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Conserving Spoons

Conserving Spoons

A little bit of using self in Social Work.

Two weeks ago I fell at my Field Placement. I was walking down the hall (using my cane, not my rollator – my first mistake!) and all of a sudden my muscles decided that it was time to take a lunch break without me. I fell backwards, scared all of the staff who were around me and came rushing to my aid, and I required four people to help lift me off the floor and get me into a chair.

Pictured: an accurate representation of how I looked when I fell down at Field Placement.

Unfortunately, my muscle strength didn’t return, I couldn’t stand from the chair, and I had to go to the Emergency Room for a bit for safe keeping. Fortunately, everyone who I work with at my field placement site is brilliant, compassionate, and trauma informed. This meant that instead of being embarrassed, or worried about stigma, that I was able to instead concentrate on getting better, and meeting with my medical team.

Dr. Hackenbush has always provided me with excellent care.

Among being neurologically special, I have two auto-immune conditions that pose the most amount of complications in my life: Rheumatoid Arthritis & Fibromyalgia (which, for me, is actually co-morbid and secondary to the Rheumatoid Arthritis).

While RA isn’t rare in males, Fibromyalgia is, which (according to my math) makes me some kind of unicorn. It took ten months, lots of doctors, a biopsy, an EMG, literally dozens upon dozens of blood tests, a trip to the Mayo Clinic in Minnesota, and finally a local rheumatologist (working with a fairly advanced medical team of primary care providers, neurologists, physical therapists, nutritionists, etc.) to get me to a final diagnosis. If I were a woman it would have taken four years and two months longer; so I’m acutely aware of my male privilege here; to say nothing of the fact that I was able to even fly out to the Mayo Clinic.

Both of these conditions effect every area of my life. Rheumatoid Arthritis attacks my joints, nerves, and muscles. When I have an acute flare up I am the equivalent of a giant newborn who can’t walk, and who can barely sit up. Both of these conditions also cause fatigue. Fibromyalgia also causes intense pain. Fibromyalgia also has this awful thing called “Fibrofog.” Generally, it’s how my cup of coffee winds up in the linen closet.

Because of this, I have had to become an expert in conserving my energy properly, so that when I’m with my clients I’m at my peak game (this is an ethical imperative). What this means is that I have had to become an expert at time management, and conserving spoons. If you’re not familiar with The Spoon Theory, please take a quick read (it’s okay, I’ll wait).

A large part in being successful in managing my spoons, is making use of a variety of tools, tech, and assistive devices:

Tom Bihn’s Maker’s Bag
I use a bag by Tom Bihn called the “Maker’s Bag.” The main reason for this (outside of the fact that I’m vocationally trained as a sewist and fiber artist, and as soon as I found out that there was a bag geared toward people like me I wen’t “cool!”) is that there are a ton of rings that you can tether (literally) all of your belongings to. This means that no matter how “foggy” I am, I’m not losing my wallet, my bus pass, or any of my every-day-carry. This of course then lowers my anxiety (which can escalate from 0 to 100 in about .03 seconds if I can’t find my wallet, which used to happen regularly before I got this bag…usually as I was trying to get out of the door just on time). Everything is connected to this bag. My keys are tethered to this bag with a tether long enough to reach my door while I’m still wearing the bag. My wallet is tethered to this bag. My crochet hooks are tethered to this bag. My life is more or less tethered to this incredible bag. When I kick the bucket at 120, I’m having this bag buried with me so I can make sure I’m still this put together in the afterlife.

NovaJoy Vibe Wide Rolling Walker
Affectionately named Zappy, my walker is one of my main mobility aids. I do have a prescription for a wheelchair that I’m waiting on; but I prefer my walker for a variety of reasons. First, I feel more comfortable and active with it. Secondly, by continuing to walk (when I can, so not during acute flareups where I just sort of flop around like a Magikarp), I ensure that I don’t lose muscle strength. That said, when I am weak, it provides support, and when I lose all energy, I always have a seat with me. My walker is pretty tricked out. It has a light, a cane holder, a cup holder, and storage in the bottom. This may seem silly, until you realize that as someone who can have a rapid drop in energy and/or muscle strength, it provides me with both a safe and comfortable spot to rest, or to wait for an Uber to pick me up and help me get home. I don’t expect a cure from two incurable chronic conditions, which is why when people ask me when I’ll be “healthy” and not need my walker, I just sort of stare at them.

