It’s the Little Things

by Constance Lee Richards, MSW, ACSW, LCSW

     As I think of the skills I possess as a clinical social worker, I have discovered it’s the little things that have lasting impact. The following list of small actions is derived from client feedback over a long work history.

     A word: I use the word URGENT whenever a client is in need of a higher level of care than individual therapy. An inevitable question in calling facilities, insurance representatives, and benefits coordinators begins with, “Is this an emergency?” Stating the client’s need is an emergency becomes a swift dismissal to an emergency room. When a client is successfully referred to an intensive outpatient program, receives a medication review by a psychiatrist, or obtains an appointment with a therapist whose scope of practice is a better fit than my own, urgent is a word that brings the greatest result in the client’s behalf.

     A note: In session, I write things down for the client. Most people come to a session to talk, not to write. I find writing useful for my memory and to provide referrals, book titles, and homework for the client. One note had greater impact than I could imagine when a client stated he kept a note from me with the number for the National Suicide Prevention Hotline with him at all times. He reported the note was a lifeline when he felt overwhelmed. “Every time I thought about killing myself, I took out that paper. Looking at the number made me feel better because I knew I could call somebody.”

     A handout: Print material is a useful tool to educate clients and normalize their responses to life’s challenges. As a facilitator of grief support groups, I have found that handing out a workbook with facts pertaining to loss and writing prompts or a list of responses to loss can have a lasting impact. One participant was so moved by a handout that she referenced it nearly every group meeting. Another participant completely filled a grief workbook and added additional pages to continue writing. This document became his lifeline in understanding his loss. Every client chooses what print material is useful, but I default to these resources because the financial cost is minimal and the benefit some derive from reading and writing them is immense.

     A phone call: My practice is to coach clients how to advocate for themselves when they need resources beyond the therapy session. Insurance companies can be daunting, and talking to authorities such as an employer, a child’s teacher, or a physician can lead to misunderstandings. If the client needs an advocate and accepts my assistance, I will call on their behalf. Making a phone call with an assertive tone can help the client broker agreements that were at an impasse and decrease misunderstandings with other providers. A phone call is the tool that accomplishes so much for a person in need.

     A plan:  Crisis counseling necessitates action steps for a client who has experienced sudden change or loss. No matter how grim the situation, a plan empowers the client to cope with tremendous stress. As an outsider to the situation, I can assist clients to sift through priorities and help them focus on what to do and who else may need to be involved. A plan helps everyone in the office establish direction for treatment and diminish sabotage by well-meaning loved ones. And the client is reassured there is order to chaos if they know what to do first.

     Granted, this list of little things reflects pre-pandemic practices, but most may be fulfilled electronically. The point is for social workers to appreciate the little things they do and may overlook as helpful.

Constance Lee Richards, MSW, ACSW, LCSW, is a clinician with expertise in sudden change, grief, loss, and trauma. Constance graduated from Washington University in St. Louis, Missouri, where she currently resides and has been in practice. She has worked as an employee assistance program specialist, trainer,  manager, and as a hospice bereavement coordinator, counselor, group facilitator, and speaker.