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

Giving Up Is Not a Social Work Option

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

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)