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Looking Through Multiple Lenses — How Bob Ross Informed My Social Work Practice
By Scott Janssen, MA, MSW, LCSW

For years before I became a social worker, I watched Bob Ross’s painting show. There was something magical about the way he’d take a blank canvas and, one brushstroke at a time, create a world of vibrant colors and natural images—a mountain scape with a winding brook or a forest glade ringed with snow-covered evergreen.

Despite my regard for his skills, I’d often find myself thinking, “Oh no, he just wrecked the painting,” as he’d put a dab of paint in what I thought was the wrong place. Somehow though, he always pulled it off, revealing what I’d thought was a mistake as something indispensable to the larger picture.

Once, the television’s sound was on the blink and I was watching in silence, mesmerized by the elegance of Bob’s brushstrokes. He was painting what I thought was a solitary cabin framed by distant hills and a pastel blue sky. But something didn’t add up. The cabin was too tiny, its foundation insubstantial and unrealistic. The path leading to what I thought was its front door was too broad for the kind of foot traffic you’d expect and, inexplicably, seemed to continue its winding journey right out the back door and onto the far away hillside.

With each brushstroke Bob seemed to dig himself deeper into a hole. I began wondering if someone needed to check his cognitive status or maybe he needed an optician. Then he did something I’ll never forget. He applied a few quick strokes underneath the cabin. Suddenly it all made sense. The cabin wasn’t a cabin. It was a covered bridge. The path wasn’t a path. It was a stream winding its way beneath the bridge.

I thought I’d understood what I was looking at, but I had unconsciously superimposed assumptions and expectations onto the picture. This had rendered me incapable of seeing it. Few lessons have been more important in my role as a social worker.

Changing Expectations
No matter how thorough our assessments or keen our clinical skills, social workers draw pictures of clients based on limited information. Given the complexity of the human psyche, relationships, and our inescapable subjectivity, we inevitably create stories, judgments, and diagnoses by extrapolating from a relatively small amount of actual data. Sometimes we think we know what the picture looks like when in fact we are missing important information.

The Bob Ross experience reminds me to cultivate an attitude of humility and openness with clients, free from rigid preconceptions. An attitude in which my training and experience allow me to develop and test hypotheses without being attached to proving them or forcing assumptions onto a picture where they don’t belong.

Another lesson Bob Ross reminds me of is how powerful our interpretive lenses are. Such lenses can illuminate and bring insight. But if we become overly reliant on just a few of them, they may distort our ability to see what is really going on.

One way to avoid this trap is to have multiple lenses for assessing and conceptualizing clinical data. For example, having a lens in which we can translate what we are seeing into a psychiatric diagnosis can be useful in understanding a depressed client’s challenges and developing a plan of care that meets their therapeutic goals. However, if that’s the only lens we use, it may blind us to aspects we might see if we also have one sensitized to a client’s creativity and strengths, or one that enables us to see their experiences as more than a “mental health” issue. A transpersonal or archetypal lens, for example, that factors in issues related to meaning, spirituality, and growth within suffering is an example. The picture might emerge even more if we have a lens that understands how the body and nervous system are affected by depression or for discerning an underlying attachment style and how this might manifest when a depressed client is struggling in relationships.

Adjusting Interpretations
We all carry various lenses. Some help us interpret what is going on; others help us determine what might be worth trying clinically. We may have a broad conceptual lens, for example, fitting data into a humanistic, behavioral, or family systems framework. We may have secondary lenses focusing on factors such as mental health functioning, relational dynamics, somatic awareness, personality factors, metaphors, or linguistic themes.

Knowing we have lenses and cultivating an ability to use them in a multifocal way can allow us to see the picture more fully. Knowing that we are seeing things through a particular framework allows us to step back and ask whether this perspective, this lens, this story is giving an accurate picture, or is something missing? Am I forcing an interpretation? Is this really a cabin or could it be a bridge?

In an approach he calls multi-lens therapy, Eric Maisel, PhD, (2019, Feb. 3) argues that “there is no single way to look at human affairs. [The fact that clients present] a problem that [they are] calling ‘depression’ doesn’t mean that you suddenly know what is going on. You don’t know if your client is in existential despair about having no life purposes, in a dark mood because of [substances] that [they are] taking that have darkened [their] mood, in anguish about [their] unraveling marital relationship, or announcing something that has always been true for [them] as a matter of temperament.”

