So what do you do when you just don’t like the patient sitting across from you?
I love people. It’s part of why I chose this profession. I love to hear people’s stories. I like to sit in the front seat of cabs so I can ask the driver a bunch of questions about his family and his life. Call it nosiness; I prefer to call it a love for the human experience. Life is a rich tapestry, as one of my favorite advice columnists often says, and I like to know all about it.
But sometimes I meet a patient that really gets under my skin. I’m not alone in this, I know. We can all point to patients or clients we’ve had that just get on our damn nerves. Right now I have two patients that are casually misogynistic and homophobic; further, they are never the problem. According to them (they’re strikingly similar, actually), it’s everyone else: their children, their exes, their friends. They aren’t the ones making their own lives miserable so why should they have to change?
I’m sure you can hear (read?) in my tone that I’m irritated with these guys. I especially resent the casual way they demean women when they’re sitting right across from one. Can you not have a little respect for my gender when you’re looking right at me?
Then, I think: maybe they can’t.
Some folks really are stuck. Their life experience tells them that they are victims and they really aren’t interested in looking any deeper than that. And really, in this role, it’s not my goal to go that deep. My goal is to help them figure out what’s making them feel anxious/depressed/stressed out and help them find their own solutions. I have the luxury of not seeing these people for years on end for true psychoanalysis. Rather, I get to help them name their issues and seek solutions for them.
The thing is, that means I have to let go a little of my own stuff. If the patient tells me that his gay son is ruining his marriage, I’m not going to get into a deep discussion of his homophobia, or his own insecurity about his masculinity, or what it means to him that his son is gay. Rather, I have to drill down on what he sees as the issue: it’s him against his wife and son. I have to help him figure out how he wants to handle that.
Inside, I’m cringing. This conversation is so gross to me. The moral part of me is screaming internally. But I’m not in private practice; I can’t refuse to see a patient that’s referred to me by one of my providers because I have feelings about his values. So I see these guys and I remind myself why I’m there: to provide short-term intervention. If it’s appropriate, I can gently push back on some of their prejudices and assumptions… but most of the time, that’s not what I’m here for. Instead, I have to let their comments roll off my back. I have to remind myself that one of my core values as a person and a social worker is that everyone is doing the best they can with what they’ve got. And I don’t get to enforce my morality onto someone else when I’m providing therapy.
So I make space for the sometimes awful things I hear and focus instead on the important underlying truths: there’s a lack of family support. Or there’s an ongoing struggle with conflict. I direct the conversation to what can be changed rather than all the wrongs they see placed upon them. And I direct myself to grace and compassion: it doesn’t matter if I like them or not, my job is to help. I’m not better than the person sitting across from me. These tough patients are a good reminder to be kind and humble, even if they are, in the moment, a real pain in the ass.