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Public Statement Regarding Resigning From the National Association of Social Work

Public Statement Regarding Resigning From the National Association of Social Work

Hello Everyone,

I was hoping that I would be able to write a much happier email than this one, one filled with hope, and solutions focused based suggestions, and maybe some ideas for some restorative justice where the WNY Steering Committee and NYS NASW could somehow come together. However, I find that I am failing in that attempt, which saddens me greatly.

After Saturday’s meeting, and a fair amount of reflection, I am left more concerned than I was when I first started the online petition calling for the immediate reinstatement of our position on Catholic Charities, and I feel compelled – in order to stand on what I believe will be the right side of history – to share my thoughts, my feelings, and my beliefs.

I am, frankly – after having had the board’s reasoning behind their decision-making process explained to me – appalled, more so than I was when this first process began…but more than that, I am hurt, deeply, and left with a crisis of conscience, and of ethics.

Already, another Christian adoption agency (this one in South Carolina) seeks to ban Jewish people from adopting under the guise of religious freedom. They, like Catholic Charities are stating their reasoning and motives outright. Would the NASW NYS not call out that agency by name if this were to occur in NYS? The Trump Administration is seeking to erase transgender people – which, in the line up of the fascist playbook, by the way, is the proverbial canary in the coal mine: go after and see if you can take away the entire rights of a marginalized group; if you can get away with it, proceed forward from there.

When we fail to call out anyone who perpetrates oppression and persecution by name for who and what they are, we are only one thing: collaborators. Full stop. Civility politics only helps the oppressor. It does not build bridges, it does not create understanding, it does not ‘raise us up’ or allow us to be ‘more enlightened’ and it is certainly not ‘professional’. Civility politics builds walls behind which the oppressed continue to suffer while the oppressors behave with impunity, facing no consequences from the outside world, which become cogs in the wheels of the systemic oppression.

To hear that the board voted for fear of maybe being sued for libel despite the overwhelming volume of quotes, newspaper articles, radio interviews, etc. put out featuring Catholic Charities themselves is not only disturbing, but shows a profound misunderstanding of our duty to accept risk as part of our profession. 

Every single day we have clients or patients in our offices that we have to accept risk for: whether they will hurt themselves, or others. We have to accept risk for whether someone will live or die, or whether an intervention will work, or whether our testimony on a client’s behalf will be enough for them to receive the services they need…when our most marginalized clients’ lives are on the line, we go to bat…and yet, here with no actual risk of being sued for libel (or, perhaps better put: no actual risk for having such a lawsuit ever succeed) here, here is where the board decides to abdicate their responsibility to their clients entirely (their clients, in this situation, being the WNY Steering Committee, the WNY Community, and the LGTBQ+ community).

During the meeting much was made about how good and nice the people on the board are, and on the importance of the relationships that exist, etc. However, it bears pointing out that there have been many good and nice people, in many good and nice countries throughout history. Sometimes those good and nice people are part of the problem…sometimes they are what allow oppression to continue.

As a disabled queer Jew, I will not be a party to my own oppression, nor will I be silent out of misplaced ideas of what constitutes professionalism in a field born out of the radicalism of the needs of the oppressed in the face of patriarchy, racism, and classism.

I will not be a tool so easily wielded into a weapon. In that light, I will continue to be a Social Worker, continue to treasure the NASW Code of Ethics, which I believe the NASW NYS Board has completely abandoned, and I am resigning my membership in the National Association of Social Workers, until such time as the entire NYS Board has resigned or been disbanded by NASW National, and the organization has returned to the ideals it once held.

It is my strongest belief that the NYS Chapter can no longer govern itself, nor can it adequately represent the needs of the most marginalized…rather now, through its own actions and inactions, its very own behavior it has shown us that, when given the choice to choose between what is hard and scary, but what is right, and just, and ethical, it has instead chosen what is easier…but what will allow oppression to continue, and therefore, has instead chosen to become a part of the oppressive system.

I will be in touch, privately, regarding a free Social Work co-working space and meet-up group that Ashley and I have been working on for the past year and a half. We were not planning on launching it this year (or even announcing it yet), but I see no reason that we should not be bringing our peers together in WNY now, more than ever, to work together as a community, for those who are interested. We are not looking at becoming the “new steering committee” – merely a place to come together twice a month for two hours on weekends for potlucks, conversation, peer support, peer supervision, and social work. 

