Best and Worst

We had a small celebration for our interns, who are leaving us after several months, and a co-worker who is just beginning her retirement after many years. We asked them each to tell about their best and worst moments. It was easier for the students, who have not been with us an entire calendar year, than my just-retired co-worker, who has been in this particular job for a decade. Over a long career, there are going to be many best and worst moments. Still, some stick in your mind.

Of course it made me think about my own best and worst. Once, when I was working in a nursing home, I developed a good relationship with a patient’s daughter-in-law. The patient was dying and the daughter-in-law was (appropriately) tearful so I put my arms around her to give her a hug. She sat like a statue and I immediately knew I had made a mistake. That was 8 or 9 years ago but I remember it vividly. It stays with me all the time. And it’s not even the worst moment in my career!

It was a good learning experience though. I was so sure this woman needed a hug that I forgot to read her body language and her cues. She didn’t give me any reason to think she wanted to be touched; it was something I would have wanted in the same situation so I went for it. I felt horrible about it afterwards. And I was too inexperienced to acknowledge my faux pas. Instead I think I held on for a beat too long and then excused myself right out of the room.

To be balanced, I should tell you about one of my best moments. But you may think it’s strange if I tell you how it sometimes feels like a victory when someone starts crying or when a patient holds my hand. So I’ll save some of my best moments for when we know each other a little better.

What I will tell you is that I hope you are able to turn your worst moments into learning experiences as well as revisit your best moments when you feel unsure of yourself. I hope the good outweigh the bad of course, but I also hope the bad lead you to reflect; then move forward. I can read a cue now in a way I couldn’t before and I can’t remember the last time I accidentally hugged someone. This work is a long journey full of moments that help us to grow. I think that may be the best part about it.

Accepting feedback

My MSW student is nearing the end of her internship, which is bittersweet for both of us. She is ready to start her professional life and I'm excited for her, but it's been a great experience and I'm sorry to see it end.

In one of our last meetings, I asked her to give me some constructive feedback about our time together this past year. I encouraged her to email me if it was too awkward to do in person. I know that I have a hard time giving feedback, especially to supervisors! She was very gracious about it and agreed to think about it so she could offer me something useful.

It made me think about accepting feedback, which is a tenet of this profession. Use of self is a technique in clinical work; we are tasked with knowing ourselves well. We also need to let others tell us what we cannot see. I know this rationally, but I always struggle with accepting criticism. I have met a few people who are able to do it gracefully and I envy them. I wonder how they can hold open a space within themselves to hear "you can do better" and grow from it, rather than feel defensive or embarrassed. It's a personal goal of mine, to be more gracious in accepting feedback.

Feel free to leave some for me here! Or share with me: how do you accept feedback from your supervisor? From your peers? Do you give it frequently or sparingly? I'd love to hear from you.

How do you do this work?

I wrote the other day about a common question my patients ask me, namely what I do as a hospice social worker. That post brought to mind another frequently asked question: How do you do it?

My co-workers and I laugh about this. Patients, their families, people at cocktail parties, all respond with a mixture of awe and fear when I (and my co-workers) tell them what we do for work. "You must be such a good person," they sometimes say (which is deeply awkward to respond to graciously, by the way). Or, "Oh, I don't know how you do it, it must be so sad."

And it can be sad, certainly. (My husband tells a great story about my first few weeks as a hospice social worker wherein I came home crying, telling him he can't ever die. It's funnier than it sounds). But, in addition to the sadness, it can also be humbling and joyful and surprising. It is an amazing privilege and honor to be with someone during one of the most intimate parts of their life. 

But, still. The work is hard.

It is also easy to forget how to care for ourselves and not let the sadness of it overwhelm us. I've heard our work described as addictive: there is an adrenaline rush when you are constantly walking into crises. It's easy to get caught up in that rhythm and excitement, making it hard to recognize the need for a break. Self care is one of the most important parts of our practice and also one of the easiest to put to the side. There is a need for many of us to be all things to all people; it's unsustainable.

So what do I do to take care of myself? I take myself out for long lunches and read trashy magazines. I call my work friends to say, "Please listen to this crazy thing that happened." I take my days off and enjoy them. This is my self care. It is both deeply personal and deeply necessary.

Tell me about yours. 

Narrative therapy or, what do you DO exactly?

The most common question my patients ask me when I first meet them is, "so what does a hospice social worker do?" A lot of people get nervous if I describe myself as a counselor or a therapist so I'm careful in how I describe my work to my patients. I tell people I'm a part of the hospice team, another set of eyes, support for them and for their families. The actual clinical work I do is more in depth than what I describe; it involves some education about disease process, a knowledge of family systems, narrative therapy, and even some mindfulness. Sounds pretty thorough, right? But I have a confession to make: until recently, I wasn't sure how to name the theoretical approach I use in my work.

It was when I started supervising my MSW student that I started considering naming the approach I've been using in my clinical work. My student was deep in her practice class and we often reviewed what theory she was studying and how it would be useful or not in her hospice practice. She mentioned narrative therapy and I thought, that sounds familiar... (Graduate school was a long time ago, after all). 

So I did some research (my go-to when I'm feeling insecure about my skills). Narrative therapy fits me as a clinician. It's about telling the story of your life. The therapist's role is to partner with the client, objectifying the problems they're experiencing and reframing them in a larger context. It's about autonomy and personal drive. It meets the client where they are, as we're told to do in school, while also helping to move them forward. 

It works beautifully with hospice patients, who are often examining the meaning in their lives, and I believe it also works beautifully in supervision. So much of this work is about self-reflection and self-awareness. Narrative therapy within the context of supervision encourages the social worker to tell the story of his or her work and identify the strengths and areas of improvement that shape that work. 

So tell me: do you have a theoretical approach to your work? 

Starting out!

I have been a practicing social worker for seven years. This year I was fortunate to supervise an MSW student during her field internship. Penn School of Social Policy and Practice (SP2) generously offered a training course for first-time supervisors that was enormously helpful to me in this new role. This experience--and my experience of offering informal supervision to my peers--has led me here. Supervising has opened a whole new chapter of learning for me that I am deeply humbled by and grateful for. I am so excited to begin this journey.

Supervision is a lifelong process and I continue to seek it myself, to grow my skills and work through the personal stuff that comes up in my practice. Because I continue to work in the field full-time, I have a unique understanding of the joys and challenges of healthcare social work. You can find my areas of expertise in the About section. 

Thank you for visiting my site and getting to know me! I hope to connect with you soon. For today, I leave you with this from the National Association of Social Workers: "Supportive supervision is underscored by a climate of safety and trust, where supervisees can develop their sense of professional identity." Wherever you are in your practice, I look forward to being a part of your development.