The Miracle Cube Timer by Datexx
I use a Miracle Cube Timer to help me get my work done. What I do is set it for 15 minutes, and then “sprint” (so focus only one one task and one task only, such as writing my case notes). While the timer is going I don’t allow myself to do anything else. Once it beeps, I flip it over to the 5 minute side, and give myself a five minute break. I’ve found that this has helped me manage my time at work more efficiently. I have one cube on my desk at field, and one cube on my desk at home. Research papers, reports, case notes get done in record time (though it does take some self-discipline to develop this skill).

Unfuck Your Habitat
Unfuck Your Habitat (UFYH) is one of the best resources I have ever encountered for anyone who is either disorganized, or faces challenges keeping their habitats unfucked due to chronic disease, illness, or mental health challenges. There’s a book, website, tumblr, and app…and I use all of them. It’s the only reason that my counseling space looks impeccable, the only reason I can function in my home office, and the only reason my bedroom hasn’t been listed as a national disaster site.

Remember The Milk
If I don’t write it down, the odds of it happening are slim to none. But I also have to be very cognizant of how much weight I’m carrying with me at any time. I use Remember The Milk as my main go to organizer for tasks. This saves me from having to carry a large to-do notebook. I have it installed on every computer I use at work (and at field placement). It’s on my iPhone and on my Apple Watch. It can send me multiple reminders hours, days, and even weeks in advance of when something is due. This means no matter how “foggy’ I am, I remember to get things done (so long as I plan in advance, since I never know when an acute flareup may strike). I obviously don’t enter client names or any PHI into it, but it’s great for things like “remember to case note;” “pick up flyers for clients,” “check your task list from your supervisor!” etc.

Evercontact
Evercontact is an application that will automatically update your address book based on your contacts signature lines. I have limited energy, and limited time. But I’m also in a field where networking is absolutely crucial to providing services to my clients. By having Evercontact update my address book (instead of me doing it manually) I save quite a bit of time. I get notifications on updates multiple times a week (sometimes even multiple times a day).

Evernote
Evernote is one of my lifesavers. I just cannot physically carry notebooks and binders with me everywhere anymore. This is where Evernote comes in to save the day. It is *literally* my everything binder. I have video clips saved there, audio clips, word docs, PDFs, notes scribbled on the back of envelopes, post-its, whiteboards and blackboards…all stored digitally, almost all searchable thanks to Evernote’s incredible handwriting OCR. I cannot praise them enough…if they were HIPAA compliant, they’d be *literally* one of the only things that a Social Worker would need…but even without being HIPAA compliant, they’re damn near perfect. Evernote is quite literally my brain’s backup device.

My iPhone & Apple Watch
My friend was kind enough to gift me an Apple Watch, which I mainly appreciate for it’s SOS feature (it provides me with a great deal of comfort knowing that I can hold the side button, have my watch call 911, and at the same time have it text my emergency contacts, including my supervisor). The Apple Watch has been useful in numerous other ways as well. I have an app on the watch that records sound at the touch of a button and then transcribes it (great for taking important notes, especially when I’m foggy). It also keeps me on track (by having my schedule on my wrist, and not having to remember to look at my phone or my calendar), reminds me to check my blood sugar, monitors my heart rate, and reminds me to remain active (among many other things). It also syncs with Remember the Milk & Evernote, which is incredibly helpful.

My iPhone has more or less replaced my daily computer. I find that an iPad is too heavy for me to hold in the long term, and after a day at sitting at desks and typing (which can be painful at times, especially when my hands and wrists lock up) that I rely on my iPhone for pretty much everything. Emails, television (i.e. Netflix & Hulu). Facebook. Even blogging.

Final Thoughts
I haven’t been paid by any of these companies. I haven’t received services in exchange for recommending these products. There are just – hands down – some of the tools that I have used to conserve my spoons, manage my energy, help my health, and remain in the MSW program (with a 3.687 GPA). They have allowed me to continue to work as a counselor, remain in my field placement, and continue forward toward graduating so that I can have my Social Work practice.

I look forward to sharing other tools and tricks in the future. I think it’s important – for true self care – that we recognize our barriers, roadblocks, and differences…and then find ways around, over, under, and through them. We ask our clients to be honest with us, and to share the most intimate parts of their lives with us…the least we can do to honor this, is to be honest with ourselves.

