Social Work Intern Diary: Volume I

Guest Writer: Vanissa Cushman is a social work intern with a BSW working toward obtaining her Master’s.

Greetings.  My name is Vanissa, and I am a new intern with Sage Neuroscience Center in Albuquerque, New Mexico.  I am finishing up my bachelor’s degree in Social Work this summer (July 2014), and I am very excited to be completing the field education component of my final two semesters here at Sage. One of the things I am responsible for during my time here is writing content for  When I was given this assignment, the directions were very simple: write something related to mental health.  My pieces could be about mental illnesses, about treatments or interventions, or even about my experiences as an intern at a mental health clinic.  I was thrilled about this assignment because I love to write.  When I was younger and my life was not as full of obligations, I used to write poetry and short stories.  I thought, “It will be nice to get back to writing.”  Choosing my first topic was very easy.

Psychotherapy picture 2

During my first week, I shadowed one of our amazing therapists.  It was my first time sitting in on an actual session.   I was fortunate that this was also the therapist’s first session with this particular client, so I wasn’t coming into the middle of the situation.  The therapist I watched is an excellent clinician.  Three and a half years of classes and textbooks seemed to come alive as I watched her interact with her client.  She had such poise and skill and compassion; I learned so much.

As I sat in on this session, I also learned about the client.  She was very kind to allow me to sit in on her session.  It was not easy for her to choose to participate in therapy.  She did it, however, because she had reached a point in her life where she needed help to make positive changes.  She felt that her sister was very supportive of her decision to go to counseling and work through the challenges she was facing.  Her cousins, however, seemed to be part of the problem.  The client’s sister and cousins were also her best friends.  The client expressed having struggles not only with how to interact with her cousins without continuing her past behavior, but also with how to do that in a way that she could hide the changes she was making from those same cousins.  From her perspective, her problem was that her cousins would not accept her.  From my perspective, her problem was that she does not currently accept herself.

I kept wanting to ask her, “why don’t you just tell your cousins what’s going on?”  I wanted to tell her, “You know, if you would just accept yourself for who and what you are and give yourself permission to just be you, you’re cousins would probably do the same”.  I refrained and asked the therapist about it after session instead.   Her answer was profound to me.  She said, “If she had felt that telling her cousins was an option, then she would have done that.  That tells me that her ego is all wrapped up in this.  Her issue isn’t really about what her cousins can handle.  It’s more about what she can handle admitting.”

Whoa!  A million questions raced through my mind.  How did she know not to go there today?  Certainly, it was a sound clinical decision.  The main purpose of the first session are to set the client’s expectations for what therapy is and what it is not.  This conversation primarily entails conveying to the client what the rights to and limitations of confidentiality are and finding out, from the client’s perspective, what the problem is.  During that initial session the question of the day is, “what brought you in to counseling?”  The therapist will want you to describe why you feel you need to be there and how you feel you will know you no longer need to be there.

At the point at which I first wondered why the client hadn’t told her cousins, that question was filled with assumptions.  Further along into the session, the therapist asked other questions, probing questions, that provided so much more insight into what really brought the client into counseling. Through her skillful guidance and the client’s courageous willingness to be honest and vulnerable, the client gave a much deeper answer than she had previously given.  She gave the kind of answer that had the potential to solve not only the one problem that brought her in to counseling, but a myriad of problems as well. Again, I was amazed by the skill with which the therapist did this.  I was amazed by her humility, by the way she didn’t allude to how smart, skilled, or experienced she is, and by the way that she made that session completely totally about the client.

And the client felt better when she left.  You could see it all over her.  When she came in, she had a lot going on in her eyebrows and shoulders.  Both pairs kept going up and down as she made her points and defended herself against the judgment she expected to receive.  She kept saying things like, “obviously that’s why I’m here”, when no such thing was obvious.  But the judgment didn’t come.  The therapist genuinely sought to understand the client and to be on her side, whatever that was.  When the client left, her eyebrows and shoulders were relaxed.  She left laughing and smiling and making jokes.  I bet she’ll come back.  And, I bet they’ll work through what she’s going through.  I bet it’ll be easier than she thought it was going to be because she had gotten through that first step of actually going to the first appointment.

But what if that that person hadn’t been her therapist? What if this was August instead of January and I was her therapist and no one was in there with me to remind me of all that cool clinical stuff she did?  What if I had asked the question about her cousins and she’d gotten angry because it wasn’t the right time and she didn’t feel like I created a safe therapeutic environment for her and then she hated therapy and never came back to me or went to anyone else ever again and all that business in her eyebrows and shoulders kept going on forever… AAAHHHHHHHH!

Hard to read that?  It was hard to feel that.  You ever feel like that?  Like all anxious and neurotic like that?  That’s okay, it’s normal… Or is it?  Does it matter?  What do you want it to be?

So there it is, my first mental health blog for  Think of it like “Dougie Howser” (you know, without the whole genius bit) meets “Scrubs” meets “How I Met Your Mother” meets ME!  Can you tell what my topic was?  Was it a creative outlet to tell a story?  Does it chronicle one of my experiences as an intern?  Does it make you think about self-acceptance?  Does it give a case study or give information about what to expect if you make the courageous step to enter therapy?  Does it make your therapist more human or you less crazy?  Does it give you confidence that you and your therapist are doing more than just talking when you’re sitting on that couch or in that chair? Was it supposed to? You ever heard of Shunryu Suzuki?

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