The Making of a Therapist

I am slowly preparing to leave my job, and I've begun telling a few of my longer-term clients that I'll be leaving in June. In preparation for my departure, I've decided to start a new series about my first years as a therapist. My heart is brimming with things I've learned, special moments with clients, questions and musings.

I told one of my longest-running clients yesterday. She's been coming for over a year and a half. She came in because of marital problems: her husband was psychologically abusive, mean, ornery, and generally a brute. She worked herself to the bone cleaning houses because he wouldn't help with any of their household costs. She was miserable. We tried a million things with her husband, to no avail, so we focused on helping her emotionally cope. A survivor of loss and abuse, she felt what helped her most was learning to maintain her emotional independence--not to let him "dominate my mind," not to react. We had all but given up on him, and we were working on helping her leave. As an undocumented immigrant, that turned out to be way more difficult than we anticipated.

Then, almost overnight, he changed. He was diagnosed with diabetes, and started turning his life around. He began helping with costs, childcare, and household tasks. He stopped yelling. His mood improved. He even went to work with her to help her clean houses. He started bringing the family to church. We were both shocked. "I ask him, 'Where did this new husband come from? Has he been hiding in the basement?'" She says. He blew our expectations wide open.

When I told her I was leaving, she teared up. "You have no idea how much you helped me," she said. "You really listened to me. I mean, I know that's your job, but I could feel that you really listened as a person, as a human being. No one ever does that. Family doesn't do that. Everyone always has their opinions and judgments. I can't tell you how much you helped me."

I was fighting back tears myself. Once in a while, life drops me into a moment like that--real. Frozen in time.

I think that's the #1 thing I've learned: that I should never underestimate the power of pure, unadulturated, supportive listening. When asked what they're looking for, and what has helped the most, that's what most clients say.

How to Appear Racist 101

A Korean-American client reports that she suffers from aches and pains and occasional insomnia. She doesn't describe any other symptoms or disclose information about her personal life or family. She says she has come in to see the social worker only because her doctor told her to. What should the social worker do?

A. Refer the client to a pastor at a local Korean church.
B. Refer the client to a neuropsychologist for testing.
C. Focus on the specific problem brought in by the client and help her develop her own goals for therapy.
D. Ask the client if she has been feeling depressed.

Dear social worker: limit your scope of practice and inflate your ability to generalize by choosing one. What would you choose? Cause did you know the answer is "A"? Forgive my language, but WTF?

A friend and I are studying for the social work licensing exam, and we send each other ridiculous questions we come across in the practice exams.

At the beginning of therapy with a Caucasian social worker, an African-American client is MOST likely to experience which of the following?

A) High self-expression.
B) Significant anxiety.
C) Transference.
D) Lack of motivation.

We're actually supposed to answer this question. My answer: Dear Social Work Licensing Board: Let's critically examine the presentation of this question. And the answer is "C." What kind of transference, you ask? Transferring of what exactly? Excellent question. The rationale makes sense to me: "It is recommended that therapists consider the influence of historical hostility as a necessary part of effective therapy with African-Americans." That's very helpful. Thanks. Apparently we missed the importance of EFFECTIVE WORDING in helping us appear less racist!