People are understandably confused as to what the different titles of all us therapists mean and what the different types of therapists there are. I’m going to to talk about what might make a social worker as a therapist different than other types of therapists. I chose social work because, well, that’s what I am.
One of the concerns a lot of people have about entering therapy is discovering that something is wrong with them. There is a concern that they’d be given a diagnosis that states they have a mental health—and get ready for the dreaded word—disorder.
There are many, many people who are comforted to know that the suffering they are experiencing can be codified in a diagnosis. With a diagnosis they know that this condition is something that others have, so they’re not alone, and there’s evidence that this can be treated. There are a good number of people who would benefit from counseling to improve the quality of their life without fitting neatly into any diagnostic criteria. (They may still request/need a diagnosis for insurance reimbursement, but that’s a topic for another day.)
Limitations of Diagnoses
One of the things that I find limiting about diagnoses is that they can give the impression that the issue is fully in the “head’ of the patient/client. This is where my social work training kicks in and may (I stress the may) differ from other ways other types of therapists are trained: I don’t just want to know about what’s going on inside you.
One of the first things a social worker is trained in is PIE. Yes, we all need to eat more pie, but this stands for Person-In-Environment. The social world that the client has lived in is important. Early on in treatment we speak about race, gender, ethnicity, socioeconomic status, etc.—and not just how the client defines that, but often how these things are perceived by others. This allows us to see how the client isn’t simply alone in their struggles, but that many of those struggles are the best way they’ve found to cope with the environment they have been placed in (as a child) and they are currently in (as an adult).
We’ll also get to explore family history, dynamics, and what’s going on inside you—your thoughts and your feelings. It’s not that social workers neglect that or give it less priority, but we also find it imperative to understand how you have taken in the world that you grew up, and continue to grow up, in.
One example of this is working with a Person of Color who is often mistaken for white. While they may seek out treatment because of relationship issues, it can become clear that they’ve spent a good deal of their life struggling to connect with their family and construct their own identity. While they knew their family’s race, their family may have subtly (or not) treated them differently because they were seen differently. When they were at school, perhaps people didn’t always connect them with their siblings. As they get older, they may be present while others made comments or jokes. This leaves the person in a place where they have to choose to “go along to get along” (especially in a work environment) or to speak up and perhaps put themselves at some risk.
When this becomes an everyday occurrence, it can be wearing.
And the stress can enter their relationship—which is what they came in to work on in the first place. But if we just worked on their difficulty with making a commitment, we’d be missing quite a lot.
Another example is a white man who grew up in a strong Italian Catholic family. He is unhappy in his relationships with friends and girlfriend. Through getting to know the context he grew up in he was able to talk about how the rituals, fear of punishment, and the guilt don’t all just go away because he rejected the faith he grew up in. It all still plays a role in how he interacts with others. While wanting to be a feminist, he still feels very uncomfortable when he isn’t carrying the heavier package for a woman or holding a door open. Is this benign, but misplaced masculinity or something more toxic where he needs to “take care” of someone who isn’t male? And what if this is causing arguments with his girlfriend? Well, there’s no DSM-5 diagnosis for this, but it is having a strong affect in his day to day life.
If the healing professional only focuses on what’s going on inside, there is a danger of a person feeling they are alone in their struggles and their pain.
Do psychiatrists, psychologists, mental health counselors, and other types of therapists take the Person-In-Environment into context? Of course, many do, but it is an intrinsic part of every social worker’s training and brings a huge amount into the therapeutic process.
This article first appeared on the HuffPost.
Justin Lioi, LCSW is a men’s mental health and relationship expert. He practices counseling in Brooklyn, NY (and online throughout New York State and internationally.) He received his degree from New York University and has been working with men and their families for over 10 years. Justin is on the Board of the National Association of Social Workers and writes a weekly column for the Good Men Project called Unmasking Masculinity. He can be found on local and national podcasts talking about assertiveness, anger, self-compassion, all with the goal of becoming the man you want to be.