Introduction
One of my biggest concerns when I wrote these essays was coming across as a know-it-all expert. That my tone would make it sound as if I had all the answers and other helping professionals needed to follow each recommendation to the letter.
In reality, I have made many mistakes during my career, and I don’t have all – or even most of – the answers. When I provide feedback, it is with the intention that you can use it to enhance your career development. Our work is messy by its nature because we work with human beings, and we humans are notoriously messy. That should not stop us from trying to improve our work, from seeking out new research and creative ways to improve our skills.
I realize there is a huge difference between the worlds of theory and practice, between what sounds good on paper compared to what our actual practice looks like. Even though concepts presented here might sound as if they must be followed precisely, the bigger purpose is to guide you toward improving your work. Use these essays like a recipe that can be tweaked as needed to suit your taste, but also with the understanding that when followed, they will make a successful product.
As I write this, it is nearing the 20th anniversary of my first day at my first job in the field: as a mental health technician at a psychiatric hospital in Chicago. I have encountered thousands of clients in various settings in that time since my initial interactions, but those first weeks in my new career role provided some of the stickiest memories.
I remember feeling almost overwhelmed with apprehension as a co-worker handed me a razor blade and a can of shaving cream and told me, “Shave that guy over there,” nodding in the direction of an older gentleman who had limited dexterity. This was my first group, a self-care session where clients gathered and took care of personal hygiene while upbeat, jazzy music played on the radio.
Nothing in the company training explained how to go about this task, or even that it would be part of my job. As it turned out, in the 18 months I worked at the hospital, everything was my job. Accepting that made it a much better place to work, too.
So when I took the razor and shaving cream and began to shave the face of a total stranger, I made a decision that I wouldn’t be fazed by anything that happened on the sixth floor of that hospital, that day or any day moving forward.
Another incident I vividly recall was boarding a late-night ‘L’ train with a recently discharged client who was sitting in the waiting room of the hospital when I was leaving for the day, which was shortly after 11:00 pm. Ben had been scheduled for a ride to a group home after leaving the unit that morning, but for some reason, it hadn’t happened. Perhaps because Ben was highly suspicious of others, he had refused to take the ride. Or maybe the ride never came at all. In any case, there he sat, a tangled mess of hair and a stained denim shirt, patiently staring out the windows.
Ben and I always got along well, even if our conversations were limited to a few words, and he was a frequent client on the psychiatric unit. I occasionally brought him food from the outside world (always something in a wrapper), which was somewhat of a policy violation, but one that the nurses and doctors readily overlooked because Ben adamantly refused to eat any food prepared by a stranger, for fear that it was tampered with.
I asked Ben what happened, and he told me that he was waiting for a ride home. However, I knew at that late hour no rides would be coming. The best decision would have been to contact the unit and try to arrange for him to get some kind of transportation, or perhaps even to come back on the unit for the night. But when I mentioned the idea, Ben became agitated, thinking I was trying to trick him.
So I did what seemed logical to my 23 year-old brain, which was to offer to get on a midnight train with him and take him somewhere he knew. Ben said he had a family member on the northwest side of Chicago, so we hopped aboard a Brown Line train and took off. After a few stops, I asked Ben if he knew where we should get off. He studied the map printed on the wall of the train for a minute, then offered up the name of a street: “Montrose.”
We exited the train at Montrose, climbed down the platform and began walking into a dark and unfamiliar neighborhood. I realized quickly that Ben had no real idea where we were, certainly had no specific destination in mind, and that even if he did know someone in this area, we shouldn’t be knocking on their door in the middle of the night hoping they would take in someone without any notice whatsoever.
After looping our way around a couple of blocks, I suggested heading back to the train, and Ben agreed. Fortunately, the train was still in service and we were able to make our way back to our original stop outside of the hospital. After I reassured him that I would do everything possible to make sure he would leave the next day, Ben hesitantly rode the elevator back to the unit with me, realizing that he had few other options at that point.
When I tell this story now, part of me laughs at the absurdity of the whole situation, and another part shudders at how poorly it could have ended. It’s easy to imagine my helping career coming to an abrupt halt that night if something had gone more wrong than it did. If I was to break down the relationship I had with Ben, it would reveal that I did not treat him the same as other clients, that I developed something of a soft spot for him and broke several rules along the way. I genuinely cared about his well-being, but I also over-stepped boundaries.
The next day, my manager brought me into her office to dish out a minor scolding for my decision. Her anger was tempered by the fact that as much as I had screwed up, my intentions were nevertheless good ones. Also, the unit itself was largely responsible for what happened and could have faced a serious lawsuit if it turned out for the worse. Ben successfully transitioned to his group home that same day, although I would see him again several times at the hospital.
My career was intact, and the months I spent at the hospital after that helped to form the foundation of my professional identity – through settings that included substance use disorder treatment, case management, counseling, two graduate programs, and eventually teaching.
I tell the story of Ben to let you know that we all make mistakes in our work. And although we might fear that we will somehow ruin our clients, the reality is that they are resilient and that when we put forth our sincerest efforts, the outcomes are mostly positive.
On a final note, the ideas shared in these essays are based on the things I have heard, seen, read, and experienced in more than two decades in the helping field. They are subject to my own biases and the narrow lens through which I am able to view the world. I only hope that they can provide you with some kernels of knowledge that help you in your own helping career.
