Getting Comfortable with Discomfort When Helping Clients

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One of the most important lessons I’ve learned as a social worker is that, in order to excel, you must absolutely get comfortable being present in situations that make your skin crawl. You will encounter people, places, things, and circumstances that will test the limits of your ability to maintain a modicum of objectivity, but how do you become comfortable with discomfort. From my experience, three things will help you learn how to do this:

  1. Time on the job. Repeated exposure over a long period of time will familiarize you with the unpleasant particulars you will face. I always say that, while nothing surprises me, some things do shock me.
  2. Having a strong sense of yourself and your values. This will help you notice whether your discomfort is more about you then your client’s presenting issues.
  3. An understanding that the process of learning this skill will never be over. You can refine this skill, but you will never perfect it.

For instance, my very first client at my first “big boy job” was a 15 year-old boy with significant anger issues to whom I would be making home visits. When I pulled up to his family’s trailer, he was sitting on the front steps smoking cigarettes with his family. By family I mean his mother, 12 year-old sister, and 10 year-old brother, all of whom were smoking. His home was infested with fleas from the seven dogs that crowded the living room in which only a few of the dogs were his. The others were strays that had simply wandered in and were being tolerated by the family.

He had lit fire to a neighbor’s car because he was unhappy with the relationship between the man and his mother. While my own values and the way I conducted  myself in my personal life were completely at odds with much of what I was experiencing, I quickly learned this kid was a person with very real and alarming concerns that deserved a shot at help as much as anyone. I had to put my judgment on the shelf and realize it wasn’t about the life to which I was accustomed. The fact that I included this story from so early in my career, about 13 years ago, shows how deeply it affected me, and how so many years later, I am still conflicted about the way I handled the situation.

I could fill a book with stories of clients/patients that led me to places that challenged my ability to stay present while feeling extremely uncomfortable. Some of these situations involved people I was tasked to help in which I found very little about them to like or admire. However, I have made it a lifelong goal to practice Carl Rogers’ idea of “Unconditional Positive Regard” which states we must treat people as human beings regardless of things they have done. It is not always easy and it would be dishonest of me to say that I always succeed, but it is a work in progress. Remember, the things that make you the most uncomfortable are also your greatest potential learning opportunities. Do not shy away from them.

Most importantly, it is crucial to have a support person whether it be your own therapist or a colleague with whom you can process such events. This will help you more clearly see what it is in you that causes your discomfort. Your continued effectiveness as a social worker depends upon your dedication to ongoing personal growth. If you do not have a support person, please seek out someone with whom you feel comfortable. It will make all the difference!

Ending the Therapeutic Relationship: Creative Termination Activities

Amy Bucciarelli, MS ATR-BC, LMHC, Board Certified Art Therapist, helped Frank “Dylan” Dinkins make a painting for his parents. Bucciarelli works with pediatrics patients at UF Health Shands Children’s Hospital.

Termination is a highly important part of every therapeutic relationship that should be addressed throughout each stage of the process. While many adult clients have the ability to easily think back to their experience in therapy, for youth this is often more difficult.  Because of this I like to provide clients with some sort of physical representation of their time in therapy that will help them reflect on their experiences, highlight their strengths, remind them of what they learned and provide them with tools they can use to help prevent regression, and even continue their progress on their own.

These activities let you both reflect on their time in therapy and transition out of services in an engaging way. I’ve also found that using metaphors often helps young clients to better understand termination and makes after-care instructions more salient.  Below are some ideas for creative termination activities that are easily adaptable to fit your clients’ needs. I am not sure of the origins of all of them, so please let me know if there is someone that I should be citing.

Session Trackers

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I recently spoke to an intern who was confused when a number of her clients seemed surprised when it came time to terminate, despite her verbal reminders.  It is sometimes helpful for young children to be able to have a visual representation of how many sessions are left, and it can help them better prepare for termination.  One way to do this is to create a session-tracking chart.  In the examples above clients color in one image, or choose a sticker, at the end of each session.  The activity is quick and also provides a good opportunity for therapists to check-in with clients and help process any feelings surrounding termination that come up throughout the process.

Ready to Set Sail: Termination Activity

By Jodi Smith, LCSW, RPT-S at “Play is Powerful”

Supplies: Toy boat, paper boat, paper mache boat, box with a boat drawn on it, etc.

