I was speaking with a client the other night and was struck by her rigid view of the world. Her boyfriend’s friends are” evil,” she’s being “attacked” by her family members.
I like to use humor, and I nearly said this: “In all my years I’ve never heard of anyone who’s actually evil – with the possible exception of Donald Trump.”
Trump was on my mind because he’d just won the Indiana primary. As much as I’d like to sit back and eat popcorn while watching the Republican Party explode, I find it so disturbing that so many Americans could be won over by hate.
The implications of Donald’s success paint a darker picture of humanity than my clinical experiences, which generally leave room for human strength and resilience. Trump is different. The fact that vast numbers of Americans would be attracted to somebody who basically embodies the fantasy of grotesque wealth no matter the human cost – I find that chilling. To me, Trump is saying “I hate all these people, but if you support me you’ll be rich like I am”; and it’s hard to see Americans buy that pitch.
Here’s why I’m glad I didn’t make a comment about Trump with the woman. During our conversation she kept bemoaning the world’s problems. Then she said, “Thank God for Trump. At least something’s right.”
I didn’t laugh in her face. Maybe that would have been justified during a normal encounter. But this is social work.
I encouraged her to volunteer with the Trump campaign.
Let’s face it, social workers tend to be liberal – myself included. Liberalism is about helping people while conservatism is about people helping themselves, so it’s hard to understand how a conservative could be a social worker (I’d love to talk to one! Please get in touch.) We need to be really careful around our political biases. Because I came damn close to ending my conversation with this woman in need before it even started.
This might shock you, but I’m quite the nerd. Sometimes that pays off for others, though – this might be one of those times.
I have issues – depression, anxiety, alcohol dependence (in remission) – and I use a variety of tools to manage those things. These include cognitive behavioral therapy, the gold standard treatment for mood disorders; cost-benefit analyses; and coping skills monitoring. These things really make a difference.
I found a way to share these things with you. I made an online form that walks you through the right skills for whatever issues you’re facing.
By nature counseling is an overwhelming job. These tools can get you up to speed quickly
Counseling is one of the hardest jobs on the planet. If you’re anything like me you regularly deal with unreasonable supervisors, out of control paperwork and clients who never seem satisfied. Worst of all, interns and beginning workers are often thrown into situations where they feel over their heads.
I can’t change any of that. But I can tell you some good news – the internet has changed every step of practice, from engagement to termination.
So let me take the load off a bit. Here are nine essential tools for any smart clinician’s toolbox.
Your supervisor introduces you to a new client and takes you aside to say, “He has insomnia. Use whatever treatment is best for that.” And you say, “Insomnia is what Pacino had in that movie, right?”
You’re in a bind – and ideally, you should seek training and supervision to help you understand your client’s issues. But in the meantime, the Social Psychology Network has a truly remarkable library of websites and articles organized by disorder. If you have 15 minutes to learn about an illness, this is the place to go.
15 minutes later…
OK, you know a bit about the client’s disorder, and you’re ready to think about treatment.
My all-time favorite online resource is Psychology Tools, an impressive and user-friendly database of free worksheets and handouts for clients. If you have a rudimentary understanding of cognitive behavioral therapy, for example, the tools here will bring it to life. I highly recommend taking 10 minutes now to explore the site – I can almost guarantee you’ll come away with a new skill.
The Centre for Clinical Interventions in Australia also has a top-notch directory of free handouts for clients as well as detailed treatment manuals for clinicians. Combined with clinical skills and training, both of these websites have resources that can go a long way towards a successful therapeutic journey.
You’ve successfully treated your client – congratulations! – and she’s ready to leave your program. But she needs a referral. Now what?
Trust the government on this. SAMHSA has created an incredibly detailed database of mental health, substance abuse and VA providers that you can search by treatment orientation, insurance accepted, and more.
You can also try a crisis referral line. Call the National Suicide Prevention Lifeline to be automatically routed to a crisis line in your area (800-273-TALK). Lifeline Crisis Chat also has a list of crisis lines for specific populations, including veterans, people with eating disorders and more. All of these lines serve consumers, but most will also be happy to help providers find the best resource.
You’ve treated all your clients and referred them to the appropriate programs – a little friendly humor there – and you find yourself with some downtime. Why not use it to get up to speed on the latest developments in mental health?
