Why Mental Health is Bad for My…Mental Health

12 04 2012

When ACS refers a case to us, there are certain things they want done. (Most often, these are things we don’t do. But that’s for another blog…) A lot of times, it’s counseling for domestic violence, sexual abuse, or substance use. These don’t apply to everyone. But one thing is constant. Everyone in the family–parents, kids, household pets–should have a psychiatric evaluation.

I’m rarely against an evaluation. It can’t hurt, right? Well, I guess anything can hurt, but the professional would have to be a real idiot. Surely there aren’t any of those. I think our kids are overdiagnosed and too often prescribed serious psychiatric meds but evaluations…why not?

There are a few problems, of course. Some parents don’t agree with them, some kids think it means I think they’re crazy. The number one obstacle, though?

Where the fuck are they supposed to get this done?

With the health care debate raging in this backwards ass country, I keep hearing about these “free clinics” that one supposedly trips over on any stroll through the ghetto low-income side of town. They’re doing free well-child visits and tossing out birth control like Gobstoppers at Willy Wonka’s factory.

Unfortunately, they don’t exist. Most of those “free clinics” actually charge Medicaid. You can get urgent care, not ongoing treatment.

This is also true for mental health clinics. In my first months on this job, I thought they were a myth, like Sasquatch, or the G train. But they’re out there. They’re just hard to find. It’s especially hard to find one that takes your insurance. Sure, everyone has Medicaid, but most people also have supplemental insurance. This place takes straight Medicaid, not Health First. This place only takes blah blahdiddy blah…

Most unfortunately, we don’t have mental health staff here at anonymous agency. We’re social workers and case workers, but no doctors. I can do family counseling, play therapy, which is all good stuff, but I can’t prescribe Ritalin. No matter how much I may try. This means that we have to refer out.

Until recently, we had a connection with a nearby mental health clinic. They came by when they felt like it to collect our referrals, and our clients were able to get appointments within a couple of months. To be honest, I thought they did supbpar work. But we had to take what we could get.

That relationship was terminated for some reason that hasn’t been explained to any of us because we’re not important. Now, we’re back to the old referral process.

Agency names have been changed for my amusement.

I call Shining Time Mental Health Station to refer a nine year old girl and a thirteen year old boy. Their mother is also to be evaluated, but I don’t mention that at first, as I don’t want to seem greedy. No one answers, so I leave a message. I do this fourteen days in a row, while also leaving messages at Miss Kitty Fantastico Memorial Mental Health Center and St. Mungo’s Center for Nonmagical Mental Maladies. No one will answer me, and I start to take it personally. I leave decoy messages, telling the intake worker that she’s won a sweepstakes and needs to call me immediately, or saying that I’m holding her puppy hostage. Nothing. That woman does not care about her imaginary millions, or her puppy.

At some point, I give up on St. Mungo’s, because they don’t take this family’s supplemental insurance. Miss Kitty Fantastico is no longer seeing children. That leaves me with one in their area. Oh god.

Finally a coworker sees me sobbing into the phone, and mentions that she has a contact at Shining Time, who might help. I get my hopes up (always a mistake) and call. Of course, this person is a domestic violence specialist only. Could you encourage their dad to stop by and rough up the mom? OK, in that case I can’t help you. Let me transfer you to our intake worker.

NOOOOOO!!!

Next, I try the child study center at St. Anastasia Beaverhausen Hospital. I call their general intake number, and am given the option to press one for the diabetes program, two for women’s health, three for dental, all the way to nine for foot problems, but no child study center.I start cursing into the phone, hoping that this will cause them to connect me with a real person (it works with FedEx) but all this gets me is some looks from my coworkers.  I hit zero for all other calls, and am told that my call is very important to them, but there are six other callers ahead of me. After an hour, I begin to doubt the importance of my call. Someone answers. I ask for the child study center. She transfers me to the foot center. I ask for the child study center. Foot lady transfers me back to the lady who transferred me to her. I finally get the child study center after three more rounds, only to be told that they aren’t accepting new clients for five months. Can’t I put my kids’ names down now, that way in five months they can have an appointment? No, it doesn’t work that way, because we say so. Oh.

While I’m chasing my tail, there are children who need help and aren’t getting it. Counseling, play and art therapy, are crucially important to their well being, and I do that. But when there are things like PTSD, ADHD, bipolar disorder, or a family history of schizophrenia going on, they need to see a doctor.

