CASE STUDY 1

Ms. V is a white, heterosexual woman, 26 years of age. Assigned to a public mental health agency, she is in the internship phase of a Master's degree program in clinical counseling at a small, Christian university. Ms. V opted to go to graduate school immediately after finishing her Bachelor's degree in psychology. Her initial motivation for studying psychology was to help people, and she chose to do this despite the protests of her upper middle-class parents, who believed that there was no "future" (financially) in the psychotherapeutic professions. Partially to ease their protests and partially to "get on" with a career, she entered graduate school. Ms. V has found working with clients to be quite a struggle. She went into the field with every good intention of helping people, and she believed it was part of her spiritual path. However, the first time a client from a background different to hers, a tall, African American man on welfare, towered over her and told her that she "didn't know what she was talking about," Ms. V melted down and spent the rest of the day in her office crying. She called off from her site duties for the rest of the week, citing illness. At this point, Ms. V is wondering if a career in counseling is really the best fit for her because of her discouraging experiences working with clients. Yet the thought of going through a Master's degree program and not using it, especially when her parents paid and supported her through the program, is a shaming prospect to her. At this point, she is at a juncture and feels trapped.

Supervisor: V, I got your email about the session you had with L (client in question) and that it took a toll on you. How can I best help you with this?

Ms. V: I don't know. I just feel in over my head.

Supervisor: Okay…Can you help me understand a little bit more about what you mean by "over your head"?

Ms. V: I mean, I have thought about it…I've really been thinking about it for the last several days, and I think he's right. I mean, what do I really know about real life? I'm just a privileged little white girl who has a degree.

Supervisor: Wow, that's heavy…Is that what L said?

Ms. V: More or less.

Supervisor: And you've been thinking about this for the last several days since it happened?

Ms. V: That's all I've been able to think about.

Supervisor: Wow, that's heavy stuff, V. I'm sorry that you've been beating yourself up about this issue. I just want to assure you that you are not alone here. We have all been told off or talked down to by clients at one point or another during our careers.

Ms. V: Really?

Supervisor: Absolutely.

Ms. V: It just seems to come so easy for so many people.

Supervisor: I hear that it can seem that way. You may have heard that cliché before that everyone who's an expert at something was once a beginner. That applies here, too, V.

Ms. V: I just feel like I'm not cut out for this.

Supervisor: Can you tell me more about that?

Ms. V: Well, yeah. I mean, the people that we're dealing with here in the city. I've just never had to deal with this kind of pain before. I can't even imagine what it's like to be on welfare, or to have parents that ran off on you, or to be addicted to drugs. I want to help people, but I just don't know what to say.

Supervisor: I hear that. What seemed to bother you the most about what L said to you?

Ms. V: I don't think it was what he said as much as how he said it. Just that he towered over me and I felt paralyzed to say or do anything. I get that I can never really understand what's going on in his life, but he was so harsh about it.

Supervisor: Interesting. There are a couple of ways we can approach this. We can look at what about this interaction with L triggered things for you. Or we might re-examine what you remember saying in the conversation that seemed to set L off. You tell me, V, where do you need to go with this?

Ms. V: I don't think it was what he said as much as how he said it. Just that he towered over me and I felt paralyzed to say or do anything. I get that I can never really understand what's going on in his life, but he was so harsh about it.

Supervisor: Interesting. There are a couple of ways we can approach this. We can look at what about this interaction with L triggered things for you. Or we might re-examine what you remember saying in the conversation that seemed to set L off. You tell me, V, where do you need to go with this?

Ms. V: I'm not sure.

Supervisor: Well, just take a minute then. You can close your eyes and get silent if you need. Ask yourself where you most need to go today.

Ms. V: Okay. (She briefly pauses) It's the way he just got up and stood over me. I felt very unsafe.

Supervisor: Okay, V. That's very honest. If I can ask, being towered over like that and not feeling safe, what is that really about?

Ms. V: Wow, I didn't think of that parallel. Whenever my parents doubted my opinion on something, especially about my career choice and field of study in college…whenever I fought them on anything, they would stand up, even if we were at the dinner table. It's like it was their way of making me feel small. Even if we were all standing during an argument, it would seem like they became 10-foot-tall giants when they started to argue.

Supervisor: How interesting. Is there a chance that your interaction with L triggered this dynamic with you?

Ms. V: Oh, absolutely. And I think it hit me even harder because my parents never really wanted me to go into this field in the first place, even though they financially supported my education. It's like L telling me I don't know what I'm doing is hitting me even harder because that sounds like something they would say.

Supervisor: That's really fascinating, V. Is this something you're comfortable continuing to talk about with me or do you feel you may want to address it with someone else?

