Is Social Work Stressful?

The math. Not emotional math, actual math. I have 22 families on my caseload. State guidelines say 15. Each family requires at minimum one face-to-face visit per month, but most of my cases are in the intensive phase, which means every two weeks. That's 44 home visits a month. Each visit takes an average of 50 minutes on-site plus 30 minutes of driving plus two hours of documentation. Round it to three hours per visit. Forty-four visits times three hours is 132 hours of home visit work per month. I work 160 hours a month. That leaves 28 hours for court appearances, staffing meetings, supervision, phone calls to service providers, and the four trainings HR scheduled this quarter on topics like "wellness strategies for frontline workers." The irony of sitting in a 90-minute wellness training when I have three overdue court reports is not lost on me.

My supervisor, a man named Terrell, knows the math doesn't work. He told me during our last supervision that two more caseworkers are leaving in April. One is going to a school social work position. The other is leaving the field entirely to work at a bank. A bank. She has a master's degree in social work and she's going to work at a bank because the bank pays $52,000 and doesn't require her to knock on the door of a house where someone might be high and angry at 3 PM on a Tuesday. I can't blame her. Some weeks I look at bank jobs too.

The triage. I cover three elementary schools. That's about 1,400 students across the three buildings. In theory, I'm supposed to provide social-emotional support, run small groups, meet with families, consult with teachers, and do crisis intervention. In reality, I put out fires. Last Wednesday I had planned to run a social skills group for four second-graders. Before the group started, a fifth-grader punched another student in the cafeteria. I spent 90 minutes on the incident: talking to both students, calling both sets of parents, consulting with the principal, writing up the behavioral report. The social skills group didn't happen. Those four second-graders, who have been waiting since October for consistent small-group support, got bumped. Again.

The stress isn't the punching incident. I can handle that. The stress is the four second-graders I keep not getting to. I know their names. I know that one of them, a boy named Caleb, has been dysregulated since his parents separated in September. He needs someone to talk to regularly. He needs a consistent adult who shows up at the same time every week. I'm supposed to be that person. Instead I'm writing a behavioral report about a cafeteria fight that, if I'm honest with myself, probably happened because that fifth-grader needed the same kind of support I'm not giving the second-graders. It's a cycle. The kids who act out get my time because their behavior forces the issue. The kids who are quietly struggling get pushed to next week, and then next week, and then it's December.

The accumulated grief. I visit people who are dying. That is my job. I drive to their homes, I sit with them and their families, I help with advance directives and funeral planning and Medicaid applications and family mediation when the siblings can't agree on the care plan. I do this for 22 patients at a time. On average, I lose a patient every 10 to 14 days. That's roughly two to three deaths a month. I've been doing this for six years. That's over 180 deaths.

You'd think you get used to it. You don't. What happens is you develop a professional layer that lets you function. I can sit with a family in their living room and help them understand what "actively dying" means, and I can do it with compassion and clarity and then drive to my next visit and do something completely different. The professional layer works during the day. It's at home where it cracks. My roommate, a dental hygienist named Petra, came home last month and found me crying on the couch. She asked what happened. I said a patient died. She said, "I'm so sorry." I said, "No, she was 94 and she was ready and it was peaceful." Petra looked confused. I couldn't explain that the tears weren't for this patient specifically. They were for the accumulation. The 180. The professional layer holds each individual loss. It doesn't hold the total. Some months the total feels close to the surface and something small, a song, a particular shade of light through a window, opens it.

The gap between what I can offer and what people need. I work with adults experiencing chronic homelessness. My caseload is 35 people. My job is to help them access housing, benefits, medical care, and employment. The problem is, the housing doesn't exist. Denver has about 6,200 people experiencing homelessness on any given night and roughly 3,800 shelter beds. The waitlist for a housing voucher through the Denver Housing Authority is 18 months. For permanent supportive housing, which is what most of my clients need because they have co-occurring mental health and substance use issues, the waitlist is two years.

So when I meet with a client and they say, "When am I going to get housed?" I say, "I'm working on it." Which is true. I submitted 14 housing applications this month. I made calls to three different housing navigators. I updated vulnerability assessments in HMIS, which is the data system we use. I did the work. But the work doesn't produce housing when the housing doesn't exist. My client doesn't care about my 14 applications. He cares that it's March and he's been sleeping in a tent near the South Platte for eight months and I still can't tell him when he'll have a wall and a door. My supervisor, a woman named Alma, tells me to focus on what I can control. I can control the applications, the referrals, the coordination. I can't control the supply. But try explaining supply-side housing economics to a man in a tent and see if it helps.

The isolation. People hear "private practice" and they think I've made it. I set my own hours, I choose my clients, I make $105 an hour. And all of that is true. But what's also true is that I sit in a small office by myself for eight hours a day. There's no team. There's no hallway conversation with a colleague about a difficult case. There's no supervisor I can call when a client says something that scares me. In agency work, which I did for 10 years before going private, I had a clinical director I could walk down the hall to. I had peer consultation built into the week. The work was harder in some ways but I was never alone with it.

In private practice, I pay for a peer consultation group that meets on Zoom twice a month. Six therapists, we present cases and get feedback. That's helpful. But it's not the same as turning to someone in the moment and saying, "I just had a session that shook me, can I debrief for five minutes?" In private practice, you debrief with yourself. You sit in the chair after a session, you take three breaths, and then your next client walks in. My wife, Natalie, who works in corporate communications, asks me sometimes if I've "talked to anyone" about a hard session. I say I'll bring it to consultation. But consultation is two weeks away and the session was today. The gap between the hard session and the professional support is the space where the stress lives.

Watching my staff burn out and not being able to stop it. I supervise nine social workers at the VA. They serve veterans with PTSD, substance use disorders, traumatic brain injuries, and military sexual trauma. The work is heavy. I know because I did it for 16 years before I moved into supervision. When I was a frontline clinician, the stress was the caseload and the stories. Now the stress is watching other people carry the caseload and the stories and seeing the exact moment they start to break.

There's a social worker on my team, I won't name her. She's been here three years. She's talented. She's compassionate. She cries in her car on Fridays. I know this because another team member told me. She hasn't said anything to me directly. And I understand why, because in a system like the VA, admitting that you're struggling feels like admitting you can't do the job, and the job needs doing, and if she steps back the caseload goes to someone else who's already overloaded. So she holds it. And I watch her hold it. And I offer supervision, I check in, I tell her about the EAP, I adjust her caseload when I can. But I can't fix the fundamental problem, which is that we have 9 social workers doing the work that should be done by 14 and the VA hiring process takes 6 to 9 months for a single position. I filed a staffing request in August. It's March. The position is still posted. Nobody has applied. In the meantime, she cries in her car and I pretend I don't know.