multiple levels of thought that this work requires likely means that your mind is racing a lot of the time. My hunch is that you articulate 1-2% of your internal processes aloud. This takes the steam off of what can feel like a psychological pressure cooker. We need to talk to process. Oftentimes, we need to talk a lot and that still doesn’t quite take the sharp edge off the scary terrain we navigate. To take care of yourself, you must talk and you must find places to talk and people to talk to. The shame you feel about talking too much must somewhat be understood as a parallel process. Most of our clients feel like “too much,” too. But by risking telling our stories and taking up space with them, we are helping our clients to do the same, by clearing out our storage areas for them to more safely occupy.
You are good enough.
When Winnicott talked about the good enough mother, he was of course also referencing the good enough therapist and the good enough social worker. He argued, thoughtfully, that all we really need to be good enough is “simple patience.” Asserting that health can only be achieved when clients arrive at their own answers, Winnicott suggested that providing a predictable, reliable, and warm holding environment would elicit the growth necessary for clients to become more authentically themselves. What this means is that we never have to have the answers. We spend so much time trying to figure out the right thing to say, the right thing to do. The fact is that, oftentimes, the less we do, the more “good” we are. I hear so many supervisees say, “But I don’t feel like I am doing anything.” And my answer, which is how I am providing for the possibility of self-care through self-talk, is: “Exactly, keep not doing anything.” In a moment when we are pressured by measurable outcomes, action steps, and endless goal setting, something about the magic of our work is lost. Self-care is a true returning to the simple essence of our work: to tolerate the not-knowing stance in the presence of others who doubt that they can ever find the answers within.
The problem with resolutions.
The idea of resolutions and why they conflict so much with actual self-care is that they are resolute, clear, black and white. Nothing that we do falls under this heading. We can have a client remain deeply attached to an abusive attachment figure and feel that we have failed because the outcome lacks resolution. Our work as clinical social workers is to resist the temptation of resolution, knowing that simplicity rarely comes when we are talking about human suffering. My work in terms of self-care is to surrender my wish for a client to seek a clear resolution, clear relief, an ending to pain. Instead, I remember that my clinical success is largely measured by own ability to tolerate the ambiguity of my clients’ choices and to help them tolerate the ambiguity of their own lives. Self-care is the embracing of ambiguity and the rejection of the possibility for resolution.
So talk more, let yourself be hurt, and know that we are all unsure about what we are doing. The self-care takes shape when we connect to ourselves and others around those exquisite realities.
Dr. Danna R. Bodenheimer, LCSW, is in private practice at Walnut Psychotherapy Center in Philadelphia, PA, and teaches at Bryn Mawr College Graduate School of Social Work and Social Research. She is the author of Real World Clinical Social Work: Find Your Voice and Find Your Way.