Blessed are You oh God! God of our fathers and mothers, God of Abraham, God of Isaac, and God of Jacob, God of Sarah, God of Rebecca, God of Rachel, and God of Leah!
God who wrestled with Jacob and was overcome by him, and so had it proclaimed “Jacob your name will no longer be Jacob, but Israel, because you have struggled with God and with humans, and you have overcome!”
You, God, who in Your infinite wisdom gave Abraham the morning, and Issac the afternoon, that you choose the one who struggled – Jacob – to give control of the night to, this most precious and sacred time…
This time where we are invited to enter into the realm of our deepest truths and dreams, to dance with the Hosts of Heavens, with the music that fills our souls, and where all those who journey can find cover and safety in your blanket of darkness, and reassurance in your stars.
Mighty and awesome God, transcendent god who bestows lovingkindness and creates everything out of love: bless and protect this space, hide it from all who seek to do it harm, and yet may it shine as brightly as the Pillar of Fire that brought your people out of Egypt and into freedom, so that all those who are seeking refuge and are in need may find there way to it.
May it serve for as long as it is needed, and may we reach a time soon where we will no longer need to transport people in secret or in cover of darkness, and where nation shall not turn upon nation, but where we can accept each other as brothers and sisters as one.
– Matthew L. Schwartz
Written in Honor of the work of Rev. Justo Gonzalez II
Thank you @tedxbuffalo for what was an incredible opportunity to share @foodgnomes message! If you haven’t seen my #TEDx talk yet, please watch it at https://iam.ms/TEDxBuffalo #ted #tedx #tedxtalks #tedtalks #tedxtalk #tedtalk
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!
Pleased to announce that the video of my TEDx talk is finally released!
Pleased to announce that the video of my TEDx talk is finally released! Watch it on YouTube by clicking the shortened link: https://iam.ms/TEDxBuffalo #ted #tedx #tedxtalks #tedtalks #tedxtalk #tedtalk
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.
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.
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.
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.
Honored to be recognized as a Difference Maker by the #Buffalo #Jewish #Federation for my work with Food Gnomes! Wish I could have been in attendance when these beautiful plaques were given out (sadly I had a chest infection that evening), but happy to receive mine just the same! Thank you to the entire Food Gnomes leadership team (and of course the Jewish Community and the Community of Pilgrim – St. Luke’s and El Nuevo Camino United Church of Christ for your continued support!)! 🙂
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.
“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.