the therapeutic alliance, part I

Social workers have passion. We struggle with hard issues, with life and death, sadness and depression, with people telling us every day that they don't want to get out of bed, not, that they cannot get out of bed, that the voices coming into their ears tell them that they are dreadful people, monstrous, that they are not worth the soil they walk on. We listen and we watch the screams of desperation of visualized trauma, rapes and abuse and beatings, imprinted on their brains and stuck as if with glue that resists any chemical or verbal attempt at coming lose.

We struggle with violence and rage and insult hurled at us from the angel faced woman whose worse curse was to be born beautiful. We sustain the invective of the exploited and abused. We take on our metaphorical laps the child within the person, and reconstruct with them another vision, another possibility. We watch in fear and wonder, as the layers peel away, and beauty and possibility reveal themselves to us.

I did not learn to be a social worker in school. But as one of my mentors said to me once, “after listening to maybe 50 people over a stretch of time, you might just start to understand what depression is”. Our patients teach us everything. We come ill prepared, with a few theories, some life experience and much trepidation. Little by little, patterns develop. As humans we are hardwired to see patterns, so we must be careful, mindful, lest we get lazy and hazy. We make foolish mistakes, embarrassing mistakes. We are called on them. By those whom we seek for advice, by supervisors, by the patients. The patients know us as well as we know them. The veneer of the profession when two people are sitting facing each other can be monumentally thin. Yet we learn that our fragilities must be borne out elsewhere. After all they seek us out. Occasionally, no word of solace or comfort is enough. Sporadically, we are left wordless by the depth of the pain or image or experience. If we are too insecure we turn the cheerfulness dial a bit. I, however, sense that it is preferable to let what was just lobbed at us sink in, in silence. We embrace, in that moment, not only their pain, but respect for their courage to expose it, we let it seep out, and slowly we de-construct to re-construct. With empathy, always with empathy. With kindness, always with kindness. Above all, with respect!