Sunday, November 6, 2016

We're All Just A Little Crazy Right Now

I'm not talking hyperbole nor am I denigrating those of us who suffer from mental illness.  I'm a Licensed Clinical Social Worker and I'm here to say I think that a huge percentage of this country's population suffers from a psychiatric illness called Generalized Anxiety Disorder (DSM-5 300.02).  According to the Diagnostic And Statistical Manual Of Mental Disorders Fifth Edition this particular disorder can be hard to diagnose.  However, some of the primary symptoms include excessive worry about stuff like health, family, money and work.  Further symptoms include feeling tense, tired, irritable and restless.  The symptom list goes on to include difficulty concentrating and sleeping.
Any of those symptoms sound familiar?
I'll go first.  I can't remember the last time I slept through the night.  I am tired and tense.  I'm having trouble concentrating maybe because I'm so restless and tense.  I worry about the future of my family, this country and, quite frankly, the world.   I keep checking my phone for updates -- for any indication that things are not as bad as they seem.  And so I ride the roller coaster of good news, bad news and of despair and exuberance.
Now your turn.  Go ahead.  I won't tell anyone.  How are you doing?
Anytime we are diagnosed with something or other we want to immediately know the cure.  The cure may be when the polls close on November 8.  However, that may be just a bandaid.  The outcome of the election may lead only to more things to worry about regardless for whom we vote and regardless of who is declared the winner.
So are we to simply descend into the morass of our disorder?  No.  Here's what we can do.  We can put down our cell phones and our iPads.  We can shut off our televisions.  We can look for reliable, objective news sources if any still exist.
We can also live our lives mindfully and with intention.  The time has come to embrace miracles:  early morning drops of dew on leaves, music, poetry, smiles, rainbows, sunsets, laughter, family, love.
I love you.
That's the bottom line and it's time to live a life of love.
Anxiety eats away at our souls.  Love replenishes, restores sanity, and nourishes life.
Live and love.
Go for it.

Thursday, November 3, 2016

Here's An Academic Article I Co-Authored

Volume 6.2 | Fall 2016 | Practice Digest | © November 2016 | Virtual Academic Challenges To Real-Time Trauma
Susan Hess, MSW
University of Southern California

Melissa Indera Singh, MSW University of Southern California
Mary Walker Baron,MSW University of Southern California