“Your silence will not protect you.” – Audre Lorde

In The Spirit of Stonewall,

Matthew L. Schwartz, MBA, LMSW

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Apples of Wrath?

Apples of Wrath?

According to author Hal Borland, there are people who would rather summer never end, and who would be much happier if we never made the transition into autumn at all. These same people often hope, unsuccessfully, that the world will do exactly what they want in other areas as well. Unfortunately, you and I (and usually these summer loving folks) usually know that this isn’t how the universe works.

Sometimes things are just out of our control – and that can be a really hard realization at times. Sometimes when we realize that things are entirely out of our control, we can feel all different kinds of ways about it. Maybe it makes us anxious, or maybe it makes us feel scared, or maybe it makes us feel really angry. And guess what? The things that get us feeling all sorts of ways don’t have to be big and important either!

One example that I often like to give is that I get upset when my packages don’t arrive on time, or when Amazon says they’re supposed to. I know this about myself, and I know that about 95% of the time, my packages get to my front door either on time, or even ahead of schedule. But if I’m not keeping my thoughts and feelings in check, my ears can start turning the shade of those apples at the top of this blog post when I get to my front door after work and see that the book I was expecting didn’t arrive when I was told it would.

So what are the lovers of endless summers and on-time-book-deliveries supposed to do? No matter what we do, the summer is going to transition into autumn (at least it will here in Buffalo, NY), and no amount of foot stomping or any amount of huffing is going to make the truck that’s sitting in Nebraska with my book on it arrive to my front door any sooner than when it’s going to arrive.

Fortunately, we can find the answer in any number of ways in both counseling or therapy. However, one of the best ways I’ve found is through learning Dialectical Behavior Therapy’s Distress Tolerance Skills; or those skills that allow us to get through a crisis (however we define that for ourselves) without making it worse, and then learning how to live with whatever it is that’s out of our control, and that we just can’t change (whether it’s the seasons, not being in the career or occupation we wanted because of life circumstances or the economy, or having to come to terms with a physical limitation or newfound disability). 

While I don’t practice Dialectical Behavior Therapy, there are many folks who do. If you’re local in Buffalo and would like to learn more, I highly recommend my colleague Ashley Maracle, LCSW. Until then, please watch the videos by Marsha Linehan (the creator of Dialectical Behavior Therapy herself) to learn a more on Distress Tolerance, and how it can help you.

…I’ll be here waiting for my book!

A moment of Mussar: הכרת הטוב

A moment of Mussar: הכרת הטוב

In Mussar we are taught to recognize the good. In Hebrew this is “הכרת הטוב” (which can be translated as gratitude, but literally means recognizing the good).

While taking my lunch break at work today I decided to reflect on my blessings. I have been so blessed in life. I am grateful for my Ohana. I am thankful for those who supported me when I couldn’t support myself. I am thankful that I have had the pleasure, privilege, and opportunity to work in each and every field that I’ve studied: as a Linguist in Foreign Relations in the IDF, as an MBA, in business, accounting, and freelance consulting for entrepreneurial development, and finally, as an LMSW, working as a Social Worker and Mental Health Counselor where I finally feel entirely self-actualized, yet with years of growth potential before me. I am so grateful. Life continues to have its challenges, but they are far outweighed by its blessings.

Why I Don’t Answer The Phone: Lessons on Sacred Space, Self Care & Executive Functioning

Why I Don’t Answer The Phone: Lessons on Sacred Space, Self Care & Executive Functioning

If you try to call me at my office, you’ll immediately get a voicemail asking you to leave a message and telling you that I’ll call you back (and offering you hotline numbers to call if you’re in crisis). If you call me at home, you’ll soon find that, almost magically, my phone there also goes to voicemail. No call screening, no maybe I’ll pick up, just a very matter of fact this is what my friends, family, loved ones and clients all know to expect. I don’t even hear my phone ring…I don’t want to hear my phone ring, and I don’t need to hear my phone ring. This is not because I’m antisocial (far from it) but because I’ve determined where my sacred spaces are, created boundaries for my own self care, and established what I require for my own executive functioning needs. I also don’t immediately respond to text messages, but respond to them as I can, and as the appropriate time and spaces allow and present themselves.

