Today's Topic



Taking a
Therapeutic Stand

Natalia J. Garland

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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 directives.

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 health.

Social workers 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.

Practicing 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 religion.

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:

Although no 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 again..............stay sane.

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Copyright 2002 Natalia J. Garland