People in need can always walk into the ER. We always hear this from people who don’t want to pay for our frivolous health care, and it’s true. They can walk in, sit down, and wait for hours. Wait, and wait, and wait. Often they choose to leave. Generally, if they aren’t actively suicidal, they don’t get to stay. I once got frustrated enough that I asked a mobile crisis worker if I should wait to call back when my (pregnant, schizophrenic, drug abusing, cutting, but not presently suicidal) client was setting herself on fire.

In retrospect, that was too far. This is not how we get what we want.

If a client is admitted, they’re often transferred to a different hospital, particularly if they’re a child. Depending on insurance, this can take forever. Not literally, but just about. There’s a sort of time suspending limbo you enter when you walk into an ER.

One of my teen girls who had attempted suicide more than once wound up being sent to a notoriously unpleasant (to say the least ) psych hospital in Brooklyn. They had an available bed and would accept her despite not having insurance. Her mother was afraid to send her there, and didn’t want her to be two and a half hours away, but she did it because she had no other choice.

I don’t think I need to point out the irony that the mental health system in the Bronx has driven me a bit insane. I’m glad I get to absorb this frustration for the parents I work with, honestly, because I can’t imagine that they could do this on their own while also worrying about everything else going on in their lives. But it’s infuriating to see how difficult it is to get someone help. Are they a danger to themselves or others? Yes, but not enough of a danger. Come back when something tragic happens, so we can all blame the parents for not having done enough.

We are tragically failing our people in need when the only way to get (temporary, kinda-ok) treatment is to be brought in slitting your wrists.

I wish I could end this by offering a solution. All I can say is that we need more, and we need better. Prevention is almost always the answer, says the preventive worker. Maybe if some of those earlier evaluations and mental health treatment could happen, we’d be taking fewer trips to the ER.

But what do I know.





Don’t read this, it’s just a cry for help!

6 10 2011

Recently, at a family party, I was talking with someone whose friend was training to work at a suicide hotline. (This is the normal turn for family parties. Right?) Another guest didn’t care too much for the idea.

“That’s for people who don’t really mean it. I know people who wanted to kill themselves, and they’re dead. If you’re calling the hotline, it’s just a cry for help.”

It’s one of those clichés we’ve all heard. “It’s a cry for help” or “He’s only doing it for attention.” Somehow, these two concepts have been conflated in a dangerous fashion. We all know that if someone, say a two year old, is doing something for attention, say, throwing a tantrum, we should ignore it and go get a margarita.

A “cry for help” is not the same thing wanting attention. It’s a recognition that there is something very wrong going on with someone, something that they can’t handle on their own. It’s a way of reaching out for support and intervention. Some people are able to do this in a constructive way, by calling a hotline or going into the hospital. Plenty of people aren’t able to do this, due to their mental health, cognitive abilities, or other reasons.

So they “act out.” We see it with kids all the time. They’re angry about their parents divorce, so they start skipping school. They’re traumatized from being abused, so they start using drugs. Some people are depressed, and untreated, so they start hurting themselves.

Cutting seems to be the fashionable “cry for help” these days. I’m never one to buy into that hysteria that you see featured on the Today show or Dr. Phil about the latest teen trends–you know, they’re all blowing each other in the school cafeteria and having “pill parties.” I don’t know how they even have time for their pregnancy pacts and school shootings!

But self-mutilation does seem to have caught on. My younger cousins keep my finger on the pulse of all things emo, and it has become something of a rite of passage. Not something that people do all the time. But lots of them seem to have tried it. Everyone has moments of feeling depressed, misunderstood, or crazy in high school. Emo kids strive to have as many of those moments as possible, so it kind of makes sense.

I remember first hearing about “cutting” when I was about 13. It was on an episode of 7th Heaven. (I admit to that, because I feel that I’m in a safe space here.) It was one of those “special episodes,” where one of the eighteen kids brings home a new best friend, who serves only to teach a lesson, and is then never heard from again. They discover that she’s cutting herself, talk about the warning signs (“I should’ve known! She was wearing long sleeves out of season, keeping to herself more, and seemed moody!” Who talks like that?) and send her on her way. I thought it was weird, until I read an article in 17 magazine. (Again, we’re not judging.)

