Vulnerability and acceptance in clinical practice

Wanna know a little secret? I love tough cases. Like really love them and I’ve thrived on the excitement, collaboration, and professional growth associated with high risk, complex cases. I find these types of clients inspiring, impactful, and sometimes energizing. But you know what else? I’m an extremely sensitive gal and I feel things really strongly. I think that is in part what helps me to connect with my clients, but it can also cause me to feel drained or burnt out.

At least once per day I find myself in a conversation with one of my clients about setting boundaries. The ongoing discussion of how to set appropriate and healthy physical and emotional boundaries is paramount to the work of so many teenagers and trauma survivors I treat. Outside therapy sessions, I also find myself in discussions with colleagues and supervisors about professional boundaries, like confidentiality, limited personal disclosure, and maintaining time limits to appointments. However, I’ve realized recently that it is not commonplace for myself or the clinicians I’ve worked with, to take the time and space to explore which cases are energizing, and which ones may have impact on the clinicians emotional or spiritual well being.

A few years ago a client that I initially described as a “piece of cake” quickly became the most intense, complex, and high risk case I’ve ever been associated with. Very quickly into our work I was completely immersed in the allure of figuring out what was going on diagnostically for this client and determined to find ways to help her. Working in a residential treatment facility at the time, I had a team of co-workers to help address her symptoms and behaviors, but I put a lot of pressure on myself as the lead clinician on the case.

My client and I had a strong connection but I was reflective enough to manage the urge to increase check ins to make sure she was okay or to offer extra time because of her fragile state. At the time I thought I was being very self aware by working in supervision to make sure there were other supports in my place for my client and that I set clear limits about time spent together. What I didn’t realize, however, was that within my fear of vulnerability in supervision and amongst my colleagues, I failed myself in not acknowledging out loud how isolated I felt in my work with her or the impact our work was having on my stress level. I began to think about the case constantly and for a few months woke up each night with the fear that my client had passed away.

It was only after our work terminated that I was able to be honest with myself about how impactful our work had been, and realize that even though I thoroughly enjoyed my work with her, I needed to further explore what supports I would need to put in place for myself if I were to choose to work with clients with a similar level of complexity or risk.

I always knew I’d grow clinically from this particular case, but what I didn’t realize at the time is that it would also teach me a valuable lesson of acknowledging and accepting my limits. I’m more motivated than ever to have a self care regimen that will allow me to have the emotional space to allow one or two complicated cases on to my case load and I accept that I cannot, and should not take every case sent my way or feel any pressure to provide treatment in a vacuum.

Now that I’m no longer working in residential care and have transitioned over to private practice, it’s more important than ever that I am honest with myself about who are my ideal clients, how to attract clients that will give me energy, and how to accept and embrace when I may not be the right fit for someone, even when faced with an enticing clinical challenge. I’m hopeful that by being vulnerable enough to accept and share my limitations, I create space to continue my professional and personal growth.