My Social Work Friend… Whose Needs Are You Meeting?

Written by: Cindi J. Jeffrey, LMHP, LISW

Idealism in Social Work

I found a paper I had written for my undergraduate social work degree. In it, I alluded to the fact that I wanted to change the world. My idealism was prolific throughout the paper; however, my vision of how I fit into the world may have been a tad skewed.

Interestingly, I am not the same professional in social work when I began this journey many decades ago. Furthermore, I am not the same person. Personal experiences, professional encounters, and traumatic cases have provided me with a new outlook on how I view our profession. Looking back at the time that paper was written is almost embarrassing. I wonder if I truly helped my clients or rendered them dependent upon me.

Social Work Goals

As a social worker, I have always made it a point to be more personable and open. I worked hard to break the stereotypical vision that most people appeared to have of the white-gloved woman going through your house and looking for things you have done wrong. I focused on what was going right, and after I earned some trust, we could go into what was not working so well.

There is a fine line between enabling and empowering our clients, and that line is often drawn in the sand. Additionally, that line appears to be constantly moving and redrawn. As a young social worker, my goal was to “fix” everyone and every situation I encountered. I did not want anyone to suffer, nor did I feel accomplished unless a problem was solved. Only once the issue was taken care of was I comfortable leaving the people involved.

Enabling or Empowering?

As the years progressed, I gained more experience, and I learned how damaging enabling a client could be. While those identified problems may have been taken care of in the short term, the client learned no skills during that process. Once I was removed from the case, the same issues were likely to return, leaving the client in the same situation as when I entered.

Listen, I get it. It feels good to help. It feels good to be needed. However, when we solve every problem for our client, we meet our needs, not theirs. The client may be grateful and express themselves as such, but who did we actually help? Whose needs did we fulfill?

In social work, our jobs can be diverse. Many of us went into the field due to our personal experiences and are very good at what we do. At some point in our career, there must be a defining moment to see the clarity of our responsibilities. If we continuously enable our clients, we are not working for them; we are working to meet our own needs.

Check Yourself as a Social Worker

It is our responsibility to draw that line in the sand. We are social work professionals. We need to meet the needs of a client, not meet our own needs. It is our job to continuously monitor ourselves so we can meet the needs of our clients. It is our job to empower our clients in order not to need us anymore. Moreover, do not forget to take care of yourself, my friend.

About the Author

With over 25 years of Child Welfare experience, Cindi brings a well rounded approach to individual and couples therapy. Understanding how the family influences one’s perspectives can enhance a person’s ability to see themselves and others through their unique lenses. Recently, Cindi has been providing therapeutic interventions for seniors in nursing facilities, focusing more on adjustment disorders, end of life, and chronic illness issues. In her spare time, Cindi enjoys biking, walking and reading.

Cindi J. Jeffrey, LMHP, LISW

Changing The Conversation

For some, there’s a negative stigma surrounding the word ‘therapy’ that can serve as a major deterrent from seeking help. Many may feel disappointed in themselves or judged by loved ones. Some even grapple with feelings of guilt or worthlessness after recognizing the need for therapy. As a clinician, do you seem to find yourself looking for effective ways to normalize getting help for your clients? 

The negative feelings a person may have regarding therapy can stem from any number of past or current experiences. Consequently, there is no one recommendation that will help you remove the stigma for each patient – but a varied approach could help address and normalize these issues. 

Ask Your Clients About Therapy Sessions

It is natural to focus on the immediate matter at hand during therapy sessions, whatever the reason may be. However, it is also important to ask clients about their thoughts on why they are seeking help and how they went about it. Some may share their feelings about being in therapy or how others have reacted to the information. This may be important to understand their immediate attitude and how you can help break the stigma surrounding seeking care.

