Saturday, May 9, 2009

The Service Eater

Most social workers have dealt with these clients.  The clients who have been to every program under the sun and hope that yours will give them that something they need, that one extra push etc…  The question is, what do you do with them? 

Something I’ve noticed, is that many of these clients have a very negative mental filter.  Despite the positive things which may be going on in their lives, they focus exclusively on the negative and seem unable to take the positive into account.  They often seem very genuine and earnest, often citing the bad experiences they’ve had with other social workers/programs.  And yet for some reason, they keep trying again. 

While some of them have tried and quit every program, there are some that are still IN every program.  I recently had a client who was seeing something like six different counselors at once, and wanted to join our program on top of that.  Despite all the counseling, he was definitely not mentally stable and I recommended we put a hold on his admittance.  I don’t think adding a seventh (or however many) service is actually going to do the client any good. 

The thing is though, no one program is going to be right for everyone, and sometimes what people need isn’t so much a program but someone who will stick with them no matter how many times they quit.  For example, if a client has a counselor who is willing to take them back no matter how many times they storm out and find a new counselor, maybe that continuity will help them to make progress.  It’s hard to know though.  Sometimes the thirtieth program is the answer, it’s the one that clicks, the one that works.

Maybe this thought doesn’t have a point? 


David G. Markham said...

I know the client you're talking about. I've had him in my program, too.

I would think Axis II and then decide what might help the client, depending on what the client says his goals are.

The skepticism is very warranted and if clinicians are not wise enough to set limits, as you appear able to do, the payors will.

The problem may not be with you or the client but with the system. The system appears to be uncoordinated, inefficient, and wasteful of resources.

You probably can't blame the client because the client is being enabled by all those programs and counselors.

If he asked me for help, I would question what I could do for him different that what others have done and tried to do. I would be hard to get.

All the best and keep up your good work,

David Markham

PS - Are you in Canada? It is very hard for clients now days to be in this position in the States. The payors have cracked down hard and won't pay for more than one provider at a time.

Still Dreaming said...

I am in Canada. And the way things are in my city, there are tons of non profit agencies where you can connect with someone for free or for very little. For example, no one has to pay for my program because we're government funded, from a couple different branches of the government.

Anonymous said...

I think 'relationship' is such a key in healing - I know from my own experience of seeing a jungian analyst (5 years now) that, whilst I've sometimes struggled to grasp the points he's trying to get across to me, it's the healing relationship with him that's helped me in moving on in my life. This has held true even during periods when I've not agreed with him.

Maybe people signing up to so many programs or constantly returning to try more programs shows their own inner drive to heal? - to want to heal? - even though they struggle to do so.

I know, for me, it's taken a long time to see the underlying complexes that have shaped my behaviour and reactions to situations. It's been a painful (though worthwhile) process.

Anonymous said...

Just to follow on from my last post, BTW re: the negative filter. You might find reading this book: interesting. I've been reading it recently and it explained a lot to me why I can get so 'down' so more easily than others. I'm finding a useful book and it has helped me to restart my meditation practice again.