Sacred Space:
I take my practice of Social Work seriously. For me, while I work with people across all faith traditions (or no faith traditions at all), I am a social worker because it is the truest expression of my personal faith – to be a part of the Tikkun Olam, the healing of the world. In that light, my office is a sacred space, and one in which I wish to give my fullest attention to the work that I do while I am there on behalf of my clients. While I would never answer a phone during a session (nor would a client ever hear one ring)! I also don’t want to be distracted by a phone while writing reports, or case notes, or conducting research. It is far easier for me to schedule a time to call people back (which we’ll get to in the executive functioning section in a moment).

My home is also a sacred space. It is where I unwind, where I connect with my friends and loved ones, and my furry children. Judaism treats the home in a very special way, and I work to ensure that harmony always exists there as best I can. Part of the way I do this is by ensuring that my home is always a sacred space, with as few disturbances as possible (and a doorbell that is easily turned off to further support this cause). Visitors are always planned for, peace and quiet reign.

Self Care:
In a previous post, I took some exception to some popular memes that were going around about always being available to others. Simply put: I’m not (and I don’t think most people are, have the capacity to be, or should be). I have Rheumatoid Arthritis, and Fibromyalgia. In order to ethically practice Social Work I need to make sure that I have the energy to do so, so that I can be mindful and present for my clients. Part of the way that I am able to do that is by being aware of, and managing my energy. If I allow others to dictate my availability, I place my energy and its consumption in the hands of others. Rather than the immediate communications that have been forced upon us by today’s technology, I have made the choice to instead interact with messages differently; treating phone calls and texts and PMs and IMs and DMs as if they were letters delivered by the Pony Express…and I try to give them the thought, and consideration, and the meaningful answers they deserve as well, in the form of what I hope is an equitable trade of for those who are sometimes frustrated at the lack of instant gratification (not that I think that anyone is entitled to make the demand, but I at least want to validate the frustration).

And, truthfully, you don’t need me right now, this very instant! You have coping skills – a lifetime of them – that have allowed you to reach this very moment in time without me…a few moments more won’t be that intolerable.

Executive Functioning:
Finally: part of mastering the effects of Rheumatoid Arthritis and Fibromyalgia are learning its impacts on my executive functioning. Many of us have something that impacts our executive functioning. By learning to reject the fear of missing out (FOMO) that comes with not answering my phone, I have the privilege  of listening to a message, triaging it, looking up any information I need to in order to respond to it, scheduling a time to call back, and giving it the thought that it deserves. I also no longer deal with spam calls and robo calls that would intrude on my day, make me forget what I was doing, and interrupt my thought process. I am able to guard against what would otherwise impact my executive functioning.

So please, give yourself permission to disconnect in ways that are meaningful to you, and in ways that enhance your development as a person. Just because others choose to be connected all the time, doesn’t mean that you need to be always on. I dare say that you’ll find ways of being social and connected, even without running whenever a bell rings (pavlov would be proud).

Welcome

Welcome

Hello Everyone and welcome to my new site (please forgive the scraps of fabric as I get everything setup). While you’re here, please check out the About Me section to get an idea of who I am and my work!

Conserving Spoons

Conserving Spoons

A little bit of using self in Social Work.

Two weeks ago I fell at my Field Placement. I was walking down the hall (using my cane, not my rollator – my first mistake!) and all of a sudden my muscles decided that it was time to take a lunch break without me. I fell backwards, scared all of the staff who were around me and came rushing to my aid, and I required four people to help lift me off the floor and get me into a chair.

Pictured: an accurate representation of how I looked when I fell down at Field Placement.

Unfortunately, my muscle strength didn’t return, I couldn’t stand from the chair, and I had to go to the Emergency Room for a bit for safe keeping. Fortunately, everyone who I work with at my field placement site is brilliant, compassionate, and trauma informed. This meant that instead of being embarrassed, or worried about stigma, that I was able to instead concentrate on getting better, and meeting with my medical team.