Like all kids at that age, I had my times of feeling down and like things would never get better. An idea that otherwise would never have crossed my mind did, and I cut my finger. I found that it hurt, I still felt down, and I didn’t care for the sight of blood. So that was that.

This has now become a concern due to all the media attention given to teen suicides. Obviously the attention is not to blame for making kids feel bullied or depressed. But is it possible that it’s planting an idea, a more effective cry for help?

Honestly, I don’t know. But I am pretty confident that the answer isn’t going after the media for paying attention to these deaths, or their friends for memorializing them. We should probably be playing closer attention to those early warning signs, so that when the kids finally get that attention they’re looking for, it isn’t too late.

A girl I’ve written about in the past, Angelica, was a cutter. Her mother and I twice brought her to the emergency room, for this and other troubling behaviors. Both times, the doctors told us that this was “attention-seeking behavior” and generally wasn’t serious. I explained, as not hysterically as I could, that I understood this, but did that matter when she was slashing up her arms for some unknown reason?

Apparently it didn’t. Until things escalated and she was hospitalized, where the truth about her rape and abuse came out.

Just because it’s a cliché doesn’t mean it’s entirely wrong. It would seem that a lot of people who attempt suicide don’t really want to die. (A rather popular first thought, upon jumping off the Golden Gate Bridge seems to be, “I wish I hadn’t jumped off this bridge.”) They want help. Obviously this doesn’t mean we should let them jump. “But SJ, it’s just a cry for help! Responding to it will only feed their desire for attention!”

Maybe. Maybe not. But if in their quest for attention they’re going to be crushed and swept away in the waves, or accidentally hit an artery and bleed to death as Bullet for my Valentine (thanks emo cousins!) plays in the background, does it really matter? Where does this idea that we should wait for a genuine desire to die come from? We accept the need to early intervention in seemingly everything else (I mean, not in the sense that we should insure for it, but as a concept) but not for depression.

Wanting help, and even wanting attention, are not bad things. We need to stop acting as though they are.





When Good Social Workers Go Bad 2: Revenge of the Wrath

28 04 2011

Working with people always has potential to be frustrating. Especially when those people have mental health issues, developmental disabilities, substance abuse problems, histories of abuse and neglect, two tons of general chaos in their lives, or all of the above. As social workers, we understand where people are coming from.

Usually.

I had a particularly difficult case to work with for a brief period of time. A single mother and her five year old son had voluntarily come to the agency due to the five year old’s severe behavior issues. They were assigned a worker, with whom they worked for about six months.

Well, I say “worked.” Mom missed almost all of her appointments. She only showed up at the office when there was a crisis. Most often, when it was too late for anything to be done.

Like I said, this family volunteered for services, and then didn’t show up for them. Somehow, their case wasn’t closed. Their worker left, and guess which lucky jerk they got transferred to?

Ah, yes. Because if the family didn’t engage with their original worker for months, surely they’ll go along with a new worker, in a new office, who is under strict instructions to refer the five year old for mental health services and close immediately, before they bring our numbers down any further.

Somehow, things got done. I had to ambush the family at school and at their apartment (my camoflauge gear is second to none) but I got what I needed. They were referred out. Mom came in for a closing conference, and signed off in agreement to having her case closed.

Then the calls started.

While I was away on vacation, my supervisor received a call from this woman, psychotically politely demanding to know why her fucking case had been closed.

Because that is how we get what we want.

My supervisor reminded her that she had attended a closing conference. No, the mom insisted. She wanted the case to stay open until her son received a formal diagnosis.

This is not an uncommon phenomenon. There are a lot of people who refuse to meet our requirements or engage meaningfully in services, but hate the idea of their case being closed. Essentially, they want a social worker on retainer. Someone they can run to when they have an emergency, but not have the obligations of weekly meetings and regular home visits. Oh, and this should also be free.

My supervisor explained, to this irate, swearing woman, how to go about reopening her case, if that was what she wanted, or how to file a complaint.

The issue was regarded as resolved. Until the next week. When I came in to a voicemail, explaining that our services suck, she had the wrong date for her son’s mental health evaluation, and I am responsible for every bad thing to ever happen, from the Holocaust to jeggings.

Despite showing up on the wrong day for her child’s appointment, the psychiatrist did see the family. (Not a moment to soon…sorry, now I’m just being snarky.) So I thought we were done.

