Real World Clinical Social Work Blog: Joining the Chorus
by Dr. Danna Bodenheimer, LCSW
author of Real World Clinical Social Work: Find Your Voice and Find Your Way
A client of mine who is revisiting a lifelong passion of hers after years of fear and ambivalence asked me, “Will I always hate myself? Will this voice of hatred always be here?” It’s a good question.
A few days later in a supervision group that I run, a relatively new social worker was talking about the enduring feelings of shame that she feels in her job because she has “bad boundaries.” She wonders if the shame will ever go away. Will she ever feel like her boundaries are good enough? It’s a good question.
In both instances, which are really just two mere examples of psychic states that we all share, I feel an internal debate about how to respond. I want to say, “Of course you will stop hating yourself,” or “Of course you will start to feel more confident about your boundaries.” I think about the strengths perspective, about the role of hope, about the power of unconditional positive regard, and the answers are so clear. Yes, relief will come.
But will it really? In many ways, I don’t actually think so. The reason that I know the real answer to this question is because of my own experience of living within the environment of my mind. I feel self hatred all the time. I question my boundaries all the time, too. Even in writing this, there are constant questions and fears about being too much, about saying too much, about not knowing what to write. Yet I am writing this and risking putting myself out there, despite the fear.
Therein lies the answer to the questions. Yes, there is a part of me that hates myself. Yes, there is a part of me that questions my own boundaries. But, those are parts of me, voices in a larger chorus. The goal, I believe, in our work with our clients, is not to stop the self hatred, but to diversify the internal experience that they have of themselves.
A powerful concept in object relations theory is related to the idea of introjects. It is argued that introjects are internalized messages taken in from early attachment figures that configure the way we have come to understand ourselves. For my patient, her mother loved her but also felt incredibly overwhelmed by her. She is a twin and was often aware (on some level) of her mother’s feeling that she couldn’t handle both of her babies. This manifested into a sense of self hatred that still sustains itself today, particularly when my client is stressed out, depleted, and lacking internal or external resources.
Our work as clinical social workers is not necessarily to compete with the introjects, although we sometimes do. But wrestling matches are often hard fought, losing battles. Instead, our work is to join the chorus, providing an alternate tune or melody. Perhaps, we are the soprano to the towering alto. Bear with me - I am a horrible singer myself and basically tone deaf. But I am a decent writer and also really good at parallel parking. See, my work is not to become a good singer (that simply won’t happen); it is to become more than a bad singer.
I once had a supervisor tell me that it was not important to hate or love our clients, but instead that we ought to hate and love our clients properly. This is a powerful notion. I can’t just say to my client, “Your mother was totally overwhelmed by you, but I am not." I can’t just become the alternate introject. It isn’t that simple. This is partly because my client may actually be overwhelming.
Instead, we need to shift the introject's hold by discovering, with our clients, that they are more than one thing. My client can be overwhelming, but she isn’t only that. She is also unbelievably smart and passionate. I often find myself thinking, when I am making food for my picky children, that this client would know what to do. She has a way of understanding the complexity of both children and food that I envy. This is the truth. And that is one of many truths that help me to love her properly, precisely, and authentically. It gives me a legitimate place on a crowded stage.
It is with that love, the specificity and idiosyncratic nature of it, that I can become another introject. As you can imagine, her mother had the tendency to sing solo with some other bit parts played by siblings, her father, grandparents, and perhaps a teacher or two. The more voices in the chorus, the less powerful any one of them can be. The hope in bringing about a chorus of voices is to aid our clients in ultimately auditioning for their own solo, sung in their own voice.
Back to the supervisee and the shame. Part of the reason that I mention her struggle alongside that of my client’s is that there is a wholly false dichotomy in our perception around who has these struggles. It isn’t just our clients. It is all of us. We all dwell in shame, self hatred, and doubt. The question is how we can keep these introjects, these self states, from becoming paralyzing or defining. By sharing her shame in group supervision, my supervisee is offered a nearly literal chorus. The fellow social workers in the group echoed their resonance with this fear and pain. However, they also countered with their real experiences of my supervisee, knowing that her astute clinical insight and capacity for self reflection are also essential parts of her melody and must be played, at least alongside (if not louder than) the painful song of uncertainty.
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.