Safety First! Or… technically second.

Dear Inadequate Graduate,

I’m a third year student and have been at a new practicum site for the last several months. To say I’m uncomfortable is a euphemism. I’m working with a population that evokes very strong reactions in most people, but I’m writing to ask you about one specific patient. Many of the individuals I serve are high-risk, but this particular person feels dangerous. I don’t know how to describe it other than I don’t feel safe with him. I don’t want to tell my supervisor because I don’t want to seem biased or weak or, well… inadequate, but I have nightmares about this guy and I find it hard to concentrate on the days we have an appointment. Normally I would never request to not work with someone as I know dealing with discomfort is a large part of working in mental health, but sometimes I feel physically sick before seeing him, and I don’t want to anymore.

Help!

-Shakinginmysneakers

Dear Shakinginmysneakers,

I’m sorry to hear you’re having such a tough time! I can’t get a feel for your site’s setting, but working with individuals who stretch us beyond our comfort zone can enrich both your personal and professional endeavors. However, this should not happen at the risk of your own safety.

In order to do good work, we need to have our basic needs met, which when referring to Maslow’s Hierarchy of Needs, include physiological needs (such as food/rest/shelter) and feeling safe. First and foremost, I encourage you to discuss this with a trusted authority. I understand that you worry that disclosing your feelings might work against you, but any good supervisor will listen and try to help you decipher why you feel so unnerved by this patient. If you don’t trust your supervisor, try to find a staff member or professor with whom you can discuss and develop a plan. Should you deem this patient a legitimate threat, your supervisor should absolutely be informed and it will be necessary for the other site employees to know, too. It is extremely important to pay attention to your instincts to determine whether this patient is appropriate for the level of care you offer, and perhaps referring him out is also in his best interest, but this requires honest and thoughtful evaluation before taking action.

Another possibility is that this particular person could remind you of someone or something that previously made you feel unsafe. Projection is a powerful defense, and patients can become vessels for uncomfortable feelings when their physical appearance, tone of voice, facial expression (the list goes on) reminds you of a prior threatening encounter, or past trauma. This process can happen outside of our consciousness despite our physical body’s response, and so we must dig deep to understand what is behind our fear, for both our patient’s and our own sake. 

Although it might not feel like it right now, this experience could be a fruitful training opportunity and I encourage you to consider it an exercise in being honest with yourself, and honest with those who are there to support you. You are likely to encounter other scenarios that are difficult to talk about, but insecurities feed on silence. As you learn to voice various discomforts or reservations, you will find that they will lose their power that currently keeps you shaking in your sneakers. Safety – be it physical, emotional, or psychological – is paramount to flourishing. Therefore, it is important to voice this struggle by reaching out, being honest, and remembering that however others react,

You. Are. Enough.

Signed,

The Inadequate Graduate

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