Author Archives: naethra

Motherhood & Other Unclear Lessons

I was assigned a family over a year ago where I had to conduct family therapy using a phone interpretation service because the mother with six children was Spanish-speaking (I am not). The mother was also undocumented. After managing to make some therapeutic headway in the first few months, the family struggled to maintain stable housing and became homeless at the start of the summer. This family of seven ended up moving on a temporary basis into one bedroom of an apartment with two other undocumented families.

Back in August, I typed out the below entry on my phone to process my feelings about a failed home visit where I was going to give the family metro cards to come into my office for a session to address the family’s concerns in privacy:

I want to be angry or feel that the mother is ungrateful but I do not feel those things. Yes, I tried my best to ensure that this visit would occur and even gave mom an out by asking her to just text me if she won’t be home. Yes, I advocated for the family to be provided round trip metro cards to our office because I know it would be unrealistic and unfair to expect the family (one mom, six kids) to come on their own. And I wanted her to come to see me for once so we could have a meaningful conversation in a private, comfortable space with the aid of phone interpretation so that her kids do not need to be burdened with being spokespersons and she can feel safe that other families are not overhearing her business.

But I also understand that in the grand scheme of all their problems, talking with me isn’t high on her priority list. So what I’m left feeling is sadness. Sadness that really and honestly, there isn’t much of anything I can do for this family in their current situation. I am a family therapist. And while I can and should accommodate the realities of many of our clients in child welfare, I’m simply not equipped to help them with concrete needs. I’m not a housing specialist. I don’t have an array of resources at my disposal to provide undocumented families the necessities they need.

Refer them elsewhere. That’s the response. It’s the right move. And yet, it feels so hollow. We all know too well how many families fall through the cracks when they change programs or agencies. After nearly 8 months of working with this family and with the last 2 months of the family being homeless, this sliding down the slippery slope of Maslow’s hierarchy of needs, I can’t help but feel what was the point of all this?

“We plant seeds. It’s not about solving their problems but about giving them the tools to face them more effectively. It’s the reality too many undocumented families face,” and so on. None of this gives me solace. I am just tired… and tired of expending more energy on a family that’s really beyond my or my agency’s capabilities.

I do acknowledge that there are strengths and some resources present in this mother and her family. But I can say with objectivity I’m not of much use to this family right now.
I’m not frustrated or angry. I’m just… Tired.

………

By the end of October, the family eventually ended up in an exceptionally safe and comfortable shelter and I was able to transfer the case to a nearby general preventive program to a dedicated worker who was also Spanish-speaking. I also got to have a very touching termination visit with the mom and children. Language barriers and evidence-based model protocols aside, I figured this was the closest to success I was going to achieve with this case.

Then in mid November, I came to learn the devastating news from the new worker that mom had been hospitalized, was found to be terminally ill, and was not going to be discharged. ACS planned to find permanent placements for the children (ages 7 to 13). I broke down.

In spite of all the problems and instability, the one constant in the lives of these children was their mother. While mom had grown more weary and drained over the year, the children remained high spirited and resilient. This mom was clearly doing something many things right no matter what her ACS worker said.

Unfortunately, this is where their story ended for me. It will be someone else’s job to see the next chapter of their story unfold. I am left mourning the loss of a woman who faced countless struggles and at times made me feel my weariest as her worker, but who unquestionably championed at being a mother.

My work with this family taught me that while my role as a social worker may often feel unclear, unsatisfying, and ultimately, not enough, it does not mean the work/effort/connection was in vain. There are not always clear lessons to be learned or closure to be gained. And I am learning to be okay with that.

My thoughts are with her children.

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Survival of the Fittest

Some days I feel like my job sets me up for failure. Weekly home visits for 10 families, lengthy progress notes, lengthier reports, phone calls, chasing after collateral information, group supervision, clinically preparing for sessions, meeting model requirements… the list goes on… and that’s when there are no crises. All of these tasks are required to be completed all of the time. In 35 (paid) hours a week. Go!

I have no shame in admitting that at any given time I am neglecting something, often consciously. Eight months into this job, I do feel like I have found my stride in getting quality work done in a timely enough fashion without overworking. But there is this assumption in my profession that has gotten horribly twisted and needs to be called out: social workers aren’t in it for the money has become social workers should be expected to get all the work done in however many hours it takes simply because they care. The altruistic, social justice motivations inherent in the profession have been exploited to make social workers work (or feel like they should work) an insane number of hours each week with no additional financial compensation. After all, we’re not in it for the money, right?

