Jeff Levy, LCSW
Mental Health, Relationships, Trauma, Identity
Jeff Levy, LCSW
(originally posted on Branching Out; The Live Oak Blog, and Linked In, August 2016)
More and more I hear people asking for trigger warnings when there is a chance something someone may say or do will evoke emotional pain. This is happening on college campuses where students are asking faculty to provide warnings about difficult classroom material, as well as in mental health organizations, where clinicians are asking colleagues to provide warnings before talking about a difficult case. Innumerable articles have been written that either support or challenge the idea of trigger warnings.
It makes sense to be warned about potential pain however, on an everyday basis in our own lives and in the lives of our clients, there is often no warning about the trauma or violence that we might experience. Trauma informed practice may not be about proactively and explicitly predicting all possible painful experiences in order to prepare for them or avoid them. Instead, it may be about acknowledging our inability to do such predicting. It is then incumbent upon us to respond with emotional presence, compassion and sensitivity when we find ourselves, our clients, or our students in a place of pain or anguish.
Jeff Levy, LCSW
(originally posted on Branching Out: The Live Oak Blog, December 2015)
Last week I finished teaching a trauma course for students pursuing their graduate degree in social work. More than any other time in the 30 years I’ve been teaching has it been more difficult to balance what has been happening in the world with what I am teaching in the classroom.
I’ve wondered if it’s because the class I teach is a trauma class, but then I remind myself that never before in the history of my teaching has so much worldwide pain been so accessible to all of us. And then I think of the reason I chose to be a social worker. I don’t wish to surround myself with pain, but then again, there is a certain opportunity that comes with being present to our own, and to another’s, pain.
Jeff Levy, LCSW
(originally posted on Branching Out: The Live Oak Blog, June 2015)
During my first meeting with clients, I try to allow time to talk about what is bringing them to therapy while still saving time at the end of the meeting to talk about how I think therapy works. Sometimes, I don’t have to reserve time for this, because my clients will ask even before we talk about anything else. Other times, I may not be able to do this in the first session, but I try to do it as early in our work together as possible.
Part of the reason I share my thoughts about the process of therapy is for people to get a sense of my philosophy and orientation. I hope that this knowledge fosters informed decisions about goodness of fit. I’ve also found that for some—even those who have been in therapy at other times—sharing my perspective on how and why I think therapy may be helpful is not something they’ve heard in the past.
Jeff Levy, LCSW
(originally posted on Branching Out: The Live Oak Blog, May 2015)
Endings have been a topic of conversation at Live Oak recently, as our current group of graduate interns and postgraduate trainees are concluding their year with us. They are all ending their relationships with their current clients, and we’ve been having exchanges about what constitutes a “good ending.”
Providing Different Endings
I’ve had many discussions about endings over the years, especially those that are involuntarily experienced by either the therapist or the client. I was having just such a discussion with Dan, a social worker who meets with me for monthly consultation. He shared that he had decided to leave his position as a therapist in a foster care program. He’s been with the same agency for just over five years and has had some adolescents on his caseload for that same amount of time. “I just want this ending to be different than other endings in their lives,” he explained.
We began to brainstorm what he might share with his young clients and what he would say if they asked him why he was leaving. He considered a few:
“I’ve decided I need a change.”
“I’ve been doing this for a long time and I need to time to take care of myself.”
“I’ve not been doing my best for you and you deserve to have someone working with you who can do more than I’ve been able to do.”
We slowly explored what was behind each of the options he had considered, and found that a theme had emerged. He didn’t want his clients to feel “bad.” He wanted to leave in a way that allowed them to experience an ending that was not precipitous, abusive, surprising, or neglectful. He was committed to doing everything within his power so that they didn’t have “negative” feelings arise, whether those were about him, about themselves, or about loss.
I absolutely understood his quandary. He had worked with some of these young people for a full five years and had gone through a number of challenges in order to form a trusting relationship with young people for whom trust comes at a high cost. Of course he didn’t want to do something as he left that compromised all the work they had done together! Still, I wondered if there was something he may not be considering.
“What would happen if you stopped trying to make them feel better about you leaving,” I asked. And very gently continued: “And who are you really trying to make feel better?” His face flushed and initially I thought he would be insulted by my question and respond with anger. Instead, he was quiet and eventually, with some resignation, shared that he didn’t want his clients to feel bad, but a good part of him not wanting them to feel bad was because that would help him not feel bad for leaving.
“Maybe you can experiment with acknowledging any feelings your clients share, either explicitly or through their behavior, and let go of trying to make them feel better,” I offered. “Maybe the way this ending can be different is by being with the sadness and loss, and leaving from a place of empathy and validation. That, in itself, might be a different experience of endings.” With a sigh, Dan’s shoulders relaxed and he sank back into the couch in my office.
