A Case for Treating the Worried Well

Mario Gallucci, "Paint Roller"

As a clinical social worker providing psychotherapy to the wealthy “daughters of the 1%,” as I’m prone to quip at dinner parties, I have learned to adopt humor and self-negation as armor against career-shaming.

Formal education for social workers is steeped in the historical narrative of our profession: attending to injustices of poverty through charity. According to the National Association of Social Workers Code of Ethics, service and social justice top the list of core values, and “Social workers are sensitive to cultural and ethnic diversity and strive to end discrimination, oppression, poverty, and other forms of social injustice.” In the real world, this translates into being respected for our ability to stretch and over-extend ourselves toward the margins of the human experience, without an offer of reasonable compensation. Traditional feminine-assigned values of self-sacrifice, caregiving, and altruism reign above all else, regardless of the practitioner. This is considered good work: loyal commitment to ragged, underfunded programs—orienting always toward those we perceive as having it “worse off” and striving unrelentingly to make a positive difference for them.

After graduating with my MSW, I felt pressured to earn my stripes amongst the battlefields of Child Protective Services, the Veterans Administration, and other prescriptive, strapped programs serving homeless youth, battered women, elders, and the needy. It felt necessary to prove my commitment to ‘The Cause,’ and like my fellow graduates, I found tension between choosing a sustainable career and staying true to the overt and covert ideals of social work. Once in the workplace, however, the liminal biases and blind spots of graduate school dissipated, and I allowed myself to explore the possibility of attending to my own quality of life issues while staying engaged in the core mission of the profession.

Four years ago I transitioned from an enjoyable but low-reward, low-paying job in community mental health to treating adolescents and families from wealth. I was harassed by my colleagues for going to the “dark side,” the for-profit industry, which they perceived as both less pure and also evidence of some underlying character flaw. While the salary increase was a factor, I was eager to experience the freedom of clinical work unbound by the constricting bureaucracy of social welfare programs. I had begun to experience noteworthy dissonance in translating human connection into “units” to keep the agency afloat. I was praised for my time efficiency and for using “contact hours” to keep the Medicaid dollars filtering in. While clients are always fulfilling a financial ‘Part-Object’ role for social workers, its extent within community mental health created a sense of psychological impoverishment from which I sought refuge. Luckily I found a home with similarly-minded professionals as a clinical social worker in a remote therapeutic boarding school in Northwest Montana.

As I reflect on this transition, I feel I have a greater understanding of the collective biases related to treating the wealthy, which I now seek to challenge with entry points for a more dynamic, graceful conversation.

Coming of age within a chosen career is rife with autonomic struggles, most often acted out with classmates, faculty, supervisors, and of course, our own parents. I came to the field because of my own conscious and unconscious longings: a set of family values relating to service, a personal interest in the stories of those muted, and a set of adaptations and qualities courtesy of my family which suited the profession. I am in good company with those also drawn to the field for our unconscious relationship with exploitation. We can relate, align, or empathize with other victims of circumstance, because all of us, at some point, are helpless in our own lives—most often in our families.  In turn, when working with the wealthy, we are challenged to empathize with those in greater positions of socioeconomic power. We perceive this as a betrayal of our own victim-selves; we feel we are aligning with the exploitive parent. The child in us squirms; we fear self-abandonment and judge our peers for joining the ranks against us when they take jobs for profit.

Admitting to our desires for abundance, we fear it says something about our virtues. Rather than evidence of a flaw, however, wanting to earn a sustainable living may also be an indicator of our own maturation and psychological health. At one end of the spectrum, our own development shapes the flavor and extent of our grace and scrutiny with our clients. At the other, more potentially dangerous end, however, we may find ourselves in full-blown unconscious reenactments of the worst of our childhoods. We cannot escape our own context and history as evoked by the profession; however, moving in the direction of prosperity may be a positive sign that we are no longer unconsciously following pre-scripted narratives of psychological impoverishment and over-identification with the exploited.

Empathic engagement requires some semblance of reflexivity, although blind spots are most often located in the extremes of either feeling too far removed or too close to a client experience. The majority of us arrive in Masters’ programs from our own middle and upper class backgrounds. If we are drawn to the field to help those we perceive as less fortunate, or “not like me,” our therapeutic approach will be inherently skewed by a sense of relational displacement. We create misguided limitations when we believe our best work is done only from the perspective of having a leg-up on our clients. Our egos are bolstered by believing we are somehow “better off” and bending down to pull them up. From this vantage, we are actually more prone to exploiting them, because they allow us to feel better about our own malnourishment. Conversely, it can be both intimidating and illuminating to be in the room with someone we perceive (at least initially) as being much better off. What can be learned about the psychology of poverty and wealth by sitting across from a millionaire? Plenty.

Lastly, there seems to be a wide-spread misconception that the psychological ailments of the wealthy are insignificant and unworthy of our concern.

Who are they to complain, we muse, when their greatest struggle is probably deciding on which exotic island to purchase a second home? Incest, neglect, abuse, addiction, trauma, depression, rage, anxiety, and character issues know no income. Just as it is painful to sit in the room with a client who has suffered long-standing complications relative to financial poverty, the same is true of one’s psychology. I have been equally touched bearing witness to someone who has lived a life of inner impoverishment, despite fortune. I have accompanied a budding narcissist as she describes the frightening inner void, masked by two sides of a false self: the grandiose and the frail. Most upsetting was the level of inner poverty despite all the outward riches, the hollowness of abundance unmatched by the scarcity of inner sanctity. As the essayist Samuel Coleridge reminds us: “Water water everywhere but nor any drop to drink.”

There is no room for financial politics in the consulting room, only curious examination. Clients of all income levels deserve the experience of attachment, attunement, holding, resonance, connection, and psychological growth. Wealth does not indicate how likely one is to receive this in their upbringing. Once they feel valued in therapy, clients learn to more greatly value themselves, others, and life itself. They come to know the humility in seeking help, the vulnerability of authentic self-expression, and the meaning of relationships. Offering our gracious presence to the wealthy can imbue their lives with greater humanity, which in turn strengthens their ability to treat others humanely. How could these changes not have a lovely ripple effect?

There will always be a need for social advocates in the territories of the marginalized, but there is tremendous potential for large-scale change in treating the wealthy. I feel lucky to have found deep satisfaction in my present role and believe we need not fear dishonoring the tradition by serving the “worried well.”


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1 Comment on A Case for Treating the Worried Well

  1. I made a similar transtion many years ago. It feels good to read what I could have written. Very thoughtful and inspiring. Thanks!

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