Dr. Hackenbush has always provided me with excellent care.

Among being neurologically special, I have two auto-immune conditions that pose the most amount of complications in my life: Rheumatoid Arthritis & Fibromyalgia (which, for me, is actually co-morbid and secondary to the Rheumatoid Arthritis).

While RA isn’t rare in males, Fibromyalgia is, which (according to my math) makes me some kind of unicorn. It took ten months, lots of doctors, a biopsy, an EMG, literally dozens upon dozens of blood tests, a trip to the Mayo Clinic in Minnesota, and finally a local rheumatologist (working with a fairly advanced medical team of primary care providers, neurologists, physical therapists, nutritionists, etc.) to get me to a final diagnosis. If I were a woman it would have taken four years and two months longer; so I’m acutely aware of my male privilege here; to say nothing of the fact that I was able to even fly out to the Mayo Clinic.

Both of these conditions effect every area of my life. Rheumatoid Arthritis attacks my joints, nerves, and muscles. When I have an acute flare up I am the equivalent of a giant newborn who can’t walk, and who can barely sit up. Both of these conditions also cause fatigue. Fibromyalgia also causes intense pain. Fibromyalgia also has this awful thing called “Fibrofog.” Generally, it’s how my cup of coffee winds up in the linen closet.

Because of this, I have had to become an expert in conserving my energy properly, so that when I’m with my clients I’m at my peak game (this is an ethical imperative). What this means is that I have had to become an expert at time management, and conserving spoons. If you’re not familiar with The Spoon Theory, please take a quick read (it’s okay, I’ll wait).

A large part in being successful in managing my spoons, is making use of a variety of tools, tech, and assistive devices:

Tom Bihn’s Maker’s Bag
I use a bag by Tom Bihn called the “Maker’s Bag.” The main reason for this (outside of the fact that I’m vocationally trained as a sewist and fiber artist, and as soon as I found out that there was a bag geared toward people like me I wen’t “cool!”) is that there are a ton of rings that you can tether (literally) all of your belongings to. This means that no matter how “foggy” I am, I’m not losing my wallet, my bus pass, or any of my every-day-carry. This of course then lowers my anxiety (which can escalate from 0 to 100 in about .03 seconds if I can’t find my wallet, which used to happen regularly before I got this bag…usually as I was trying to get out of the door just on time). Everything is connected to this bag. My keys are tethered to this bag with a tether long enough to reach my door while I’m still wearing the bag. My wallet is tethered to this bag. My crochet hooks are tethered to this bag. My life is more or less tethered to this incredible bag. When I kick the bucket at 120, I’m having this bag buried with me so I can make sure I’m still this put together in the afterlife.

NovaJoy Vibe Wide Rolling Walker
Affectionately named Zappy, my walker is one of my main mobility aids. I do have a prescription for a wheelchair that I’m waiting on; but I prefer my walker for a variety of reasons. First, I feel more comfortable and active with it. Secondly, by continuing to walk (when I can, so not during acute flareups where I just sort of flop around like a Magikarp), I ensure that I don’t lose muscle strength. That said, when I am weak, it provides support, and when I lose all energy, I always have a seat with me. My walker is pretty tricked out. It has a light, a cane holder, a cup holder, and storage in the bottom. This may seem silly, until you realize that as someone who can have a rapid drop in energy and/or muscle strength, it provides me with both a safe and comfortable spot to rest, or to wait for an Uber to pick me up and help me get home. I don’t expect a cure from two incurable chronic conditions, which is why when people ask me when I’ll be “healthy” and not need my walker, I just sort of stare at them.

The Miracle Cube Timer by Datexx
I use a Miracle Cube Timer to help me get my work done. What I do is set it for 15 minutes, and then “sprint” (so focus only one one task and one task only, such as writing my case notes). While the timer is going I don’t allow myself to do anything else. Once it beeps, I flip it over to the 5 minute side, and give myself a five minute break. I’ve found that this has helped me manage my time at work more efficiently. I have one cube on my desk at field, and one cube on my desk at home. Research papers, reports, case notes get done in record time (though it does take some self-discipline to develop this skill).