Supervision

Supervision

Every Wednesday my mentor and I have supervision at my field placement. This time is – and I hesitate to use this word, but it’s the best one I have – a sacred time, and I truly treasure it.

The notion of supervision in Social Work can be confusing to those outside of our profession: it doesn’t mean that my supervisor is in my session watching me interact with client (that’s observation). Rather, supervision is where (at least in my current setting, because it varies by practice, agency, setting, and individuals involved) my mentor and I sit down for an uninterrupted hour, and get to share in each other’s presence, where we close out my case notes for the past week (since I am functioning under my supervisors clinical license, he must sign off on all of my work). It’s where we discuss case conceptualization, where we talk about struggles that I am having free from judgement. It is where new ideas and concepts are bounced around, and where I can ask for help that I wouldn’t necessarily interrupt his day for during the regular week. It’s for bi-directional feedback.

Generally my feedback is incredibly positive; two weeks ago I was given feedback by my mentor (after the staff meeting) on something I needed to improve on. However, I wasn’t left ‘high and dry’: my mentor reminded me that he was my greatest advocate, and that he was there to work with me on what it was that I needed to improve. He checked in with me all of this week, and during our weekly session he made sure to find out if this week was a better week than last (which it was). On top of that, we’ve been doing satisfaction surveys of our clients, which – while anonymous, are linked to clinician – and my clients are in the “extremely satisfied” or “very satisfied” categories, so I felt much more confident walking out of supervision this week, than I did last week…not only because I did better as a colleague and Social Worker, but because I knew my clients were doing better as well.

The important part, though, through all of this, was that when presented with negative criticism, I was willing to listen, and willing to change: because at the end of the day, the goal is being a better clinician, a better colleague, a better co-worker…and even if I didn’t agree with that negative criticism; I didn’t want others to have that perception of me (whatever it was) so I worked to change my behavior, so I could – in turn – change the behavior of others.

Supervision is important, it is ongoing, and it is important we pay attention to what we like in our supervisors, because at some point (very soon) we ourselves will be providing (and yet still receiving) supervision…and we want to be the supervisors that we have enjoyed and learned from most.

36 Steps in in 12 Hours: Meeting Our Clients Where They Are

36 Steps in in 12 Hours: Meeting Our Clients Where They Are

While I am working to complete my Master’s of Social Work (MSW) I am also completing my CASAC (Credentialed Alcohol & Substance Abuse Counselor) credential alongside it as well.

For one of my classes, The Nature and Treatment of Alcohol and Other Drug Problems, we are required to go to three 12-step meetings. This is not the first time I’ve been required to go to 12-step meetings, and I always find them empowering, and interesting, and insightful (for a lot of reasons).

A few Thursdays ago I went to 3 twelve-step meetings in 12 hours…so I had 36 steps under my belt by the days end: I went to a morning AA meeting, an afternoon AA meeting, and an evening NA meeting (and truth be told, I always prefer the NA meetings to the AA meetings…I’m not sure why yet, something for me to meditate on and explore within myself).

We often say (or are often taught) that we have to “meet our clients where they are, not where we want them to be.” But how many of us actually follow that advice?

What I found so interesting is that at almost every 12-step meeting I’ve gone to there has been a similar theme, and one that I think is telling (or should be) to my fellow counselors:

“My counselor doesn’t get it,” “my counselor doesn’t listen to me,” “my counselor wants to talk about past issues…and all I want to do is move forward.”

This – to me – is a failure of meeting our clients where they are. When I have a session with a client, the questions I ask have to be carefully constructed…and I can’t ask them because they interest me…I have to ask questions because they’re beneficial to or are of interest to my client.

This justified negativity toward counselors doesn’t spring from the Big Book or Basic Text, it’s not endemic to AA or NA, or to 12-step programs or literature…so if you’re an addictions counselor and you’re looking for someone to blame, you’ll have to do some inner reflection.

While we (as counselors) can look at a client’s past and find useful threads, and meaningful connections to trauma, if our clients are looking forward to their bright future, we can’t allow ourselves to be anchors holding them back – or worse, dragging them back – to their past…instead, we have to be Solutions-Focused, allowing them to pragmatically reach the goals that they set for themselves, so we can remain helpful, and relevant to them…otherwise we just become a stumbling block on their path to recovery.

Always remember: Just for today!