Break the “Crazy” Myth

Research from Bradley University points out that the stigma surrounding therapy is directly correlated with society’s view of mental health. It confirms that these stereotypes reduce the likelihood of people seeking help and also hinder the healing process. Those who seek help often struggle with personal feelings or external bullying that paints a picture of the “crazy” person needing treatment. An open mind is essential to getting better, and sometimes professionals have to help their clients get to that point. Anyone can benefit from therapy – no matter what their background is.

Teach Coping Mechanisms

Professional behavioral health services can help people overcome some of the most devastating trials in their lives, one of the many reasons why it’s so valuable. However, if your client does not know how to cope with the adverse reactions to therapy from others, they may begin to see therapy as part of the problem. Prepare them for potential negative reactions from family and friends and equip them with the coping mechanisms necessary to tackle this. Then, return to the issue at hand.

Consider Group Therapy

Research done by Bradley University believes that clients may feel less awkward about therapy once they realize how many other people from all walks of life rely on it. Occasional group therapy sessions may help make this possible. If you do not personally host group therapy sessions, you may recommend local community outreach programs instead.

Be Mindful of Word Usage

Sometimes, how clients feel about therapy comes from subconscious reactions to specific words. For instance, if someone already thinks they are ‘crazy’ for seeking help, terms like ‘patient’ and ‘suffer from’ may not help break this mindset. Research  confirms that these terms and others like them often have negative connotations that may also dehumanize the individual. It also recommends reconsidering the phrasing of diagnoses. For instance, it is better to say “someone who has schizophrenia” instead of labeling an individual as “a schizophrenic.”

Encourage Daily Sessions

The more often someone engages in a particular activity, the more desensitized to it they become. Your client may not have the means or time to meet with you several times per week. However, there are other things they can make personal time for each day. The regular addressing of mental health may help to desensitize the negative feelings that accompany therapy sessions. These are some tasks to consider assigning for personal me-time sessions such as journaling daily, keeping a gratitude journal, and doing daily meditations.

Take Varied Approaches

As mentioned earlier, the reasons behind the stigma people internalize may differ. Take time to understand the problem and the client before deciding how you will address the issue. In some cases, you may find it is better not to address the issue at all or not in the beginning. There are many instances of clients starting sessions enthusiastically and only running into negative perceptions from others after the fact. In some cases, they may never experience this negativity at all. Being the first to bring up the potential stigma to prepare patients before it happens may do more harm than good.

Regardless of how you think your client should treat therapy, they will have their boundaries in place. Strike a balance between guiding them in the right direction and respecting their existing boundaries. 

The Bottom Line

One of the biggest mistakes behavioral health professionals make is to wait until the beginning of sessions to advocate for clients. The work begins outside of the office. It starts with family, friends, and even other colleagues. Educating the general public can help reduce the likelihood of negative reactions for others. There are more people in therapy than ever before. Millennials have been credited with spearheading this development. This trend signals that the stigma is lifting, making it easier for you to normalize therapy. Having a stable platform to depend on for strong referrals can further help build trust in behavioral health services as part of a standard, holistic treatment. Start your free trial on TPN.Health to access more trusted referrals today.

Lessons From My Mentors

Written by Brandy Price Klingman, LCSWBACS

In my career thus far, I’ve been blessed to have some great mentors, supervisors, and colleagues. These leaders have helped shape me into who I am today through their generosity and knowledge of wisdom. In the spirit of sharing the wealth, here are my favorite tips for new or developing therapists that I have learned from many mentors and supervisors (P.S. I’m naming these great masters to honor them.)

1. Strangers on a Train

An early tip from a great mentor came from my internship’s first supervisor, Butch Robicheaux, LCSW, BACS. I was excited to be interning at this site and had prepared a beautiful binder full of handouts for my clients, covering every topic from coping skills to grief and loss. 

I asked him, “What should I do before going into my first individual session?” He looked at my color-coded binder and was kind enough to say, “That’s very nice, but you won’t need that. You will have a conversation in this session. You will speak to this person with sincere curiosity and compassion like a stranger on a train. You don’t need to have anything wise to say because the connection is good enough to start the relationship. You won’t connect with a handout from that binder.” 

