The newly impoverished

Susan Mason in her Editorial Notes  in the Fall, 2011 issue of Families in Society journal writes a brief essay on what Social Work has to offer to the newly impoverished. The newly impoverished are the people who have lost their jobs, become chronically unemployed, lost their health insurance, lost their homes, perhaps have had to file for bankruptcy. They have seen their IRAs and 401ks depleted as they have used them up to meet expenses after they reached their limits on their credit cards.

Often times these financial strains lead to marital problems, difficulties maintaining their children's standard of living, and a loss in social status among one's previous professional and community peers.

I see these people in my private practice who are working two and three low paying jobs trying to scrape by and maintain some remnants of their previous standard of living. They are experiencing problems with anxiety, depression, substance abuse, relationship problems and they cannot afford mental health care which would be very helpful in sorting out the stressorss and making adjustments to a life style neither desired nor expected.

Fear runs high in America as the middle class way of life is rapidly disappearing with the concomitant evaporation of the social safety nets. Those who begrudgingly supported policies for the poor and for health care now are caught up with the lack of support which they previously voted against to save "taxes".

I would like to think that the newly impoverished from their suffering would develop a society more compassionate, more loving, more cooperative, more willing to help one's neighbor. How the continued unemployment and rising rates of poverty affect us psychologically and morally will be interesting to observe.

In the meantime those of us in the helping professions have an opportunity to be what Alice Miller calls "enlightened witnesses". People are suffering from social dynamics of their own making. Hopefully, an awareness will arise that things don't have to be this way. If we as a people can overcome our materialism, our greed, our egotistical ways, there can be an abundance for all. The current impoverishment is not necessary, but people will have to raise their consciousnesses and shift their perceptions to what they can share and mutually accomplish together rather than trying to get more for me when it means less for you.

As Mother Theresa said, America is a very poor country spiritually even though we are very rich materially. The suffering we as Social Workers observe and contend with on a daily basis is unnecessary if we influence our social policies and interpersonal supports in more functional ways.

In the meantime, downsize, right size,  and engage in more cooperative living. While we may be materially more poor, we, perhaps, can become spiritually enriched.

Certain Therapies Appear Beneficial in Reducing PTSD Symptoms in Some Trauma Survivors

Prolonged exposure therapy, cognitive therapy, and delayed prolonged exposure therapy, appear to reduce posttraumatic stress disorder symptoms in patients who have experienced a recent traumatic event, according to a report published Online First by Archives of General Psychiatry, one of the JAMA/Archives journals.

For more information click here.

Editor's note: An educated person asked me the other day whether PTSD is a "real thing" or just a scam for ex-G.I.s to get disability from the government.

Yes, it's a real thing. Killing other human beings under the auspices of one's government is not good for one's mental health and spiritual well being. Being a witness or perpetrator to such things creates a hell on the psychic level that few people can adjust to with any degree of peace and love in their mind and hearts.

While medications can help subdue the symptoms, they are not the answer to a basic spiritual problem.

Talk therapies save HMOs and employers money

Referring patients with mental health problems to talking therapies seems to cut their use of healthcare services and the amount of sick leave they take, suggests research published online in the Journal of Epidemiology and Community Health.

For more information click here.

I have known this for years as have other psychotherapists. However, we do not have the marketing budget of the pharmaceutical companies or the HMOs. As numerous studies have shown restricting behavioral health benefits and erecting barriers to service winds up costing the health care system much more money in the long run.

Friedman's theory of differentiated leadership

I love Edwin Friedman and have learned a lot from him in my career. He was a student of Murray Bowen.

Differentiated leadership is a key concept in healthy organizations. I am struggling with idea currently in my church which is newly formed in the last 3 years and which is going through some growing pains.

I will fill you in more on my experience later.

Mother's suicide gives Psychiatrist purpose in her profession

There is an interesting article in the May 21, 2010 issue of Psychiatric News about psychiatrist Nancy Rappaport whose mother killed herself when Nancy was 4 years old.

Here is a snippet from the article:

A child and adolescent psychiatrist transforms a quest to understand her mother's untimely death into a tool to educate others about the impact of suicide on those left behind.

When she was 4 years old, according to family lore, Nancy Rappaport, M.D., was the last person to see her mother alive.

You can read the whole article by clicking here.

