Learning From Mistakes

 

I love the title of this book!  Learning From Mistakes in Clinical Practice by Carolyn Dillon (Brooks/Cole: Pacific Grove, CA: 2003---all of the following quotes are from this book).  I have long believed that this is the best attitude a social worker can have---the attitude that you WILL make mistakes and that the task is to accept that fact and learn from them when they happen.

 

“…mistakes are great teachers, and they are as inevitable in clinical practice as they are in everyday life…human fallibility and systemic complexity ensure that none of us will ever be exempt from error” (p. x).

 

The above is very important.  However, in some ways an even more important part of being open about error making is the effect it has on others.  “…when we share our own mistakes…we symbolically decrease distance” (p. x).

 

A client or mentee or friend all will tend to value your relationship more when you admit error.  One of the best things to do with clients is openly say: “I’m really sorry. I goofed there.”  Clients are far more forgiving than we can imagine and in fact not only forgive our mistakes if we are open and genuinely apologetic about them, the admission helps to humanize the relationship and as Dillon says, “decrease distance” which is one of the most important things we want to happen in a relationship.  However, please keep in mind throughout this discussion, that we are assuming that you are always working hard to minimize mistakes.  No one is going to be nor should they be accepting of incompetence!

 

“A goal of this book is to help learners identify and rework some classic mistakes frequently  observed in counseling work, such as too many boilerplate responses (‘mmmhmm,’  ‘I see,’ excessive head nodding); detouring around uncomfortable subjects like financial practices, sexual activity, and death; talking intrusively; often interrupting the client; and asking too many---or irrelevant questions” (p. xi).

 

Common Client Signals of Mistakes in Progress

 

One of the most important things a worker needs to do is catch the mistake you are making while it is happening.  Dillon provides the following list of signals of mistakes:

 

  1. The worker says something far afield of where the client is, and the client does not even seem to register it.  It’s as though the worker’s statement is a nonevent.
  2. A ‘huh?’ response.  The client is baffled, either by an idea itself or the language used to frame it.
  3. The client corrects the worker, expecting him or her to change.  ‘No, that’s not what I meant’ and ‘You just don’t get it’ are frequent signals of tension and differences around material or feelings at hand.
  4. The client suddenly shifts emotional contact or focus following a worker offering.  The client may look down or out of the window nervously etc.
  5. The client suddenly questions the worker’s competence.  Questions may abruptly emerge about the worker’s age, experience, etc.
  6. The client suddenly becomes more superficial or mechanical in presentation.
  7. The client, a faithful attender, suddenly no-shows, cancels, or comes very late.
  8. The client suddenly brings someone else to the meeting, and that person’s activity or presence affects the work in progress.
  9. The client suddenly seems distant or cold towards the worker. The worker may have hurt or offended the client, who now wants to be very careful to avoid further wounding.
  10. The client abruptly discontinues work permanently, permitting no further discussion.  (pp. 21-23).

 

Mistakes in Contracting

 

Contracting is one of the most important parts of the interview process.  “It’s easy to make mistakes while discussing and negotiating working agreements, because there is often time pressure to complete initial assessment and contracting and move on into problem-solving work without delay” (p. 109).  Dillon notes the following mistakes:

 

  1. Promising more than can be delivered.  In false reassurance, you may innocently try to cheer clients on by reassuring them that work together will resolve complicated matters, or bring new happiness in relationships.
  2. Confusing clients by using contract jargon.  Jargon disempowers consumers and makes interns and workers appear more allied with the professional team than with the client.
  3. Proceeding without real agreement.  Sometimes workers try to talk clients into a treatment they provide or espouse instead of dealing first with ambivalences they hear in the client’s misgivings, or see in the client’s hesitations or newly tensed up body language.
  4. Agreements with built-in problems.  Hidden agendas are secret aims of the worker unexpressed to the client.
  5. Intentionally vague agreements.  Vague working agreements usually characterize the work of someone who is either afraid to speak frankly about why the client need to be seen, or hasn’t been well trained to carry out an assessment and working agreement.
  6. Agreements that empower workers more than clients.  When rushed or impatient, it’s all too easy to do for rather than with clients.
  7. Keeping secrets from supervisors and other authorities.  Sometimes inexperienced workers plan with clients to carry out activities forbidden by agency policy or supervisors. (pp. 109-112).

