I had a dream the other night about a client. It was a client I had only seen three times, probably two years ago or so. In the dream, she offered to act as the security guard for my newly widowed mother. She said it was to thank me for our work together.

     I am sure there are a lot of meanings that can be made of the dream, most of which I will probably think of with my therapist or forget about completely. But the obvious meaning that I draw from it, right off the bat, is that sometimes we want our clients to take care of us - not because we aren’t good at our jobs or because we have some pathological need, but, instead, because it’s hard to be in non-reciprocal relationships all day. Sometimes we get thanked and sometimes we don’t. Most times we don’t. And the need to be seen shows up somehow, in our waking life or sleep.

     This is all to say that it’s hard to be a social worker. And this fact makes it necessary to discuss our mental health openly with each other, with our loved ones, with our supervisors, and with our families; as a fact of our lives that we need to tend to carefully, diligently, and thoughtfully. 

     Mental health exists on a continuum. We all have it. Sometimes we lean more toward mental health struggles, and sometimes we lean more toward mental health stability. We never stay in one place permanently. It is ridiculous to think that some of us struggle with mental illness and some of us don’t. Our minds and psyches are all in this, and none of us are invulnerable to that reality.

     Here are some ways to pay close attention to where we are on the continuum at any given time. 

1. Do daily body scans.

    The relationship between our minds and our bodies is correlated at an exactly 1:1 ratio. Sometimes information about how our mind is doing is stored in our body, and sometimes information about how our body is doing is stored in the mind. We have opportunities to discuss our minds in different settings, but the body is rarely invited into the conversation. It falls on us to bring it back. The other day, my watch gave me an alert that my heart rate was unusually high. It was during a particularly difficult conversation with a supervisee. But had my watch not alerted me to how my body was responding, I truly would not have known. We become so inoculated to our body’s signals because of the pressures of our work that sometimes we cease being able to clearly hear them. Tune in and take the data seriously.

2. All buildings have maximum occupancy. What’s yours?

     I am certain that all clients maintain psychological real estate in our minds. Some amounts of square footage we are aware of; some are less obvious to us. I have clients who occupy so much of my thoughts at times that I wonder how I have time to think about the other things in my life that really matter to me. This is particularly true when the cases have high levels of acuity and I am second guessing a lot of the decisions that I am making. Please know that you, too, have a limited amount of psychological square footage, and it needs to be used economically in order for you to experience sustainability during your career. You can assess your own max levels by the sheer numbers of clients you have, but the formula is rarely this simple. In fact, the more diverse your caseload, the more space you often have. But if you are dealing with recurring themes, diagnoses, and behaviors, it is easy to short circuit. It is really important to take your own limits seriously and to figure out how to establish boundaries around them...which leads me to my next suggestion.

3. You can’t work with EVERYONE.

     There are clients who simply trigger too much of our own stuff during different periods in our lives. There are also clients who have certain presenting issues that will always trigger us and who we simply can’t help. Don’t get me wrong; there are certainly ways in which we can work with clients even when we are feeling set off by what they are bringing up. But there are also ways in which we simply cannot. This is a complex truth to articulate to ourselves, our supervisors, and sometimes our clients. For example, a clinician in the early stages of sobriety might struggle to work with someone actively engaged in substance dependence. Or we can have a family member who has never achieved sobriety and we put overabundance of focus on our client with a similar issue to compensate for what feels wrong in our family. Overlapping issues can create problematic blind spots, and without the distance of time and reflection, it can be hard to be deeply immersed in parallel processes with our clients.

4. Yes, we take our work home. But maybe we should block off some of the rooms in the house.

     I talk about work, at home, all the time. Sometimes I don’t even hear myself. It’s actually annoying. But I have so much processing to do that it is hard to stop. I have a partner who is supportive and patient to a fault and listens with incredible levels of attention. But the fact is that it isn’t totally fair, because everyone that I live with has full days to talk about, as well. It’s just that our work, the work of social workers, can feel overstimulating in ways that are hard to regulate. A few months ago, I realized that it actually matters what room I talk about all of this in. The dining room warrants this kind of “how was your day?” kind of talk. But where my family chills and watches TV and my bedroom truly deserve to be held as sacred from my work. So, I have been trying to only talk about work on the first floor of my house. Yes, it’s heavy handed. But it’s also my way of trying to not spill over too much. And when I am unable to honor this simple boundary that I have made, I know that something at work warrants an additional level of support and attention.

5. You need a team to maintain your mental health.

     If I didn’t have a partner, a supervisor, and a therapist, I am pretty sure that my psychological ship would sink. This work brings up so much from both from my past and about feeling spent in my present, that I need to distribute some of the emotional labor of it. And, so do you. I don’t think it really matters who is on your team, as long as there are people who you feel you can tell the whole truth to. One of my team members is someone I exercise with. We don’t talk about work at all, but we both have really difficult jobs. What we do, instead, is check in on each other when we haven’t seen each other in a while to make sure everything is okay. That’s all it is, and it’s a lot. Find a few people who are interested in where you are on your psyche’s GPS.

6. Cry out loud - cry at work.

     I don’t know anyone who doesn’t cry at work sometimes. And in our field, I think there should be a compulsive normalization of this fact, because the work can be upsetting and overwhelming and shocking. These are not facts that we should habituate to, but should react to and be able to reflect the reality of. There are probably people at your work who cry. Maybe they do it alone in their offices or on their lunch breaks, but it is happening. I encourage folks to discuss this with each other and to cry in front of each other. I encourage this because the sharing of affect is healing. And, on the contrary, the storing up of it is a guarantee of growing deep cavities that are harder and harder to treat as time goes by.

7. Don’t feel as if you can’t do this work if you have your own diagnoses.

     In a world of hyper-medicalization, obsession around productivity, and extreme stress and trauma, very few of us are functioning without diagnoses of our own. I, myself, struggle with anxiety and depression - more often anxiety. Some mornings, I wake up and feel like I am on some sort of speed because of how crazy my anxiety makes me feel. I am also sober and have been for almost 19 years. I have some shame around these truths, but I also know that they are the places from which I practice most powerfully. I know that mental health and mental illness are fluid from my own life. I also know what it is like to be high functioning and struggling at the same time. This helps me to see my clients for their own intricate level of functioning and the many different ways in which they feel both okay and not at the same time.

8. Normalize that mental health and mental illness co-exist and talk about it as a form of activism.

     I am partly writing this to normalize the reality of being a social worker with a psychological life. I am also trying to dismantle some of the power that we hold to write diagnoses, treatment plans, and progress notes. This power is founded on the fallacy that we are objective observers without our own subjective, internal experiences that have also informed our functioning, our behaviors, and areas of resistance and stuckness. The more we talk about being in the same sea as our clients, the more we can demystify the stigma around mental illness that keeps all of us from building the robust teams we need to continue our work in this powerful field of social work.

Dr. Danna Bodenheimer, LCSW, is the founder of Walnut Psychotherapy Center, and the executive director of the Walnut Wellness Fund. She is the author of Real World Clinical Social Work: Find Your Voice and Find Your Way and On Clinical Social Work: Meditations and Truths From the Field (The New Social Worker Press).

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This article is from The New Social Worker, the social work careers magazine.