Family therapy – why I like it, even when I don’t

Subtitle: once you've tried it you can't go back

The reason I decided to study social work was because I thought it would be nice to be a therapist. Not necessarily a private practice therapist, but a therapist. I'd been interested in psychology since before I knew that I was interested in psychology, and I realized that it was much more interesting to talk to someone that to sit in front of a computer. At that time I envisioned being an individual therapst, because I didn't know a thing about family therapy.

After some investigation and indecision, I decided that social work was the quickest route to becoming a therapist, and indeed it was - I was doing therapy about a week into my first year internship. Now, about 2 years later, here I am, a family therapist. As far as I can recall, nowhere along the line did I actually decide to be a family therapist. However, over time, it just seemed like the best thing to do. Here is why.

First of all, there are the practical reasons: Fresh out of grad school with an MSW, you have to work in an agency. Let's say you want to do clinical social work and you are not focused on working with people with severe mental illness. My unscientific, ballpark estimate is that there are about 10x more opportunities for jobs in the child welfare/family services arena than in individual counseling. For reasons I'll discuss below, I never really tried to find a job at an agency providing only individual counseling, but my impression is that it would have been a lot more difficult, and I'd probably still be searching.

On to why I didn't bother trying in the first place. I am, I should note, personally inclined towards individual therapy. I see an individual therapist and value her greatly. I am generally more interested in the interworkings of the mind, the layers of conscious and unconscious material, symbols and structures, archetypes and object relations, and selfobjects. All that stuff has an inherent allure - the "mysteries of the mind".

However, once I got a taste of (doing and reading about) family therapy, I have had trouble letting it go. It just makes so much sense, practically - especially for someone like me who enjoys working with kids (stay tuned for a future post on "Why working with kids alone is the easiest thing for a family worker to do, and that's why you shouldn't do it"). In my opinion it is hard to exagerate the importance of family on development. Kids spend most of their lives with their families except when they are in their school-prisons and asleep); the family atmosphere and structure have a huge impact on how a child develops.

Of course, an individual therapist can make all the difference with a child in spite of their family difficulties. As Clare Winnicott wrote,

my recent experience with young adults has brought home to me
very vividly how much suffering might have been avoided if there had been someone outside the family to whom the boy or girl could have turned for help and understanding when things began to get difficult. (Winnicott, C. "Communicating with Children")

This is true for adults as well (although perhaps not as easy, since over the years we develop shells and defenses that seem so familiar and safe that change can be quite difficult, however many years of therapy we've been in).

A therapist/social worker can help a child individually, but the question still remains: Given the choice of working with the family or in spite of the family, what is best for the child? Then, the answer seems obvious: family therapy.

When we come to adults, the answer is not so obvious. In many cases, life difficulties can be due to problems with partners or children, and individual therapy can be like an escape from that system, rather than addressing the key problems, e.g. a breakdown in communication.

At the same time, many people want personal growth, self-understanding, and self-actualization; whatever all that means, they want it. That is a big reason that I see a therapist. When it comes to actual growth (as opposed to problem solving), I am of the opinion that everyone who feels that impulse could benefit from seeing a (good) individual therapist. Not that everyone needs to or should see a good individual therapist.

So my the verdict is: Family therapy is better than individual therapy for children, especially because children are often blamed simply for reacting to stressful family and social environments. This should be the standard intervention, long before meds are discussed.

For adults, I think good family (or couples) therapy can help with the communication and interpersonal patterns that keep us arguing, feeling judged, or stuck - all the things that take up time that could be spent meditating or writing our novel. However, this is not a replacement for (good, non-stagnant) individual therapy for people who want to dig down into their souls a bit and see what happens.

All that being said: Will I stick with families? I don't know. How am I supposed to make a decision like that? It kind of looks that way... In my idealized future, I develop two specialties: one, in family work of one kind or another (in NYC, Ackerman and Minuchin are the big theorhetical perspectives); and another with an individual, psychodynamic perspective - I lean more towards the object-relations field. Then I'd have all my bases covered and I could really begin raking in the dough.

Alternately, I could split the difference and go into Internal Family Systems. This is a model, developed by Richard Schwartz, that I know very little about, but it sees to apply systems thinking to inner life. That would kill two birds with one stone, as it were: Schwartz claims it can be applied to familes, groups and societies too. I'm sceptical but interested, and one of his books just came in from Amazon, so I'll probably write more about it soon.

Money and Value

I just came across a blog (that I may discuss later) suggesting that social workers not complain so goddam much (to wildly paraphrase). Well, I like to think I'm "exploring" rather than complaining, but it's all grey, now isn't it? So on to this post's topic: my measly salary.

