What is therapeutic alliance and how do I teach/do it?

November 5, 2017 § Leave a comment

I’ve noticed with students that they understand what therapeutic alliance means but are confused about how they can create it or “do” it. Conversely, my fellow educators already know how to do it, but may not know how to explain it or teach it to their students.

Therapeutic alliance is so important and is one of most basic and foundational skills in social work because it is a tangible expression of empathy and trust. Without a therapeutic alliance, a social worker cannot expect to have a clear path to a positive outcome with a client.

More simply put: If a client doesn’t trust you, then there is no motivation to change behaviour or to make better decisions. Why would anyone do anything for someone who isn’t trustworthy and in their corner?

The challenge we have as social workers is that often the environments where we work aren’t necessarily conducive to being able to slowly build a therapeutic alliance with clients over a period of time. Most social workers – in hospital settings or community agencies – have only intermittent and brief periods with their clients which presents a challenge. (Of course, my colleagues in private practice, intensive case management, or in settings that allow for more frequent contact with clients may have more freedom and opportunity to cultivate really strong and robust therapeutic alliances.)

So what are the basics of creating a therapeutic alliance? These are the steps that I’ve learned over the years that work for me.  But a warning here: this will not work for all situations and clients but for new students or educators, it’s a good place to start.

Step 1: It’s all in the approach

As social workers, we ask much of our clients. Sometimes we ask them to reveal alot about themselves – to tell us their deepest and darkest struggles. Stories that maybe they have never told anyone else. Or we come upon them in times of crisis or a major life event – when they are not at their best or are not coping well – and we have the task of gleaning as much information as we can in order to figure out how best to provide support. So approaching a potential client in these situations therefore is the first thing you have to think about.

A rule of thumb to remember is this: Be open, curious and remember your humanity.

Right now, you’re probably thinking: Huh? How in the world do I do that?

Remember that you are a stranger to this person. Introduce yourself. Sit down next to them, if you can. Look them in the eye. Explain why you are there and how you can help. Ask gently if they will tell you what is wrong or worrying them. Ask them where they would like to start. Slow down and let them choose. Learn to be comfortable with waiting and silence.

Step 2: Always, always, always acknowledge the emotion

Our western society, which eschews and judges emotion harshly, makes it difficult for clients to express their feelings in the first place and as a result, most individuals have very little practice or skill in handling these situations.

This is often the situation that scares and worries social work students the most. I’ve seen students go pale with fear when they have to see a patient for the first time who is crying or angry or acting out in some way.  (Social work educators should do their utmost to ensure the safety of students, but sometimes these situations are fertile opportunities for learning, strengthening of skill, and professional growth, with close supervision and support, of course.)

But what is social work if not to create connection and avenues of change for our clients? Acknowledging the emotion behind the words is the first step to connection and alliance. Ultimately, every person wants to be seen and heard. To acknowledge the emotion is a way to see your client, to demonstrate that you understand or are trying to understand how it feels

I’ve found this works equally for emotions of sadness and anger, as well as with happiness.

An example? For an angry client: “You seem angry. You’re fists are clenched and you’ve raised your voice.  Tell me what has been making you feel angry?”

This may seem overly simplistic on the surface, but ultimately I’ve experienced that the simple things are often the most difficult. To acknowledge the emotion of your client requires a willingness on your part to take an emotional risk. Yes, as social workers we have to be brave enough to ride that emotion with them. And the goal is not to make the emotion go away or to help them feel better. The goal is to wade in and guide the client through – to brush away a path to their own resolution.

Step 3: Do what you say and say what you do

This is about followthrough, integrity and honesty.  Therapeutic alliance ultimately comes down to trust. And the best way to cultivate trust is to followthrough with what you say you are going to do, to act with integrity and to be honest with the client.

This may mean acknowledging that you don’t know the answer or that you may not know what to do. But what is most important is that you are going to try. Most clients don’t expect you to know everything but trust doesn’t come with you knowing something. It is created when someone knows and feels that you are being honest and are doing your best for them.

Clients don’t expect perfection, but they do expect sincerity. Believe me, clients know when you are not being sincere or honest. And when that happens, you may be in a position where the alliance has broken and it will take much more hard work on your part to repair that rupture.

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Ultimately, cultivating a therapeutic alliance is an ongoing process. It’s not a “one and done”. Experienced social workers know that – with some clients – they are revisiting their alliance over and over. But when an alliance with a client is strong and leads to a positive outcome – whatever that may be – it is truly, truly worth all the time and effort.

 

 

 

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I’m a social work student or I have a social work student – now what do I do?!?

October 28, 2017 § Leave a comment

After a long break, I’m preparing to embark on another journey with a young and eager student and it’s got me thinking about some of the basic skills and competencies of social work.