Helping graduate level social work students address and process recent mass casualty violence is a challenge to any classroom. We feel it is especially challenging when the classroom is virtual. While the virtual format allows for video and audio contact, students and instructors may be thousands of miles apart and see each other, like the old Hollywood Squares television program, from only the shoulders to the top of the head. Our Virtual Academic Center (VAC), while in most ways a marvel of technology, does present special challenges when faculty is confronted with such sensitive issues as the killings in Orlando, the deaths of Alton Sterling and Philando Castile and the shooting of police of cers in Dallas and Baton Rouge.
Classroom conversations dealing with emotionally charged topics are always challenging. However, in our virtual atmosphere, the subtle nuances of discussion may be more dif cult to interpret. According to the Substance Abuse Mental Health and Service Administration (SAMHSA, 2014), the guiding principles of trau- ma-informed care are: safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment; voice and choice; and cultural, historical and gender issues. These guided principles were presented in the discussions with faculty with encouragement to be integrated with students in their class- rooms in order to avoid re-traumatization.
Shortly after the events in Orlando, Florida, we met with other VAC instructors for a regularly scheduled faculty consultation group, which we co-facilitate. During that meeting we presented the question of how best to approach this tragedy in our virtual classrooms integrating the principles of collaboration and peer support. What we immediately discovered was that before facilitating any type of effective student discus- sion, faculty needed an opportunity to address their own thoughts and feelings. We provided some of that needed time before moving on to classroom and student issues.
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We expected the student conversations to be intense. What we did not anticipate was the intensity of our faculty discussion. Such intensity, however, deserves opportunities to both problem-solve and process. We believed that to be effective these opportunities for dialogue would need to avoid personalization and politi- cization while including safety as a guiding principal to facilitate a trauma-informed dialogue. The challeng- es were to invite students to explore their own experiences with stigma and to facilitate the creation mecha- nisms for personal and professional stigma reduction.
We provided students opportunities to engage in critical thinking and discussion on micro, mezzo and macro levels.
We suggest the following whether your classroom be in person or virtual:
  1. Often we begin our classes with a “check in” designed to help students enhance their clinical interven-
    tion skills by inviting them to facilitate and to share recent challenges or experiences. We encourage faculty to adopt the “check in” as a way to begin each class. Aligning with the Trauma-Informed Care principles of empowerment, voice and choice, students can “check out” if they do not feel comfortable discussing the tragedies.
  2. It can be challenging for even the most seasoned clinician to differentiate between the personal and the professional. We suggest faculty encourage students to check their own responses to determine whether the response is personal or professional. Our personal voices may be emotional or opinionated informed by our own bias and potential dysregulation. However, our professional voices must stay calm. We need to let our personal voices go at the appropriate time in the appropriate manner. We discourage using social media as a forum for our personal voices. We also remind students and faculty that our own expe- riences shape our unconscious bias.
  3. It is critical to address the effects of listening and watching traumatic events on a daily basis and to implement strategies of wellness in order to prevent burnout, vicarious trauma and secondary trauma (Schott & Weiss, 2016). Students and faculty are encouraged to identify daily wellness strategies.
  4. We stress the value of creating an educational frame of bias, self-awareness and self-regulation in the classroom. One way to do this is to offer questions around informing the students’ identities and
    how they can be challenged by those who are different from themselves. This approach incorporates
    the guiding principles of trauma-informed care by integrating cultural, historical, and gender issues (SAMHSA, 2014). Another strategy would be to incorporate mindfulness of emotions leading to taking a breath prior to engaging.

  5. Regardless of the venue, faculty can set a framework to focus the discussion on feelings, re ections, and counter-transferences instead of politics.
  6. Regardless of the venue, faculty can set a framework to focus the discussion on feelings, re ections, and counter-transferences instead of politics.
Some faculty attending the consultation meeting later shared their classroom experiences, which we now present for additional consideration.
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“I showed the video Imagine a World Without Hate ( and asked the students to be fully present when they watched it and to think about the circumstances and the shooting in Orlando. After the video we came back together for a very thought provoking dialog about what it means to have
a social work response to this tragedy. Later I showed Dear Young Men of Color ( BUaLsXmQ) and invited students to discuss this through a macro, micro and mezzo lens.”

