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Social workers do not have the option to throw their hands up in
the air and give up on a patient. I mean, have you ever heard a
social worker say to a patient, "Your life is just too
mixed up, so I think you should stop coming to me for
therapy." Such a reaction would be absurd and unethical.
Perhaps this is
partly because social workers have a lot of curiosity about human
behavior. This curiosity can find expression in the details of
the patient's assessment and treatment plan. For private
practitioners there may be more flexibility in these areas, but
there is at least a formation of the presenting problem and some
ideas about the direction in which the therapy might go. Whether
an agency employee or a private practitioner, there is a strong
commitment to the welfare of the patient.
We expect that some
cases will be more difficult than others. We expect that
sometimes there will be obstacles, ambivalence, struggles, three
steps forward and one step backward. This is why we continually
assess progress and modify treatment plans. Some patients will
terminate therapy prematurely. Some mandated patients will
become non-compliant. The response of the therapist, however,
is to do outreach and attempt to bring the individual back to
complete treatment successfully.
Even those patients
who quit therapy know that we never stop caring about them. Some
of them will come back to treatment at a later time. They know
they are welcome. It takes courage to ask for help, and it takes
trust and confidence to return to a therapist whom they may have
treated badly. Patients come back because the therapist's genuine
concern was able to shine through their defense mechanisms.
Sometimes, dropping out and coming back is just part of the
growth process.
When patients have
problems that are beyond our expertise or beyond the scope of
agency services, there are other possibilities for bringing about
a successful outcome. Some patients in outpatient treatment may
need to be referred for medication, or referred to a higher level
of care such as to inpatient psychiatric or alcohol/drug
rehabilitation facilities. Conversely, some patients may be ready
to leave inpatient care and be referred to an outpatient
facility.
My point is that
there is just no such thing as a therapist walking away from a
problem, no matter how large or small. Somehow, solutions are
found. Some solutions are not always ideal, but they are usually
adequate.
Probably the most
difficult situations are in the areas of housing and jobs. These
practical needs can be more difficult to fulfill than the
psychotherapeutic needs. Community resources are scarce in some
parts of the country, especially in rural areas. It can take
numerous phone calls to find housing, job, or training
opportunities for patients. The sad thing is when it is more
livable to receive welfare than to work and grow.
Social workers
who give up on a patient's potential to improve coping skills or
living conditions could be sending a message of hopelessness to
that individual. Quite the contrary, we need to instill hope and
positive empowerment. We can do this, in part, by serving as role
models in our own ability and willingness to face reality, cope
with feelings, and follow through on solving problems.
(Written 10/04/04)
Until we meet
again....... .......stay sane.
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