Supervisor: V, help me understand. On one hand, you believe L when he accused you of knowing nothing about real life, yet on the other hand you share that you know what it's like to be towered over and looked down upon by your parents. Isn't that real life?

CASE STUDY 2

Mr. B is a homosexual man, 38 years of age, of multiple ethnicities. (His mother was born to a Jamaican father and a white mother, and his father was of Dominican origin.) Mr. B is recovering from a substance use disorder (heroin and alcohol), having amassed three years of clean time in his chosen twelve-step program. A machinist in his first profession, Mr. B was not able to maintain employment because of unreliability in showing up. After trying rehabilitation programs several times, unsuccessfully, his last attempt seemed to stick, following his diagnosis with hepatitis C. Taking an open mind to recovery, Mr. B discovered a new life for himself, and he especially found that working with others gave him a renewed sense of purpose in life. At two years sober, he decided to complete an associate degree program in chemical dependency counseling at his community college. Mr. B loves school and loves working as a chemical dependency counseling intern at his community's correctional treatment facility. He has every intention of going on to complete his Bachelor's degree and perhaps a Master's degree, but he is not sure if he is "smart" enough to handle the writing component of this advanced education. The clients at the facility connect with Mr. B's easy, natural style, partially because it is very clear that he has been to the dark places that they have been.

Supervisor: So, what would you like to work on today?

Mr. B: Well, I'm struggling. When I was in treatment all of those times that didn't work, I used to get pretty nasty with counselors when they brought up the idea of going to AA or NA meetings. Then, I got clean in a 12-step program and it all clicked, as you know from my story. So now when I talk with clients about meetings or using 12-step language, they're getting smart with me the same way that I used to get with counselors. And it's frustrating me like crazy. I just want to shake them sometimes and tell them that they're going to keep failing until they get into a program.

Supervisor: I see. Well, I can relate to some extent. It can be a struggle when you feel that, as a person, you worked hard and something really clicked for you, and you just don't see why others won't get it too.

Mr. B: Yeah, that's a big part of what's going on. I didn't think it would bother me so much.

Supervisor: What do you think you need to do to address it?

Mr. B: I mean, meetings are the only way for a person to get clean. How can I make them see that?

Supervisor: Well, let me share this with you. Technically, if we look at what the studies in the field say about getting sober, we know that meetings aren't the only way to get and stay clean, although they are certainly one of the most popular and effective ways. Again, that's what the field as a whole teaches, so we need to respect that. But what this treatment center has learned through experience and feedback is that meetings seem to work the best for the most people who come through our doors…if they want to stay sober long-term.

Mr. B: I don't know if I buy that. About what "the field" says.

Supervisor: I'm not saying you have to buy it, B. I'm just sharing the information with you. What you do with it is up to you. I'm just asking you to keep an open mind to it and think about how sharing both sides with a client, like I just shared with you, might be helpful.

CASE STUDY 3

Ms. T is an African American woman, 50 years of age, who completed her Master's degree in social work two years ago. Ms. T was grandfathered into being a licensed social worker in her state before formal licensure laws came into effect; she worked her way up the ranks in the medical social work department at a hospital near her hometown. Around 40 years of age, she became restless in the "paper pushing" culture of her hospital and decided it was time to make some changes. She thought about going to school for another profession, like nursing, but ultimately decided to complete a Bachelor's degree in social work and stay on for her Master's. She enjoys working with clients in an individual manner, conducting therapy; she feels that she has a great deal to share because of her rich life experience. Ms. T is the mother of three, the grandmother of five, and lost one of her grandchildren in a fatal car accident. Ms. T's father worked with Medgar Evers during the Civil Rights movement, and Ms. T was raised with a strong commitment to social justice. Despite liking her clinical job at a company near her hometown, Ms. T experiences frustrations. For instance, she never thought that there would be as much paperwork in clinical life as there was in medical social work. She finds juggling her schedule, with the mixture of clinical and administrative demands, to be a challenge. She also finds working with some of the younger counselors from a more privileged background to be a struggle, as she sees them as being "out of touch" with what their clients go through. Moreover, Ms. T's clinical supervisor is 18 years younger than her, and Ms. T often has resentment in having to take direction from her.

Ms. T: I find that J (a client on Ms. T's case load) is frustrating me more and more. I don't know if she's just rubbing me the wrong way or if I'm doing something wrong.

Supervisor: What seems to be the source of the frustration?

Ms. T: Well, she comes into session, always with a catastrophe, just chattering and chattering away and I can't get a word in edgewise.

Supervisor: Hmm…Did you ever deal with these chatty types when you were working at the hospital?

