Markham's Behavioral Health

40 Years - Chapter two - Manipulation

            Dr. Maureen Didier, my Casework Professor at SUNY Albany, where I got my Masters In Social Work degree in 1972 also told me that as a Social Worker clients would manipulate me. I remember her telling me that it is OK to be manipulated if you know you are being manipulated and agree to it, but to be manipulated and not realize it will lead to a world of trouble and is incompetent practice.

            Over the course of 40 years of practice, I can’t tell you how many thousands of times I have been manipulated and have known it and gone along with it. Over the same period of time I have been manipulated also by my wife, my children, my neighbors, my friends, my colleagues, my employer, my political representatives, business people, and the list goes on.

            Dr. Didier told me it is OK to be manipulated as long as I am aware of it, and I have struggled for years to become more and more aware. Developing awareness takes ongoing effort. It never ends. Being aware of the need to continually increase one’s awareness requires ongoing willingness to learn, to approach life in a “not knowing” and open hearted way, and to reflect on one’s own experience and sift it for nuggets of wisdom.

            This self-reflection often requires a discussion with trusted others who have the time and interest and willingness to listen carefully, ask good questions, and provide honest feedback. Seeking out consultation and supervision is critical to good Social Work practice and to just about any other endeavor in life whether to manage your own emotions, manage your intimate relationships with others, parent your children, take care of your health, manage your finances, develop your spirituality, or learn any new skill or master any new body of knowledge.

            On the other hand, Social Workers also manipulate clients all the time under the guise of providing service or “treatment”. Social Workers value the client’s right to self determination and we have an ethical responsibility to obtain a client’s informed consent before we engage them in service activities and yet formalizing this idea of protecting clients from unwanted and involuntary manipulation often is illusionary because we are manipulating people all the time when we interact with them to get what we want and to influence other people’s behavior and to move situations in our desired directions.

            Manipulation has taken on a pejorative meaning in our current terminology but if we change the word from manipulation to influence it doesn’t seem so bad. The point to this chapter is that manipulation goes on all the time. It is part of life. There is nothing wrong with it necessarily as long as you are aware, and when ethically required, we disclose our intentions and obtain consent. It is the way we give respect and maintain our self-respect.

40 Years - Chapter One - Take The Client Where They're At

If you asked me “what’s the most important thing you learned in your Social Work graduate education” I would say it was Dr. Maureen Didier telling me, “Take the client where they’re at, take the client where they’re at, not where you want them to be, not where you think they ought to be, where you think they should be, take the client where they’re at!”

I had Dr. Didier for three out of the four semesters of our 64 credit hour Masters in Social Work program. I, as a young person, had some disdain for my graduate work become it wasn’t pure social science but applied social science with lots of methods courses. And so I held a lot of my education in those days in some contempt I am embarrassed to now say because it has served me very well.

Outside of class I would mock Dr. Didier and say to my fellow students, “Can you believe that this is what passes for graduate education, her standing up there saying ‘Take the client where they’re at. Take the client where they’re at” in a high sing song mocking voice. And yet 40 years later I have Dr. Didier on my right shoulder whispering into my ear when I am frustrated, when I am going too fast with a client, when I find myself imposing my values, and hopes and dreams and preferences and desires onto the client, “David, take the client where they’re at.” And I slow down, step back, listen more deeply, try to understand where the client is coming from and what the client wants,  and I realize that things always go better.

I find the maxim, “Take the client where they’re at” to be just as important and just as good advice in my personal life as in my professional life.

After 40 years, I thank Dr. Didier and marvel at her wisdom. I laugh at my vanity, egotism, condescension, and am ashamed to tell you that I laughed and mocked her.

I don’t know where she is, or even if she is still alive. I think she has probably died. I thank her every day and say a prayer of thanksgiving for what she taught me. I am sorry for mocking her. I hope she would forgive me for not appreciating her wisdom when I was younger.

I pass her wisdom along to you and suggest if there is never anything else you learn in your Social Work education and/or practice or life, remember Didier’s dictum – “Take the Client Where They’re At.” It will serve you, your clients, and those with whom you are in relationship very well.

40 years and counting #1

I realized the other day that on October 31, 2008, I will have been a Psychiatric Social Worker for 40 years. I am thinking to myself - "What have I learned in all that time that might be valuable for me to reflect on and remember and might be of value to others?" So I decided to write a book. And part of that book writing effort I am going to put on this blog. I entitleing the book, at least for now, 40 years and counting. (If you have better titles let me know.) So, if you want to follow the progress as I write and comment on this work in progress check in regularly for the latest installment.

Here is installment number 1

On October 31, 2008, I have been a Psychiatric Social Worker for 40 years. I started my career at Kings Park State Hospital in Kings Park, New York half way out on Long Island just over the Nassau County line into Suffolk county on Long Island’s north shore. I started on October 31, 1968 as a Psychiatric Social Worker Trainee II.

My supervisor Fred Ironside asked me where I wanted to work and I told them on the Child and Adolescent unit and they put me in the geriatric building with 900 geriatric patients and where they hadn’t had any Social Worker services in over 1 ½ years.

I learned many things there but most of all to love and respect old folks.

This book is about what I have learned as a Psychiatric Social Worker over 40 years of practice. It is going to be a lot of very personal things. You may find a lot here that you disagree with or even find offensive and that’s OK. Part of practicing any profession is not what you learned in your professional training or what the textbooks say, but how you applied what you learned and made it work for you and made sense out of it.

Social Work is a very personal profession. A good Social Worker uses his/her personality as  their primary professional tool. Most of Social Work depends on developing a helping relationship with individuals, couples, families, groups, communities and representatives of all kinds of organizations, companies, agencies and governmental entities.

The key to good Social Work is the effectiveness of one’s interpersonal skills which depends on one’s emotional intelligence. It also helps if one is smart. It also depends on humility and knowing what one doesn’t know and being able to recognize one’s ignorance, incompetence, and asking for help. Without that humility you are dead in the water and would do better in some other profession or career.

I have taught over the years at various colleges as an Adjunct Professor teaching Social Work courses, Psychology, and Health Education. I have worked over my career as a clinician as well as a manager and administrator and so I bring the experience of several life times to my teaching. Angela and I were married 35 years and have 9 children so I always worked at least three jobs often 60 – 80 hours per week and sometimes more. With all this experience, I find myself saying things to my students like “I know this is what it says in the textbook, but let me tell you how it really works.” Of similarily, “I know this is how it says in the textbook to do it, but this is what it really looks like and feels like as you try to bring those principles, ethics, practices into application.”

Am I cynical? Yes. Do I passionately believe in the field and the value of the profession? Yes and more so with every passing year. I have been abundantly blessed to have entered into the profession of Social Work and my life has been richly benefited both professionally and personally. To be able to earn my living and get paid for something I love doing and passionately believe in is the greatest life any human being could have.

So, enjoy my stories of my 40 years of experience. Hopefully you will find them entertaining, maybe enlightening, and above all else, it is my wish that you find them useful as you go about living your own life and finding your way in the world.

I will be tagging these entries as "40 years"