Let me just dispel that myth right now. I am in it for the money. And the benefits. It’s called being employed. And the funny thing about being employed is that I expect to be compensated for my honest hard work because I need to support my life. I’m also in it because I’m passionate about direct practice and the communities I serve, otherwise I could easily be employed at a far less stressful job (and make more money). But that would also be less impactful and fulfilling.

So I feel like I’m faced with two equally unappealing options: 1) complete everything required of me in as many hours as it takes or 2) stick to a 40-hour work week and accept that the quality and timeliness of my work may suffer from time to time. Option 1 is simply not sustainable (or sane). Option 2 doesn’t sound too bad until I realize that much of my “work” is directly connected to my clients’ wellbeing. In other words, it seems my only options are that I can either overwork and burn out or feel guilty and/or anxious for work left undone (and families left unattended to in crisis).

The field of social work loves talking about how to practice self care in order to achieve this elusive work/life balance, but we are working within systems often diametrically opposed to fostering workers’ wellbeing. In fact, I feel like self care takes the onus for our wellbeing off the industry and places it back on us. So not only are we expected to work crazy number of hours and be responsible for an unrealistic amount of things, we also are supposed to make time to take care of ourselves. And when we take off work, we are still expected to meet the same requirements and deadlines… It’s ironic that we work with a population that experiences systemic oppression not totally dissimilar to the oppression we workers face in trying to serve them. No one is surprised by the high worker turnover, but it surprises me how much our profession has come to accept it as inevitable.

Before anyone assumes that this is the rant from yet another disillusioned, burned out social worker, let me take a moment to acknowledge how motivated and fulfilled I am feeling in my work overall and how I feel it is the right place for me to be at this time. I am figuring out how to maintain my peace of mind in spite of the limitations and burdens. This is precisely why I feel the urgency to voice these thoughts and hopefully begin a more meaningful dialogue that goes beyond my own venting, because I really do still care. In order to effectively advocate for our clients, we need to advocate for ourselves. To be skilled, compassionate workers, we need skilled, compassionate treatment from our work environments. Until then, this field will continue to feel like the survival of the fittest.

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Evidence Based Therapy in Child Welfare- One Worker’s Reflections

Social worker/ preventive worker/ counselor/ therapist/ “the lady”… all titles I’ve responded to at my work, and each one relevant in its own way. But these multiple identities also capture the inherent challenges of integrating two professional spheres, one a carefully honed practice, and the other a colossal institution. One often associated with privilege, the other with poverty.

On one hand, there is a natural connection between family therapy and child welfare (specifically preventive services). Both are often involved during a time of crisis. Both are concerned with the safety and well-being of children. Both are committed to stabilizing and healing families. And the desire for child welfare to move away from historically punitive and inefficient practices toward ones that are more therapeutic and accountable is both logical and good.

On the other hand, there are also competing interests, which have made me wrestle with my own professional ethics as a clinically focused licensed master social worker (LMSW). The power differential in child welfare is much more pronounced than in family therapy alone because of the focus on safety and risk. While all helping professionals are mandated reporters, there is an intrusive (though arguably necessary) element within child welfare that still does not sit well with me.

There have been times where the pressure of fulfilling ACS requirements has directly contradicted my commitment to therapeutic rapport, self-determination, and unconditional positive regard in my work with families. That may sound like Social Work 101, but it seems many families in child welfare have simply been denied these experiences. Without them, no amount of training, funding, programming, or research is really going to help families heal and protect their children.

However, child welfare does not shoulder the challenges alone. Evidence-based models of family therapy have their own rigidity and time restrictions. And I am not convinced that these models are always in the best interest of families experiencing complex trauma and persisting barriers to basic needs. Having learned that therapeutic approaches should be adapted to the client, it can feel counter intuitive to try to make the client fit the therapy.

But I am optimistic that a good intention may evolve into good policy. One thing I have learned so far is that there is a niche of families in child welfare for whom the model of family therapy I am practicing is extremely appropriate. These families often have some interpersonal and environmental risk factors but are also stable enough to address emotional and relational needs. These families do not have the luxury to access mainstream mental health services, but in a time of crisis, come to the attention of ACS. Being able to provide in-home therapy to these families and aid in their healing has made this demanding work worth it.

 

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