Adults Have Kids (or The Wisdom of Not Always Being Placed Where We Want)

Adults Have Kids (or The Wisdom of Not Always Being Placed Where We Want)

I am not a kid person. I general I dislike having to deal with any children that are not my Godson, or any of my adopted nieces and nephews. In fact, when I adopted my cat they said “you need to be warned, she doesn’t like loud noises or children” and my response was “perfect, we’ll get along just fine!”

Entering the MSW program in my 30’s I had a relatively good idea of where and what I wanted my future Social Work practice to look like (or at least I thought I did: it’s expanded tremendously as I went through my program, though the general idea has largely stayed the same).

So last year, for my first field placement, I indicated on my placement request form that I was looking for an adult population, in a clinical setting…and my Field Placement office met me half way: I would have one day a week doing Solutions-Focused Brief Therapy at a Family Solutions Center (so adults would be involved…but so would their children…).

I said “Okay…”

Then the other shoe fell: I would be spending my other day a week doing School Social Work.

I was (initially) a little disappointed. I was super excited at having the opportunity to do some clinical work…but…School Social Work? Children? Teachers? Parents? PTA? Soccer Moms (and Dads)? Why would I – a soon to be Social Worker working with adult clients – need to do any of that? How was that at all relevant to my future practice!?

Because. Adults. Have. Children. You. Doorknob (I say to myself, now…older and wiser…)!

…and sometimes it is absolutely critical that we learn how to interact with populations that we are uncomfortable or dislike working with, because our clients (and our code of ethics) require us to do so…and it was one of the world’s most amazing experiences.

I learned Theraplay and I learned how to work with children and their families. I learned how to work with parents and guardians. I learned how to interact with CPS. I learned how to liaise between administrators, teachers, parents, and students. I learned about the incredible developing minds of Kindergartners, First, and Second Graders…and how they can explode cartons of chocolate milk with only their eyes (sort of like…Darth Vader). I learned how to elicit information (and the truth) from unwilling children, and how to play games while at the same time conducting counselling sessions. I learned how to effectively advocate for my students’ needs. I learned a lot about myself. I also learned about the incredibly important role of public schools within a community, and why I think they need to be protected and cherished at all costs.

Now, as I complete the last 8 months of my MSW program, and I am in the Field Placement of my dreams, and I interact and work with adults as a Domestic Violence Counselor as part of my day job, I am extraordinarily thankful that my first field placement forced me to grow and stretch my boundaries as a Social Worker…because while day-to-day I get to work with my “ideal” populations, I also know that if I need to work with children I can, and because I had this incredible experience, with incredible mentorship, guidance, and supervision, I know I can do so effectively. 

My first field placement gave me the gift of expanding my toolkit, which can only benefit my clients…so if I client tells me that they’re having concerns at home…and they’re an adult…and they have children, I can have them bring their kids into the office and I know that I have the training and the experience to work with that client and their family as a whole…and I would have never had that if I had my “ideal” field placement for my foundation year.

…I also wouldn’t be working as a Domestic Violence Counselor either with my incredible team at my incredible place of employment…so if you’re a student working your way through an MSW program, work with your Field Placement Office…and trust them (at least a little bit)…they may not give you what you want your first go round, but odds are they may give you what you need.

 

Permission to Nuke The Whales

Permission to Nuke The Whales

One of the traps that I think some of my clients (and even myself, to be honest) can get caught up in is that generally we want to do the right thing, and that sometimes we want to do the right thing so much that it becomes deleterious to our overall well-being and daily functioning. I think this is especially true if one has a chronic disease, disability, condition, or illness.

For instance, if you have a disability that makes lifting and moving difficult, and you really want to recycle…but the act of recycling causes your kitchen to fill up with plastic bottles because you don’t have the physical strength or energy (or spoons) to bring the bags down on recycling day once a week (or once every other week)…and then you find yourself constantly falling over bags of recycling in your kitchen, then is recycling really your best option? In this case I advise my clients to give themselves permission to nuke the whales and throw the bottles out with their regular garbage.

Sometimes depression makes it hard to clean up the litter box. Who wants to use disposable litter trays? They’re bad for the Earth, it’s wasteful, you’re throwing out aluminum or plastic each week…all of that’s true. That said, a kitty litter box that’s overflowing is bad for a client’s health, can contribute to a greater feeling of depression (due to the smell/mess/’failure’ to take care of something), and the kitty won’t be happy either. So what’s better in this case? Personally, I think giving yourself permission to nuke the whales and go for the disposable kitty litter trays.