Unfuck Your Habitat
Unfuck Your Habitat (UFYH) is one of the best resources I have ever encountered for anyone who is either disorganized, or faces challenges keeping their habitats unfucked due to chronic disease, illness, or mental health challenges. There’s a book, website, tumblr, and app…and I use all of them. It’s the only reason that my counseling space looks impeccable, the only reason I can function in my home office, and the only reason my bedroom hasn’t been listed as a national disaster site.

Remember The Milk
If I don’t write it down, the odds of it happening are slim to none. But I also have to be very cognizant of how much weight I’m carrying with me at any time. I use Remember The Milk as my main go to organizer for tasks. This saves me from having to carry a large to-do notebook. I have it installed on every computer I use at work (and at field placement). It’s on my iPhone and on my Apple Watch. It can send me multiple reminders hours, days, and even weeks in advance of when something is due. This means no matter how “foggy’ I am, I remember to get things done (so long as I plan in advance, since I never know when an acute flareup may strike). I obviously don’t enter client names or any PHI into it, but it’s great for things like “remember to case note;” “pick up flyers for clients,” “check your task list from your supervisor!” etc.

Evercontact
Evercontact is an application that will automatically update your address book based on your contacts signature lines. I have limited energy, and limited time. But I’m also in a field where networking is absolutely crucial to providing services to my clients. By having Evercontact update my address book (instead of me doing it manually) I save quite a bit of time. I get notifications on updates multiple times a week (sometimes even multiple times a day).

Evernote
Evernote is one of my lifesavers. I just cannot physically carry notebooks and binders with me everywhere anymore. This is where Evernote comes in to save the day. It is *literally* my everything binder. I have video clips saved there, audio clips, word docs, PDFs, notes scribbled on the back of envelopes, post-its, whiteboards and blackboards…all stored digitally, almost all searchable thanks to Evernote’s incredible handwriting OCR. I cannot praise them enough…if they were HIPAA compliant, they’d be *literally* one of the only things that a Social Worker would need…but even without being HIPAA compliant, they’re damn near perfect. Evernote is quite literally my brain’s backup device.

My iPhone & Apple Watch
My friend was kind enough to gift me an Apple Watch, which I mainly appreciate for it’s SOS feature (it provides me with a great deal of comfort knowing that I can hold the side button, have my watch call 911, and at the same time have it text my emergency contacts, including my supervisor). The Apple Watch has been useful in numerous other ways as well. I have an app on the watch that records sound at the touch of a button and then transcribes it (great for taking important notes, especially when I’m foggy). It also keeps me on track (by having my schedule on my wrist, and not having to remember to look at my phone or my calendar), reminds me to check my blood sugar, monitors my heart rate, and reminds me to remain active (among many other things). It also syncs with Remember the Milk & Evernote, which is incredibly helpful.

My iPhone has more or less replaced my daily computer. I find that an iPad is too heavy for me to hold in the long term, and after a day at sitting at desks and typing (which can be painful at times, especially when my hands and wrists lock up) that I rely on my iPhone for pretty much everything. Emails, television (i.e. Netflix & Hulu). Facebook. Even blogging.

Final Thoughts
I haven’t been paid by any of these companies. I haven’t received services in exchange for recommending these products. There are just – hands down – some of the tools that I have used to conserve my spoons, manage my energy, help my health, and remain in the MSW program (with a 3.687 GPA). They have allowed me to continue to work as a counselor, remain in my field placement, and continue forward toward graduating so that I can have my Social Work practice.

I look forward to sharing other tools and tricks in the future. I think it’s important – for true self care – that we recognize our barriers, roadblocks, and differences…and then find ways around, over, under, and through them. We ask our clients to be honest with us, and to share the most intimate parts of their lives with us…the least we can do to honor this, is to be honest with ourselves.

Permission to Nuke The Whales

Permission to Nuke The Whales

One of the traps that I think some of my clients (and even myself, to be honest) can get caught up in is that generally we want to do the right thing, and that sometimes we want to do the right thing so much that it becomes deleterious to our overall well-being and daily functioning. I think this is especially true if one has a chronic disease, disability, condition, or illness.