I think it’s true that we, as teachers within our profession, sometimes don’t do a good enough job of articulating the foundational skills of social work.  Or, I should say, perhaps we don’t do enough to unpack the basics for students in a way that is easily understood.

To be honest, I remember coming out of my graduate program and into my first practical placement and realizing that I really didn’t know a darn thing. I had studied all the social work theory and had practiced with simulated clients (ie. fellow classmates mostly) but did I know anything about what happened in the real world? No way. I knew nada, zero, zilch.

So much about our work is about contextpatience and empathy – concepts which are so much harder to articulate, explain and obtain. It’s often assumed that social work students just come with an understanding of these concepts already; that these aspects are an implicit part of their very beings. And yes, with some students, this does come easier and more naturally to them.

But what to do about the ones who struggle? We have an eager and motivated generation of young people who have grown up native to a digital universe that is often antithetical to providing context, rewards the fast and new, and promotes solipsism. How do social work educators and field instructors provide guidance and understanding of these very necessary skills and concepts in the face of such a massive influence?

So, I’ve decided in the next few blog posts, I’ll try to tackle the issues that I’m seeing in social work education by breaking individual skills and concepts down into practical language that – hopefully! – can be easily grasped. I’m crossing my fingers that this will be helpful to both social work educators/field instructors and students alike.

But as I’m certainly no expert and in the interest of learning together, I would be interested in your opinions and questions. Feel free to share what has worked or what hasn’t worked. Perhaps you’ve been stuck on something for a while and still haven’t figured it out. Or better yet, you have a tip or made a breakthrough that you’d like to share. (Remember, no identifying information please.)

So here’s to learning and teaching and growing together!

 

 

 

We are needed now. More than ever.

January 18, 2017 § 1 Comment

This past year has been tough – for alot of us.  And as I look ahead, it’s easy to think that the road in front of us will bring us more of the same.

The news is a constant barrage of catastrophes, disasters and disappointments. Tales evoking disbelief and illustrated examples – almost unrelenting – of the awfulness that humans can embody and the indignities we can do to one another.

More and more, I see pictures of the ravages that we have inflicted on our precious Earth. And I wonder, whether we will ever be able to atone for the destruction. I often feel tremendous sadness at the burden we will leave to our next generation.

Even in daily life, I’ve observed the effect of our ever-increasing pursuit of fast money, fast success, and fast lives through the erosion of our personal relationships, our increasing inability to respect one another, our growing unwillingness to engage in true dialogue and in our decreased capacity to recognize what is truly important in this world.

And I’ve seen, over and over again, the destructive nature of social media – where lawlessness abides – and where the boundary between an Internet reality and real life is slowly but assuredly becoming more and more blurred. Where young kids and youth are now navigating a landscape where bullying is the norm  – almost expected – and internet trolls are a de facto part of this new technological culture.

Finally, we watched, some with utter disbelief and a dreaded awe, as one of the most powerful and influential nations in the world, democratically elect a leader with whom, we can be sure, will begin to unravel the progressive and compassionate reforms that many of its citizens sacrificed and fought for, sometimes with their very lives.

There were so many moments during the past year where I felt overwhelmed, helpless, and often in despair. But most of all, I felt outrage. Outrage in a way that I have never felt before. My feelings of anger finally had a freedom in them, a voice of “enough is damn enough“, and a clarion call of wanting to be heard.

This tumultuous year has taught me finally what it is to stand for something. What it truly means to live one’s values. And that the value of my life is the sum of what and how I contribute to this world. The final tally will rely more on how I’ve left it, than in what I’ve gained from it.

Which is why I think we – as social workers – are needed now. More than ever.

If anything, my years in this work has taught me that we work in the spaces in-between, amidst the unknown, in order to carve out the paths for others to follow. We are teachers of humanity. We carry the wells of empathy. We create safe spaces for dialogue. And most importantly, we know how to not be paralyzed by fear and outrage.

Our work takes courage. I’ve always said that social work is not for the feint of heart. And courage in the face of fear is what is needed now.

If we want change to happen, then it has to start with us. And it’s okay if you don’t know how to start. What is most important is that you try. Be brave and make the attempt. And keep making the attempts.  You most certainly will fail, but that isn’t the point. The point is to not give up.  The point is that you will learn as you go. The only blueprint that we have for change is that there is always a place to start – an individual’s courageous beginning.

It’s important to note that being on the Internet is not a moral imperative. I believe it’s a mistaken view that actual social change can happen from behind a screen. But going out there and living and contributing to this life is the truly crucial and moral work.

Whatever your values, creed, religious affiliation, ethnicity or orientation, I implore you – as social workers – to use your abilities and skills to foster and teach what we will likely and desperately need in the coming years: dialogue and empathy.

