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.