On The Way to Becoming A Healer: The Journey of a Young Social Worker

(This article is dedicated to R.M. who inspired it. Thank you for reminding me of what we are supposed to be doing.)

For some reason lately I have been seeing quite a number of brand new social workers for supervision, some of whom are still in graduate school. It has been a poignant and privileged rite of passage for me after all these years to be passing on what I’ve learned.

One in particular touched me. She worked some time ago in a hospital emergency department in another state. As you might imagine, she bore witness to countless tragedies and sorrows, the worst of which was one little girl who had been beaten so severely by her mother’s boyfriend that they didn’t know if she would make it.

When she originally came on the ward she had been warned by the other professionals on staff to “watch her boundaries.” That’s a trigger point for social workers who, as a group, have been known to go the extra mile for patients and clients. This has become an “issue” for the profession as it has grown over the years and tried to maintain its status along with psychologists and physicians. What the well-meaning advisers meant was that she would be facing horror and that she needed to “detach” and “not bring it all home with her.” The real meaning: don’t get involved.

Those were their words. People warned me the same way when I started out.

I have been a psychotherapist and crisis counselor for nearly 30 years. I have worked with rape victims, survivors of war, children who had been abducted by drug lords, parents who were abused by their own offspring, addicts who had been lost and left to die on the street, and a full retinue of the mildly neurotic. I have stared into the abyss with friends and colleagues at Ground Zero and had to breathe the acrid smell of death.

But what I have learned is that there are boundaries and there are boundaries. Some should be zealously guarded and some not so much. And whenever I have made a real difference I have absolutely become involved though not in the way you may imagine or some may fear.

I will explain through her story.

As the baby was being treated, she called the proper authorities, as was legally required. She watched as the mother and boyfriend were carted away. And she stood nearby as the baby, broken and battered, moaning in pain, was gently set to rest in a small bed in PICU.

She was told to go home, that she’d had a hard day, and to have a glass of wine. There was nothing more to do.

But something inside her rebelled at that: there’s nothing more you can do.

And, against all the advice of authority, against all the warnings, she went into the PICU and sat with that little girl, breathing gently with her, resting her own fingers carefully in the child's small hands, smoothing the downy hair on the little girl's head, the one place that had gratefully been spared from the brute’s rant. She sat with her for hours until the little one was able to rest. She talked to her. She sang to her. She hoped for her. And then she reluctantly went home.

The case moved on from there and she doesn’t know what happened to her or the family. But there she was in my office, years later, wondering if she’d done something horrible by not letting go, by not listening to the advice of the nurses and administrators who told her to detach, to not take it home. “Did I make a terrible mistake?” she wanted to know.

Through tears as I listened to her and through tears as I write this, I said “No. You did everything right.”

She didn’t understand how she could be right and feel pain that way and disobey the warnings she’d been given. But I did. And I have found that when you do the right thing, there is often no way to sidestep the pain and sorrow that is common to us all. Nor should there be.

Suffering and Professional Boundaries

Social workers’ boundaries are important, but not in the way we might think.

I think there are actually two separate questions in this larger issue and it is a far more complicated topic than people might imagine.

Boundary Question One: How do we face suffering and not get lost in it? How do we help people in pain without absorbing it? How do we have empathy and compassion without becoming the patient? What do we do with suffering if we can't fix it?

Boundary Question Two: How do we treat people in a clinical setting and keep our focus on them rather than using the session or relationship as a way of working out our own lingering issues? How do we stay clear-sighted about the pathology and vigorous in our pursuit of  health and the well-being of our patients?

These are two separate issues and I believe that we often confuse them in clinical practice.

I hope I can answer them both briefly and simultaneously by drawing on my experience and explaining what I think is necessary in any healing relationship.

Over the years, despite accruing more and more “tools” for my clinical tool bag, despite learning more and more techniques and styles, I have actually simplified. One of my mentors in graduate school told me, “Learn them all well so you don't have to use any of them.” I didn’t know what she meant then, but I do now. She also told me, “Don’t for a second think it’s you doing the healing. It’s the love.”

So, the distillation is this:

• Presence and Pacing

• Compassion and empathy

• Seeing someone fully without bias and without projection

• Spiritual context

Presence and Pacing

Presence is paramount. It is foundational. The ability to be fully present in the moment with whomever is there, with whatever situation confronts you, is to be adaptable, available, and genuinely healing. It addresses both Question One and Question Two in that being in the moment (as opposed to the past or the future) allows you to feel fully, be ready to do what is needed, and then move on to the next moment. When you are in the moment truly, you will be more adept clinically. You will know the situation at hand is not about you and that it will not last. You can fully feel and know that when you go home you will be fully present to the joy and life that is there.