I often reflect on this “strangers on a train” guidance and smile because I’ve now made my career off of this simple piece of advice. The importance of a connection that comes from the simplest of conversations filled with compassion and curiosity can change the session’s dynamics from ‘therapist driven’ to the ‘client here and now.’ It’s helpful because there are so many problems a client could bring into a session that are out of anyone’s control, and I could never create enough handouts for all those stressors. But, I can always go back to the idea of a conversation with a stranger on a train.

2. Crisis Is Contagious, So Prepare Yourself

One of my first jobs required me to provide psychotherapy to groups of 10-12 people in a partial hospitalization program. I loved this work. I enjoyed and feared these groups. Often these settings had many personalities and a shared struggle of emotion regulation. The job was simple in my mind – find the problem with all the clients, and fix it. 

But the issue was complicated because there was always a crisis. Luckily, I’m good at crisis management, and during this time, I considered myself a professional firefighter (always looking for small fires to put out, as I was feeling better and better about my skill set). However, I was exhausted at the end of the day, week, or month, and I knew I would quickly be spent by the end of my career. This must be what they taught us in school about burning out. I understood at this point. 

When I discussed this with my clinical supervisor Karen Travis, LCSW, BACS, CGP (even more letters behind her name), I told her how well I was managing these crises, and she asked me how I felt. I described myself as tired, overwhelmed, and anxious. She then told me, “Crisis is contagious girl, and you are catching it.” She discussed the importance of understanding the client’s crisis separate from the therapist’s. She reviewed the importance of not meeting their situation with my crisis of “managing,” “fixing,” or “resolving.” She taught me how to help them explore their concern and process their feelings around it. 

Karen also told me the importance of allowing them to sit in the crisis until they were ready to move on. I will forever hear her voice when I think of rescuing my clients in crisis. I now even reposition myself the same way she did when I notice this happening in a session (very relaxed, arms casual on the chair, shoulders back and low, and voice soft, calm and confident). I’m grateful for this lesson as a professional and as a person. It turns out to be great advice for parenting, too!

 3. Permission to Feel in the Session

In school, I had a professor, Sherry Smelley, LCSW, who taught a Grief and Dying Class. The class was particularly difficult for me to remain in my cerebral safety zone due to all of the presenters’ vulnerability in sharing their experiences of grief or loss. At one point, I remember a speaker sharing something so sad, the entire class (including me) became tearful. When I asked my professor, “How are we supposed to hear these kinds of stories and not feel too much?” She smiled and said, “Well, honey, you are supposed to feel…you are human. It’s what you do with these feelings that’s important. You’re permitted and even encouraged to feel in these sessions.” She said this with a soft, buttery voice and a southern accent that reminded me of my grandmother. 

Permission to feel is vital in our daily work. It is our job in individual therapy to serve our clients in the ways they need, and one of those is by checking in with our feelings, thoughts, and judgments as a barometer of the room and the world concerning them. Our emotions are important and helpful in figuring out ways to serve our patients best to achieve their goals. 

This advice is incredibly useful these days due to the overwhelming stressors of current times. I encourage my staff to be mindful of their stress, grief, worry, fear, anger, etc. as they walk into a session. This personal awareness improves their ability to connect to the client in the here and now. 

As I write this, I am mindful of so many things my early mentors and supervisors have taught me – I could go on and on. For now, I will stop here, flooded with gratitude for so many great lessons from the masters who took the time to reach out to me. #blessed

About the Author

Brandy Klingman, LCSW-BACS

Brandy Klingman, LCSW-BACS, is a skilled psychotherapist with a small private practice, as well as an owner and operator for mental health and addiction clinics. Her mission is to improve behavioral health standards of care and decrease barriers to accessibility for all. She does this through direct patient care, professional supervision, academic/university affiliations, professional consultations, public speaking, business development, and legislative advocacy. She is a coveted speaker in professional workshops, academic settings, and trainings.

