A competent human service professional is a lifelong learner

Since first entering the field of psychiatry, I have had two abiding interests: group therapy and existential therapy.

Yalom, Irvin. The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients . HarperCollins. Kindle Edition. 

Like Dr. Yalom from the earliest years of my career I was very interested in and practiced group therapy and what he calls existential therapy. Then in the 80s I had the good fortune to become trained as a family therapist and in the 90s I learned Solution Focused Brief Therapy and Narrative Therapy.

Throughout my practice I truly have been “eclectic” drawing ideas and models from various models of psychotherapy, but my fundamental understanding of human nature, functioning, and change is based on what is called the bio-psycho-social- spiritual model.

Social Workers are trained to conceptualize human behavior based on the “person in situation” model. The courses we take on human development and behavior are often labeled as “human behavior and social environment” HBSE. There usually are two or three courses. HBSE I, HBSE II, HBSE III.

Understanding human growth and development while helpful is not enough for the practitioner to be a good clinician. The practitioner has to learn how to apply this knowledge developing skills and competencies in working with clients individually, in couples, in families, in communities, in societies, and even multiculturally.

A good Social Work practitioner is always learning from clients, colleagues, scientists, and life. A good Social Worker is a lifelong learner and autodidact. I have always thought of myself, and sometimes refer to myself to others laughingly, as a “scholarly social worker” as I am always reading and studying for fun. I enjoy always learning more about human nature, social systems, and myself.

Whither psychotherapy?

So I worry about psychotherapy—about how it may be deformed by economic pressures and impoverished by radically abbreviated training programs. Nonetheless, I am confident that, in the future, a cohort of therapists coming from a variety of educational disciplines (psychology, counseling, social work, pastoral counseling, clinical philosophy) will continue to pursue rigorous postgraduate training and, even in the crush of HMO reality, will find patients desiring extensive growth and change willing to make an open-ended commitment to therapy.

Yalom, Irvin. The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients . HarperCollins. Kindle Edition. 

Social Workers make up the largest percentage of mental health professionals in the United States at about 60% while psychiatrists make up 10%, clinical psychologists 23%, and psychiatric nurse practitioners about 5%. There also are other groups of licensed mental health professionals in some states such as licensed mental health counselors, and licensed marriage and family therapists.

Increasingly, health insurance reimbursement for psychotherapy has been restricted and made difficult to access. As a married male with nine children I was forced out of private practice because with reimbursement rates from insurance companies for a unit of service so low, and there are only so many hours in the day, revenue did not cover my practice expenses and cost of living. At this point of my life, at age 77, I still practice 3 days per week seeing about 20 clients per week and I am what I call a “gentleman psychotherapist” like a “gentleman farmer” in yesteryear. 

Dr. Yalom is very optimistic about psychotherapy continuing as a profession. In our current climate of telehealth it has devolved into case management and psychoeducational coaching for symptom relief.

To continue, psychotherapy will have to be rebranded as an activity other than a medical service. Psychotherapy is more akin to education and the facilitation of growth and development. Mental health services sold its soul to the devil when it sought health insurance reimbursement as a commodified service targeted to symptom reduction rather than personal growth.

There are other paths to consider such as considering mental health as a public health concern as was the case during the days of the Community Mental Health Model following deinstitutionalization of State Hospitals. This will require a return to deficit financing of agencies such as community mental health centers.

"This is good. I feel so much better."

‘All sorrows can be borne’, the writer Karen Blixen once said, ‘if you put them in a story, or tell a story about them’, and this belief is often thought to lie behind much of the work of psychoanalysis: not just a talking cure but a telling cure.

Green, Kelda. Rethinking Therapeutic Reading: Lessons from Seneca, Montaigne, Wordsworth and George Eliot (Anthem Studies in Bibliotherapy and Well-Being) (p. 7). Anthem Press. Kindle Edition. 

Listening, attentive listening without interruption, is such a rare and healing experience. Being a sounding board, a shoulder to cry on, an empathic presence who becomes what Alice Miller calls "an enlightened witness" is one of the most difficult and significant activities of helping. Edwin Friedman calls this kind of listening the activity of providing "a non anxious" presence.

