Limitations of a Therapist
In my fifteen plus years working in the mental health field I have encountered a variety of scenarios. My early days after graduating college were spent working with adults in recovery from substance abuse and dependence, working with developmentally disabled children, and working with children diagnosed with mental and behavioral health issues most of which were part of the foster care system or living in unstable environments. My observations: life is unfair.
But, it was those first four years following graduate school working as a mental health therapist that made a hard lasting impression. I worked with individuals, children, and families at an agency that served the community’s severe and persistent mentally ill population. Looking back I don’t think I really knew what I was getting into becoming a therapist. I wanted to save the world one person at a time. What I learned was the harsh reality of the system that these clients had to depend on, the biases of others, and that there are limits to my role as a therapist. I am not Superwoman like I thought. Damn, now that’s unfair.
I experienced a world I did not know existed through the eyes of my clients. I lived very far away from this world. From drug and alcohol dependence to being diagnosed with disorders like Schizophrenia to the Child Protective System (CPS) to suicide my innocence couldn’t help be tested and my eyes pried open. I think I was shocked at least once a day. However, I stuck to my values believing all people deserved a chance. I prided myself on being nonjudgmental and assumed that all working in this field did too. This is not the case; another harsh reality. Really, life is unfair.
In this photo: A counseling session. Photo credit: Clinic Counseling Session
What I am about to share is not typical but shaped the way I practiced and supervised therapists in the years to come. The case I am sharing was referred to me through CPS. There was nothing strange about that as much of my caseload was either children or parents involved with CPS in some way. The reason for the referral was due to a couple’s child being removed from their care due to environmental neglect and their inability to parent. I followed my protocol and completed the necessary assessment with my recommendations.
I worked with the couple and provided individual therapy for the young woman which was not unusual in a busy agency like this. At the time therapy started she was pregnant and as stated above the couple’s first child was in foster care. In one session I remember her saying that she was determined to change the “cycle” of her family being in the “system”. This was a profound statement and thus set the stage for treatment. She had already learned that life was unfair from a very young age.
Her initial presentation was one of extreme anger and sadness. The couple continued to have difficulty getting along although reported some improvement. It became more apparent as time went on that she was more invested in treatment than he. Not too long after therapy began the couple decided to separate and couples therapy ended. Despite these and other changes she continued to show motivation for treatment and change if not more so now. Even when sessions were missed she was persistent in connecting with me even if only by phone. Her progress even showed in the way she was dressing. She went from black dull clothes to bright colored clothes with a more pleasant affect. This was a true testament to how far she had come in treatment and it was a pleasure to witness.
As time moved on she gave birth to a baby boy that, to my surprise, she decided to voluntarily terminate her parental rights. As she would share stories about her interactions with CPS I couldn’t help wondering if she felt pressured by CPS to make this decision. She was very sad about the decision but stated that she made this decision because she wanted the best for her son. I felt so much sadness for her and thought how unfair.
Custody for her daughter for which the case was started was still pending. She continually expressed how deeply she missed her daughter and her desire to continue the relationship with her daughter. With all of the progress she was making and had made I honestly thought reunification with her daughter was a no-brainer. But, I had a nagging feeling CPS was not on the same page.
In this photo: A pensive mother. Photo credit: Teen Angst
I tended to my responsibility in my role as the therapist of writing updates and speaking to the worker via phone or in person consistently. I made sure to convey the progress that I observed. My understanding was that my written updates were being made part of the case record for CPS and the judge to review to therefore make an informed decision. But on one occasion during a conversation with the assigned worker when the case was moved to a different department I was informed otherwise.
It was during this conversation that my heart sank and my anger flared. The reality of my limitation as a therapist was realized in this short conversation. The reality that my observations of the progress made by this client were not perceived the same by another. The reality that all involved were not working on the same page for this client was validated. The reality that the next steps to be taken in regards to this case was completely out of my hands despite my clinical opinion.
During this conversation the worker and I discussed my written updates and how they are presented in court. I distinctly remember her words verbatim because I think I almost fell out of my chair and I know my jaw dropped. At that very moment she said to me “I read your updates and just take what I think the judge should read”. It must be noted that in this conversation was also the hint that reunification was not going to happen for my client and her daughter.
I felt anger like I had never felt for another professional. My thoughts were scattered. Was I really hearing this? How could she? What do I do? I was dumbfounded so much so that I couldn’t form any words to confront this worker. I shut down. I hung up the phone feeling deflated and feeling bullied. I couldn’t get it together to defend myself or my client. I thought if I felt bullied how my client must have felt all this time? Is this the way our system really works? This was a shock to my core and an eye opener about my own personality in the face of conflict. I wanted to save the world and I couldn’t even confront this worker.
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I worried and agonized over the details of this case and the conversation I had. I sought supervision but unfortunately I was leaving the agency and all I could do was put it in the hands of someone else. I did decide that it was best to be honest and transparent with my client. I shared the conversation I had with the worker and did what I knew how to do best, encourage. Encourage my client to use her newfound confidence and all of the progress she made to keep moving forward and fight.
Life is unfair indeed. A difficult lesson for a young woman who wanted to save the world and believed everyone thought like I did. I left this case feeling helpless with no closure, answers, or conclusion. A case like this could make or break a young therapist. I chose to confront my fears and continue to build my confidence to be a better therapist. My perspective has changed but it has led to great things.
I have since been able to stand up to the bullies of the field whether it is lawyers, CPS workers, or other therapists. I now know my limitations in my role as a therapist and that the world can be an ugly, unfair place. I may not be able to save the world but I can be an example and affect others. I am living proof of how facing your fear although scary is well worth it. And, if my story can help even just one young therapist struggling and needing normalization in this fragmented world of working with emotions and behaviors then I have won. It’s not easy admitting you are wrong or have failed but I truly believe everything put in our lives is a lesson and a blessing. Yes, life may be unfair at times but we have a choice in how we are going to respond. That is the true lesson.
EDITOR’S NOTE: THE OPINIONS EXPRESSED HERE BY IMPAKTER.COM COLUMNISTS ARE THEIR OWN, NOT THOSE OF IMPAKTER.COM.
Feature image: Flickr/Quinn Dombrowski