Memoirs of A Healer/Clinical Social Worker: Autobiography of Bruce Whealton

Chapter 30: Doing Therapy During My Internship

My tasks allowed me the opportunity to get to know others in a therapeutic setting. Recall that when a person is admitted to the hospital there is a short period of time during which the intake assessment for each department must be completed.

Unlike during my first year when it seemed like they were making work for me to learn as a requirement for an internship, this was a setting where I was being asked to do something that was required by and for the hospital.

This wasn't busywork. If I was asked to complete this, I was being counted on to do this. It was necessary and required. This made me feel so much more useful than during my first year where it was hard to see that I was making a difference. Also, as I said, Chris knew what I was learning from him and through my studies.

Instead of feeling bad about volunteering my knowledge, wisdom, and insights, I saw that what I was offering was valuable information to consider when evaluating what a patient was experiencing and perhaps how they could be helped.

I had mentioned that during my first internship I had some doubts about my competency. I chalked up every "mistake" as a learning experience.

Okay, so during the intake assessments we try to get a lot of information from a patient. Why they are in the hospital as they understand it... what has been going on in their lives... are they married? Do they have children? Can they describe their symptoms and problems? And so on.

The ability to gather information from a person requires building rapport, creating trust, demonstrating empathy and compassion. The quality and nature of what you learn, what information you are able to gather, are a reflection of your skills and talents in this area. It's also important to ask very open-ended questions as much as possible because the patient knows things that we don't.

As you can see, I have come a long way from the young man who needed counseling to learn social skills, communication skills, and how to control my anxiety - social anxiety.

I constantly reflected upon how good I felt about having accomplished so much. Over a decade of hard work had been invested in getting me here where I am in my late 20s.

It also seemed that when you do demonstrate respect for others, empathy, and concern, they want to talk about their experiences. That was my observation time and again. Chris recognized my growing talent and eagerness and let me start doing some brief therapy with patients. Because the patients were not in the hospital very long, the therapy had to be brief.

Chris gave me some pointers as to what I might want to do when I sat down with a patient - what kinds of interventions might be helpful. I discussed what I had been learning in my classes and other studies.

What might I do in a session with a patient? Well, if they are dealing with major depression, we could try Cognitive Behavioral techniques where we learn to challenge automatic thoughts that create negative emotions.

With trauma issues, deep relaxation techniques are very helpful in talking about a disturbing event. I would demonstrate or guide a person in the use of guided imagery and deep breathing to create relaxation.

By that time, I was clearly demonstrating empathy and powerful listening skills. I received that kind of feedback from Chris when I turned in notes about my activities, but I also had that impression from the feedback that I received from the patients. I'm not saying they gave me a score on empathy and listening skills but there were so many times when I noticed how much people wanted to share their stories and feelings with me.

There were various opportunities when I was on the unit where patients had a chance to approach me and ask to talk about an issue that had come up in a group or from our earlier conversation when I did the intake assessment for example. Sometimes all I did was just listen with empathy. The experience of being in the hospital is not likely to be a pleasant experience.

This kind of listening may not sound like a technique but in the psychological theories that were developed by Carl Rogers, unconditional positive regard and empathy are valuable tools.

I would tell them when I met with them for therapy that I was going to write up notes about what we discussed in therapy to see if it could be helpful to others who might be offering treatment for them. I instinctually felt that I could and would offer to let them tell me something and ask that it not be recorded in the notes.

Gender issues were never relevant. I mean the fact that I was male was not a factor in a patient choosing to disclose any details about what they had experienced. Sometimes you might think that a woman might only talk to another woman about something traumatic, especially if they were victimized by a man.

What probably intrigued me the most was the experiences that people with schizophrenia or psychotic disorders might be having. I thought that if I could demonstrate empathy, understanding, and compassion, and be able to help people struggling with these issues that would be something amazing.

In seeking to help someone with a psychotic disorder, treatment might include active listening which means summarizing or rephrasing what someone just said to see if we can understand one another. That connection is so important. It's sad but some people with schizophrenia will develop serious problems with communication and what they say might not make any sense. I believed I was making a difference by listening and trying to understand.

There is a great deal of research that demonstrates a genetic predisposition for various psychiatric disorders. However, it seems from my own experience that being confronted with major life stressors, even stressors that might not seem like traumatic events, and any person can develop a range of different symptoms – hopefully, that is temporary.

I did file away the observation that so many people were coming to the survivor groups, even though trauma was not an issue that necessarily had an impact on why they were admitted to the hospital.

Often Chris was present in the group sessions even when he allowed me to lead the group. I would talk about relaxation techniques as Chris had done. I would employ the kinds of guided imagery exercises that were used in the groups that Chris led, meaning, I invited them to follow along with my suggestions or guidance.

I know that I have covered a great deal here and may not have been overly specific when describing theories and techniques or what I specifically did. I'm not trying to give psychology or psychotherapy lessons, per se... but I will go into greater detail later in the book.