First of all, my current job – the first since getting my MSW this spring – is going great. It's the first full-time, salaried job I have ever held for more than 2 weeks, and I don't dread going to work as I thought I would. But I have been looking forward to getting a steady paycheck after paying to work all the way through social work school.

But then...I received my second paycheck yesterday. I was shocked – shocked! – at how many taxes were taken out. Ok ay, I know everyone says it, but it's different when it's actually your money. Also, in my former jobs I’ve paid my own taxes as a small business. This sucks in its own way – writing a check for thousands of dollars when you don't really have thousands of dollars – but it still came out to about 14% when all was said and done. How much was taken out of this most recent paycheck? 25%! Okay, I'm naive but I was not prepared for that, and now I have to go back and recalculate my whole budget. My annual salary suddenly seems, well, not so good.

(Let me note that I'm in favor of taxes and social services, I just don't want to be the one paying them. I would not complain if social workers were exempt from taxes, and I would be okay with just me being exempt too.)

But let's get to the point: After I accepted reality I started wondering...first, what value is placed on social work, and why? I don't wonder why working with poor people is undervalued, since we all know our society as a whole doesn't care much about the poor as long as they stay out of sight. I do often wonder why poor children are so undervalued when they are actually so important, and when we live in a country where people (particularly politicians) are always going on about the children and families.

This may be why some social workers think their work is "noble" - "If I can't get paid in money, at least maybe I can pay myself in self-admiration and pats on the back".

But let me tell you what I'm really wondering: what is the impact on our morale, just in knowing that our labor is under-valued? Do we work less hard? Take more breaks? Have more stress? Justify it to ourselves? Kick the dog when we get home? Or just bitch and moan and feel special? Or just feel special? Probably some mix of the above, depending on our personality.

Whatever the impact, there must be one, and we might as well talk about in that case. I, personally, have a complicated brew of bitterness, jealosy, and self-riteousness, which is kind of unplesant to have once you notice it.

(Tangent: If a profession can be a a personal arch-nemesis, mine is school psychology. They study for 3 years and get paid about 50% more than social workers. I don't even want to know more about school psychology because I'm afraid I'll learn something I like).

The assumption in all my mental ruminations, of course, is that money is a proxy for the value of my work, and that the value of my work is a proxy for the value of me. Money is a symbol for respect and value of an individual - it is how much we are "worth". Also inherent in all of this is the idea that I need value to be given to me by an outer authority (society) in the form of a salary, and that a low salary is evidence of my lack of value. I believe it too, except when I don't.

When don't I? Basically, when I am with a client. When I am with a client, I don't think about the value of my work because I am present and in contact with the other person. If there is value, it is a value in the relationship and the present moment. I also feel this way when I come home from good day of work - I feel content in my day, not for having filled out all the right paperwork but for having been in contact with people - and in that state, money is not important (as long as I can pay the bills).

It is really only when ideas come in, when I think about the injustice of being paid less than a school psychologist, or a psychiatrist (which is really the injustice of believeing that I am worth less then them) that I loose that sense, and my head gets activated, and suddenly there is something wrong. Before, I knew the value of things; then, I forgot.

Social Work Insecurities

Okay, let's not beat around the bush: Social work is not exactly the most widely respected field out there. I know it, and I don't even respect it that much because I've bought into the crap our society peddles (I am changing in this regard, but bear with me).

Social work isn't valued by most people. I'll consider why this is some other time. Today I'm going to talk about why I don't value it.

I went into SW so that I could become a therapist, but I had grave misgivings. Shouldn't I get a PhD in clinical psychology? Was I going to be able to do therapy or just case management? What will I tell the rich bastard-lawyers and arrogant prick-MDs at my high school reunion? Am I "aiming low" out of a deeply ingrained sense of failure and self-loathing? Will I graduate and just want to go get a PhD again? Has a social worker ever won a Nobel Prize? (Yeah, that's what goes on in my head.)

A lot of this crap I've gotten over, some of it I haven't. I am starting off this blog with this issue because I want to make clear: Yes, I am writing a blog about social work, but it's not because I'm a proud social worker; or because I think my profession is "noble"; or because I think that social work's biopsychosocial approach and systems perspective is the only one that works; it's not because I want to write about how hard, or great, or fulfilling, or low-paying social work is.

Just to be clear, I don't necessarily not think all those things. They just are not why I'm doing this. The reason I'm starting a blog about social work - or at least the reason I'm most conscious of at this moment, which is probably not the core reason, but let's just go along - is because I am a social worker. I'm not even sure how I ended up being a social worker, but here I am. I like my job a lot so far (after about a month), but I am still coming to terms with my "professional identity," whatever that means. So writing here I hope to disassemble that identity and the profession as a whole; and then put it back together in a way the way that works best for me, knowing full-well that it is not me.