Recently I changed jobs at the agency I work for, and had to give up my caseload. Okay, I GLEEFULLY gave up my caseload, for the most part. But there are always special people you work with. They touch you in a soft spot others don't reach, or make a lot of progress, or would be friend material if you weren't treating them. The patient I met with today did all three. J is a perfect example of how anyone at all can get a devastating mental illness. She has an advanced degree in a helping field, has been a social worker herself in the past and is one of the most intelligent, intellectual people I have ever met. J came to our town after getting an offer of employment based on her advanced degree. After she had moved, it fell through. She was completely isolated in a new place with no support system, no money, and rapidly declining mental health. J lost everything when she got sick. Her symptoms are a mixture of several diagnoses, although she is assigned two specific ones. The DSM is shifty sometimes, but more about that another time.

J has a sense of humor that helps her cope with her multiple psychiatric and physical illnesses. She has gone through major surgeries and chronic pain. Living at a terrifying residential hotel in the tenderloin of the town, she joked about what the streets should be named. Worried over her college aged child making bad life choices, she referred to the kid as a specific and fitting cartoon character. Watching her use the coping skill of humor against all odds was a touching and impressive experience.

A few people are always devastated by a change in social workers. It happens to everyone who works in the field, and you have to accept that when you work hard with someone when they are struggling and needing support that they might miss you a lot when you don't anymore. So I'm not saying any of this because I have some kind of ego trip or savior complex going on here. J was devastated when I stopped working with her. Despite an established need for frequent appointments, she has not been scheduling them much and has not come in for over a month to meet with her new worker. When I was assigned to do some work with her, she responded to my calls when she hadn't been returning calls from her new worker.

Her new worker and I met with her today. Her sense of humor was gone. She could barely look me in the eye. She did open up when we used especially validating techniques, but she was clearly doing much worse than she was before.

It is hard not to feel guilty.

One of the ways I avoid burnout is to not play the guilt game. I cannot change another person's life, they must do it alone. Supported, encouraged, assisted, but alone. I know this, but sometimes I still feel it despite all my experience in my field. I would like to be able to magically make lives better, to have precisely this amount of professional attachment and not a whit more. To not feel.

Perhaps I am a better social worker because I do feel.