Two months after receiving my Master of Social Work, I was offered an employment opportunity with a rapidly growing inpatient behavioral health facility. One of the facility leaders, Ms. Anderson (a pseudonym), with whom I had worked in another professional setting, extended the invitation.
“I am familiar with your work ethic and style and believe you would align and assist with my ultimate goal of building a great team,” she said. “You will be fourth Social Worker to join the team if you accept my offer.”
“Thank you so much,” I replied. “Could I have a few days to consider this offer?”
“Of course.”
I spent the next few days weighing competing opportunities, as well as my financial obligations, and decided to accept the offer.
The salary was appealing, and I liked the mission and vision of the facility. Moreover, the company’s leadership seemed committed to creating a flagship behavioral health facility, one that could serve as a state-wide model. Being an integral part of this team seemed to present a unique and perfectly tailored opportunity for me to help turn this vision into a reality. For a new LMSW, the experience seemed to provide an opportunity to become more knowledgeable in the field of Behavioral Health and make significant differences in the lives of those I served.
Ms. Anderson, also fairly new to the organization, was upbeat as she gave me an initial tour of the facility.
She did admit, “The décor of the facility is a bit unsavory and drab, but I’m optimistic about the future. It’s on its way up!”
This reaffirmed my excitement. “I’m pleased to be part of this effort.”
I felt we were on the same page, working toward the same goals and committed to making a difference. After completing the necessary paperwork and prescreening activities, taking the required trainings, and attending a full day of orientation, I was still enthusiastic. I couldn’t wait to begin.
A week later, during my first day of work, I was abruptly reminded that everything that glitters is not gold. I learned there would be only three Social Workers instead of four as I had thought. The individual with whom I was to have shared the unit and caseload had been suddenly dismissed. My caseload would now be between twenty-two and twenty-seven patients. This number of patients might have been normal for a Social Worker in Child Protective Services but represented a daunting task in Behavioral Health. My responsibilities included completing psycho-social assessments and coordinating discharge plans for each of these patients, as well as facilitating groups and attending Treatment Team meetings. The patients’ stays averaged one to three days, creating narrow timeframes for such a high volume of casework.
I also quickly learned there was no shortage of organizational problems. Specifically, the culture of the organization seemed toxic. In addition to general disarray at all levels of the organization, there were problems with nepotism, ineffective communication, patient complaints, HIPAA violations, premature employee terminations, and employee resignations. My initial vision of the facility becoming a flagship was beginning to fade.
I thought long and hard about what I could do to facilitate cohesion within the facility without appearing pretentious or being perceived as a troublemaker. I began to journal my thoughts, clearing any type of emotional connection I had to the issues at hand. Strong emotional reactions to my discoveries were easy, even reasonable. I was disappointed, angry, and exhausted from the workload. However, I had grown to understand that negativity doesn’t solve anything. I needed to recognize and acknowledge my legitimate emotions but take steps to intervene at a higher cognitive level. I also believed that to be an effective leader and communicator, to help bring about change, I had to get others to buy in. I could not accomplish this by spreading negative energy.
As part of my journaling process, I listed each discipline within the facility, and to the best of my knowledge, their tasks. At the center of all these tasks were the patients. This made me think of a puzzle. I made a crude drawing of a jigsaw puzzle, showing patients as the center puzzle piece, with the various disciplines surrounding it. Next, rather than focusing on deficiencies or opportunities for improvements, I outlined the strengths I observed in each department and how those benefited patient care. After pulling all my thoughts together, I arranged a meeting to share them with Ms. Anderson.
There was excitement in my voice as I explained, “My logic is simple: if everyone, in every department, were valued as an essential piece of the puzzle then patient care would inevitably be great. Excellent patient care would lead to enacting our larger, collective vision of flagship status.”
To my surprise, after asking a few questions, Ms. Anderson seemed to be on board, saying, “Hmmm. This makes sense. Would you put together a formal and detailed writeup and send it to me via email?”
“I would be glad to!” I replied. And eagerly did so.
A few days later, she sent me her version of what I had provided. Instead of using my original and deliberately themed title of You’re an Essential Piece of the Puzzle, she entitled her writeup, Piecing it Together.
I felt insulted and angry at how she seemed to have distorted my message. My title was intentionally focused on conveying a belief that if everyone felt essential, the company stood to get the best from each employee. Her title deflected that focus. I felt misunderstood. To me, the notion of piecing something together had ragged, negative undertones.
So back to my journal I went. This time around, not only did I need to clear more negative emotions, I needed to question my assumption that Ms. Anderson was out to drive me crazy with that awful title. So I generated other hypotheses for why she reframed my original message. I knew she was in no way malicious and would never have done anything intentionally to upset the situation. After all, her goal was also to assist this facility in becoming a flagship.
I wrote: “Maybe changing the title from You’re an Essential Piece of the Puzzle to Piecing it Together was just a matter of semantics for Ms. Anderson.
“Maybe Ms. Anderson imagined the beauty of how quilts are pieced together. Thus, she used Piecing it Together metaphorically to describe the potential beauty of cohesiveness among the disciplines within the facility.
“Maybe Ms. Anderson used the word piecing in its most literal sense, meaning to assemble something from individual parts. In this regard, the word piecing could be thought of as each discipline coming together, to strengthen the mission and vision of the facility.”
As I wrote and pondered alternative explanations for her actions, I intentionally treated each as a serious possibility, thus making my original assumption more tentative. It was important to focus on what I knew, not what I might be making up about the situation.
After I wrote until I was on the verge of carpal tunnel, I concluded that I could not afford to allow my emotions or subsequent feelings and thoughts to overly influence me. As Dr. Latting’s work had taught me, I had to interrupt or intervene in old habits of processing thoughts and emotions. Only then could I effectively help the company fulfill its goal of rendering the best possible care to patients.
After reconciling my thoughts, clearing my emotions, and testing my assumptions, I was able to discuss the issue further with Ms. Anderson. My goal was to birth a mutual understanding and reignite commitment to the vision.
Fortunately, we were able to get to a point of common understanding. Unfortunately, the campaign never came to fruition—the operative goal of the hospital shifted to simply keeping the beds filled.
The company continues to be successful, but the important puzzle pieces of the employees and patients have been forgotten, as was the mission that inspired me.
Nevertheless, by learning to clear my emotions, I also learned to choose my battles and focus my energy where I can exert the most positive influence. In doing so, I stress less and am more present for myself, my family, and my patients. I no longer hold onto negative thoughts or feelings because I now understand they are like visitors who come and go.
Tracy Forman, LCSW, received a Master of Social Work from the University of Houston’s Graduate College of Social Work (GCSW). For over fifteen years, she has worked in the field of Social Services and Behavioral Health, subsequently finding her passion working in Forensics and Inpatient Behavioral Health, as well as in her private practice. Tracy enjoys spending time traveling with her family and shopping.
Her introduction to Conscious Change came by way of Dr. Latting’s leadership, administration, and advocacy course, at the University of Houston’s GCSW. Upon learning these skills, Tracy began to put them into practice by making a commitment to test assumptions in both her professional and private lives.