Reduce, Reuse, Recycle…always sound advice. Paper plates, plastic forks, spoons, and knives: who needs em? Just more petroleum based products in our landfills. However, if your chronic illness, disability, depression, mental illness has you living with a kitchen sink full of dishes all the time (which can bring with it bacteria, mold, or vermin)…and it’s easier to just throw out paper plates, plastic forks, spoons, and knives…and those disposable plates and utensils are what makes it possible for a client to have a clean living space (and feel better)…then it’s time to nuke the whales and stock up on disposable plastics.

There is a time and a place for environmental activism…there’s also a time and a place to remember that clients have every right to put themselves first, and it’s one of our goals – I believe – as Social Workers, to remind clients that they are allowed to take care of themselves first, that they are allowed to put their needs first, and that we can work together to help them find other ways of taking care of the environment (and even offsetting their adaptations/restrictions) so that nuking the whales can become a win-win situation…because our clients aren’t going to be healthy (or successful) if their own environments (remember PIE) aren’t inhabitable, let alone be able to worry or do anything about Mother Earth.

*Social Work Desk does not advocate nuking actual whales. Please do not do this. Looking at you, 45 & Kim Jong-un.

Boundaries, Scope, Diagnosis & Diagnosis Dilution

Boundaries, Scope, Diagnosis & Diagnosis Dilution

“No doctor should assume responsibility for the health of one he loves or one he hates” – Dr. Michaels, And Be a Villain, A Nero Wolfe Mystery by Rex Stout

These words were written by one of my favorite authors in 1974, as Dr. Michaels was being interviewed by Nero Wolfe and his sidekick, Archie Goodwin, as they worked to take down the nefarious Arnold Zek.

Boundaries
Boundaries are not only important, they are critical. They not only protect our clients, but they also protect us as workers. Dr. Michaels, in the Nero Wolfe Mystery And Be a Villain by Rex Stout makes an incredibly important point: boundaries are not just about the use of self in our individual practices, they’re also about whom we accept to take on as clients, and whom we recuse ourselves from working with.

While I have found that certain positions such as Community Health Workers (CHWs) and Patient Health Navigators (PHNs) can have a little leeway, since these positions are non-therapeutic in nature, and are about connecting clients to resources and brokering information between providers, I still think the best practice is that they don’t work with those with whom they have a personal relationship.

Some in the CHW community disagree, given their role as communal workers. I think this is also fair, and I again point to the work that they’re doing as non-therapeutic in nature, and therefore subject to some amount of leeway: they’re working as brokers and educators within their own communities. They know their communities (and themselves) best. So far it seems to be working quite well, in many different communities, around the world.

Then there are those positions such as Social Workers, Psychologists, Life Coaches, Psychiatrists, and all the branches of Medicine where there really is no leeway: we don’t take on family, friends, loved ones, or enemies as clients. Period.

We also don’t take on those cases where we’ve heard too much. For instance, if a case has been brought up over and over and over and over again in case conference, it’s better to refer the case to a clinician outside of the organization or agency: no matter how well trained the clinicians at an agency are, no matter how trained they are to be impartial, the client – ethically – deserves a real fresh start when they’re being transferred because the clinician and client have agreed that it isn’t working out. It is unfair to provide the client with a “fresh start” while the person that they’re having their “fresh start” with has heard a large portion of the background story, and the problems that the worker and client were having together.

Boundaries also mean staying within our professional scope and training.

Scope
Scope of practice is important, ethically and legally.

Few pediatricians are trained to accurately diagnose Fetal Alcohol Syndrome (a specialist must be called). Clinical Social Workers do not all work with the same populations (some specialize in grief and loss, some are generalists, others specialize in childhood and adolescent issues, others in addictions, etc.). Life Coaches may have some knowledge of psychology, yet it is against the law (and also ethically improper) for them to provide psychotherapy, counseling, or interventions in any way that are clinical in nature. Psychologists do not have the same psychopharmacological training as Psychiatrists do, etc. Each and every one of us have a defined scope of practice that we must work within.

When we respect our own educational boundaries, when we recognize and proudly proclaim that in certain situations “I don’t know” it frees us to work within the scope of our own knowledge (and removes from us the pressure of being an all knowing expert). It allows us to safely make referrals to colleagues (of which there is the side benefit of building our professional network). It protects the best interests and safety of our clients, and it protects ourselves.