So roll up your sleeves. Our work is only just beginning.

 

 

Set your boundaries and replenish the well…

July 13, 2016 § Leave a comment

It’s a hot and blustery evening and I’m sitting here, a little sweaty and a lot tired. It’s a tired that I know very well. The edges of my fatigue are very familiar to me – I’ve gotten to a point where I can gauge the different “stages”.

The beginnings of my fatigue are benign – it feels like a small muscle ache in the middle of my back, but with a good stretch, it releases. And there’s a sense of relief that comes with that. An acknowledgement that good work has been done and a nice reward is deserved.

The “middle” fatigue feels more like I’ve done thirty leg squats and just want to lie down for days. It’s a bone-weariness that weighs me down and I start to crave sugar like no tomorrow. The prospect of that burst of energy from a sugar or caffeine high is like a drug and I look forward to it. It catapults me to the end of my workdays – tricking me into thinking that I can keep this pace up.

One would think that my “ultimate” fatigue would simply be like a stock market crash. One day I’m up and the next day I’m worthless. But for me, it doesn’t work that way. In fact, it’s almost like an audible `click` I hear in my head. Like the switch to my brain being turned off and the automatic pilot of my body taking over. Any good sense I have goes out the window. I end up pushing and pushing, working harder and harder, denying and ignoring all the signs of impending trouble. It’s almost an out-of-body experience in a way, because my brain is no longer in control but it can see everything that’s happening and is helpless to stop it.

The way I know that I’m beyond fatigued is when I feel and know that I no longer can empathize with my clients, my friends, my family. When I start to feel the burden of being “put upon”. When I start to have thoughts of, “I don’t want to have to do one more thing for this person.” Or when I begin to take deep and very loud breaths without realizing it. When I get preachy and I can hear the shrillness in the tone of my voice. When I`m actively avoiding certain topics of conversation or not starting where the client is at.

Finally, I know when I`ve reached my limit, when I have not maintained my boundaries – that they have become porous and translucent. And then the vicious cycle of being hard on myself begins – berating myself for not maintaining that vigilance and protection. (Which of course, only makes me feel worse.)

Every social worker has their limit – whether they realize it or not. We are not endless wells of empathy and compassion. We are human beings with both flaws and strengths. What we most commonly are though, are givers. People who feel more like themselves when they give to others. But with this also comes the danger of giving too much and becoming empty, if we don`t adhere to our boundaries. It`s a constant checking-in to make sure that the well doesn`t dry up; that our integrity as a person first and a social worker second, remains intact.

My favorite social worker, Brene Brown, has some great comments about maintaining boundaries and she certainly says it better than I can right now. But what she says is so very important.

It`s a good reminder: set your boundaries and replenish your well.

Success/Failure, Failure/Success

March 26, 2016 § 1 Comment

I’ve noticed that many young social workers are finding this blog and leaving me wonderful comments! But as lovely as these comments are, I also sense a lot of trepidation in them – either about having to make decisions to go into social work or the struggle with the work itself.

I too remember those tumultuous feelings at the beginning of my career. Often wishing that someone – anyone!- would pop out of the woodwork and just tell me what to do. Give me the answers please! (Wouldn’t it be great if stuff like that actually happened? We’d all be out of a job, I think – ha!)

I only have two things to say. I won’t say this is advice, but I will leave these tidbits on your doorsteps to do with however you please.

This first thing has to do with how you define success.  Ask yourself this question – many, many, many times:  What does success mean to you?

I’m not talking about what career milestones that you are planning to reach. Or the lifeplan that you have etched in your head about love, relationships, family, home ownership, happiness, travel, retirement, all packaged tidily and benchmarked at different ages and stages.  (Don’t get me wrong, this is all well and good. Life goals are important.)

What I’m talking of is more about the success in the work that you do or will do with your clients. How will you define success with them? Because your answer to this question will be crucial to how you will fare as a social worker.

If your answer is: Well, success means that my client will finally be cured of their addiction, depression, grief, etc., then I’m sorry to say that your social work career will be very intense – and very short. You will soon be shaking hands with your new friend named Burnout, with your relationships in shambles, your health detrimentally affected, and you’ll desperately be looking for a way out. Tying your definition of success to an absolute outcome can be anathema to your career as a social worker.

But if your answer is: Well, I’m doing my best and I’m batting 50/50 with my clients where some are making baby steps toward a positive direction and I think that’s a good day, then you may enjoy a long and very rewarding social work career.  Moving toward progress can be a form of success. Making attempts where there had been no effort before – even so-called “failed” attempts – can still be a form of success.  Hard work can be a form of success. I think you can glean what I’m trying to say here.

The second thing is something that was passed on to me by a cherished mentor, whose voice I can still hear in my head, even now.

