In September, The New Social Worker collaborated with the American Association of Suicidology on a series of suicide prevention articles written by experts in the field. The series includes entries on dispelling myths about suicide, essential suicide prevention resources, working with suicide loss survivors, autism and suicide, crisis centers, and more.

 

 

 

     Social workers are in the business of supporting and advocating for vulnerable individuals and communities, many of whom have endured unspeakable trauma and oppression. Given this tall order, it makes sense that, as a profession, we’d want to focus on successful outcomes. Which treatment interventions have the highest empirical evidence? What works? At the same time, some argue that our focus on outcomes has diminished the role of process in social work practice (Applegate, 2004; Urdang, 2010).

    In considering the value of process, important professional questions emerge: How does the focus on process facilitate self-other awareness, reflection, and our capacity for feeling and understanding emotion? How does the practitioner’s increased capacity for awareness, reflection, and empathy influence the treatment relationship and, therefore, the client?

 

    As a social work educator and practitioner who is sympathetic to both a relational perspective of social work practice and the experiential philosophies of yoga and Buddhism, I’ve had ample opportunities to explore the above questions with other practitioners, students, and clients. Specifically, I’ve considered the value of sitting with, being fully present with, difficult experiences and encounters in the context of clinical practice (Szczygiel, 2016). This article will use a composite case example to explore the value of staying fully present with difficult emotions, as well as the clinical consequences of avoiding them.   

 

 

    Sara experienced chronic pain resulting from a car accident that had occurred years prior. She endured physical abuse and neglect throughout her childhood and had a long history of difficult, combative relationships with loved ones, co-workers, acquaintances, and, as it would turn out, with me. Sometimes Sara would enter therapy in a good mood. A good mood for Sara meant that she would laugh and crack jokes, usually at my expense. But most of the time, Sara presented as irritable, frustrated, and overwhelmed. Her physical pain manifested as generalized body aches, headaches, and/or stomach cramps. Sara’s body was screaming. She pleaded for me to “do something” to help her, “to fix” her pain. She constantly questioned why she needed to be in therapy. When I would attempt to have honest conversations with her about this issue and how she felt about my inability to fix her, she would cling to me, pleading that she wasn’t ready to leave treatment. Following a session like this, Sara often needed to call me before the next session or schedule an extra session. These “in between” sessions typically consisted of Sara crying, yelling, and further pleading for me to fix her.

 

    Even though we continued to explore the importance of Sara acknowledging her emotional pain and suffering, her pleading for me to “do something” or “to fix” her, coupled with her occasional verbal attacks toward me, intermingled with every ounce of insecurity I had, leaving me feeling worthless and ineffective as a therapist. My response, then, was to scramble and push for answers. I found myself making feeble attempts to offer her more suggestions and advice—referring her to other treatment professionals and various alternative therapies, trying desperately to help her. These were all desperate attempts to “stop the bleeding” and, in all honesty, an attempt to provide myself with respite from Sara. Despite my tendency to value sitting with difficult emotional experiences, as well as using the client-clinician relationship as a main source of intervention, I became fixated on stopping Sara’s emotionality, as it became too difficult for me to endure. We were working very hard and getting nowhere.

 

 

    As you already see from the case description, this is not an example of my exceptional abilities as a relational and Buddhist-informed therapist. Rather, it’s an acknowledgment of just how chock-full each therapeutic encounter is with emotional exchanges, many of which are missed, because it is so challenging, for clients and clinicians alike, to stay present with emotional pain. My high responsibility reflex often kept me from being able to sit with Sara’s discomfort. Rather than being deeply attentive to the emotional needs beneath Sara’s cries for help, I often bit the hook on the surface and engaged with her in a never-ending charade of “trying this or that technique.” And, Sara tried a lot.

 

    Despite her limited financial means, Sara attended nutritional counseling, experimented with yoga and acupuncture, and tried various other adjunctive treatments. One of her strengths was her openness to trying new things. But as soon as she realized that the new technique was not a cure all, she would panic. “Why can’t you come up with anything else,” she’d ask me.

 

    I’m certainly not devaluing the importance of the various therapies and tools that Sara tried. I’m a fan of yoga and various other holistic therapies. Rather, I’m saying that the focus on tools, techniques, and interventions can come at the expense of being able to fully acknowledge our emotional experiences. This is a phenomenon that Zen teacher and psychoanalyst Barry Magid (2013) refers to as emotional bypass. In other words, in our efforts to feel happier or more effective, we may suppress the emotional experiences that can offer us insight into our functioning and relationships.

 

    Like Sara, I would also panic when a new strategy or technique didn’t work. I fantasized about fixing Sara, in part, because I resisted my developing feelings of responsibility for her. These feelings were very scary to me, and I desperately tried to avoid them. In my attempts to stop Sara’s emotional and physical pain, I was sidestepping some very significant questions: Why was I working so hard to end Sara’s emotionality? Why was I equating Sara’s emotionality with my own lack of effectiveness as a therapist? Why was Sara so afraid of her emotions? Why did she feel so incompetent and angry with herself for having emotions? Why did she both ridicule me and then cling to me? What was the meaning of this “dance” between us?

 

 

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