Saturday, November 2, 2013

Holding On to Self-Care and Promoting a Holistic Approach

About a year ago an article with the intriguing title "End of Self-Care" by organizer B. Loewe was going around. It took me a long long time to read it and all that time I was under the wrong impression of the article's focus. I thought it highlighted community-care, encouraging social workers and caring professions to rely on one another for support as opposed to emphasizing internal and self-reflective coping methods. I finally read the article, agreed with a few points and disagreed with some of the author's main points, and went on to read a few responses. I wanted to share writer and activist Spektra's response in particular. 

Though it may be more than fashionably late to respond to the original article but it's not too late to talk about self-care and respond to some of B. Loewe's statements that I've heard elsewhere, if not explicitly then implicitly. I did like that the article sparked conversation about a topic that stirs a reaction in many a social workers and case managers. An eye roll from the very compassion fatigued professional, an anxious tug from another who looks at self-care forlornly, a third holding it closer more confidently and comfortingly. It also brings up a valuable need to define what self-care means.

Back to 'End of Self Care', most of the message I got was Loewe encouraging care providers to reframe our work so it is not exhausting. He makes an argument that certainly sounds reasonable: if we work for something that we deeply care about and, importantly, its purpose is positive then it should not be draining. The article indeed discusses community care, in the sense of let's be involved with each other and support each other as a community, which I agree with. 

I agree that as social workers, organizers, care providers, we often work towards positive goals. Ideally this is rewarding. Hearing thank you from clients also, developing good rapport and trust makes difficult work easier since you feel like you're working in partnership with your clients. But -- just like conflict is usually inevitable in interactions with others (which does not mean it cannot be it worked through) I also remember vividly going to protests or engaging in community actions that felt discouraging when I considered the obstacles that we deal in reaching social justice goals. I know the challenge of working with individuals with psychological or physical disabilities who face systematic obstacles that are very real in hampering their growth. 

Taking away our need to self care and self compassion invalidates not just the discouragement we understandably feel at times but also downplays the challenges we consistently face -- and our clients. Yes, we should be working towards improving the services we offer or our organizing approaches and methods so they are more effective. But even as these continue to improve we will find obstacles to client and community success. Real obstacles, not just because of me as Anatolia or us as individuals, but systematic blocks. And the answer to feeling frustrated or exhausted or sad isn't to forget that I have an idea of 'self' (generalize this sentence to we). Does it help to feel and behave (completely) selfless to do this job well? To work towards social justice? If it works for ya, great, but it doesn't work for me and it doesn't have to. 

Let me say it again. We deserve to give self-care and self-compassion to ourselves (both professionally and in our personal lives) and this is something that I did not get from End of Self-care article. I find self-care especially crucial to promote when the same concept gets pushed down the priority list over and over again. Not just by us, but our employers.

It seemed that Loewe equated self-care with going off on yoga excursions or otherwise luxurious activity. The idea of self-care how I define it and often hear it discussed is care we give to ourselves physically, emotionally, spiritually, creatively, intellectually, and professionally. Exercising, which I am really able to do if I enlist a friend (if that's what it takes...) even though I feel much better afterwards. Something so basic. Singing. I've been wanting to take a art class for a while to do something completely different. Self-care also means caring for basic needs, getting enough sleep, eating well. Seeing the dr. regularly. Having friendships and relationships outside work. Practicing (or discovering and developing) self-compassion.

I do think that community care has deep value and this is something that I use informally, relying on colleagues and offering them support, learning from fellow case managers and social workers in other agencies and online journals. Self-care can be limiting if it's done only introspectively. Both in our personal lives and professional lives, camaraderie may be so nurturing. When morale at an agency is good and when colleagues help each other work satisfaction is much improved.

And, and this I will emphasize too, our agencies, our bosses need to give us supervision, fair compensation for our work, good benefits. Professional support. Staff duties should be clear, caseload manageable, and we should be forced to have lunch breaks. The time and money to train new workers is not worth the short term cost cuts of lower wages and reduced benefits (that lead to higher turnover). Yeah I know, between supportive jobs and reality there is discrepancy in many places. I would love to hear from folks who advocated for themselves or caring professionals in their organizations for improved conditions.