The Power of Endings
When I think about endings with clients, there is one ending I experienced that almost always comes to mind.
It was over 30 years ago, and I still think of Robbie regularly. It was my first job after completing my bachelor’s degree in recreation therapy and I was working in Champaign at Illinois’ only free-standing state funded child and adolescent psychiatric facility. In those days, children stayed with us sometimes for years. We functioned more like today’s residential treatment agencies than we did a psychiatric hospital.
It was early 1980 and Robbie was 8 and his older brother Sam was 10. They were dropped off by their mother at a movie theater. When the movie was over, both boys left the theater and searched for their mother’s car. They were waiting for quite awhile before she ultimately came to get them and just as they were opening the car door, Robbie remembered he left his glasses in the theater.
He and his brother ran back to the theater to look for Robbie’s glasses and when they eventually found them and came back outside, their mother was gone. Gone. They could not find her and, in fact, they never saw her again. Police also could not locate her and soon both boys were in foster care.
Sam did well in foster care and adjusted quickly. Robbie did not. He lied. He stole from his foster parents. He didn’t follow rules or directions. While Sam stayed in their first foster home, Robbie was placed and replaced, moving through at least five foster homes before he eventually found his way to us. While initially we saw some of the same behaviors that made foster care difficult for Robbie, he quickly settled into the structure and consistency of our program.
Robbie thrived. He did so well in our school that he was eventually transitioned to public school. He also became involved in recreation activities in the community, including little league. As the recreation therapist, I was responsible for coordinating all of Robbie’s activities within our program and in the community. I was usually the one driving him to his games, watching them, and bringing him back to our program.
Before and after games, as other boys talked to their parents, Robbie would run back to me. “Please don’t tell them where I live,” he begged. “If they ask can you please just say you’re my father?” I was 22 years old at the time and he was 8. “Robbie, I don’t think people will believe that I could be your Dad,” I responded more than once. “OK, “ he continued to beg, “then please just say you’re my brother.”
If you looked at us, we could be related. Robbie was bi-racial with light olive skin and black wavy hair. My skin tone was slightly lighter than his, and the texture and color of our hair was almost identical. I relented. If asked, I would say I was his older brother. He had so much shame about not having family. Living in a state facility was embarrassing to him. I didn’t have the heart to contradict his introduction of me to his teammates and their families.
After being with us for over two years, we learned that Robbie’s mother had terminated her parental rights (his father was unknown), and that he was eligible for adoption. His state caseworker decided he would move to a group home while awaiting an adoptive family. Unfortunately, the group home was three hours south of us by car, and we learned it was their policy for new residents to have no contact with anyone from a former placement for six months.
That was not an uncommon policy in those days, though it is certainly in conflict with everything we know today about attachment and the power of relationships to heal. In the two years Robbie was with us, we had become his primary attachment figures. And all of us had become attached to him, so in addition to trying to support his leaving, we were also trying to manage our own feelings of loss as the date of his discharge approached.
I remember being coached by my supervisor to try to talk with Robbie as he was readying to leave, and to also be prepared for him to return to old behaviors, some of which were the reason he was placed with us initially. She explained that for some people, it was easier to leave from a place of conflict and anger—and sometimes more frightening and vulnerable to leave from a place of connection. Robbie, however, refused to speak of his departure and continued to follow our rules and routines without incident.
Even 33 years later, I have vivid and distinct memories of Robbie’s last day with us. We had just completed evening snacks and were in the dining room. Everyone else had been excused to their rooms for evening routines and to get ready for bed. Robbie and I were left, putting the dishes away and wiping off the tables.
When we had finished and were just about to lock the dining room door, I saw Robbie’s eyes welling with tears. He looked directly at me, tears streaming down his face. “I’m really going to miss you,” he haltingly shared, with stifled hiccups as he tried not to cry. This was the first and only time he said anything about leaving and I remember feeling inarticulate and inadequate. I tentatively put my hand on his shoulder.
Robbie grabbed me around my waist with both arms, hugging me tightly, not asking if he could have a hug (the only rule he broke in his last few months with us). Reflexively, I hugged back. And after a few moments, I broke the silence. “I’ll miss you, too.”
Being With the Pain of Endings
Endings in therapy are never easy, even when they are planned. They become even more complicated when a therapeutic relationship ends because a therapist is moving, a client is moving, or someone’s time at an agency is coming to an end.
It may seem counterintuitive, but experience has taught me that when our relationships with our clients end, whether voluntarily or involuntarily, it is imperative that we lean into the pain; that we validate the sadness that comes from losing a relationship. Paradoxically, it is by being in the sadness and pain that we provide the most profoundly different and healing kind of ending.
How lucky I am to have something that makes saying goodbye so hard.
~Carol Sobieski and Thomas Meehan, Annie
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