Who Are The Trusted Providers On Our Network?

As a behavioral health professional, it’s known that life challenges may make it difficult for people to cope without seeking help. Patients start asking, “Where can I find a behavioral health provider?” However, clients may not know about all the different types of resources available. They may understand that to be a behavioral health professional, you have completed some training in a field related to psychology, but they may not understand the various education and training levels required for specific credentials and the high degree of specialization involved. In this blog, we will go in-depth about the multiple licensed professionals our subscriber directory consists of; as there are many fine distinctions among the various practice areas that may help you to refer the patient to the right professional.

This information varies from state to state

Counselors

These professionals have at least a master’s degree in psychology or related fields, such as family counseling. Their specific training allows them to evaluate a person’s mental health and apply therapeutic techniques to help with addiction, job issues, conflicts in families, general stress, etc. If you have a client who is grappling with a particular problem, such as addiction, you may have to refer them to a counselor with specific training addressing that particular problem.

Psychologists

Psychologists need to have licenses and training in clinical psychology; psychology is a pretty broad field and only certain training paths can do therapy. Psychologists don’t go to medical school, but receive their advanced degrees in different psychology or counseling programs. If you have a client struggling with problematic thoughts/behaviors or having difficulty coping with stressors, it may be beneficial for them to see a psychologist who takes a specific approach. For example, dialectical behavioral therapy and cognitive behavioral therapy are mainly designed to teach coping skills and help clients change problematic behaviors and thoughts.  Child psychology is different from that of adults. If you have a pediatric client, it may be helpful to find a psychologist with specific training in dealing with this age group, whether in education or counseling.

Psychiatrists

If you have a client whose issues seem to stem from an underlying medical problem or whom you believe would benefit from a psychiatric evaluation, you may need to refer them to a psychiatrist. A psychiatrist starts by going to medical school to earn an M.D. or D.O. degree. To become a psychiatrist, the newly minted medical doctor has to undergo additional training in the specific field of psychiatry.

Like psychologists and counselors, psychiatrists may complete additional training to treat specific types of patients primarily. For example, some psychiatrists specialize in treating conditions in patients of a particular age, such as the elderly or children and adolescents. Psychiatrists can provide the same types of services that psychologists and counselors do related to diagnosing, assessing, and treating mental health disorders. However, because they also have medical degrees, psychiatrists can also prescribe medication to patients, which most behavioral health professionals cannot. The ability to prescribe medication can be incredibly helpful in treating patients with substance use disorders. A psychiatrist may provide medication-assisted treatment programs for addiction that combine FDA-approved medications that block the effects of illicit drugs with behavioral therapy and counseling, taking a whole-patient approach.

Nurse Practitioners

A nurse practitioner has undergone advanced nurses’ training and is licensed to provide general health care services. Working under the supervision of a medical doctor, a nurse practitioner has the authority to examine patients, make diagnoses, and prescribe medication. A Psychiatric Mental Health Nurse Practitioner receives training specific to the practice of mental health. Like nurse practitioners in other specialties, a PMHNP works under a doctor’s supervision, in this case, a psychiatrist.

Social Workers

Social workers are trained to help people cope with challenges in every stage of their life such as child abuse or neglect, domestic violence, unemployment, housing situations, etc. A licensed social worker focuses on clinical skills and developing relationships with clients while operating under an agency’s authority to deliver intervention.Further education and supervision can grant a licensed social worker with the qualification of a clinically qualified social worker (LCSW). These professionals work in a wide variety of settings to provide emotional support, mental health evaluations, therapy and case management services to people experiencing psychological, emotional, medical, social and/or familial challenges. Their scope mirrors an LPC and can individually practice.