Until next week. Another voicemail, explaining that she had been trying to get in touch with me for two weeks, and I’ve been giving her the runaround. She also reiterated that our agency, and our services, suck.

I’m sorry. I didn’t realize you were expecting a call back. Apparently, “y’all suck, y’all should get shut down” in fact translated to, “Please return this message at your earliest convenience.”

I passed it off to my director, as my supervisor was out on vacation.

Yes, I opted not to return the call myself. I just couldn’t see the point. For all I listen to and get blamed for on a daily basis, my job description does not actually include the term “punching bag.” This woman was being irrational and aggressive. As I told my director, unfortunately, I do not get paid enough to sit and listen to a diatribe on why I suck.

Apparently, he does. He called her back, since, you know, it’s kind of his role. He then checked in with me, explaining that we have to bear in mind “the kind of people we work with” and that she “just wants to be heard.” Which is why he invited her in, to berate him in person.

That’s his call, if he wants to listen to that. But I really wanted to explain to him–I know “the kind of people we work with.” Because I work with them, while he is in his office filling out reviews and signing off on service plans. (Necessary work? Absolutely. But he’s not out in the trenches anymore, and hasn’t been for some time.) I am understanding for a living. But I’m also human. I have limits. In this case, I reached it.

Oh, and she doesn’t “want to be heard.” She wants to make a scene. There is a difference. Venting is not always productive. What would come from this powwow? I don’t think we do people any favors when we give them the idea that if they yell and swear loudly enough, the rules will be bent for them.

As I predicted, she never showed up, and we haven’t heard from her since. I wish things could have gone differently, and better, but they didn’t. We can’t win them all, and we can’t beat ourselves up over that.

And maybe it’s ok to give ourselves permission to run out of patience, once every few years.





I’m being sincere…no, seriously

21 04 2011

We all have cases that get to us. They take up more of our time than they should when we’re with them, and we continue to think about them and wonder how they’re doing, even after they’re closed. Cases like this kind of define our experience as workers. We wish Steven Spielberg would direct a film about our triumphs and tribulations with them.

My defining case came to me my first week on the job, almost two years ago. A mother was pursuing a PINS petition for her supposedly “out of control” (oh, aren’t they all?) 14 year old daughter. The 14 year old, let’s call her Angelica.

Angelica was an intimidating kid. She was big, and looked much older than 14. She got in fights on the street and at school. She had a mouth like a sailor. (At least, that’s what I’ve heard, I don’t know many sailors.) There were allegations that she was engaging in, what I documented as, “inappropriate sexual activity.” Meaning her mom heard rumors that she was blowing older guys in the stairwell.

Mom…mom was a treat. When they first came in, she wanted nothing to do with me, or our services. She just wanted Angelica out of her house. She was fed up. She told me that her daughter was the only one to give her trouble. Her three older sons were always respectful. (I later learned that they all served jail time. Two for robbery, one for attempted murder.) At times, mom was just nasty to Angelica. They fought like teenage girls.

But for all mom said about being done with her daughter, she still “kidnapped” her the day of her eighth grade graduation and brought her to IHOP, a surprise they couldn’t afford. She worked twelve hours a day, seven days a week, as a home health aide. She slept on a mattress  in the living room. Angelica had a bedroom, which she retreated to often to write poetry. Her brother, his girlfriend, and their two children had the other bedroom.

This kid just got to me. I had her for individual counseling, mostly. After she threw a chair in a mom and daughter counseling session, we decided it would make sense to work individually for a while. Not to mention that mom had no time for counseling, and really didn’t think that she had anything to do with the problem.

This girl was difficult, but she was also hilarious. We laughed in session more than is at all appropriate. And I never had to chase her down. She always wanted to tell me what she had done well–when she avoided a fight, poems she had written, times she made her bed or prepared dinner for her mom. This kid ate praise up like no one I had ever met. It seemed like she had never heard anyone say that she was good before.

But it was always two steps forward, one step back with this family. Or three steps back. Sometimes it seemed like they were running backwards. Angelica would stay out all night. Mom would respond by calling her a slut. Angelica would roam the street, waiting for someone to look at her the wrong way.

One of Angelica’s older brothers came home from prison over the summer. Mom made Angelica give up her room, and sleep in the living room with mom.

