Real World Clinical Blog: Self Care, Clients as Tenants, and Peer Support

by Dr. Danna Bodenheimer, LCSW, author of Real World Clinical Social Work: Find Your Voice and Find Your Way

     The issue of achieving “good” self care at any time during one’s social work career is a near universal one. First, what “good” self care means varies from social worker to social worker. Some social workers need to have exercise in place to clear their heads. Others need excellent group supervision. Let me try to discuss, though, why self care itself feels like such a complicated issue. Let me also attempt to address part of why there is something about the dialogue about self care that can feel so frustrating and odd.

    Simply put, the work we do is exceptionally hard. Yes, there are a lot of professions that do very complicated and difficult work. I am not arguing that. I am arguing that social work is uniquely complex for the psyche to metabolize. The fact is that when we are performing our job really well, we will see our clients walk out feeling tremendous relief. It is hard to say exactly why this relief is happening. There are a million reasons, and the reason is likely different every time. But there is likely a unifying reason why this relief is taking place, and that is because something transactional has occurred in the dyad between the client and the clinician.

Our Clients Are With Us

    We ask our clients to rest their minds at our doorsteps. Many times, what we are also asking our clients to do is to part with significant pieces of their stress, to make them freer to function. But this stress, on a psychic level, has to go somewhere. I would argue that it floats into our minds, and it rents out space in the crevices and vacancies of our buildings. I think that as a social worker, it is fair to think of yourself as a building manager, with many different units, large and small. Clients come in and they make deposits in our minds—in our buildings—and we accept this. The clients don’t stay forever, and we never know exactly how long they will stay, but we do hold things for them.

    This is why, sometimes, we are in the shower and it feels as if we have a sudden realization about a client. We might be doing the dishes and the same thing will happen. We have our clients with us in ways that can feel both intimate and haunting. We have clients with us in ways that we can often feel ashamed about. This is because there is a lot of dialogue out there about boundaries and the need to have them. In fact, we need to have really good ones. That is true. But this dialogue often produces an internal sense of shame or a punitive feeling driven by an overly regulated super ego that keeps us from sharing just how truly “with” us our clients are.

    I want to echo that Carl Jung spoke eloquently about a collective unconscious and a psychological field that we coexist in with our clients. This field does not end when our work day ends. This fact does not dismantle, whether or not boundaries are present. But somehow, there is some confusion about all of this, and many new social workers are made to feel that if they take their work home with them, they have failed at creating good boundaries.

    My hope is that self care begins with separating these two dialogues. There is an important dialogue to be had about boundaries. There is another important dialogue to be had about how intense our treatment relationships feel and that we often wake and sleep with this, which does not render us unprofessional, naïve, or ill-prepared for this work. Self care, in my opinion, begins with a level of acceptance about how deeply penetrating this work can feel, coupled with a surrendering of shame around that reality. We often conceive of self care as a highly behavioral intervention, and it can be. It is also a mindset that allows us to recognize the gravity of our work, the extent to which it is not fully understood by other fields, and the very dangerous way that we, as social workers, can inappropriately police each other’s boundaries in a way that silences our very real experiences of having our clients as tenants.

Peer Support for Self Care    

    My best advice, when it comes to self care, if I have any advice at all, is that you need to hang out with other social workers. This does not need to happen all the time, but I do think it needs to happen. I think it can and should happen inexpensively. I think it is important to find a community of peers with whom you can talk about all of this shamelessly, honestly, and where the complexity of your role is celebrated and recognized.

    I do not believe that this is something that can easily happen with co-workers. Relationships among co-workers in agencies and nonprofit settings are notoriously complicated. Yes, there is certainly support to be had, and it happens all the time. The cultivation of relationships outside of the agency setting can be a sincerely saving grace, free of the daily politics that dominate your workplace. It will allow you to have a place where you get to say what you need to say freely.

    Beyond hanging out with other social workers, it is of particular import, in our field, to do things that give you renewal. This sounds trite, because it has been said a million times. It can mean journaling, art, exercise. The bottom line, though, is that if you can’t do those things for whatever reason, you need to pay close attention to protecting yourself from the shame that might ensue as a result. There is a very strong relationship between self care and shame, and this is something that I hope you can find yourself feeling particularly on guard against. No one has the self care “thing” down. It is an elusive entity at best, so have patience for its unfolding and mysterious role in your life.

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. This article is excerpted from her book, Real World Clinical Social Work: Find Your Voice and Find Your Way.