Social work is about the relationship between two groups of people. On one side are those who have chosen a helping profession and are providers of services (health and social services), on the other side clients who use those services. In long-term interaction, ties are formed between them that reflect the "quality" of the services provided. What I mean is that the higher-quality the helping service is, the more positive the dynamic becomes in their mutual relationship. Although to a layperson it may seem entirely absurd that a relationship could develop between helper and client that emotionally affects one of them and complicates life, the opposite is true.
I have spent the last three years examining and processing materials for my dissertation, which is devoted to the problems of workers in helping professions. The primary goal of the work was an analysis of lifelong learning needs and a proposed educational model that would support helpers' self-reflection and be effective in preventing helper syndrome and burnout syndrome. Naturally, I was based on the real practice of these professionals. While collecting and processing case studies, I was drawn to cases of social workers and medical staff who described socially pathological relationships between client and helper.
Possible consequences of an empathetic approach to the client The essence of effective social work is the social worker's empathetic approach to the client. A social worker should "step into" the role of the client in order to actively meet their bio-psycho-social needs. For the client, the social worker is often the only person in their life they have, and they "cling" to them with their whole being. The client becomes psychosocially dependent on the helper and requires their constant presence. An example is the profession of field social workers. The essence of their work is establishing and maintaining contact with clients and, if possible, not rotating workers, because clients have great difficulty getting used to a new face and are very distrustful. Gaining trust is crucial for social workers. They must know their clients' needs in detail in order to meet and satisfy them. Clients share personal problems with their social workers and caregivers and expect understanding from them, often advice and solutions. Social workers strive primarily to support clients' mental well-being, which is important for their overall health status. After all, this also matters for helpers' sense of professional fulfillment. This kind of long-term interaction can profoundly affect the personal lives of helping professionals. We must not forget that workers in helping professions are people too. They have their own worries, personal goals, wishes, and biases. Their profession is demanding because in contact with clients they have to set aside their own concerns and address the problems and worries of others. Often, these are socially serious events that clients are experiencing and they try to find solutions or provide comfort (the death of a partner, serious diagnosis and loss of mobility, abandonment, search for meaning in life). It is logical that they think about their clients even outside working hours. They also need, like their clients, to confide in someone and reassure themselves that the decision they made was the right one. If they do not want to drag their own family into their professional life, they look for a needed "ear" among colleagues and friends. At first, clients perceive social workers' active approach as a professional matter. They are initially distrustful and distant. They perceive care as an intrusion into their privacy and refuse cooperation. In long-term interaction, some begin to experience the relationship intensely, and the social worker becomes a key part of their life. At times this can become an emotional spark, at other times a psychological need for safety and belonging. A paradox arises: the more successful a social worker is in their work, the greater the danger they face.
When a powerless client becomes a stalker The following story confirms what workers in helping professions are exposed to and how far their active empathetic approach to the client can change their life. (Author's note: The story is true; names are fictional. The social worker requested to remain anonymous.) Mrs. Anna wanted to help people all her life. As a young person she worked as a volunteer in a non-profit organization and worked with medically disabled people. When she passed the selection process for a position as a field social worker, she felt that her life dream had come true. Among her clients was an older man with a disability, Jaroslav, who lived alone and had mobility impairment. Jaroslav moved in a wheelchair. Anna visited him regularly and tried to motivate him, an isolated Jaroslav, and to find meaning in his life. The problem was that Jaroslav had no children and after the death of his wife he had completely withdrawn. At their first meeting, Anna immediately assessed professionally the situation in which Jaroslav found himself and chose a strategy of "life change". She gained Jaroslav's trust, and in time she managed to re-establish broken contacts with his surroundings. She helped her client return to life, to friends. Jaroslav initially saw Mrs. Anna as a social worker with a professional approach who was trying to help him. A long-term relationship and positive changes in his life paradoxically provoked the fear that if Anna left, he would again lose meaning in life. He tried to extend the duration of her visits. He tolerated each of her departures worse and worse. In good faith, Anna gave him her phone number. Jaroslav called more and more often, even at night. Anna began to have problems even with her husband. He reproached her for devoting herself more to her work duties and became jealous. The unfortunate social worker sought help from her supervisor. They solved this by arranging for another social worker to start visiting Jaroslav. Anna changed her phone number. This did not solve the situation. Jaroslav began to stalk Anna and could wait for hours in front of her home for her to return from work. He sent flowers, expensive gifts, and letters in which he threatened suicide. The situation became unbearable. Rumors began to spread around Anna about exploitation of disabled clients and infidelity. The family put Anna before a fundamental decision: "You, or your work." In the end she decided to change her profession, and the whole family moved to another city.
Today, Mrs. Anna works in an insurance company. She has psychological problems that have also led to health problems. At the end of our conversation she says: "I loved my job. I could not imagine doing anything else. The experience I went through took away all illusion I had about people. I do not want to help strangers anymore; I could lose my closest ones."
How far can one go Anna's story is not unique. Not only social workers but also nurses have similar experiences. Patients often see them as their "guardian angels." They confide secret matters in them that they often do not share even with their partners or children. They expose their inner selves, and in doing so, bind the nurses to them, making them their "life accomplices." They become convinced that the sympathy is mutual and start to perceive nurses more as women than as nurses. They try to get their phone number and look for their address. As a nurse, I have heard sentences like: "You were so kind and nice to me, why can't I be with you anymore?" or "You know everything about me, and I know nothing about you."
I also have a bad experience. After finishing secondary school, I worked as a nurse in an internal department. I was married; my husband worked in the mines. One day, a patient with a heart attack was brought to us, my husband's supervisor. As soon as he passed the acute phase and his condition improved, he began making indecent advances toward the nurses. Whenever a patient becomes active in this direction, we take it with caution. We are glad he is feeling better, and it is a sign of recovery. However, the attention of the patient was focused on me. He found out my husband was his subordinate and began to threaten us. He threatened that if I did not comply with him, my husband would lose his job. I chose the path of least resistance and, at my own request, I changed departments.
The goal of my reflection on the topic The Reverse Face of Social Work is to trigger dialogue between academics who are still trying to find the "philosopher's stone" and practitioners from the field. It is to stimulate discussion of problems that are very difficult to solve. It is to offer a space for discussion to people who want to share their experiences and to provoke them into collaboration.
Mgr. Ivona Buryová The author teaches at the Faculty of Business and Entrepreneurship in Karviná, Silesian University in Opava
This reflection was published in the journal Sociálna práca/Sociální práce, no. 1/2010 Social Work and the Fight against Poverty. http://www.socialniprace.cz