Real World Clinical Social Work Blog: The Myth of the Perfect Intervention

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Perfect or progress

by Dr. Danna R. Bodenheimer, LCSW

(Editor's Note:I am pleased and excited to welcome Dr. Danna Bodenheimer as a blogger on The New Social Worker's site. She is the author of Real World Clinical Social Work: Find Your Voice and Find Your Way,  and is passionate about helping new clinicians navigate the difficult questions that come up for them.)

     To best introduce this blog, let me first introduce myself. My name is Danna Bodenheimer. I am a clinical social worker. I feel incredibly passionate about my work. I graduated with my master’s in 2005 from Smith College's MSW program and went on to get my doctorate in social work from the University of Pennsylvania in 2010. Since that time, I have taught at Penn, Rutgers, Temple, and I now teach at Bryn Mawr College. I also practice clinical social work. I had been in private practice for 7 years before opening the Walnut Psychotherapy Center, an outpatient setting that mainly serves the LGBTQ population. 

     I certainly would not say that I am an expert on clinical social work, but it is something that I do a lot of thinking, writing, and reading about. Until now, I haven’t had a venue available to me on a weekly basis, to discuss some of the issues that I frequently mull over in my mind. 

     I will use this weekly blog to write about recurring issues facing and thematic struggles that I see coming up for students and new social workers, as I teach and supervise. I am also completely open to hearing about what YOU want to hear about. I hope that this blog is a conversation, and a space for you to calm your own minds around the aching and unrelenting practice questions that you grapple with.

     For my first blog post, I want to address the powerful myth of the “perfect” intervention or the search to say the “perfect” thing. I often hear students and supervisees struggling to figure out what to say or what to “do” from one clinical moment to the next. I think that we are all haunted by the myth that the perfect clinical social worker (whoever that may be) would always know the perfect thing to say, and we can never match up to that person, that image. Our fantasies tell us that, perhaps, with enough training we might be able to figure out what the elusive thing is ourselves.

     I had a client who recently disclosed a sexual assault that he had experienced as a 15-year-old. It wasn’t that he didn’t remember the assault; it was just that he wouldn’t let himself understand it for what it really was until recently. He knew that something inappropriate had happened, but felt ambivalent about really allowing it to impact him in the ways that it very powerfully had. In many ways, accepting his assault meant a shift in his self perception. He needed to consider that he was a victim and survivor. Up until this point, he had understood himself to be just like everyone else, whatever that means. 

     My first fear when he was telling me was: has he told me this before and I forgot it? My second was: how can I say the right thing? What is the right thing? I don’t want to mess this up! There are so many different routes to take, right? I could validate him and say, “You are incredibly brave for calling this what it was and owning it.” I could practice reflective listening and say, “This sounds very hard.” I could also employ some normalization and offer that “many survivors take time to understand what happened to them and let that in.” I could also ask a series of open ended questions, “Can you tell me more about what happened?”and "What feelings are you having around this experience?” 

     None of these options are wrong, are they? I don’t think so. So if none of them are wrong, how can there be one that is precisely “right”? The fact is that there is no single right thing to say at any clinical moment. The other fact is that it is perfectly okay to get it wrong. Because in clinical encounters, we have the chance for repair. What makes an intervention right, or good, or useful, is one that keeps the client talking. What makes an intervention right, or good, or useful, is one that keeps the relationship strong. Often, there is not even a word that needs to be said at all. Often our silence is the most valuable instrument that we can offer.

     Our work, really, is to keep our clients feeling safe with us, safe within their own minds, and safe to keep exploring what feels incredibly unsayable and unthinkable. My client, by even entertaining the devastating reality of his assault, was both remarkably brave and vulnerable. For me to flee into the interiors of my own mind, in search of the perfect thing to say and the perfect way to be, would actually be a defense on my part and an abandonment of him. 

     A lot of the thinking we do when we are in session is avoidance of the intimacy that is created by the spontaneity that is required of simply being with an other. A lot of the thinking that we do when we are in session also removes us from the essential idiosyncratic reality of each unique clinical dyad. So perhaps instead of searching for the perfect thing to say, we might benefit by surrendering to the impossibility of the search and realize how naturally the actual relationship guides us to say, simply, the next best thing. 

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.