It is impossible to know everything, and there is a great deal of danger in assuming because one has a little bit of knowledge in many subjects, that one is professionally able to work in all of them.

Unfortunately, not everyone stays within their scope of practice (and this is a serious problem). Also problematic is when those who do not stay within their scope of practice and training attempt to diagnose, or provide off the cuff diagnosis.

Diagnosis & Diagnosis Dilution

Unless someone is fully qualified, they should not attempt to assign diagnoses and labels to others, and never to themselves (there are a plethora of reasons why it is improper to self-diagnose).

No matter how much one thinks they’ve read, one is neither qualified nor ready until they’ve taken the very heavily supervised coursework and completed a heavily supervised process.

Just so one can understand what it takes for a Social Worker to eventually be clinically qualified in New York State: we must take Graduate level Psychopathology, have two field placements over two years with 1:1 supervision for one hour, once a week (minimum), and 9 other graduate credits in evidence based clinical course work. Then there’s the initial licensing exam (which *still* doesn’t make one qualified).

After initial licensure you get hired and work under another clinician’s license. At this point, after all this coursework and a master’s, the only expectation your supervisor generally has of you when you start is that you have a basic understanding of differential diagnosis. Then, with regular supervision, and after 3,000 hours of paid clinical work (where you hone your differential diagnosis and counseling skills daily, M-F, 9-5) you can sit for the clinical licensing part of the exam.

Assuming you pass, you then earn your clinical designation. But guess what? New York State views that as a learner’s permit because it will still be about another three years (with weekly supervision sessions) before you get your R privilege that lets you have a home practice/open up your own private office (that means they want to make sure you’re still working, supervised, under someone).

Differential diagnosis of mental health disorders is not easy. It is a time consuming, slow, laborious skill to learn because it’s more than the DSM: it is quite literally thousands of hours of working with clients attempting to draw out from them the necessary and nuanced information to make an accurate clinical diagnosis of which the DSM plays but one small roll.

If one wants the capability to diagnose and to be taken seriously, they need to do the time and coursework necessary to get it. This of course saying nothing of the inaccuracy of psychiatric diagnosis in general and its questionable use in therapy. That’s another (post-modern, sociological view of disability) discussion for later (hopefully sometime this month).

Related and also problematic is the situation of Diagnosis Dilution (usually occurring when individuals self-diagnose themselves): there are clinical standards to determine if one has depression, bi-polar, anxiety disorders, etc. By self-diagnosing oneself, and providing improper diagnosis to others, the general public begins to view these diagnosis in a casual manner, with less and less understanding that they’re very real mental health conditions, that can have a real and pervasive impact on someone’s life.

Build your boundaries (learn from mistakes), know your scope, and don’t diagnose unless you’re trained and licensed to do so.

The Incredible Power of Love & Joy

The Incredible Power of Love & Joy

I am always amazed at the power of love and joy: there is so much negativity right now, we stand at a historic cross roads in so many countries around the world. The headlines are jarring, and yet there is so much beauty: there are so many people doing good, so many people

On Goal Setting & Advice Giving

On Goal Setting & Advice Giving

I believe that one of the mistakes that those in the various and affiliated helping professions can find themselves making is falling into is the trap of giving advice (speaking of, this post isn’t advice to anyone: it’s just my beliefs. Take it, leave it, modify it…the choice is entirely yours).

I am of the very strong belief that the only ones who should ever be giving out advice professionally are consultants which is a very different role (and one I’ve often held as a business consultant) than the roles held in the helping professions.

Consulting is a very different practice than working in the helping professions. In consulting I am being paid to provide professional advice based upon very specialized knowledge I have, within the scope of my education, training, and experience. In the helping professions, we are paid to help our clients elicit the answers that exist within themselves, and to be a guiding light, and a reflection board for them, so that they can make their own decisions.

The Problems With Giving Advice

There are two main problems I see with giving advice (and you can read this in a plethora of text books, conference proceedings, and on more blogs than this one. This idea is not unique and it’s certainly not originally mine):

  1. The worker becomes responsible for the advice.
    This means that if the advice fails the client, the worker is responsible. This also means that If the advice helps the client, the client doesn’t get to claim victory over their work.
  2. The advice is coming from the helper and the helper’s perspective.
    We are not experts on our clients or our client’s lives. The client is the expert on themselves, not us. This means that we, as the helper, are saying what we think is best for the client, rather than listening to the client and helping them verbalize what they think is best for themselves.