For instance, if you have a disability that makes lifting and moving difficult, and you really want to recycle…but the act of recycling causes your kitchen to fill up with plastic bottles because you don’t have the physical strength or energy (or spoons) to bring the bags down on recycling day once a week (or once every other week)…and then you find yourself constantly falling over bags of recycling in your kitchen, then is recycling really your best option? In this case I advise my clients to give themselves permission to nuke the whales and throw the bottles out with their regular garbage.

Sometimes depression makes it hard to clean up the litter box. Who wants to use disposable litter trays? They’re bad for the Earth, it’s wasteful, you’re throwing out aluminum or plastic each week…all of that’s true. That said, a kitty litter box that’s overflowing is bad for a client’s health, can contribute to a greater feeling of depression (due to the smell/mess/’failure’ to take care of something), and the kitty won’t be happy either. So what’s better in this case? Personally, I think giving yourself permission to nuke the whales and go for the disposable kitty litter trays.

Reduce, Reuse, Recycle…always sound advice. Paper plates, plastic forks, spoons, and knives: who needs em? Just more petroleum based products in our landfills. However, if your chronic illness, disability, depression, mental illness has you living with a kitchen sink full of dishes all the time (which can bring with it bacteria, mold, or vermin)…and it’s easier to just throw out paper plates, plastic forks, spoons, and knives…and those disposable plates and utensils are what makes it possible for a client to have a clean living space (and feel better)…then it’s time to nuke the whales and stock up on disposable plastics.

There is a time and a place for environmental activism…there’s also a time and a place to remember that clients have every right to put themselves first, and it’s one of our goals – I believe – as Social Workers, to remind clients that they are allowed to take care of themselves first, that they are allowed to put their needs first, and that we can work together to help them find other ways of taking care of the environment (and even offsetting their adaptations/restrictions) so that nuking the whales can become a win-win situation…because our clients aren’t going to be healthy (or successful) if their own environments (remember PIE) aren’t inhabitable, let alone be able to worry or do anything about Mother Earth.

*Social Work Desk does not advocate nuking actual whales. Please do not do this. Looking at you, 45 & Kim Jong-un.

Boundaries, Scope, Diagnosis & Diagnosis Dilution

Boundaries, Scope, Diagnosis & Diagnosis Dilution

“No doctor should assume responsibility for the health of one he loves or one he hates” – Dr. Michaels, And Be a Villain, A Nero Wolfe Mystery by Rex Stout

These words were written by one of my favorite authors in 1974, as Dr. Michaels was being interviewed by Nero Wolfe and his sidekick, Archie Goodwin, as they worked to take down the nefarious Arnold Zek.

Boundaries
Boundaries are not only important, they are critical. They not only protect our clients, but they also protect us as workers. Dr. Michaels, in the Nero Wolfe Mystery And Be a Villain by Rex Stout makes an incredibly important point: boundaries are not just about the use of self in our individual practices, they’re also about whom we accept to take on as clients, and whom we recuse ourselves from working with.

While I have found that certain positions such as Community Health Workers (CHWs) and Patient Health Navigators (PHNs) can have a little leeway, since these positions are non-therapeutic in nature, and are about connecting clients to resources and brokering information between providers, I still think the best practice is that they don’t work with those with whom they have a personal relationship.

Some in the CHW community disagree, given their role as communal workers. I think this is also fair, and I again point to the work that they’re doing as non-therapeutic in nature, and therefore subject to some amount of leeway: they’re working as brokers and educators within their own communities. They know their communities (and themselves) best. So far it seems to be working quite well, in many different communities, around the world.

Then there are those positions such as Social Workers, Psychologists, Life Coaches, Psychiatrists, and all the branches of Medicine where there really is no leeway: we don’t take on family, friends, loved ones, or enemies as clients. Period.

We also don’t take on those cases where we’ve heard too much. For instance, if a case has been brought up over and over and over and over again in case conference, it’s better to refer the case to a clinician outside of the organization or agency: no matter how well trained the clinicians at an agency are, no matter how trained they are to be impartial, the client – ethically – deserves a real fresh start when they’re being transferred because the clinician and client have agreed that it isn’t working out. It is unfair to provide the client with a “fresh start” while the person that they’re having their “fresh start” with has heard a large portion of the background story, and the problems that the worker and client were having together.

