Ok, I have no way of actually knowing whether your therapist is a social worker, but Im going to talk about what might make a social worker as a therapist different than other types of therapists.

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 theyd be given a diagnosis that states they have a mental healthand get ready for the dreaded worddisorder.

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 theyre not alone, and theres 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 thats 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 therapists are trained: I dont just want to know about whats 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 isnt simply alone in their struggles, but that many of those struggles are the best way theyve found to cope with the environment they have been placed in (as a child) and they are currently in (as an adult).

Well also get to explore family history, dynamics, and whats going on inside youyour thoughts and your feelings. Its 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.

Two Examples

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 theyve spent a good deal of their life struggling to connect with their family and construct their own identity. While they knew their familys race, their family may have subtly (or not) treated them differently because they were seen differently. When they were at school, perhaps people didnt 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 relationshipwhich is what they came in to work on in the first place. But if we just worked on their difficulty with making a commitment, wed 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 dont 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 isnt 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 isnt male? And what if this is causing arguments with his girlfriend? Well, theres no DSM-5 diagnosis for this, but it is having a strong affect in his day to day life.

Conclusion

If the healing professional only focuses on whats 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 healers take the Person-In-Environment into context? Of course, many do, but it is an intrinsic part of every social workers training and brings a huge amount into the therapeutic process.

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Justin Lioi, LCSW, Counselor for Men

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