A measure of overlap between the services provided by different behavioral health professionals may be confusing to clients. When patients seek help, clinicians have a responsibility to assist. Fortunately, when you subscribe to Trusted Provider Network, you gain access to resources that aid referrals to reputable and trustworthy behavioral health providers in multiple specialties.

The Dual Role of Faith in Gambling Disorder

Written by: Ramon Zelaya, LPC-S

The addiction treatment field is often rich with broad and diverse themes, often containing hidden meaning waiting to be discovered by the perceptive clinician. One such theme – faith – often intersects with the wisdom touted by the 12-step recovery tradition and emerges frequently throughout the treatment and recovery process.  Faith, I have found, plays a dual role in the world of disordered gambling: it is the manner by which gamblers remain bound to their gambling habit, yet it is also a means by which they may escape their bonds.

For many disordered gamblers, a key component of their inability to stop or control gambling behavior is a misplaced faith in the outcome of the bet. More accurately, it is their perceived outcome that becomes problematic, a “cognitive distortion” that is self-reinforcing and difficult to challenge. Each bet is an attempt to resolve problems that result from previous, failed bets: financial losses, strained relationships, emotional consequences, etc.

These problems accumulate as gambling inevitably yields more losses than wins. Yet the gambler infuses each attempt with hope: hope of breaking even; hope of making a fortune; hope for a better life, a mended marriage, or relief from the pain of every loss experienced thus far. The gambler keeps following the same path hoping that everything will get better, that everything will be okay again. They persist despite all of the physical evidence suggesting that continued gambling is a bad idea, and everyone’s insistence that they are doing the wrong thing. They continue to hold onto real, albeit misguided, faith.

The profound wisdom of the serenity prayer offers a solution to the problem of misguided faith. It calls the individual to find and employ the strength to change for the better all things within their locus of control. In therapy, the cultivation of autonomy, self-efficacy, and positive self-regard leads to a new type of faith for the disordered gambler: faith in oneself. The goal here is for the individual to learn how to take responsibility where responsibility is due, and to make active efforts toward recovery and personal growth.

Additionally, the serenity prayer guides the individual to seek acceptance, challenging them to become comfortable with the experience of powerlessness in affecting certain outcomes. In this regard, faith must be held in the providence of the individual’s higher power, as they understand it. With an addiction wherein so much is left to chance, it is ironic that disordered gamblers have such difficulty letting go of their attempts to control. Nonetheless, letting go is crucial to recovery, and inherently requires faith.

As treatment providers, we often tell our clients to “have faith in the process” of therapy and recovery. I would ask all who read this to pause for a moment and consider the depth of that statement. For many whom we treat, we are asking for a monumental shift: to relinquish faith in a substance or behavior and gain faith in us, in recovery, and in themselves. This is not a step to be taken lightly, and should be approached with as much care and compassion as we can muster.

About the Author

Ramon Zelaya, LPC-S

Born and raised in New Orleans, Ramon began studying psychology during his senior year of high school. Never deviating from the subject, he completed a BA in Psychology from Loyola University and an MA in Counseling Psychology from Lewis and Clark College (Portland, OR). Ramon has been working steadily in the mental health field since 2003 in various settings: inpatient, outpatient, university, and private practice. Over the years he also culminated an interest in and knack for technology, pursuing ways to enhance therapeutic practice with state-of-the-art solutions. This pursuit brought Ramon to TPN Health where he accepted the position of Clinical Outreach Liaison, then moving on to become Clinical Outreach Director. Ramon hopes to continue his contribution to the clinical community by helping others discover new dimensions of practice through the TPN Health platform.

