Real World Clinical Blog: When Everything Hurts

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

     I am not writing this blog with the assumption that everyone feels the same way about the outcome of the election. At the same time, I am sure that we share in the reality of the fact that our country feels deeply divided. Our clients are suffering because of this. Many of our clients, of course, have been suffering for decades, and the outcome of an election doesn’t change a thing. But, for me, the election has highlighted some stark truths that have shifted my clinical practice. These are some of the realizations that I have arrived at.

We can no longer subscribe to a binary between micro and macro practice.

     In social work school, we are asked to select a “track” and to refine our area of study very early on. These decisions likely guide our course selections and placements for the two years of our time in school. They also place us in silos that prevent us from truly studying the constant interplay between the field and the world, the treatment room and the street, the Affordable Care Act and the clinical hour.

     As policy inevitably will change over the next four years, our clients’ lives will inevitably be affected. It is going to be essential to stay on top of how policy shifts and to work to prepare our clients for these changes. Sitting with them in the pain and the disappointment of policy changes will not suffice. We need to also serve as their eyes and ears as services rapidly shift and entitlements dissipate.

     We also need to become even more aware of the ways in which policy is currently having an impact on our clients’ lives, presidential politics or not. This is because the outcome of the election was essentially a desperate cry out for change. Although I am not sure of the change we will get, I do know that the status quo was already leaving huge parts of our population behind, and this is not something that we can continue to remain blind to.

The economy is a social justice issue; the economy is a clinical issue.

     The largest population of individuals who use food stamps are Walmart employees. While we are tempted to think about the use of social services as highly correlated with unemployment, it is actually the working poor in this country who are suffering tremendously. Walmart employs 1% of the American population and is the largest American employer that exists. Their employees constitute 18% of food stamp users. Many employees work up to 60 hours a week and are still not able to put food on their tables.

     There is no way to think of that as simply an issue of economic inequality, although of course it is. It is also an issue of psychological suffering. As social workers, we need to think in wholes, not parts. When we hear about shocking economic disparity, much of which we suffer from ourselves, we are the ones who need to listen for the interplay between the mind and the environment, the mind and systemic oppression, the mind and the shame of never having enough.

Trauma is awoken in the ways that we don’t always understand.

     For my clients with histories of sexual assault, the results of this election have been electrifyingly painful. The fact that the candidate elected had been implicated in past sexual misconduct made several of my clients feel that their perpetrators had been vindicated. I have had clients share feelings of being locked in a room with their perpetrators, while others have discussed a wish to move into a cabin in the woods to feel safe.

     The wish for safety has never felt more pronounced in my work. And my inability to clearly offer it has never felt more difficult. I don’t necessarily think this is a bad thing. Instead, I think it is just a real thing. There are painful psychological states that we can bear witness to and survive with our clients, but it isn’t our job to fix it. And the surrender to our inability to “fix it” can only deepen our work.

We can’t know what we don’t know.

     I have spent the last week watching my clients watch me for some sort of answer or relief. I have spent the last week listening to my clients listening for my reassurance that things are going to be okay. The fact is that I don’t know any more about the future than my clients do. And I never have. But sometimes I feel like I do, and this is an inauthentic performance on my part. I have worked diligently, this week, to not reassure beyond that which I am capable. I have also worked alongside, not ahead of, my clients in their efforts to make meaning and sense of how the world is changing around us. And I do believe that meaning can and will be made, together.

A movement is unfolding.

     I have never seen so many of my peers become activated in such a short amount of time. Nearly everyone I know has become increasingly informed and moved toward action. If this movement is going to work, social workers MUST be a part of it. I know we are overworked, and I know that our work is already activism. At the same time, our systemic view of the world and our capacity to hold intersectionality is what will make this movement sustainable. I have never believed in the wisdom of social workers and psychological thought more than I do now. It is our time to demand a seat at the table, as we see how our clients’ rights fade and the coverage for the work that we do evaporates.

It is always darkest before the dawn.

     I was sitting on the floor of my kitchen at work because we were out of seats the other day, and I made a joke about feeling like the kitchen was a bomb shelter. Everyone laughed and agreed that the safety of this small room of social workers was indeed a bomb shelter. In reflecting on this, I realized that the comfort and direction toward the future that we must find, we must find in our own experience, our own camaraderie, and our own practice wisdom.

     It is only through the support of other social workers that the ways forward will be lit. I am going to try and shine a little light. I hope you all do, too.

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. Read more of her clinical perspective and tips on the most burning questions of developing clinicians in her book, Real World Clinical Social Work: Find Your Voice and Find Your Way.