Sunday, September 6, 2009

Transferring a Client Out

I’m lucky I have the luxury to be able to transfer a client to another case manager. Sometimes clients are found ineligible for services upfront because we’re not able to offer services they need. Sometimes while they’re client due to inappropriate behavior (like aggressive behavior towards other clients or staff) they may no longer seek services. Other times a client’s mental health may become unstable to the point we can no longer help them (we don’t have suitable tools onsite, like no clinicians).

Other times something else may not work between a case manager and client. The right chemistry isn't there, a certain goal isn't being met but a case manager thinks a client would still benefit from services. This move is ideal in a lot of ways -- a client's still in the same agency but sees a new worker. Granted a transfer isn't something that can happen regularly but knowing that that option exists is reassuring. It’s sometimes the best course of action a case manager can take for himself as well as the client. I’ve transferred a client who flourished under her new case manager.

Until now I've transferred a few clients and last time it happened I was feeling quite anxious over it. Mostly thinking about the conversation that would take place with the client letting him know he would no longer be able to work with me. I had worked with Nick for around 8 months. He initially came to search for work and was referred to case management by his job counselor. It sounded like Nick had all but been estranged from his family for reasons he never quite completely explained. It sounded like his dad was a strong figure in his life at one point but that he had gotten in trouble when he was younger and didn’t graduate from high school. Interacting with Nick was tough – each time we spoke it felt like I had to establish rapport all over again. This was hard for me because I wasn’t used to doing that with other clients and because I didn’t make the switch that Nick worked differently. Although he would usually not be very talkative and challenged almost everything I said he kept coming back to my agency and our working relationship was quite intensive.

I tried to set goals with him and he would follow up on a few but then stop. I made a mistake as well by not being consistent with him since I wouldn't always make sure he'd follow through. Granted you can't force clients to follow through but I would sometimes cut him slack when I know I shouldn't have. I tried to give him constant positive reinforcement and encouraged him to think about responsibility and taking responsibility for his actions. Towards the last few weeks I would look at our upcoming appointment on the schedule and just feel bad, like I was already expecting the mental battle we'd go through when I’d see him.

It didn't happen quickly but eventually I realized that it was an unproductive and to a degree an unhealthy working relationship. We weren't working towards any goals. We'd start bickering because I let Nick press my buttons. And then Nick told me, though he didn't spell it out, that he had developed feelings for me and I knew that that was it.

It wasn’t a difficult decision to come to in the sense that clearly Nick and I shouldn’t continue to work together. But a part of me couldn’t help that I failed him as a case manager. I learned how I needed to work more effectively in the future I learned it through making a mistake with him. Maybe these are remains of this faulty idea I had of being some sort of savior for another person, which I know is not my role. But I felt it more on the human level. I wanted to help him, but I wasn’t able to.

The good news was that it was possible to keep him in the program and that if Nick agreed to it, he would be transferred to another case manager who was willing to take him. The one thing I was thinking about was how Nick was going to take the news. I had my supervisor sit in on the conversation with he and I because while I wanted to be the person who told Nick he would be transferred to a new case manager I wanted support with me. On the advice of a coworker I never used the word “decision,” in a sentence like “A decision was made that.” I talked about a move, a change, something that would work for Nick. When Nick understood what I was talking about he made a motion to walk out, pushing his chair back, but not actually getting up. He didn’t say much for the first 5 minutes, but then he started nodding and responding. I still felt some hostility from him but in end it went really well. Indeed I had overthought the conversation too much in terms of him taking the news badly. My supervisor introduced Nick to his new case manager. A few days later security approached me and let me know that Nick tried to push his boundaries with his new case manager in the front lobby but was put in his place* and that he was treating security with more respect. Power of social psychology is fascinating.

* 5/28/2011 Rereading this I don't like my usage of "was put in his place." More appropriate to state that the case manager addressed this immediately whereas I didn't necessarily do this consistently.

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