I have known several of my mental health colleagues who have killed themselves. Over my 43 years, I can think of 5 or 6.

I also worked as a Psychiatric Assignment Officer in three urban hospital emergency rooms for 18 years from 1972 to 1990. I estimate that I did over 14,000 suicide evaluations during that time. I learned some interesting things from all those years of engaging in that kind of practice. I will share the lessons later.

At the moment, take care of yourself and seek out good supervision to keep yourself mentally balanced and enjoying The Work.

Quote of the day - Emotional labor

I am reading Dr. Sanda Bloom and Brian Farragher's new book, Destroying Sanctuary:The Crisis in Human Service Delivery Systems, New York: Oxford University Press, 2011.

Here is their dedication:

"This book is dedicated to the administrators, managers, direct and indirect care staff in our healthcare, mental health, and social services who, every day, are willing to take on the emotional labor of doing whatever they can do to relieve the suffering of those in their care."

Throughout my career I have been so blessed and at time appalled by the behavior of the co-workers with whom I have worked. Human service work is extremely demanding and undervalued by our society. Those who would serve stimatized populations often share in the stigma themselves. They usually are poorly paid, with long hours, and under very oppressive and judgmental circumstances. Highly over regulated and poorly reimbursed by policy makers and managers who often have never done the work, or left it because they were not well suited for it and decided that an administrative career was less stressful and more rewarding than providing clinical service.

I myself have followed a parallel path continuing to do clinical work while moving up the ranks of supervisor, Program Director, Deputy Director, and Executive Director. I still do clinical work because it is my first love and it keeps me grounded as go about designing and evaluating and obtaining resources for service delivery systems at a management level.

Many of the clients we serve "...have been exposed to significant adversity usually beginning in childhood. That adversity had changed them, had played a determining role in their cognitive, emotional, behavioral, social, and moral problems.

...

That shift was best captured by one of my colleagues, Joe Foderaro, when he noted that we seemed to have changed the foundational question asked of troubled people, "What's wrong with you?" to the very different question, "What happened to you.?"

Sandra Bloom, M.D., Destroying Sanctuary, p.xv

As servants addressing the emotional needs of distressed clients we deal not only with current symptoms, crises, dysfunction, pain, suffering, but we are seeing the consequences of many years of trauma. The vicarious trauma experienced by the professional witness can be cumulatively burdensome and the organizational support is often lacking as requirements and expectations for productivity, paperwork, regulatory compliance, and competence exceeding knowledge and skills can be ennervating and toxic without understanding and support of enlightened supervision and management.

I have rarely received this kind of support in my career except for one period in the 80s when for about 4 years I had an excellent supervisor, Dr. Susan McDaniel from whom I not only learned the skills of family systems therapy, but the lesson "Dave, if you're not having fun, you're not doing it right."

Her statement has stayed with me for almost 30 years and I will share the story of its delivery later on.

Being gay and what it means for Social Work

Take the client where they are at

Poverty getting worse and more people eligible for food stamps

(Effective October 1, 2011 through September 30, 2012)

Click here for worksheet.

After you take the allowable deductions see whether you are eligible.

Empire Justice Center’s Food Stamp Budget Worksheet for New York State

Click on image to enlarge for easier reading.

I want to be a Social Worker like Dr. Shulman when I grow up

Living Proof, the Social Work podcast, produced by the University of Buffalo, School of Social Work, had an excellent program on August 25, 2011 with Dr. Lawrence Shulman on Mutual Aid groups. Along the way, Dr. Shulman discusses a number of other topics which are well worth noting.

From the Living Proof web site:

Episode 78 - Dr. Lawrence Shulman: Leading Mutual Aid Support Groups: Exactly How Can People with the Same Problems Help Each Other?

Monday, August 22, 2011, 9:26:34 AM

It's our third anniversary, and in this special episode Dr. Lawrence Shulman returns to our series to discuss his research and experience with Mutual Aid groups and group practice. Dr. Shulman's extensive research and experience are complemented by numerous examples that illustrate his points and practical recommendations for effective mutual aid group leadership. Seasoned professionals and those just getting started in group work will find a useful framework and concrete ideas from a leader in the field.

I first fell in love with Dr. Shulman when I was teaching a course on Social Work Methods at SUNY Brockport in their BSW program as an adjunct instructor and Dr. Shulman's textbook was used for that course. It's one of the few times in my life that I have made a fan call to someone I admired. I never did talk with him but I left a message on his voice mail telling him how much I loved his book and admired and appreciated his work.