Ms. T: Sure, but it never seemed to be this bad. And I never have this sense, like I had with J, that she's expecting me to fix things for her. And I mean, how can I fix things for her? She won't let me suggest anything.

Supervisor: Well, that is a very good point. Just to look at it though, did you ever do anything with your clients at the hospital that seemed to get them on track?

Ms. T: Well, it's little, but I usually found that the "take a deep breath" line would work, even if I was interrupting them to suggest they take a breath.

Supervisor: I think that you're on to something, T. In my work, I really praise the benefit that breath and using the body can have with clients. So let me share with you something I've tried before with clients like J.

Ms. T: Okay.

Supervisor: Clearly, there is some type of relationship established because J keeps coming back for sessions and seems to trust you. So, the next time that she comes in, after you get the initial hellos out of the way, be assertive. Ask if she is willing to try something different to start this session. Ask her if she would be willing to just do some breathing for the first 5 minutes of the session, before you do any talking.

Ms. T: Interesting. You think that would work?

Supervisor: I've tried it before with some success with those chatty types of clients or those who want to analyze everything.

Ms. T: What if she resists?

Supervisor: That's definitely a possibility. Whenever a client puts up a protest, a common line that I use is, "Would you be willing to try it? It's something different than what we've been doing and I have a feeling it may work better for you." Make her realize that you are interested in trying every possible option to help her.

Ms. T: That's a good point. I never thought of it that way.

Supervisor: How is this suggestion we just discussed resting for you?

Ms. T: I like it. It feels good, and it's certainly worth a try.

CASE STUDY 4

Mr. N is a self-described "family man," 52 years of age and of Polish Jewish descent. His parents were refugees following the Second World War and immigrated to the United States in the 1940s. Education was highly valued in his family growing up, and Mr. N immediately went to college, finishing a Bachelor's and Master's degree in social work. Mr. N established a career working with Jewish family services in a major American city as a clinical social worker, and he genuinely enjoyed his work. At 45 years of age, Mr. N was compelled to return to college and complete a PhD. His brother is a medical doctor and his sister is a lawyer, and even though he is successful in his own right, he was always made to feel like the underachiever in the family for not living up to his full potential. At the advice of his agency director, Mr. N decided to pursue a PhD in psychology, not in social work, as completing the degree would make him eligible for a psychology license. This new license would make Mr. N eligible to do forensic and educational evaluations that could be quite lucrative in his state; after all, his agency always "contracted out" such services. However, completing a PhD in psychology means that Mr. N would have to complete another internship with a licensed psychologist. He has a friend who is willing to conduct the supervision, monitoring his existing hours at Jewish family services, in addition to mentoring him through other evaluation-based tasks that he must learn. About halfway through the program, Mr. N finds he is growing weary of being supervised again and wishes that he would have chosen to complete a PhD in social work instead.

Supervisor: N, I need to ask how you feel things are going with our supervision sessions.

Mr. N: Oh, fine.

Supervisor: Fine?

Mr. N: Yup, no complaints. You're doing a good job, if that's what you want to know.

Supervisor: Thanks, N. Bringing this up with you is a bit tricky, because we've had a collegial relationship, and I'd like to think friendship, for many years now.

Mr. N: Uh, oh. I feel a lecture. What's the problem?

Supervisor: Now, don't jump to conclusions. There's just something I feel I need to address. According to the terms of our supervisory agreement for your psychology license, I need to meet with you in person at least once a week for our session. I've noticed that you've been showing up at least 15 minutes late to almost all of our sessions, and you're skipping a few of our meetings, which doesn't seem to be like you at all.

Mr. N: It's no big deal. I'm just really busy juggling my work at family services, my course work, coming here, and doing some of the new evaluation tasks I'm being asked to complete. I thought you understood this.

Supervisor: I'm sensitive to the position you're in. I'm just starting to feel like the time I'm setting aside doesn't matter to you or that these sessions are more of a chore for you than anything.

Mr. N: Well, to be perfectly honest with you, they kind of are. It's one more thing I have to do.

Supervisor: I can appreciate that. Is there any part of you that is resenting being supervised?

Mr. N: Well, it's kind of tricky, yes. I know there are some different tasks as a psychologist that I have to learn, but in essence, I'm just doing the same thing I've always done as an independent social worker.

Supervisor: I understand. But I would be dishonest with you if I kept pretending that everything was okay here. Above all, I want to make sure that you're alright and to see if there's anything I can reasonably do here to make this situation more beneficial for you.

Mr. N: Is it okay if I think about that and get back to you?

Supervisor: Absolutely. If I were in your situation and needed to go through supervision all over again to get a new license, I would probably be a little salty, too, so know that I can relate. I just hope we can figure out a way to move forward that works for both of us.