Eventually Angelica had such a fit at home that mom called 911, and she was admitted to a children’s psychiatric hospital.

It was supposed to be brief. She had been brought into the ER before, but never admitted. But the days turned to weeks. Angelica was admitted at the beginning of the summer, and talk of getting her home by the fourth of July eventually turned into hope that she would be home in time to start the new school year. She celebrated her 15th birthday there. I brought her a journal, which she kept with her the rest of her stay.

Mom didn’t visit Angelica at first, saying it was too far and she couldn’t afford it. So she started traveling with me. We went for weekly meetings with the psychiatrist, which often resulted in Angelica having to be restrained. I visited even when mom decided she couldn’t make it. Angelica would call me with her food order every week, telling me if she was in the mood for Chinese or McDonald’s. We had lunch together in the tiny visiting room, while Angelica asked for updates on her nephews.

Every time it came close to Angelica being discharged, something happened. Once, she returned from a day pass, saying that she had smoked marijuana over the weekend. The test came back negative. She was sabatoging herself.

Angelica befriended a girl on her unit, who had been sexually abused. Angelica confided in this girl, who encouraged her to tell her psychiatrist, the secret that Angelica had been holding on to for ten years–her older brother, the one who recently returned home from prison, the one Angelica was pushed out of her bedroom for, the one who mom enlisted to help discipline Angelica, had raped Angelica when she was five.

Angelica told us this with a blank face. She started having nightmares and flashbacks. Mom was distraught and didn’t know how to react.

The psychiatrists villified mom. She hadn’t protected Angelica, she wasn’t reacting properly now. They compared the situation to the movie “Precious.” (Because that helps. A lot.) They pretended as though Angelica’s mother could be written out of her life, and Angelica could become a grand, triumphant success story without her.

It was easy to blame this woman. She was far from perfect. But she was incredibly damaged herself. She was the kind of mother that Angelica would probably become, if she hadn’t gotten all the help she was getting in the hospital. Though she warmed and opened up to me over the course of our time together, going so far as to call me for support when she felt that she needed to be hospitalized for her own depression, she refused to discuss her own childhood.

I have no idea what happened, but I have some pretty good guesses.

Shortly after all this, I had to close the case. There was no child in the home, and  the family had been evicted, and moved out of the Bronx. My supervisor held off on this for as long as possible. For a long time, I was the only one Angelica had any contact with that she had known before her life in the hospital. But the time had come for us to close.

Angelica cried when I told her. She told me how everyone leaves her, and she didn’t want to get to know anyone else. Somehow I held it together. But I cried plenty afterwards.

We had our last meeting a few weeks later. We shared french fries and she made fun of me for drinking diet coke, as usual. She gave me an art project she had been working on. I told her I’d be thinking of her, always, and that I wanted to hear from her when she was on the supreme court. She laughed and hugged me good bye.

I’m at peace with the way things went. I wish they could have gone differently, but that’s the job. You can’t stay with people until the end, because there is no end. You can just hope that you’ve done everything you can, let them know that someone cares about them, and, at best, send them off with better tools and skills to cope with what life hands them.

I ran into one of Angelica’s psychiatrists on the train recently. We approached the case from different professions, and somewhat different values, but we both cared deeply for this girl. Neither of us had heard from her family, and we didn’t know where she was or how she was doing.

I just hope she knows that we’re both still thinking about her. I think she’d appreciate that.





Did you forget to take your meds?

17 02 2011

The kids I work with are nuts. I think we all know that is said with affection. At times I get concerned, but for the most part, they’re a hoot and a half. If you can’t be crazy at age eight, when can you?

Not everyone shares my view of childhood.

I got a referral for a six year old the other day. Presenting problem? “Child plays around and is very silly.”

It’s high time for this lad to settle down. That mortgage is not going to pay off itself.

I’m sure there’s something there. It’s distressing his mother. But what was recommended for this child? The all-powerful psych eval.

I have one eight year old waiting on a psych eval. Family court is insisting. What behavior is she getting up to? She stopped doing homework and her grades dropped. Then her mother beat her with a belt. (Hence the ACS case.) The kid had just been diagnosed with diabetes over the summer. Her life changed. To make up for it, she got tons of attention from her family and friends. By the time school started, the attention had faded, but the diabetes was still there. She acted out.

But we need a psych eval. Even though the kid’s mother doesn’t really want it. Even though the kid is doing much better.