This is not easy and it has taken me many years to learn. Being present has a caveat. It means we are there for all of it—the pain, the glory, the defeat, the sorrow, the loss, and the redemption. All of it.

Pacing is a term coined by Milton Erickson, M.D., the greatest hypnotherapist in American history. It  is also a technique I focus on quite a bit when I teach Verbal First Aid to first responders, medical personnel and clinical professionals. It means to "move with" or "walk along." It can include mirroring (to some extent) but I use it mostly to stress the act of being with another person. When a person is in pain and we are hoping to move them to a state of greater comfort, we do what is called pacing and leading. We pace their pain (I can see your wound and your discomfort…) and then lead them, sometimes one tiny step at a time, to healing (…so as I hold your arm and apply this bandage, you can rest more comfortably and stop the bleeding). Without the pacing, there can be no proper leading.

Pacing requires presence. Presence implies pacing. It is an emotional and spiritual partnership that may last anywhere from a few seconds at an accident scene or at an ER or go on for years in a psychotherapy setting.

Compassion & Empathy

This is not the same thing as taking on another’s pain. It is a communion, an experience of commonality, not a sympathy or an absorption. It is also NOT a projection of our own feelings onto them and this is where our skill must be honed and refined over and over again. Sometimes it means feeling what someone else is feeling, but that doesn’t mean it’s ours. It is a subtle difference, but an important one.

Many of the patients that come to social workers have been hurt terribly. We may in fact be the first person in their lives to genuinely feel them. (S.W. Recall: Winnicott’s “The Good Enough Mother.”) This can be in and of itself enormously healing.

What I have come to both believe is that feeling is not the problem. Over-interpreting and/or ignoring feelings is the problem. And that’s where we—as healers—can get into serious logjams.

In fact, it is the social worker’s ability to feel fully (and know what to do with those feelings) that is the hub of all clinical work. If we can’t do it, how do we expect our patients to do it?

Seeing Fully

When I was in school for classical homeopathy, my teacher used to warn us, “If you can’t see your patient, you can’t heal him.” He spent five years talking to us about the power to see.

I think this is true in any clinical setting. We open the door, a patient comes in and sits down. What do we see? What do we want to know? Can we see the hurt? What’s broken or bruised? What still works? How does it still manage to work?  These are the questions we want to ask and have answered.

Seeing someone truly may also entail some detachment, but not in the way it is used colloquially, which is to “not feel” what our patients are feeling. To see the truth means not get beguiled by façade. Most patients will come to us with a well-practiced façade in place, a mask they use to get through their lives—to hide pain, to forestall an accounting, to deceive and manipulate for one thing or another. We have to see past those deceptions, both conscious and unconscious. We have to see past the acquired skills and into the recesses of a person’s heart. We have to observe carefully. They may say they feel fine, but they can’t stop biting their nails. They protest over much about how calm they are, but their feet don’t stop tapping, they sigh repeatedly, or their eyes twitch.

As healers we are observers. Both of ourselves and our patients.

Spiritual Context

I cannot imagine doing this work at this point without two backups: One is the homeopathic philosophy and Materia Medica of Samuel Hahnemann and the second, most important one, is God. Suffering is intolerable (our own or anyone else’s) without some context within which we can hold it. Suffering or pain without meaning in a purposeless, random world is utterly intolerable. When there is meaning and purpose, even the worst pain becomes manageable.

Over the years, my work has become more about serving God (this is not about proselytizing by any means) than adhering to an agency code or a diagnostic manual, more about being present and truly healing than politically correct for the moment, more about truth and love than techniques.

I explained it to that young social worker that while others may not have understood what she did for that baby, God did. And the baby did. I am as sure of that as I am of the nose on my face. That baby heard her soothing voice, felt her calming breath and heartbeat, rested in her loving hands. Is there a better “technique” than that? I don’t think so. Those few hours she spent with that child may have changed the trajectory of her entire healing process.

I no longer aim for detachment, though I respect it. I no longer aim to fix every broken thing that is presented to me, though I very much want to alleviate suffering and disease. I no longer aim solely for technical skill, though I love learning.

What I am for is this: I aim to be present. I aim to see the truth. I aim to serve. Doing this work for so many years has required that I become more like a tube than a vessel. I do not “hold” other people’s pain, but I allow it flow through me and then up to God, Who can do with it what must be done, whatever that is so that peace and health and love are restored.