At an orientation for new MSW students this week, a more advanced student shared one of her first-ever process recordings. In it, she had misinterpreted a client's standoffishness as resulting from (rather than causing) her discomfort. The advanced student explained that, at the time, she hadn't understood what was going on with the client well enough to understand her reaction.
One of the new students expressed skepticism: "Didn't you have referral information? And access to a Diagnostic Manual?"
The experienced clinicians in the room smiled and shook our heads - likely the new student won't understand why a manual isn't enough information until she starts her own work with clients.
The truth is, no book can adequately capture the information we, as clinicians, learn from our own feelings. (Students - this is why your professors, supervisors, and advisors all keep pressing you to reflect on your feelings!) Provided that we've done enough of our own work to separate our "stuff" from the client's, the feelings we experience while sitting with someone provide invaluable data on that client's experience.
I think there are at least three ways that our feelings can be a source of clinical information:
- Perhaps most obviously, our reactions to a client may be similar to the reactions he or she receives from others. For example, someone whose dependency makes me feel claustrophobic may be having relationship issues because their significant other feels similarly.
- Our feelings while sitting with a client may also mirror what the client is feeling. For example, when I sit with someone who is severely depressed, I always feel like I've entered a black hole - bleak, and slow.
- Lastly, with enough experience encountering various diagnoses (and reflecting on our reactions), I think we each develop a knack for determining a client's most likely diagnosis based on the feeling they elicit. This may not be true of every diagnosis in the DSM, but I have definitely found it to be true of many. For example, psychosis is tricky to sort out using DSM criteria, but schizophrenia, schizoaffective disorder, and mood disorders with psychotic features all have a different "feel."
How do you use your feelings as a source of information while sitting with a client? Are there times when your reactions seem more or less helpful?