This is a poem I come back to over and over again. I found it years ago, and every time I look at it, it seems to resonate in new ways.
After some days of supporting clients, it’s the “immense responsibility and very little authority” that catches me. After other days, it’s about “resounding triumphs and devastating failures.” And still other days, it’s about “always be[ing] frustrated.”
My frustration is sometimes directed at the systems. Why are they so complicated? Why do they set people up to fail? Why don’t they support people the way they should?
Sometimes, quite honestly, my frustration is directed at the people with whom I am working. Why did she go back to her abusive partner? Why did he spend his $10,000 settlement in a month? Why did he pay his phone bill, but not his rent? Why did she use again?
Over the years, I have developed strategies that help me cope with the heartbreak and frustration that often comes from supporting clients and working with marginalized populations.
- Compassionate Detachment
Compassionate detachment is caring deeply for a person, and simultaneously knowing that their decisions are theirs to decide and live. This is different from simply detaching by numbing and distancing ourselves. Compassionate detachment is wanting the very best for our clients and helping them reach their goals, but giving up ownership of where and how they choose to travel on their journey.
- Unconditional Positive Regard
Psychologist Carl Rogers developed this term as part of his “person-centered approach” to therapy. It does not mean to like or approve of people’s behavior. Rather it is to fundamentally accept and support people regardless of what they say or do. Sometimes this means reframing how I think about their behaviors. For example, thinking of them as “a good advocate for themselves” rather than “manipulative” or “demanding.” Other times, it’s focusing on their strength, resilience, and survival skills. When clients feel completely accepted, seen, and appreciated for who they are, they can feel safe enough to be vulnerable and attempt change.
- Understanding Addiction as a Brain Disease
Addiction hijacks the brain’s reward pathways and alters its decision-making system. Addiction has physical, social, and emotional components; often, the individual struggles deeply with controlling compulsions and cravings. Relapse is common, with some estimating that 85 percent of opioid users relapse within the first year. While I always hold hope for people, I have learned to not be upset with them when they relapse. I am often frustrated and sad because I deeply want something different for them, but I know that relapse is part of their process.
During my first year working with homeless young adults, I supported a client to go to detox a number of times. He would get out, and a few weeks later, would come to our syringe-exchange program asking for clean syringes. I initially felt conflicted. Was giving him syringes actively undermining the sobriety we worked so hard to attain? When I broached the topic with my clinical supervisor, she gave me advice that fundamentally altered the way I approached my work. She said, “Most people don’t get sober on their first try. Your job is to keep him alive and uninfected so that when he is ready, willing, and able to do the work, he can.” I realized the syringes were helping him stay HIV and HCV negative, and the overdose prevention conversations were helping him stay alive. The work isn’t always so dramatic, but learning to partner with my clients to support, honor, and appreciate their incremental steps towards health and safety has made the work less heartbreaking and more enjoyable. (Learn more about Harm Reduction.)
Sometimes it feels like “self-care” is a buzzword without much meaning, but I have learned over the years that I cannot give of myself without finding ways to also nourish and replenish. You cannot do this work well unless you truly care for your clients. Supporting clients by bearing witness to their pain is exhausting and often heartbreaking. I have found that listening to live music, being in nature, reading inspiring books, connecting with colleagues, being with joyful people, and creating time where I have no responsibility to anyone else helps me get up and do it again, day after day, month after month, and year after year. (Read more about self-care strategies.)
Ultimately, we continue to do this work not just despite the heartbreak, frustration, and sadness, but because when we feel these things, we know that we have connected, we are alive, and we are doing something to create a world in which we want to live. We continue because we have hope for ourselves and others. We continue because giving up is simply not an option.
Learn more from Ayala in an online t3 course on "Client Centered Behavior Change: Using a Harm Reduction Approach" starting February 3, 2016: