Personal Space

It's been six weeks since we opened the satellite clinic where I work. At that time, we began with a limited staff, and only two programs - adult partial hospitalization and intensive outpatient programs for eating disorders. In the last few weeks, a whole  additional team of staff has joined us in the space, and began their program - adolescent intensive outpatient. We've also added a program director to manage the whole clinic and all three programs. Suddenly, what once felt spacious is feeling pretty crowded. 

Two other clinics the agency opened last year demonstrated how important it was  for morale that staff felt like they had a place to call their own. In limited quarters, communicating and sharing effectively was the key to making sure that no one felt left out, pushed aside, or like their toes had been stepped on. The agency has tried to learn from these earlier experiences, and involve everyone in deciding how best to allocate, arrange, and use the available space. As a result, the multiplication of staff and programs has gone relatively smoothly...but, as with any transition, there have still been hiccups.

We expected to have to be creative about where to meet individually with clients, especially when both staffs are present. This will likely cause some challenges when multiple clinicians assume that a shared room will be available, only to find someone else is using it. It is already challenging because only one of the shared consultation rooms used to have a computer and phone...which have now been moved into the adolescent program staff's office. As a result, the members of our treatment team who are not there every day - namely, the prescriber and dietitian - do not have a readily-accessible phone or computer. The full-time direct-care staff have also recently learned that they're sharing one desk in the chart room, with one computer and one phone. Both shifts have resulted in some sense of displacement, and perhaps even a feeling of being less valued. 

Full-time clinical staff have our own desks, computers and phones in shared offices. This has worked out well so far - I think that just having a designated space allows us to feel secure, settled, and somewhat organized. At least, that has been the case for me. However, when we got new furniture and my desk wasn't facing the way I wanted it, I was perhaps unreasonably unhappy. My office-mate doesn't love the way I have it, but it's important for me to feel comfortable, and she got to choose how her desk would be. Facing a different direction is a small thing, but would be an unnecessary distraction. Amid the chaos of this kind of work, I need at least my desk to be the way I want it!

It's actually remarkable how much our surroundings can affect our mental and emotional state. My old roommate used to say that her messiness would expand proportionally to her stress level; another friend quipped: "my room's a mess = my life's a mess." Having a few personal objects, at summer camp or in your office, provides a feeling of belonging, a tangible anchor that is soothing in a new or chaotic environment. And remember the feeling the first time you got to paint and decorate a room for yourself? While we could theorize how and why we are so influenced by our "personal space," I find it more useful simply to recognize, and hopefully make use of this influence. If satisfaction goes up simply by having a little area to call one's own, we should prioritize this as an easy way to improve - rather than diminish - morale.

How do you connect to your space to feel anchored? How do you arrange clinical and personal space? When has space been an issue for you?

 

Another Take on Termination

A few months ago, as I was leaving a job, I wrote about the termination process in individual therapy. Now, as I prepare to transition from the program where I've been filling in to my permanent program (set to open in a few weeks!), I'm reflecting on how termination seems different at a different level of care.

The therapeutic relationship is (obviously) different in individual therapy than it is in a setting where treatment is provided by a multidisciplinary team in groups on a milieu (as it is in all higher levels of care). Specifically, the relationship is more intimate and therefore more intense in individual therapy, making termination feel more like a loss. In contrast, relationships are more diffuse in a group setting, so termination is less significant (at least termination between client and clinician; I think clients feel more sadness about terminating with "the program," because the whole is more than the sum of its parts).

At the last partial program where I worked, staff held mini "graduation" ceremonies for clients as they left the program - diplomas and all. At the program where I work now, staff help clients lead their own ritual of saying goodbye with each of their peers sharing something positive about who they are and/or how they've changed/grown. While we introduce the process, this ritual happens without staff present. In both programs, clients have tended to feel more sad at saying goodbye to peers, and anxious about leaving the safety the program symbolizes, than anything they may feel terminating with staff.

Perhaps as a result, my own feelings about terminating from the program are almost opposite to the feelings I had leaving my last job (which involved all individual therapy). At my last job, I was sad to say goodbye to clients, but didn't have a lot of feelings about leaving colleagues or the clinic. This time, I don't have a lot of feelings about leaving clients, but am sad to leave the team.

My theory is that my feelings about terminating with clients are countertransferential (reflective of the client's degree of attachment to me), while feelings toward colleagues perhaps reflect the degree to which the team, versus individual clinicians, is the central therapeutic relationship. Of course, my feelings could simply reflect the amount of time I've spent with a client, and how collegial my relationships with colleagues are.

How do you feel about termination? Have you noticed different feelings in different settings? If so, what do you make of it?

The Golden Rule?

In interviewing potential social workers, the CEO of the health center where I work always gives a standard speech: the case managers - paraprofessionals who are members of our clients' cultural/linguistic groups, and serve as culture brokers in addition to connecting clients with concrete services - must be treated with equal respect as any professional. 

To me, this rule seemed obvious - why wouldn't I treat them with respect? However, he wouldn't say it unless some previous staff member had been disrespectful. This fact got me thinking about how we, social workers or other professionals, treat each other. 

We're taught (repeatedly) about the importance of respect and sensitivity toward all forms of diversity in our clients - race, ethnicity, class, age, gender, sexual orientation, ability, religion. However, there is little talk about the importance of showing each other the same respect. 

How often do we judge each other on the basis of the same kinds of diversity we make such a point of accepting in our clients? 

I know that I have faced prejudice from colleagues and potential employers because I identify as Christian - they assume or fear I represent the "religious right" rather than my actual progressive Christianity. Other people I know have faced other forms of discrimination: Male social workers are assumed to be gay. Persons of color are sometimes assumed to be less educated. The very presence in the profession of those of us with any history of mental or emotional problems is questioned. Not to mention physical disabilities: You can't work on a psych unit if you can't participate in restraints! Or, how can you be a therapist if your hearing or vision is impaired?

If we step back and imagine making the same assumptions of clients, we are appalled, and yet we readily say or think these things about each other. What scares me is that, if we think these things of each other, are we really not harboring the same attitudes toward clients? That was my reaction to our CEO's speech - any professional who treats the case managers disrespectfully may very well be treating clients just as disrespectfully. 

So, let's try to extend the same respect and acceptance toward each other that we aspire to show our clients, and that we hope to receive ourselves. We may be surprised by how it enriches our profession for everyone to feel free to bring all of themselves to the work.