Boundaries also mean staying within our professional scope and training.

Scope
Scope of practice is important, ethically and legally.

Few pediatricians are trained to accurately diagnose Fetal Alcohol Syndrome (a specialist must be called). Clinical Social Workers do not all work with the same populations (some specialize in grief and loss, some are generalists, others specialize in childhood and adolescent issues, others in addictions, etc.). Life Coaches may have some knowledge of psychology, yet it is against the law (and also ethically improper) for them to provide psychotherapy, counseling, or interventions in any way that are clinical in nature. Psychologists do not have the same psychopharmacological training as Psychiatrists do, etc. Each and every one of us have a defined scope of practice that we must work within.

When we respect our own educational boundaries, when we recognize and proudly proclaim that in certain situations “I don’t know” it frees us to work within the scope of our own knowledge (and removes from us the pressure of being an all knowing expert). It allows us to safely make referrals to colleagues (of which there is the side benefit of building our professional network). It protects the best interests and safety of our clients, and it protects ourselves.

It is impossible to know everything, and there is a great deal of danger in assuming because one has a little bit of knowledge in many subjects, that one is professionally able to work in all of them.

Unfortunately, not everyone stays within their scope of practice (and this is a serious problem). Also problematic is when those who do not stay within their scope of practice and training attempt to diagnose, or provide off the cuff diagnosis.

Diagnosis & Diagnosis Dilution

Unless someone is fully qualified, they should not attempt to assign diagnoses and labels to others, and never to themselves (there are a plethora of reasons why it is improper to self-diagnose).

No matter how much one thinks they’ve read, one is neither qualified nor ready until they’ve taken the very heavily supervised coursework and completed a heavily supervised process.

Just so one can understand what it takes for a Social Worker to eventually be clinically qualified in New York State: we must take Graduate level Psychopathology, have two field placements over two years with 1:1 supervision for one hour, once a week (minimum), and 9 other graduate credits in evidence based clinical course work. Then there’s the initial licensing exam (which *still* doesn’t make one qualified).

After initial licensure you get hired and work under another clinician’s license. At this point, after all this coursework and a master’s, the only expectation your supervisor generally has of you when you start is that you have a basic understanding of differential diagnosis. Then, with regular supervision, and after 3,000 hours of paid clinical work (where you hone your differential diagnosis and counseling skills daily, M-F, 9-5) you can sit for the clinical licensing part of the exam.

Assuming you pass, you then earn your clinical designation. But guess what? New York State views that as a learner’s permit because it will still be about another three years (with weekly supervision sessions) before you get your R privilege that lets you have a home practice/open up your own private office (that means they want to make sure you’re still working, supervised, under someone).

Differential diagnosis of mental health disorders is not easy. It is a time consuming, slow, laborious skill to learn because it’s more than the DSM: it is quite literally thousands of hours of working with clients attempting to draw out from them the necessary and nuanced information to make an accurate clinical diagnosis of which the DSM plays but one small roll.

If one wants the capability to diagnose and to be taken seriously, they need to do the time and coursework necessary to get it. This of course saying nothing of the inaccuracy of psychiatric diagnosis in general and its questionable use in therapy. That’s another (post-modern, sociological view of disability) discussion for later (hopefully sometime this month).

Related and also problematic is the situation of Diagnosis Dilution (usually occurring when individuals self-diagnose themselves): there are clinical standards to determine if one has depression, bi-polar, anxiety disorders, etc. By self-diagnosing oneself, and providing improper diagnosis to others, the general public begins to view these diagnosis in a casual manner, with less and less understanding that they’re very real mental health conditions, that can have a real and pervasive impact on someone’s life.

Build your boundaries (learn from mistakes), know your scope, and don’t diagnose unless you’re trained and licensed to do so.

The Incredible Power of Love & Joy

The Incredible Power of Love & Joy

I am always amazed at the power of love and joy: there is so much negativity right now, we stand at a historic cross roads in so many countries around the world. The headlines are jarring, and yet there is so much beauty: there are so many people doing good, so many people


 
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