Directions:

  • I’ve found that the use of metaphors increases the amount of information that clients retain and internalize so I use them frequently in termination.  Start by explaining to the client that because of the progress they have made they are ready to sail off on their own.
  • Reflect on what that feels like and process any anxiety, and transition into talking about all the things they will “take” with them to help with their journey.
  • Have the client answer each question and write their response on the back of the cards.  The boat will contain cards related to tools they will take with them (supports, coping skills, etc.), things that may get in their way and strengths (as identified by the client and therapist).  Along with my pre-made cards, I also give them blank ones.

Treasure Chest Termination Activity

Supplies: Treasure box (Michaels Crafts has wooden “treasure” boxes that are cheap and easy to decorate.  A link to directions on how to make a paper one can be found here; Stick-on plastic jewels (found at crafts stores, oriental trading co., etc.); Small note cards (cut to fit the box); Pen.

Directions: First, have your client decorate a treasure chest.  Then stick a jewel to each card as your client writes down the “task” that is assigned to that specific color (see below).  On the back of the card, they include a specific example of how what they identified has helped them in the past and/or how it will help them in the future.  Below are examples of possible color codes, but you should change them to meet your client’s specific age and needs.  In the end, the chest will be full with a stack of jeweled cards.

  • Blue: Strengths (Identified by both the client and therapist)
  • Red: Coping skills
  • Green: Supportive people in their life
  • Orange: Resources from therapist (ex. hotline numbers, therapist referrals or directions for reenrolling in services.)
  • Purple: Self-care activities
  • Pink: Inspiration (future goals, motivational quotes, etc.)
  • Yellow: Things they have learned in therapy

 Suitcase Termination Activity

At termination, your client is finally ready to continue their journey on their own.  Even though they will be leaving you behind, they can pack up everything that they have learned during their time with you to take with them.  This metaphor is easy for most people to identify with and it is a fun activity.

Supplies: Plastic or cardboard suitcase; Blank sticker labels; Paper luggage tag; String; Cards; Travel stickers.

Goals: Process termination; Provide transitional object; Help prevent regression; Identify accomplishments, goals, coping tools, etc.

Directions:

  • Have your client make and/or decorate their suitcase.
  • Then they write something they will “take with them” from their time in therapy on each card provided (I print cards with travel clip-art on the back).  These can be things they have learned, coping skills, supports, resources etc.
  • You can also integrate this with the after-care kit I posted.
  • On the labels, they write or draw goals they have accomplished.  (Like the old suitcases in movies that are covered with stickers of past travels).  I also provide additional travel stickers.
  • On the luggage tag, they write where they are going next.  This could be a new life stage (ex. my 8th graders usually write “high school”) or a goal they would like to accomplish that the contents of the box will help them achieve on their own.
  • Process feelings about termination throughout the activity.

Therapeutic Goodbye Cards

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This is such a simple, yet powerful termination activity.  I got this idea from a client who gave me a very touching thank you note during our last session.  It is something I have kept and reflect back on, and I realized that it could potentially play a similar role for a client.

  • The focus of the content is on the journey through therapy and what has been accomplished.  I highlight strengths, review coping tools and lessons learned, and express my thoughts about termination. In the end, I usually include instructions of what to do if they decide to enter therapy again.  You could also have the client write a letter to their future self that they can read when they are struggling.

Summer Bucket List

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I put a therapeutic twist on this summer craft.  Most school therapists are unable to see clients throughout the summer but may pick up treatment again during the following school year, which is not ideal.  This activity can help encourage adherence to after-care recommendations.

Directions: Have your client design a bucket that will help them to continue your work together on their own and prevent regression.  On the back of the paper bucket, they can write goals for the summer, self-care activities, etc.  For the 3D buckets, these can go on cards placed inside the bucket.  On the shovel, they write down “tools” that will help them to accomplish their goals (social supports, coping skills, resources, etc.)

You’ve Got Mail: Group Termination Activity

mailbox

Directions: First, have your clients create their own paper mailbox.  Then, each person, including the therapist, writes a short note to every other member of the group.  You can instruct them to write something that they have gained by knowing that person, a strength they can identify in that person, a motivating message, etc.  The notes are then placed in the mailboxes for the group members to take home.

Graduation 

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Certificates are very simple to create in programs like Word, Pages, etc., and are a good wrap-up for clients who have worked hard to meet their therapeutic goals.  In my example, I left space to write specifics about progress, accomplishments, reflection, etc.  One the last group session we have a “graduation party” where we have fun, reflect on our time together/progress made, and process termination.  They are then presented with their certificate.

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