From the Book, Chapter One, Culinary Arts
Observe
June 22
The first experience is always the most difficult because there is nothing to compare it with. It’s like walking into a room filled with unfamiliar people. There is no connection with anything. There is you, your environment, and the awareness of your separateness pushing against you.
Inside, the rooms feel large and empty, but there is evidence that many people live here. In the living room, there are several old couches and upholstered chairs set around a television. In the kitchen, there is a huge sink and appliances big enough to service a restaurant. The walls are bare. And in the dining room, there is a table long enough to accommodate a party of twelve. Two researchers, Lisa and Jerry, sit at one end with three women: the group home supervisor and two residents, Marilyn and Sophie, who have expressed interest in the project. As Jerry and Lisa explain the purpose of their work, the supervisor encourages the residents to participate. She tells them that they might learn something from the experience. She tells them that the staff will support them and assures them that they do not have to participate. The decision is theirs to make.
The first resident, Sophie, is short and quite heavy. Her face, round and wrinkled, conceals her eyes through the shadows of deep sockets. She appears forty, but she is twenty-nine. She listens to Jerry and Lisa. She is silent and somewhat intimidating. When she speaks, though, she radiates playfulness. She instructs her guests to call her “Hope.” Eager to sign the consent forms, she tells them she can meet again tomorrow because she does not work.
The other resident, Marilyn, a friend of Sophie, is quite unlike her: She is younger, twenty-three, and not as heavy. Her skin is smooth. She’s neither intimidating nor playful. She’s nervous. She takes refuge in the smoke of cigarettes, which the residents are allowed in common areas on the first floor. Nearly everyone smokes here. Smoking is part of the culture; the walls have a thick patina of tobacco. By the end of the conversation, Marilyn agrees to participate in the study because Sophie has. Marilyn trusts her friend.
Reflect
Case management is challenging and creative work that offers many opportunities to experience the healing power of human relationships in real-world environments. In traditional psychotherapy, it is the client who walks through the office door into the unfamiliar. In case management, you cross that threshold. It is likely that both you and your client will experience strong emotions as you enter: fear, shame, disappointment, anger, and many others.
In beginning a relationship (some call this the engagement phase), it is especially important to start where the client is, which means that you acknowledge and respect the client’s current reality, his or her present situation, and what the client brings to you in each moment of your interaction. The alternative, starting with where you are (i.e., with your agenda, your feelings, your thoughts, or with a checklist of things to get done), rarely works to support the beginning engagement. Take a few minutes to imagine a time in your own life when you wanted, badly, someone to listen to your story or worry and the listener wasn’t fully present. Instead, the listener was focused on his or her own problems or on the future or yesterday, looking out the window, were watching the television or listening to music, answering cell phones or fiddling with a text message, or distracted by another interaction. It’s like listening to the melody without hearing the lyrics. In our everyday interactions with clients, we try to stay in the moment. Listen. Remain attentive to what you, along with your client, are feeling, thinking, or doing. Second, avoid becoming active; if you feel the impulse to act, not only are you likely to step out of the present, you are also taking control. Third, you must know where you are. That means that you must be aware of what you are feeling, thinking, and doing. Fourth, when we are not mindful of our present feelings, especially uncomfortable ones, we are more likely to pass them along to others. Often we offload that which does not make us feel good. Imagine a time in your own life when you felt someone’s anger at you, but somehow things got all turned around. They said to you, instead, “Why are you so angry?” This was anger they couldn’t bear to feel, so they turned it into an angry feeling in you. In short, “I’m not angry, you are.” At these moments it’s not easy to stay in the present. It takes patience and practice.
Practice this in your own relationships, every day, and in your supervision. Listen and observe. You will not only learn about your client. You will learn something about how you relate to others and how others make you feel.
As you enter your client’s physical and psychological space, notice your body, notice your movements, the tone of your voice, and the choice and timing of your words. What does all this say about what you are feeling and thinking? Talk to your supervisor about it. While you are noticing, also notice your client—her posture, her tone of voice, her word choice, and her movements. These details provide clues about what she might be feeling. As these clues begin to reveal themselves over time, you will recognize a pattern: yours and theirs. With this knowledge, you will be equipped to help your clients recognize their own behaviors and feelings. This self-reflective skill is essential for recovery.
When you meet your client for the first time, your first goal is to be respectful. You may accomplish this by accepting the table your client sets for you. For example, you may not smoke cigarettes and may find a smoke-filled room uncomfortable or repulsive. Yet by accepting this environment you not only show respect; you also adopt a nonjudgmental attitude. In the engagement process, it is important to use gentle observation. In this way each encounter with your client will present new and potentially useful information. It is important to let information reveal itself naturally and in its own time; if you ask a question, you will get an answer. Imagine a time in your life when someone threw questions at you like darts at a board, continuously.
How did it feel, especially when answers did not come easily? In the scene described earlier, observations reveal subtle and important information. Marilyn and Sophie need encouragement to explore. It is the supervisor who encourages them to participate. We also learn that Marilyn is more hesitant. Her friend Sophie is more eager for a trusting relationship, less protective of her inner self, or both. Finally, we learn that Marilyn may be using tobacco to manage intense feeling. This is an important detail to observe. It may offer future opportunities to help her notice feelings that motivate her to reach for the comfort of fire and smoke.
In sum, as you begin work with a client, keeps these things in mind:
1. Acknowledge and respect the client’s current situation. Stay in the present. This is sometimes called starting where your client is.
2. Avoid the tendency to become active, to take control. Listen and observe.
3. Know where you are, that is, monitor your own feelings, thoughts, and actions.
4. Don’t pass your feelings along to others. And beware when others offload their feelings onto you.