The American Medical Association makes some articles from its prestigious Journal of the American Medical Association available online for free – its psychiatry articles are here. The American Psychiatric Association also puts out truly informative updates on clinical issues, as well as developments in politics and the mental health system.
I also highly recommend finding a news aggregator that helps you subscribe to your favorite websites and blogs. I personally love Feedly, which is available on Android, iPhone and the web.
You should throw a subscription to The Onion in there, too – life is short, and you’ve earned a laugh.
Will any of these tools help you in your work? Did I miss anything? Let me know in the comments and I’ll include updates in a future post!
Would you read a SocialWorked newsletter? I’ll start one if people say they’re interested – let me know here.
Warning: Adult language and themes; triggering content.
“I think it’s time you consider a higher level of care.”
The psychiatrist’s words hit me like buckshot.
A beat passed in his office on the Upper East Side. Between us there was a marble table. In the bathroom there were four kinds of soap.
I play it cool. Inside I’m screaming. “Like a five-day-a-week program? ,” I say. “Would the idea be to get my meds sorted out?”
The psychiatrist leans back in his chair as if I’d asked for the meaning of life. He paws through my intake form, which had been blank 30 minutes ago.
Calculating route. Calculating route.
“It would be an opportunity to get your medications sorted out.” He points to a page of the intake form. “And you’ve told me that you’re experiencing significant pain, to the detriment of your ability to function; and that you’ve had significant thoughts about suicide in the last couple of weeks.”
When you drink all you need to do to fix your life is stop drinking. When you quit you’re left with what’s left – yourself.
I tell him I’m not worried about the thoughts of suicide. I can handle the thoughts of suicide. They’d always been there, like a loyal friend.
The depression and anxiety suck, and I’ve been working on them forever, I tell him. My therapist and doctor know about every thought, every symptom, I say.
I’m seeing him because I can’t seem to wake up in the morning, as if the meds I’m taking have a gross weight that holds my body to the matress. I’m seeing him for a second opinion. I sure got one.
“I need some insight,” I say. “I need your opinion about whether my medications are working for me. Right now that would help me more than a referral to a program.”
“You can come back if you like, but I’m not saying I’ve taken you on as a patient,” he says.
“I understand,” I say. “You’re worried something bad might happen.”
Calculating route. Calculating route.
He points at my intake form, now full of scribbled notes. Somewhere in there is my sister, dead by suicide at 20; my abusive grandparents; my estranged alcoholic aunt; my ex-wife and the pills she swallowed one fall afternoon in a church courtyard.
“I’m only worried this isn’t the proper treatment setting for you,” he says. “I think you need a higher level of care. You’re experiencing significant pain, to the detriment of your ability to function; and you’ve had thoughts about suicide in the last couple of weeks.”
You’re worried you’ll be liable if I swallow a bottle of pills, so fuck you.
Earlier I’d told him where I’m employed as a social worker. Will he ever refer people there again? Will he tell everyone about the messed up counselor he met from [Mental Health Inc]?
Earlier still I’d told him I’m one year and three weeks sober. Congratulations, he’d said. It doesn’t feel like congratulations are in order. When you drink you’re a badass – you’re Don Draper or McNulty from The Wire. When you quit you’re just some depressed anxious dude. When you drink all you need to do to fix your life is stop drinking. When you quit you’re left with what’s left – yourself.
We shake hands and I leave. The receptionist is confused about my insurance. I’m panicking: are they buying time while the psychiatrist calls 911? This is exactly how they’d do it.
We sort out the insurance and I leave. I light a cigarette, then another. I catch my reflection in a window. Fuck you. The psychiatrist will tell all his colleagues about the messed up social worker from [Mental Health Inc]; don’t refer people there, they’ll hire anybody.
What right do I have to be a social worker, being in the condition I’m in? I’ve spoken with rape victims and domestic violence survivors. I’ve spoken with people who were suicidal while being suicidal myself. I’ve spoken with people who had the knife in their hand, the pills in their belly. I haven’t lost a person yet. I haven’t made a person feel as scared and powerless as I felt just now.
I think of the psychiatrist; of that quality of empathy. I think: I’ll never refer anyone to him.