Wave of Consciousness, "A Voice of Sanity in a World of Conflict"

Meet Me Halfway

by Natalia J. Garland, M.S.W.

Much of my everyday clinical social work could be highlighted by three idioms of the English language:

Let's get started with some impressions of the first idiom. Treating mandated patients can sometimes be a trying experience even for the most dedicated therapist. Some mandated patients present with severe anger and hostility. Referrals from the criminal justice system, for example, can require the therapist to set firm behavioral limits in order for the therapeutic work to proceed. Learning the skill of meaningful and tactful confrontation can seem foreign to therapists unaccustomed to the mandated population.

Each therapist will develop their own style in establishing a trusting relationship with their patients. I will share with you a simple yet effective way that works for me when treating resistant patients. I just ask them to meet me halfway. It is usually evident from the first session if I must engage an unmotivated individual who feels, real or perceived, that the legal system has treated him unfairly.

For this type of patient, mere cooperation with the treatment mandate is a significant accomplishment. These patients are struggling to accept responsibility for self, for their behavior, and for the consequences of their behavior. They need to learn there is a connection between their actions and the trouble they get into.

By meeting the therapist halfway, the patient agrees to keep his counselling appointments, fulfill the treatment plan, and to keep an open mind. His incentive to cooperate with treatment is reinforced, that incentive being to avoid an unwanted alternative such as jail or to obtain a positive reward such as getting his driver's license reinstated.

If the patient can keep an open mind he will possibly learn new coping skills and gain insight into his non-productive behaviors and attitudes. This type of patient usually seems to understand that the therapist has a job to do, and appreciates a straight-forward approach. The therapist's respect for a difficult patient can in itself gain a lot of therapeutic mileage. Some of these patients will internalize the treatment mandate into their own desire for a better life.

By meeting the patient halfway, the therapist enables the the patient to have as much self-determination as possible in a court-mandated situation. The patient is engaged in a therapeutic situation in which he can gain recognition that his loss of self-determination to the courts was due to his socially unacceptable behavior. This behavior, in turn, is often due to an addictive disorder. The patient can then exercise self-determination by making an informed decision for himself whether to continue or to change these harmful behaviors.*

For the mandated population, a trusting relationship with the therapist is crucial. The therapist must be genuine and believable, otherwise the street-smart patient will see through any insincerity.

Let's move on to the second idiom. There are some patients who just need a fighting chance to survive in this world. It is as though they live in a mental fog. They seem to need the therapist to clarify reality, validate their feelings, help them to stop repeating dysfunctional relationships and situations, and offer them suggestions for change. There are certain sensitive, vulnerable people who need, so to speak, to wise up and toughen up.

I remember a French language teacher that I had when I was in school. He was having difficulty teaching French because some of the students had never learned English grammar. They were in a fog. They did not know the difference between an adjective and an adverb, a direct object and an indirect object, and so on. This teacher loved teaching and he really wanted the class to learn and enjoy French. Therefore, he spent a portion of each class hour teaching English grammar so that the students would have a fighting chance to speak French.

Having a fighting chance means that someone has cared enough to equip you with the essentials, and then the rest is up to you. Perhaps others failed you in the past and, as a result, you became emotionally crippled in some way. But now someone, a competent therapist, has helped you to grow. Now it is under your control, within your power, to make something good happen for yourself.

This is in keeping with a basic social casework principle: that not only are people acted upon by the environment, but that they can also act upon their environment. Some patients have been acted upon so negatively that they need someone to help sort out the dynamics, validate the impact, and support them in becoming successful and influential participants in their environment.

Finally, I have come across some patients who just seem to need someone to tell them to have a nice day. There are a lot of lonely people in our society. Some patients can be fairly high functioning in some life areas and yet lack socialization skills. Sometimes, too, the world's coldness and life's tragedies render some people alone.

Allow me to use a comment from another teacher that I had. You know how classroom discussions can sometimes drift? I had a teacher who one day made the remark that loneliness is a sin. What he meant was that it is a sin that any community leaves some its members without companionship and emotional nurture. In social casework terms, this seems closely related to what is meant by the concept of an ecological system. Some people have lost or have never been afforded the niche, the social structure, that supports their lifestyle and liberates their full potential.

The idea of human interdependence was expressed well by the British writer, John Donne, in his "Devotions Upon Emergent Occasions," from 1624:

Some people will go to a therapist just to have a friend to talk to. My personal opinion is that therapy is a legitimate arena in which the lonely can find their way. Should loneliness be a diagnosis? If loneliness were ever to become a diagnosis, the criteria would have to be organized such that no blame would be placed on the victim of loneliness. Lonely patients need to borrow strength from the ego of the therapist, find ways to connect with their community, and develop a meaningful spirituality.

This essay is not meant to be prescriptive. I am only writing from personal experience. What works for me may not work for others. As I mentioned earlier, each therapist will develop their own style in reaching patients.

It helps me if I conceptualize my caseload, without stereotyping or pre-judging, into workable impressions. Diagnosis is usually necessary when working in social service agencies, for various reasons, but diagnosis is not the whole picture. Diagnostic categories alone, like Donne's islands, involve neither the entire patient nor the entire therapist.

[*NOTE: A patient's decision to continue harmful behavior cannot be supported by the therapist. The therapist must remain steadfast in upholding mental health and in the belief that the patient can make positive changes. Also, if the patient has been referred by the courts or other agency, the therapist is obligated to report an accurate assessment of the patient's progress or lack of progress. Appropriate consent forms must be obtained.] (Written 10/06/03)

[NOTE: For other essays on similar topics, see Kindness of Strangers (written 02/06/06), That's Your Opinion (written 08/02/04).]

BIBLIOGRAPHY NOTES:

1.) John Donne quotation is from the online Santa Cruz Public Libraries Ready Reference Files website, [WWW document] URL http://scplweb.santacruzpl.org/cgi-bin/readyref.pl