I’m not against medication. My cousin was prescribed Ritalin for ADHD, right when everyone was saying that it was incredibly overprescribed, and that those kids were just being kids.

I saw what Ritalin did for this kid. He didn’t turn into a zombie. It allowed him to be himself. He was still energetic and hard to keep up with, but he was able to channel this into his love and talent for sports. He was no longer angry at everyone and frustrated with himself. It made a huge, positive impact on his life, and our family.

That being said–not all of my kids need medication. And yet I’m being told that they do. ADHD isn’t even enough anymore.

I was working with a seven year old recently, who had what everyone thought was a pretty clear case of ADHD. He was bright, but doing poorly in school because he couldn’t concentrate or sit still. He was delightful in counseling, but required constant one on one attention. He got up to do the running man at random moments. (I admit, I never wanted that one to end.)

His mother was against a psych eval. She felt that he would be drugged and his personality changed. In this case, I felt the evaluation was really necessary. As did my supervisor, and the kid’s teachers and doctor. The mother and I talked about it at length. We went over her concerns, and her right ask questions. She finally felt comfortable with it.

Also, she couldn’t take another homework session interrupted by this boy’s need to express himself through 80s dance moves.

They were on three waiting lists for months. Mental health services in the Bronx are frighteningly hard to come by. Finally, though, the kid was in.

After three meetings, this seven year old had been diagnosed as bipolar and sent home with a free sample of Abilify.

Who doesn’t love samples?!  The little packets, so fun.

Being a responsible, loving mother with an internet connection, this woman did a little Googling. Reading the fine print for any medication will terrify you, no matter what. WebMD convinced me that taking more than one Tylenol causes internal bleeding, asphyxiation, talking in tongues, and the ability to fly.

Abilify, though, is serious business. For bipolar disorder, it’s only approved in ages ten and up.

Not to mention that the psychiatrist met this child three times. A grand total of 135 minutes. Her first thought was a label like bipolar, and a powerful antipsychotic? The mother’s very legitimate concerns were brushed aside. Just try the medication, keep an eye on him, he’ll be fine.

Ultimately, mom couldn’t go through with it. She returned the samples, and discontinued mental health services.

And I supported what she did.

Again, I’m not anti-medication. But I think we can all agree that not everyone is bipolar. A third of the kids I work with have had a doctor or counselor speculate that they might be bipolar. About the same number are on psychiatric medications.

I would think that this is a nationwide issue, but I recently spoke with a nurse in a lovely, wealthy suburban community. She was shocked to hear that a sixteen year old she knew was diagnosed with bipolar disorder. “They try not to put a label like that out there until age 18, because the kids are changing so much.”

What?!

She couldn’t believe what I was telling her about my experiences. Apparently, likelihood of serious mental illness decreases as tax bracket increases. Curious.

People should be open to medication. They should not be ashamed to admit to having a mental illness. But why the disparity? Why is the future of a child of affluent parents in an impressive zip code so important that he can’t be saddled with a serious diagnosis, while my kids and their parents, many of whom are rather young and rather not-white, are told to just be good and take their meds?

Stories like this seven year old’s are exactly what people are afraid of when the idea of a psych eval is raised. It drives people away from mental heath treatment that their children may really need.

It’s hard as a social worker to question the opinion of a doctor. Who the hell do we think we are?

We are the ultimate advocates for our clients. And for our kids’ right to be nutty kids.





Let’s all take a deep cleansing breath…now shut the hell up

8 11 2010

Once again, it’s confession time: I don’t like Enya. I haven’t used incense since high school. I don’t know what chakras are, and I’m OK with that. I don’t really even believe that people are sincerely good at heart.

I am a bit cynical and sarcastic. I’ll give you all a moment to let that news sink in.

Sometimes, it makes me feel a little out of place in this profession.

Back in Dr. Horrible’s social work school, I got tired of learning how closed minded I was. Well-meaning suggestions that I introduce my elderly clients to the healing power of crystals or repetitive chanting just didn’t do it for me. I didn’t mean to laugh at people, I genuinely thought we were joking.

I started to feel like the Grinch Who Stole New Age.