In the meantime, I'm here holding on to self-care so it doesn't slip from my fingers -- it does have a tendency to try and do that.

Sunday, June 9, 2013

They Figured it Out on Their Own

It does feel good when you are checking in with a client who was struggling with an issue, and she lets you know, matter of factly, oh yes I dealt with that situation. Especially when the issue first seemed like a colossal feat (which incidentally, was made so either by what she was telling you or the impression you developed on your own). Or you get a voicemail from the client with the same message – I do like these voice mails. I know I have to occasionally actively remind myself the degree that clients have survived and succeeded before I worked with them and likewise that they will continue to do so after I leave Empoder.

A few thoughts are behind this last paragraph. One is that sometimes I feel like I get attached to clients’ specific situations. Meaning that, especially in the past, I could potentially empathize so much with certain clients that I would worry about them post office hours or take steps to advocate for them to a point where I worked harder than they did.* Hearing from clients that they resolved a situation independently reinforced individuals’ capabilities. In some ways it also showed me that typically and ultimately, people were responsible for their situations. I could not make decisions for them. This does not mean I do not support them but that if there is a balance between the two, more of the responsibility or ownership of their lives is in their hands. Which, honestly, is an exciting idea because your role becomes more to empower an individual rather than take care of a challenge for them.

I eventually learned not to work harder than my clients but it took time. In fact, even after I learned this it was tempting to go against it at times, like when working with an individual with physical or mental health disabilities that seemed to be particularly challenging to him resolving an issue on his own. But honestly, even in cases where clients did work as hard as me, in a field where developing relationships is key to a lot of what we do,  if our employers or supervisors do not guide us as to boundaries when we start, we may not know how much advocacy or outreach is required of us. And if your attitude is to run and try to “take care of things” for your client because you believe that is how you will help him, then that is what you do before learning to rein things in. Sometimes the hard way.

I encourage everyone in the field, particularly folks who are new, to be sensitive to starting to feel attached to their clients (in the sense of wanting to work harder than them to experiencing vicarious trauma). If you start feeling that this happening, talk to your supervisor, talk to your colleagues, your therapist, your mentor. Many human beings naturally build attachments as they get to know people, particularly on a close level. And case managers know a lot about many individuals we support. We often care about the people we serve. But we have to maintain a professional relationship for everyone involved, including our well-being.

Sometimes clients’ situations trigger past or current experiences for me. Or I have other reactions to my work with clients. I debrief with my support network. And I learned, even though it may seem clear, that these conversations about how we work as case managers, processing all that goes into it, are ongoing. Knowing that it won’t take only one conversation or even a few, that’s a relief.

I have learned to continue and encourage clients to try and resolve certain situations on their own first. My client and I talk out possible courses of action and then they act on their own. The problem happens when clients come to Empoder already on the end of their patience and frustrations. They have already spoken to the case worker of an organization to resolve an issue or more likely have been on a phone tag of trying to get in contact with a provider or a landlord. And when you are talking to someone who may have a physical or mental illness and/ who is feeling agitated or defeated, you sometimes just want to help directly. Call the place for him. You know as a case manager that at times we are taken as individuals with more credibility. We are more likely to know the system or even the provider. It is harder to instead encourage a person in a challenging state of mind to advocate for herself in a new way that may be more likely to yield results. In some situations, yes, it may have come to the point that a case manager’s intervention is the appropriate response. However, in many situations it is more appropriate and empowering for clients to take action on their own first. 

One approach that has worked for me in some situations, where clients strongly prefer not to make a call or advocate for themselves alone, is to have them call the providers at your office. Then you can debrief afterwards and get a sense of how your client communicates over the phone. Is she impatient or does she quickly give in, how is the provider communicating with her. It gives you more insight on how a person communicates with someone who is not you. Don’t we all know how we communicate differently depending on the person (and tied in with that sometimes, the relationship we have with her)?

* This is where I note the importance of assessing and reassessing your clients’ capabilities in advocating for themselves, troubleshooting, social skills, and so on, when contemplating the level of support that they need.