"MSW?"

I heard a colleague quip that many students begin their MSW program under the assumption that MSW really means "Must Save World." Now, I know they don't really think it stands for that - but, many do think that is, in fact, what it means to do social work - saving people and/or society.

I can't remember if that's what I thought at the beginning - how much I was able to distinguish between "helping" and "saving." I do know that I started to become aware of this distinction quite early on in my MSW program, with the first semester focusing heavily on empowerment, strengths-based, and solution-focused approaches to social work, which privilege the client's agenda and wisdom about what should change and how. In contrast, trying to "save" someone tends to veer into benevolent paternalism - the sense that you, rather than they, know what's best for them. It can result in disempowerment, dependence, resentment, and continuation of patterns of oppression. The goal of helping professions is to help - to offer tools and support for clients' own processes of change - rather than to impose change.

With this learning under my belt, I left school (with my MSW) believing that it wasn't my place, and could harm my clients, to try to "save" them. However, it wasn't until my first job after graduate school that I fully understood that I couldn't save anyone. The old adage holds true: "You can lead a horse to water, but you can't make it drink." While I can use motivational techniques, suggest options available to a client, or even get them hospitalized to stop them from harming themselves or others, I cannot impose change on anyone through the force of my will. If they don't want to change, they aren't going to.

Many clinicians use the rule of thumb that you shouldn't work any harder at a client's recovery than they do. I'm not sure it's possible or desirable to follow this rule exactly. For example, I think sometimes the therapist or peer group can hold onto the possibility of and desire for change when a client has lost sight of the goal, or lost hope of achieving it...but only if the client starts with, and eventually regains, their own motivation. I also think there are times when it becomes necessary to work harder than the client - for example, when the stakes are high as a result of suicidality, homicidality, or other risk to physical safety.

Sometimes a suicidal client will ask why I don't just let them do it - what does it matter to me if they live or die? It's their life.... And yes, preventing suicide is imposing my values about life (and my professional mandate) over client self-determination. I believe that suicidality is a time-limited symptom that will pass, while death is permanent. If we can keep someone alive, by hospitalizing them or whatever, there is every chance that they will eventually feel better. But, these are my beliefs, and may not be shared by the client. However, I also know that people who are fully committed to suicide, or addiction, or any other life-threatening path, will not show up, or will take off, or will lie and say everything is fine...they have the autonomy to pursue their own agenda. As long as they're presenting for treatment, though, I'm going to assume they do want help. I have learned from this work that I can't save anyone - but I when people allow me, I can help them save themselves.

Ultimately, I'm glad that I don't have the power or the responsibility to save the world. It's a relief to know it's not possible, even if it's also sometimes frustrating or scary. How do you think about and feel about this issue? When and how did you discover that MSW does NOT stand for "Must Save World?"