The Therapeutic Value of Giving a Damn!

I work in a large behavioral health clinic in Central New York State, as a Psychiatric Rehabilitation Specialist. As such, I’m privy to the shared and sacred boundary between clients’ clinical counseling work and the actual outworking of their daily lives. What I do is not actual “counseling,” though, in some senses, it is. I’m not a licensed clinician, but I, nevertheless, have to listen like one, care like one, and attempt to assist some very challenged people build what they consider to be meaningful lives.

This Medium Blog is dedicated to my experiences in that position, what I have learned and what I am learning, about caring for the individuals I serve, about what it means to help someone build some meaning and purpose into his or her life, and about navigating both the limitations and the incredible discoveries inherent in that context.

This first post addresses something I care deeply about: The therapeutic value of giving a damn!

One of the gentlemen I work with is in that gray, in-congruent space between wanting to die and not wanting to fully live. He isn’t actively suicidal, nor does he entertain active suicidal ideation. He has answered yes to the question on the Columbia Suicide Severity Rating Scale (C-SSRS): Do you want to go to sleep and not wake up.? But he doesn’t think about killing himself. He doesn’t ruminate about ways to end his life. He doesn’t have any plans or lethal means. He just “lives” in the minimum sense of the word. He gets up at about 10:30 AM (Two years ago he got up at 12 noon). He eats cereal for breakfast, a bologna or ham sandwich for lunch, and a TV dinner for his evening meal .(He has hardly any dishes to wash that way.) Sometimes he takes a walk in the afternoon to his pharmacy, to the dollar store, to his doctor’s, or to our clinic. He fulfills this mundane and simple routine every day, and has done so for longer than I’ve known him, which is over two years now.

This gentleman has some local relatives, a sister, a brother-in-law, a nephew. They rarely see him; he rarely sees them. Thanksgiving and Christmas. (his nephew does take him to the grocery store every two weeks.)

This man was referred to our clinic by his Primary Care Provider, who saw that he was clearly depressed. He has generally lived what we might construe as a “depressed life,” which got worse after he lost his job in a warehouse because he got inappropriately angry at his coworkers and supervisor, due to the unfair way that his supervisor had been handling things.

This dear man was never a ball of fire when it came to relating to people, usually fairly quiet, an introvert, not the kind of guy who would stand out in a crowd. But he is a “good man,” having always applied himself authentically in his jobs, striving to do a decent job, aiming to be fair to himself and others, putting in his share and not complaining a lot about it. He is your basic “plain John,” getting through life by minding his own business and fulfilling relatively normal and minimal obligations.

After working with this gentleman for as long as I have, he has not moved forward in a dramatic way. Recently when I was with him, I asked what value he thought our services were to him. “Well. To know somebody cares.”

Of course, it’s impossible to tell. The man has been committed to his appointments, with his Primary Counselor, with me, and with his Medication Provider. Though he is barely engaged in his life, he has chosen to remain engaged with his treatment, though that engagement has rarely risen above his faithful attendance at appointments. The scores on the assessment for depression have gone up some, so there is an objective measure.

I notice that he makes a joke spontaneously sometimes, which he would never have done a couple years ago. When I take walks with him (we are in the era of COVID 19, and have just begun to loosen restrictions), he is much more relaxed and willing to participate in reciprocal conversation, as long as I don’t try to “make it happen.” He has to feel safe, not pushed; he has to feel accepted. It has taken months and months for him to believe that what he says is important to me; so even when he does initiate conversation or respond to conversational cues, he’s still slower than most.

I would contend that “giving a damn” has made a difference in this man’s life. Were we not to relate to him in ways that showed genuine care, I don’t believe he would be still engaged with us, let alone even made the slight improvements in his life he has.

I may write more on this in the future: Showing people authentic care, giving a damn. Yes. It’s therapeutic!

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