Self-Care When You Still Can’t Touch Other People

For many of us, it has been slightly over two months since social distancing went into effect on a collective scale. Still for some, it has been even longer. With COVID-19 still in the air, it is possible many will still be living socially distant lives, at least to some degree, through the summer season. The coming of summer, under normal circumstances, is flavored with travel plans, pool days, parties, and other activities that a pandemic-tinted world does not allow for. Even as many businesses and public areas re-open, the future of large-scale social activities and the intimacies of casual interchanges are still largely uncertain. While no one can detail exactly what living in a semi-post-pandemic world looks like long-term, or even short-term, people can continue to cultivate new ways of caring for themselves and their relationships. 

If you are among the 11% of people living alone in the United States, you know what it is like to be without the pros and cons of partners, housemates, or family in your living space (Duffin, 2019). However, living without the back-and-forth of casual domestic interchange coupled with a lack of social activity outside the home can breed poignant loneliness. Even if you enjoy your alone time, at some point everyone needs the regulation that comes from emotional and physical connection with other humans. Although communication technology can help to supplement the need for emotional connection, the lack of platonic physical touch can certainly take its toll. 

A recent Texas Medical Center article responding to COVID-19 outlines the effect of touch-starvation, a condition that occurs when humans want to experience touch but are not able to do so, in this case, because of the fear of spreading COVID-19. As touch regulates the nervous system, going without touch for a long time can cause the body to release the stress hormone cortisol, ultimately exacerbating other mental health challenges and increasing susceptibility to physical illness (Pierce, 2020). 

The good news is there are ways you can attend to the mental health deficits created by a lack of physical contact from other humans. One way is to warm up your Zoom calls. Increasing physical warmth is known to have positive effects on a person’s experience of interpersonal warmth. For instance, one 2008 study exploring the relationship between warmth as a personality trait and temperature found that participants who held a hot cup of coffee perceived the qualities of care and generosity in others more so than participants who were holding a cup of iced coffee (Williams & Bargh, 2008). Similarly, it was found in a second trail of the study that participants were more likely to complete generous acts themselves if they held a therapeutic hot pad than if they held a cold pad (Williams & Bargh, 2008). Now, imagine incorporating something warm to enrich your video chat experience. Perhaps the summer is not the best time for additional heat, so perhaps try this activity on a day when you want to crank up your AC an extra notch. After all, these times call for creative measures!

Another way to expand your options for physical touch alternatives is to create pleasurable sensory experiences. Even with social distancing in effect, there are still so many ways you can get creative by engaging the senses, perhaps more mindfully and gratefully than you did before the pandemic times. With our capacity for sight, touch, sound, taste, and smell, the options are truly limitless if you put your thinking cap on and dig up a few household items. For instance, research shows that touching different textures can produce different emotional states with soft textures generally yielding more positive feelings. And of course, you can use the material that is the most available of all—your own skin! One recent Healthline article offers several ways to incorporate self-touch into your self-care routine, including noticing where touch feels the most restorative, incorporating it into a body-scan meditation, and gentle self-massage where there is bodily tension. The practice of self-touch is also beneficial to care in the context of relationships with other people. As you become more aware of what touch feels good, you can then practice communicating this to partners, family, and friends, that is, when you can touch these people again. 

TPN.Health is grateful for the behavioral health professionals and providers that create this trusted digital community. Click here to create your TPN.Health clinical profile and receive all the membership benefits–building a digital referral network, CEU access, and participation in live panel discussions!

References:

Duffin, E. (2019, November 22). Single-person households United States 2019. Retrieved May 29, 2020, from https://www.statista.com/statistics/242022/number-of-single-person-households-in-the-us/

Pierce, S. (2020, May 15). Touch starvation is a consequence of COVID-19’s physical distancing. Retrieved May 29, 2020, from https://www.tmc.edu/news/2020/05/touch-starvation/

Williams, L. E., & Bargh, J. A. (2008). Experiencing Physical Warmth Promotes Interpersonal Warmth. Science, 322(5901), 606-607. doi:10.1126/science.1162548

Image Credit: https://medium.com/@m.fabienne.lang/if-you-do-one-thing-today-hug-yourself-3a03ac44a03c