Advice giving isn’t the only, or main problem though.

I have worked with a number of various helping professionals who will agree with what I wrote above in its entirety…and yet, when it comes time to write a client’s goals and service plan, will then let their pen fly across the paper: using their words, their thoughts, their beliefs of what their client’s goals are, instead of the client’s words, the client’s thoughts, the client’s beliefs, the client’s goals.

The exact same problems exist here/with this as they do in the section above.

When I studied Motivational Interviewing is when I learned what – for me – is the ideal in goal setting, and it looks a little like this: Instead of making goal suggestions, or asking a client “what are your goals?” I ask a client a scaling question:

“On a scale from 1-10, with 1 being the farthest away from being where you want to be, and 10 being you’re exactly where you want to be, and everything in life is near perfect, and unicorns are dancing around you as we speak, where are you right now?”

Then the client will respond, and say they say something like:

“Well, right now I’m at a 4.5”

And then I might say:

“Wow, a 4.5! Okay, how do you know you’re at a 4.5, and not a 4?”

And I will then, in the words of one of my many incredible teachers and mentors, Mr. Sobota: “shut up and stare at them.” while I reflectively listen.

When the client is done, I will generally use an affirmation, or a reflective statement based on what they said. And then I’ll say:

“So, on that same scale, if you were to take the leap from 4.5 to 5, what would be different? What would being at a 5 look like?”

I then shut up and stare at them again. When they’re finished, I then go:

“So what would you need to do, to get from a 4.5 to a 5?”

And here’s where it gets totally critical: you shut up and stare at them again. As soon as they start telling you what it will take for them to get from a 4.5 to a 5 you start writing as fast as you can, because what they’re telling you is their entire goal list and service plan…literally, they’re telling you everything they need to do to get to the next step closer to where they want to be, so take good and detailed notes. 

After this, at least for this session, it’s generally smooth sailing: you should have a lot of:

“So what I hear you saying is…[read back what you wrote down as reflective statements/affirmations]…so if I understood you correctly, you would like to work on [goal] and you believe that you can accomplish this goal by [action]…”

You can then take all of those (now confirmed/adjusted and then re-confirmed) notes, and transpose them to whatever agency goal/service plan forms you’re forced to work with.

Guess what’s missing from here? Any of my interests, any of my biases…any of me determining what I think my client wants…and since it all came from my client they are the one who bears responsibility if their plan doesn’t work (and then you can help the tweak their plan, if that’s the case, or work through roadblocks int he exact same way)…but they client is also the one who gets to claim victory when their plan DOES work! THEY did it! CHEERLEAD THE HECK OUT OF THEM!

What if my client is making the wrong choices? Selecting the wrong goals? What if what they’re choosing will get them sent back to jail or won’t help them reach recovery?

Generally speaking, it doesn’t matter a lick if you agree with your client’s goals or not. There are, of course, exceptions: if those goals are robbing a bank, or injuring themselves or someone else, or anything similar to any of these situations…then what you think becomes very important and safety is paramount (codes of ethics, and laws almost everywhere support this).

That said, even in a drug treatment program the client may not have a goal of entering into recovery…and that’s okay: the consequences are theirs, not yours. A client who may need to see a job coach as part of their probation may not want to engage in services. That’s okay too: you’re not the parole officer. You’re merely presenting the client with an opportunity to engage in work or not and informing them of what the consequences might be if they engage, or if they choose not to engage. What they choose to do with that opportunity (and the consequences: positive, negative, or neutral) are their’s to bear alone.

What our job is, as workers, as helpers, is to help our clients enumerate what their goals are, to help them elicit from within themselves the way in which they  believe they will best be able to reach those goals, and if the client’s goals aren’t safe, or may have devastating consequences it is our job to help them understand what those potential consequences might be, to work with them to ensure that they (and others are safe), and to help them see alternatives.

However, at the end of the day, our clients must be the ones to develop their goals, to develop their own service and care plans, and to make their own choices. Sometimes those choices are incredible and beautiful to behold. Sometimes those choices will land them back in jail, which can be terribly painful to watch…but that’s okay too: they have every right to make that choice, especially if they’ve worked with you to examine all of their potential options, and all of the potential consequences that can be foreseen, based upon their goals and interests.

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