When I landed my first job as a social worker, I was giddy and riddled with excitement. This was finally what I had worked so hard for and I was determined to be successful. And for the first few months, I worked hard – stayed late, answered every phone call, every email, wrapped up every issue tidily, sat and listened with empathy to every client, mediated tense discussions with families, supported staff and their struggles, put out as many fires as I could – basically tried to be the magical social worker that I expected myself to be.

But you know what that led to? Me – crying in my office, almost every single day.

My mentor found me like this. And I remember her quietly closing the door and sitting down across from me and saying: “Sometimes, and maybe especially at the start of your career, you will have to take the time and find your place in this work. Not every social work job is going to be the one for you. You will have to take your time, try different things, work in different environments, until you find your place. Give yourself this time – if you can. It’s so very important.”

I’ve shared this not just because I hope it will be helpful, but because even at this stage in my own career, these two things I find I come back to, time and time again.

Redefine success. Take the time, if you can. It’s so very important.

 

 

What you might not want to hear…

January 30, 2016 § 1 Comment

Warning: I’m going to be blunt. Brutally honest. I’m going to tell you the cold, hard truth. Perhaps you should sit down, take a deep breath, and stop operating any heavy machinery.

Are you ready?

Okay, here goes….

There is absolutely no way to keep your emotional distance being a social worker.

I’m very sorry to say this. And perhaps this is not what you wanted to hear. But I would be remiss if I didn’t tell you how it really is.

There will be days that you will wake up in tears. That you will go to bed in anger. And many, many moments where you will feel numb or frustrated because you just cannot bear to hear one more heart-wrenching story.

And yes, you will have times where you feel like the world is in the palm of your hand – when you have made something happen and relieved someone of their burden – even if just for a day.

But mostly, this work places you on the neverending rollercoaster of emotion that sometimes you may feel you cannot get off of. The ride keeps going and most of my career has been just as much about learning how to ride that wave, as opposed to wanting it to stop.

I’ve laughed with clients and I’ve cried with clients. It is the very nature of the work – we are guides and companions on the journey. And we cannot do this if we are just that one step removed or that slight distance apart. In my practice, I don’t believe in throwing the life preserver into the water and then walking away.

So how does one not become decimated? How does one continue when you are wrecked and wracked with emotion?

You don’t.

You take a time out. You rest. You let yourself be grateful for what you have. You learn how to be compassionate with yourself. (Because you cannot be compassionate to others if you are unable to first be compassionate with yourself.)

And then you get back on that ride. Because what we do is important and for me, still the best work in the world.

 

 

 

The Indelibles

September 13, 2015 § 3 Comments

It is inevitable. As a social worker, you will encounter those who I will call The Indelibles.

The people who will never leave you. The ones whose encounters imprint themselves on your brain like a pool of ink. The individuals whose stories will continue to walk along side you for the rest of your career. The visions of their faces and bodies will emerge in your head at the most inopportune (and opportune) times. The ones that will take hold of you and sometimes leave you at the precipice of your own limits and force you to face yourself, the world and your work in it.

I have a number of stories that I carry around with me. Even now, I still can’t shake them.

Especially one: a pair of blazing young eyes and lips made piercingly violet by whatever noxious substance had taken hold and whose unblinking stare held me down like black anvils on my shoulders. I still remember the utter silence of that stare. And the colour of her puffy jacket as she walked away from whatever help I could offer.

These people – these stories – often bring social workers to the grim reality of people’s lives and sometimes make us face our utter helplessness as professionals. The inability to do anything. It is a very uncomfortable stance to face, but a necessary one to truly understand the work and yourself.

I tell my students that there is a difference between being a “helper” and being a social worker. A “helper” is putting yourself in a very selfish position – of gleaning a sense of personal satisfaction from some small act of assistance that only addresses the problem in the moment. But this “help” is usually very fleeting and often doesn’t impact a client’s life in a meaningful way.

In my version of social work, things work very differently. A social worker often does not have moments of triumphs with clients in days or months or sometimes even years, but we continue to attempt to lay the difficult groundwork and foundation to help clients enact real and lasting change. The decisions and conversations we have are difficult and fraught – there are no easy battles, no settled conclusions, no turn-key solutions. We do the best with what is available in the system. We help to guide a client as best as we can without stripping them of their dignity, their autonomy, and their responsibility.

It is in this way that I think social work is a profession that teaches you who you truly are. We are in a profession that pushes our personal boundaries and prejudices and limits almost every day. We are asked to walk away from our comfort zones and enter another’s harrowing experience more often than most. I can’t comment on what and how you will feel when you first realize you are at that point in your work – it is different for everyone. I can only assure you that, at that moment and on that edge, you will have to make a choice about what kind of social worker (and maybe even, what kind of person) you want to be.