Suffering shared is reduced in intensity and creates a perspective of of increased objectivity so that it can be managed.

After this kind of listening I will sometimes ask, "What do you call it?" or "What do you make of all this?" or "What is the moral of the story, the lesson to be learned." We discuss this for a while struggling to find a name for the causes of the suffering. I often point out, "If you can't name it, you can't manage it. Naming it is 90% of getting on a better track."

Then, I ask, "What more did you want to get out of our meeting" and the person often says, "This is good. I feel so much better."

Learning objectives in Clinical Supervision

 Daryl Chow has posted a good article on 12/07/22 entitled "The 7 Mistakes of Clinical Supervision."

How many people on this list are interested in this topic? We all have been subject to it and some of us provide it. So what thoughts do you have about it?

The seventh mistake Dr. Chow identifies is "Lack of focus on learning objectives." We all have to do _____number of CEUs to get our licenses renewed so I ask clinicians what topics are they interested in and want to take a CEU in?

As we enter a new year, 2023, I am curious what your learning objectives might be for 2023?

I asked one of my supervisees yesterday and she said she wanted to learn more about "overthinking" and how to help her clients develop more self confidence. We talked about these learning objectives for a whole hour.

I have several learning objectives for 2023. The big ones I have been working on are "estrangement" in family systems, and spiritual intelligence and how this can be assessed and nurtured in our psychotherapeutic work.

What about you?

Iatrogenic consequences of CPS system

Iatrogenic consequences occur as a result of human service provision occasionally. There is an interesting article published in the Washington Post on 12/07/22 about CPS in Massachusetts removing two young children from their parents care over dubious suspicions of physical child abuse. The infant was found to have had a cracked rib found on an x-ray in an emergency department where the mother had taken the child for a fever.

In the article, there is a quote that about 1/3 of American parents will be subject to a child protective investigation. This seems very high to me.

“There are statistics from a couple years ago that estimate that 37 percent of all American children will be subjected to one of these investigations before they turn 18,” Arons says. “That is a huge, kind of mind-boggling number that speaks to the scale of the system.”

Arons’s research into child welfare practices in New York City has led her to believe that a vast, invasive surveillance apparatus is not necessary to keep children safe. “That experience is forced on millions of families around the country every year, and fewer than 20 percent of reports end up being substantiated,” she says.

There is another quote stating that the child investigation process is traumatizing to the parents with long lasting effects.

It is the adults, he says, who are more likely to shoulder a lasting emotional burden.

“With proper support, with a family with access to the resources they need, this should all be in the rear-view mirror on the part of the child in months,” he says. “But the parents — the parents are going to be traumatized. They’re going to be reviewing this episode forever.”

This trauma to parents comes up often in my sessions with parents.

Accusations are common in conflicted divorce situations.

Mental health practitioners are mandated reporters and I have often been involved with clients caught up in the CPS system. It is very rare that I have made a referral to CPS myself. My experience with the competence of the CPS workers varies widely from county to county.

I have learned over the years to be very careful when interacting with representatives of the CPS system. I often find myself advocating for clients as most of the accusations wind up being unfounded. However having one's parenting and family under investigation seriously undermines a parent's confidence, self worth, and status in the community. Support and validation when appropriate can be soul saving.

Mental health professionals are usually respected by the CPS system and have authority to help make decisions about whether a CPS complaint is founded or unfounded. It is the mental health professionals job to advocate for the well being of children, parents, and families.

Clinical Supervision in a substance abuse agency.

 Back in October of 2008 John Bennett, the Director of Outpatient Treatment Services at the Genesee Council on Alcoholism and Substance Abuse in Batavia and Albion NY, and I met to discuss clinical supervision.

Even though it has been 14 years, this interview is still relevant in today's world. I retired from GCASA as Executive Director in 2011 and John became the Executive Director, a position he still holds today.

Take the client where they're at.