Listening to this podcast brought back all those positive members of appreciation, pride, and admiration. I kiddingly can say, I want to be a Social Worker just like Dr. Shulman when I grow up. I have never met the man but I learned a tremendous amount from him.

I highly recomment the podcast to you which you can access by clicking here.

Zoloft and Lexapro are best antidepressants

According to a recent meta-analysis on the efficacy of antidepressants published in the early online publication of Lancet on January 29, 2009, the best antidepressants are Zoloft and Lexapro.

You can read the abstract by clicking here.



I pass this information on to my clients who might benefit from an antidepressant on a regular basis. I suggest Citalopram (Celexa), the earlier form of Lexapro, because you can get it in a generic and it is cheap, about $4.00 for 30, 20mg., pills at Walmart.

Antidepressants don't work, by the way, much better than a placebo which helps about 30% of patients. If clients ask me about antidepressants I usually ask "What have you heard? Do you think they will help?" and go from there. If the client thinks they will help, they very well might help. If not from the psychopharmacological effect, then from the psychological hope and expectancy.

I want to be clear, I am not giving medical advice here. I am only providing information, and my clinical observations from my practice, and what I have read in journals, reports, etc.

I, myself, take 20mg. of Citalopram per day and find it helpful in a subtle way. Whether it is biochemical or psychological I am not sure, but I believe it helps me. Having said this, many studies have shown that over all psychotherapy is a more effective treatment for depression than psychotropic drugs. This advocacy for psychotherapy is heresy in this day in age when pharmaceutical companies are pushing their drugs and physicians hand out samples to their patients hoping for a quick and easy "biochemical" fix, but pyschotherapy gets better outfcomes according to the best outcome research findings available.

Custodial cf. therapeutic residential care

I love "Living Proof" the podcast series from the University of Buffalo School Of Social Work. They distribute a podcast every two week on Social Work topics and they are excellent. The podcast published on August 8 and September 5, 2011 involved Dr. Nancy Smyth interviewing Brian Farragher about the Sanctuary Model in his agency, the Andrus Children's Center,  in Yonkers, NY.

 

My first year internship during my graduate Social Work study at SUNY Albany, NY, was at VanderHeyden Hall in Troy, NY in the fall and spring of 1970 - 1971.



Over the course of my career I have seen residential services move from custodial care to therapeutic community models. I did a term paper in graduate school on the difference between custodial care models of residential services and therapeutic community models of residential services. There are important differences. Rudolp Moos and other social psychologists and sociologists studied and wrote extensively on this topic in the 60s, 70s, and 80s. These ideas have lost traction as the biochemical brain science models and evidenced based practice have moved to the forefront. However with the Sanctuary model attention is turning back to the social dynamics of residential care settings as being important therapeutic experiences to help people learn better self management and interpersonal skills to improve psychological and social functioning in their later life.

Welcome

I started my career in Social Work at Kings Park State Hospital in Kings Park, NY. on the north shore of Long Island on October 31, 1968 as a Psychiatric Social Work Trainee II. This October 31, 2011 I will have completed my 43rd year of practice in the Social Work field.

I am retiring from my main job as an Executive Director of a Substance Abuse agency in Western NY on 12/23/11. I turn 66 on 12/25/11. I will continue in my private practice in Brockport, NY where I have providing Psychotherapy since 1985.

I have taught as an Adjunct Professor at three colleges in Social Work, Health Science, and Psychology. I also have done numerous workshops and trainings and prepared agencies for the JCHCO and New York State OMH and OASAS certifications.

My ex wife and I had 9 children so always worked 3 sometimes four jobs to pay the bills and keep food on the table.

I have been blogging for several years and find it intellectually stimulating and generative. I love comments and feedback.

I will be posted on a number of areas of practice both micro and macro as well as advocacy on Social Justice issues, values, ethics, management, history, and probably a potpourri of other issues.

I am irreverent, passionate about "the work" and every year I have practiced I have become more humbled, appreciative, and grateful for our wonderful profession. If I can give back in the way of support, encouragement, inspiration, insight, knowledge, practice wisdom, etc. I sincerely want to do that out of gratitude and hope for the upcoming generations of Social Workers.