I’ve worked on improving, really I have. I’ve opened up the old mind a bit. Meditating isn’t for me, but that, combined with breathing exercises, has helped a lot of my anxious clients with the scary life stuff they can’t control. I’m willing to incorporate that with some of what I’ve been told are more traditional, “Western” methods. (Apparently, “Western” in this case does not mean that lassoes will be used. Boo.)

I’m even co-leading a teen girls’ self-esteem group that combines movement with shouted affirmations.

Does anyone need another minute? OK.

Once a week, a group work intern and I lead a group of 13-17 year old young women in stretching, punching the air, jumping invisible ropes, and other moves designed for the sole purpose of making me look ridiculous. All the while shouting along that we are strong, beautiful, and “no” is our power.

Followed by snacks and discussion time. (Both of which bring me right back into my comfort zone.)

I was rather skeptical at first. I did not become less skeptical when my co-leading intern brought out electric mini-candles and a silk scarf, to place in the center of our circle to “calm the environment.”

But you know what? The girls love it. And this jerk over here is having a great time.

Meditation, breathing, and scented candles help some workers to cope with the stressful, upsetting situations we deal with. I cope through obnoxious sarcasm humor. I’m willing to make a deal with the tantric (I don’t know what that word means) social workers out there.

Accept my methods, and I’ll accept yours. Turn on those electric tea lights, pretzel your legs, and imagine a glowing ball of warm energy illuminating your face.

But when I am venting after my fourth unsuccessful home visit attempt that week, saying, “The woman has two babies and no money, where the hell is she going, to a day spa?” the correct response is just to let it go. Not to say, “Wow, she must really be experiencing a lot of isolation. Maybe she’s identified some new supports.”

We can coexist. I firmly believe this.

Provided we all learn to relax, remain aware of one another’s auras, and practice laughing at ourselves.





For “savior,” press one. Para español, oprima numero dos.

30 08 2010

Confession time: I’m a comic book geek. Who doesn’t love a good hero story? My favorite is, of course, Batman. (I was there before Christian Bale, just so we’re clear.) A traumatized child grows up and uses his phobia to rectify his past? What social worker wouldn’t love that?

The truth is, we all want to be heroes. No one goes into a helping profession hoping that it will be a futile, uphill battle. You know it probably will be, but you hope that you’ll have those superhero moments.

“A child care subsidy? I believe I’ve got that right here!” “Domestic violence? Unhand that lady! To the shelter!”

This is particularly acute in social work school. During your internship, you want someone you can save. Just someone who will be able to look back at your time together and say, hey, this social worker helped me. Life is better now.

Sometimes it happens. Some people notice. But often, progress is so gradual, and not at all what clients expect, that they aren’t able to look back and see these things.

And then there are the heroes along the way.

These people are what I call “swoop and savers.” They haven’t been present for the life of the case. They get called in, very late in the game, and things are abundantly clear to them. These people know just what the clients need, and it is oh-so-simple to deliver it.

I have a teenage client who has spent her summer in a psychiatric hospital. Psychiatrists are intimidating as it is. They have medical degrees, they wear white coats, and they have access to all those drugs.

One psychiatrist in particular decided he had my client figured out. The real problem stems not from her mental illness, but from the tense relationship with her mother. Why hasn’t the mother been more involved in counseling?

Well…I…we did, at first, but…I stuttered for a while on the phone, embarrassed at my ineptitude, until I agreed to come in for a family session.

After about ten minutes, the girl and her mother were yelling over each other, while the girl punched a wall and threw anything in the room that wasn’t nailed down. I tried to reason with her while Dr. Saves-a-lot called for help.

Oh right.

That’s why we hadn’t been doing this.

We had done family sessions. For months, when the case first opened. But sometimes there’s a lot to be done before those can be productive. After a year with this family, I knew that. In knowing this family for a week, this psychiatrist assumed he knew better than the social worker. (Note: anti-MSW bias will come back to bite you.)

I’ve gotten lots of questions from other helping professionals, similar to the ones I got from this psychiatrist. “Why hasn’t this child been evaluated?” “Why hasn’t this family been reunited?” “Why didn’t you help this family to find new housing?” “Don’t you know ANYTHING?”

We all want other people in similar fields to know that we’re competent, that we’re doing our jobs, and that we’re doing the best we can. We also all want to be that one person who can change this client’s life.

We each know how hard it is to do that. But why is it so hard to remember that when we’re looking at someone else’s work, and trying to fly to the rescue?