Citing a few of the lenses used in multi-lens therapy, Maisel (2019, Feb. 6) makes the case that “if you are leaving out temperament, social and cultural realities, life purpose and meaning issues, and the other lenses through which a multi-lens therapist looks at [their] clients, you are leaving out too much. You are operating from too limited a place and making it harder on yourself to be effective by virtue of not meeting your clients where [they are] ‘really at.’”

In recent years, one of the lenses I’ve added that has enhanced my practice is the one which allows me to consider whether a client’s symptoms and behavior may be influenced by underlying psychological trauma. This is illustrated by the following case.

Looking Through the Trauma Lens
Mick had staff at the assisted living facility (ALF) on edge. Though his father had long been a resident of the ALF it had only been since his father’s health had worsened that Mick had begun visiting. He had a pattern of finding fault, verbal aggression, and blaming staff for perceived slights and “incompetence.” He often became intensely angry or, as one ALF staffer put it, “he goes from zero to 100 on the rage-meter at the drop of a hat.”

Various interpretations had been made in the attempt to explain his behavior and strategize about the best way to respond. Depending on one’s lens, these explanations covered a broad spectrum.

For those apt to see things through a psychiatric lens, he had poor impulse control and deficits in self-awareness, empathy, and self-regulation. Some even speculated about underlying psychopathology such as intermittent explosive disorder.

For those with an eye toward social learning, Mick had learned to get his way by pushing people around, bullying, and intimidating. From a gender socialization lens, there were some who believed he must have absorbed toxic notions about male identity embedded with values prioritizing dominance and aggression.

Using a lens that prized respect for diversity and social justice, there were some who noted that most of his explosions were at staff who were black and/or female. This raised the possibility that he was a racist and/or sexist who was using his privileged position as a white male to attack people in groups that, in cultural and historical terms, have been less empowered to fight back.

Others speculated using what might be called a psychodynamic lens, attributing Mick’s behavior to some imagined “overcompensation” or thoughts or emotions that were being repressed, displaced, or projected. For example, “he’s feeling guilty that he never came around until his father started dying and now he’s taking it out on us”; or “he just wants his dad to die so he can take his house while acting like we’re the bad guys, not him.”

One morning Mick demanded a meeting with his father’s hospice team to discuss our “poor communication.” When I arrived with the nurse and chaplain Mick began accusing the nurse of hiding essential facts about his father’s medication schedule. When the nurse attempted to address his accusations, he interrupted her and launched into other attacks.

At one point I stepped in to set some ground rules and to inform Mick that if he did not treat staff with respect our meeting would be over and his father would be discharged from hospice services. When the nurse tried speaking, though, Mick pounced again, accusing her of making excuses and lying, and threatening to call the nursing licensure board.

At this point the nurse and chaplain left the room, leaving me and Mick alone. Throughout the visit I’d noticed his body making physiological changes—sweat on his forehead, clenched jaw, face red, mouth dry, pupils dilated—suggesting that his autonomic nervous system was generating fight-flight-freeze energy. These cues combined with behaviors indicative of fighting or defending and his hyperreactivity can be signs that a psychologically traumatic wound has been triggered.

Mentally, I mapped out directions we might go in our conversation depending on which lens I used. I decided to start with observations about what I was seeing and some basic education about how the nervous system works when a person is stressed or feeling threatened in some way.

Mindful that Mick had avoided talking about his childhood, I asked whether he’d be willing to tell me something about his relationship with his father, letting him know that there was no pressure if he’d rather not. That’s when the cabin turned into a bridge. Whatever useful information other lenses might have provided, it became clear that Mick was not displacing anger at himself for not having been there sooner for his father. He was a survivor of a painful and confusing childhood trying to cope with situations that were constantly bringing up memories of trauma.

As a kid he’d been verbally and physically abused by his father. He’d watched helplessly as his mother and siblings were repeatedly beaten and injured. He’d left home at the age of 14 to escape the violence and had been fending for himself ever since.

It was a nightmare, he said. Coming to see his father unearthed traumatic memories he’d tried hard to avoid. It also caused feelings of fear, anger, and shame at having “left my mom and siblings alone with that psychopath.”