 

Sharing Mistakes

 

One of the nice features of this book is that Dillon courageously gives you examples of her own mistakes.  It is rare for a textbook author to be so candid.  Not all of her stories about her work are examples of problems, but she does this often enough throughout the book to demonstrate that she practices what she preaches.  The following is one of her examples:

 

“A client of mine in her fifties had lost her father, husband, and nephew in short order, all people she adored.  She had failed in a serious suicide attempt from which her cat saved her by mewing loudly at the door until someone came and found her.  When she subsequently came for counseling, she was almost inconsolable with grief, and often I simply witnessed and supported her crying and remembering all that she loved about these missing family members.  She said at one point that she would never marry again because, while lonely, she would never get over her husband’s death, and felt mad at God for taking all these people in this way.  After a while I asked if she ever talked with her husband in heaven.  She looked surprised and said that none of her friends or work friends had ever asked her that.  She said she talks to him all the time, and that he comforts her, but that she gets so sad that she has to shut off the conversation.  I said I was glad that she could talk with him, and that I believed in angels and their capacity to comfort and guide us.  Maybe he was doing this for her now.  She said she’d thought that her own beliefs like that were crazy, so she hadn’t revealed her conversations with anyone.  She went on to reveal some of the things they said to each other, much of it about love and loss.

 

“I said that, picturing how much he’d loved her, I couldn’t imagine him wanting her to be lonely and miserable for years to come.  She was a little thrown by this, since she couldn’t picture that, either.  His particular generosity just made her remember him all the more as irreplaceable.  I encouraged her to keep listening in the conversation to what he advised her.  I couldn’t believe he wanted her dead and with him now---something she sometimes wanted for herself.  Eight or ten weeks later, she began to say that she didn’t think her husband would want her to die either, because she still had her elderly mom and her cat to take care of, and the husband believed in talking care of loved ones.  I said that a little further along in time, I wouldn’t be surprised if her husband encouraged her to get out socially again and try to meet some men and women to lift her spirits.

 

“Perhaps two months or three months later she started to play again in a small bell choir at church and rally enjoyed that, having abandoned it previously due to her sadness.  Her minister then introduced her to a widower whom she felt her husband would approve of if he could meet him. I wondered with a smile whether her husband had already met him, which helped her to laugh for the first time in a long time.  When her old cat died, on her own she went out and bought two baby kittens ‘to keep me company’---a good sign of reinvesting in life, I thought.  A year later she married the fiend from church, a move she now felt her husband approved of when she visited his gravesite.  She made sure always to compare her second husband somewhat unfavorably with her first one, so that Number One would always know that he would never be replaced and that she couldn’t wait to see him again someday” (pp. 146-147).

 

Obviously, the client felt that Dillon was being helpful and the case appears to have gone well.  However, is Dillon presenting this as a success story or an example of a mistake that she made?  As Dillon says: “My disclosing my belief in angel guides was genuine, but some colleagues would say this was perhaps a self-indulgence rather than a client-centered move.  What do you say?” (p. 147).

 

Remember that self-disclosure is an area where we can go too far.  Has Dillon gone too far here?

 

Also remember that being a competent social worker means that you are a creative artist, you are someone willing to make calculated risks.  Is this what Dillon is doing?

 

If you are pushing into relatively new or dangerous ground, be sure you are well prepared.  Dillon says she believes in angel guides.  If her belief is entirely based on faith, then someone could well argue that she is not being professional.  Social work is not founded on faith, it is built on knowledge.  Therefore, if you say that Dillon is doing the right thing, then you had better develop your knowledge in this area.  That does NOT mean that you read the bible or other religious works to provide you with knowledge.  (Those are great sources, but you cannot build your practice on your religious beliefs alone and contend that you are a professional.)  It does mean that you become more aware of the literature and research in the field of spiritual social work so that you are grounded enough to practice this type of intervention.