Learning to “Play the Game” Without Losing My Why

Many of us aren’t just practicing care, we’re negotiating it. As clinicians, we are asked to hold space for complexity, while also meeting productivity standards. To honor individual experiences, while documenting in ways that fit predefined categories. To be present, while being efficient. Care becomes something we have to fit into the system, rather than something the system is built to support, for the receivers and providers.

Million dollar words like "evidence-based," "measurable," and "standardized" are advertised as neutral and objective, but they aren’t. Because the "evidence-based" diagnoses, treatment models, & outcome measure are all man made. It's useful, but incomplete, because the context, culture, or complexity of lived experience is not fully accounted for. What gets measured gets prioritized, but not everything that matters can be measured.

And I find myself thinking about this even more in my work within the U.S. Department of Veterans Affairs. I’m in a six-year contract, which means six years of learning how to navigate this system and “play the game.” With four years still ahead of me, I’ve been sitting more intentionally with what that phrase actually means.

Because the truth is, working in a system where I don’t always feel like I belong has forced me to learn how to move within it.

Sometimes that looks like using the language of the system to advocate for what a client truly needs. Sometimes it means being mindful of how I’m perceived, because likability can shape access, trust, and opportunity.

And if I’m honest that doesn’t always feel good to admit. But I learned early, navigating spaces that weren’t built with me in mind, that “playing the game” isn’t always about being inauthentic. Sometimes it’s about learning how to move within the system without losing sight of why you entered it or felt called to it in the first place.

Still, there’s a quiet tension that comes with practicing care in these environments. Moments where care starts to feel like performance. Where I catch myself wondering if I’m reducing someone’s story into something more digestible, something quicker to write to meet note quotas. Where I’m more aware of the 45-minute session mark than the depth of what’s unfolding in the room.

And without intentional, ethical grounding, that tension can become draining. Not because of the people I serve but because of the systems surrounding the work. And the reality that, for many of us, this work is also tied to livelihood, stability, and the need to sustain ourselves in an unpredictable economy.

So where do we stand? Is it really as simple as conforming or resisting? Where do we adapt and where do we refuse? What does integrity look like in spaces that weren’t built with us (or our clients) in mind? And how do we continue to practice care without turning it into just another metric?

I don’t think there’s a clean answer. But I do think these are question worth pondering on.