Indicative of posttraumatic stress, he was confused at how instantaneously he could “feel cornered or disrespected and lash out.” Reluctantly, he had started visiting the ALF because he felt a duty as a son which was associated with his religious beliefs. He wanted to wash his hands of the whole thing, but couldn’t. He felt trapped—just like when he was a child.

Reevaluating Go-To Lenses
We all have lenses. The ones we choose to develop and emphasize, consciously or unconsciously, reflect our clinical training, life experiences, and philosophy about what makes people tick. Lenses are essential to our work with clients. Still, we should bear in mind Abraham Maslow’s warning that “it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail” (Maslow, 1966).

The same is true for lenses. If we become overly attached to making clinical data and observations fit our favorite lenses, we will miss important dimensions of our clients’ lives. We may also miss innovative and powerful avenues for helping clients catalyze therapeutic change.

This is particularly true in an age of costly, time-consuming, specialized trainings that purport to teach the latest “best practice” strategies or to leverage “cutting edge” research in fields from neurology to cognitive science. We may believe we have found the perfect all-encompassing lens when really, we have picked up Maslow’s hammer.

Social workers often work within systems in which there are high caseloads that limit the amount of time with each client. There is often pressure to make quick assessments and/or diagnoses. Clients may be grouped into generalized categories or “populations” for which there are standardized, often brief, prescribed interventions.

Outcomes data and best practice protocols have advanced our field and increased accountability. However, we should bear in mind Bessel van der Kolk’s caution that “Studies of nondrug treatments are rarely funded unless they involve so-called manualized protocols, where patients and therapists go through narrowly prescribed sequences that allow little fine-tuning to individual patients’ needs” (van der Kolk, 2014).

These factors can pressure social workers toward a one-size-fits-all approach to problems and suffering that are unique to each client and not reducible to simplistic formulations. Rather than expand our practice by adding lenses, we may be tempted or pressured to keep a precious few polished and ready for action.

Whatever the merits of these few lenses, if we become overly reliant on our favored lenses, we may become stuck in habits of perception that blind us to our clients’ wondrous complexity. No small handful of lenses will ever give us a full picture. Having multiple lenses helps us recognize when something doesn’t add up. Instead of forcing what we are seeing into an existing framework, a multi-lens approach prompts us to shift or add lenses. This deepens our understanding and can enhance empathy as well as our ability to accurately attune to clients’ experiences, hopes, and concerns. In a sense, having more lenses gives us more paint with which to see the nuanced colors of our client’s lives, and to see the big picture.

Cultivating this type of approach doesn’t mean we cannot rely on lenses we have tested and learned to trust. It doesn’t mean studying perspectives that don’t resonate with our broader training or clinical and philosophical orientation. It means following our intuition and interests into other perspectives that might complement or challenge our existing framework in positive ways.

Incorporating new lenses can be done over time. This can enhance our effectiveness and creativity with clients and keep us from routinized or automatic patterns of thinking, interacting, and observing. Multiple lenses can also protect us from creating narratives about clients that are one-dimensional or less than compassionate. Cultivating new lenses helps our practice deepen and evolve. It keeps things fresh through an ongoing commitment to learning and discovery that may even stave off compassion fatigue and burnout.

— Scott Janssen, MA, MSW, LCSW, is a hospice social worker with UNC Health Care Hospice, and a member of the National Hospice and Palliative Care Organization’s trauma-informed care work group.

References
Maisel, E. (2019, February 3). Introducing multi-lens therapy: A brand new way of working with psychotherapy clients. Rethinking Mental Health. Retrieved from https://www.psychologytoday.com/us/blog/rethinking-mental-health/201902/introducing-multi-lens-therapy.

Maisel, E. (2019, February 6). The 25 lenses of multi-lens therapy: How to avoid reducing clients to labels and diagnoses using multi-lens therapy. Rethinking Mental Health. Retrieved from https://www.psychologytoday.com/us/blog/rethinking-mental-health/201902/the-25-lenses-multi-lens-therapy.

Maslow, A. (1966). The psychology of science: A reconnaissance. New York: Harper & Row.

van der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York: Viking.