Natalia J. Garland
In the profession of social work there are certain values
which become almost doctrinal. Some of these values are
tolerance, non-judgment, unconditional regard, and
self-determination. Sometimes it seems like the real
definitions of these terms get confused. Social workers do,
in fact, make judgments, set conditional limits, and provide
When we say that
mental health is better than insanity, we are making a certain
judgment about the quality of individual life and the
preferred composition of our society. Mental health is the
consensus of a more-or-less sane society. A schizophrenic
person not taking his medication might not agree with this.
An antisocial personality spends much of his life
intentionally breaking the norms and laws of society. A
dictator might not give two cents about anyone's mental
also set conditional limits in the therapy session and adhere
to the conditional limits set by the criminal justice system.
Most therapy groups have certain rules, especially regarding
confidentiality, tardiness, name-calling, perhaps a dress code,
and so on. Some treatment programs would not exist without
court-mandated patients. The mandated clientele has had some
aspect of their self-determination involuntarily removed. The
drunken driver has limited choices which he probably perceives
as no choice at all: he can cooperate with a therapy program,
or he can face a future without a driver's license.
What do you do
when you have a suicidal patient? Right, you try to talk him
out of it. You will call the police if you have to and have
him involuntarily hospitalized. When a patient is in crisis
they are often unable to think clearly and make good
decisions. The response of the social worker is to become
directive: in other words, telling the patient what to do.
When it comes to
certain behaviors and emotions, we obviously think that our
way is the best way and that other people should live
according to our way. Life is better than self-imposed death.
Happiness is better than unnecessary suffering. Respecting
others is better than ripping them off. There are underlying
judgments in everything we do as therapists. We are always
taking a stand.
There is nothing
wrong with exercising good judgment, setting conditional
limits on behaviors that are out of control or destructive,
and giving directives to people whose mental faculties are
clouded. In fact, not to do so would be irresponsible. Not
to take a stand means not to think, not to analyze or
critique, not even to evaluate or assess.
tolerance, non-judgment, and unconditional regard really
means that we do not persecute those who are different, that
everyone has equal rights, that we do not blame victims or
condemn the needy, that we maintain a national allegiance
while developing cultural pride and identity. It means that
we do not discriminate on the basis of sex, race, age, or
Lately I have
begun to read again the classic book on group therapy, The
Theory and Practice of Group Psychotherapy, by Irvin D.
Yalom. I will close today's topic with an except that begins
at the bottom of page 113:
self-respecting therapist likes to consider himself or herself
a social reinforcing agent, nevertheless the therapist
continuously exerts influence in this manner, unconsciously or
deliberately. Therapists may positively reinforce behavior by
numerous verbal and nonverbal acts, including nodding, smiling,
leaning forward, or offering an interested "mmm" or
a direct inquiry for more information.
[End of quote.]
Just because we
are social workers, that does not mean we are bland. Quite the
contrary, we are role models and constant objects for our
patients. They are watching us, studying us, and they can be
very sensitive to nuances of eye contact and voice modulation.
They know whether or not we care, or if it's just a job and a
paycheck. (Written 11/18/02: bibliography available.)
Until we meet