“I gave my students the following activity. I told them that they were the management team of a community based social work agency. A mass casualty shooting had just taken place in their area. Their task was to triage needs based on the capacity of their agency and formulate responses appropriate to social workers.”
Students attending our Virtual Academic Center are from all over the nation and part of the conversation, according to faculty response, was about why we all need to care about this.
Faculty shared that some expressed ideas about engagement on LGBTQ issues in their communities. Other students discussed violence used by police through a historical context while others sought to understand historical trauma, generational trauma and systemic trauma.
“We talked about healing and how social work promotes healing.”
The activity sparked engagement in some students and raised their consciousness about thinking like a social worker. For minority students in the class it was a forum to be heard and supported.
“Overall it was very moving to see the up and coming social work professionals address this tragedy from a new perspective.”
As social workers and as teachers we understand the implications of vicarious trauma. We also appreciate the challenge of creating opportunities to process feelings while avoiding personalization and politicization. The frequency and magnitude of recent mass casualty events challenge our objectivity and our capacity to absorb. The degree to which we reel from it all surely must mirror the degree to which our students reel. We all need a forum in which to absorb and process and learn so we can move forward to create viable solutions based in our core social work principles. We believe the best venue for such innovative healing is the social work classroom.
Since the social work classroom extends to eld placements, our student learners may encounter the parallel processes of managing their own trauma reactions while providing places of clinical refuge for those seeking assistance. Students may also feel buffeted by the employees of their placements as they process their own trauma related thoughts and feelings.
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We believe that wellness plays an essential role in social work education and must receive attention as students new to this very demanding profession begin their eld education. Those students intent on academic accomplishment may resist the very notion of taking care of themselves and become at risk, even before graduation, of professional burnout. We believe that social work faculty can prepare students with readings, videos, and discussions of secondary traumatic stress, vicarious trauma, compassion fatigue, and professional burnout. We also encourage faculty to integrate mindfulness practice in each class. We further believe in the value of frequent student contact from faculty to reinforce wellness for students in their eld placements. While eld faculty cannot function as student therapist, we can identify possibilities and suggest school-approved resources for students needing additional emotional support.
In order to assess student burnout potential, we suggest that eld faculty become comfortable discussing topics such as emotional exhaustion, depersonalization, and reduced sense of personal accomplishment (Newell & MacNeil, 2010). In order for students to successfully provide their own wellness, the eld instruc- tors in the placements must also embrace this educational and personal necessity. We acknowledge that this may be a signi cant barrier to the prevention of student burnout since encouraging wellbeing might very well y in the face of the culture and practice of the placement agency.
Regular attention to wellness has the potential, we believe, to minimize the toll of vicarious trauma. In the classroom as well as in the eld we suggest frequent discussions of the realities and the emotional, mental, physical and spiritual symptoms of vicarious trauma (Gerding, 2012). Gerding (2012) further suggests that supervision can be a coping mechanism for clinicians if the supervisee feels safe to express fears, concerns, and perceived inadequacies. Once again, such supervision should not stray into the realm of therapy.
Realizing that students may have already experienced trauma, it is critical that Field Instructors provide trau- ma-informed discussions to prevent additional trauma. Field faculty may need to facilitate such discussions during eld visits. During eld placement, it is important to discuss populations that may trigger students and how eld placement may feel like a scary environment.
While we often think of families, youth, individuals and communities experiencing trauma, it is important to recognize that the trauma experiences of our students may have led them to the eld of social work. SAMHSA can be used during individual supervision when exploring countertransference. Students who present with ght, ight or freeze responses, for example, may be experiencing re-traumatization and it is important to know how to support them in eld placement. An effective response to such a student might be to offer a break before discussing a client experiencing trauma. Providing choice and safety can support the intention of doing no additional harm while providing students with trauma-informed supervision.
With or without the involvement of the placement agency eld supervisor, faculty can facilitate student wellness by encouraging student activities to help minimize the effects of vicarious trauma. Pearlman and McKay (2008) suggest activities to help escape, rest, and play. We have suggested that students escape by
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watching videos of cats riding robotic vacuum cleaners or listening to music. Rest for graduate students may seem an anomaly. However, students schooled in the value of wellness may schedule times to stand up and stretch or meditate. Play can come in many forms. We might participate in sports, write poetry, go to the gym, or read an absorbing mystery. If wellness is included as an essential part of professional development, we believe students will become more aware of their own physical and emotional needs and this increased awareness will move students toward successful completion of their eld placement experience.
We regularly remind our students that the world needs social workers and thus the world needs them. An essential task of faculty is to prepare our students to enter and remain in this essential profession. Such preparation, we believe, must include not only familiarity with trauma-informed care but increased awareness of the urgent need for our own wellbeing.
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Gerding, A. (2012). Prevention of vicarious trauma: Are coping strategies enough? Master of Social Work Clinical Research Papers. Paper 27. Retrieved from
Newell, J. M., & MacNeil, G. A. (2010). Professional burnout, vicarious trauma, secondary traumatic stress, and compassion fatigue: A review of theoretical terms, risk factors, and preventive methods for clinicians and researchers. Best Practices in Mental Health, 6(2), 57-68.
Pearlman, L. A., & McKay, L. (2008). Understanding and addressing vicarious trauma. Pasadena, CA: Headington Institute.
Schott, E. M. P., & Weiss, E. L. (2016). Transformative social work practice. Thousand Oaks, CA: SAGE.
Substance Abuse and Mental Health Services Administration. (2014). Guiding principles
of trauma-informed care.
Retrieved from Number_2/trauma_tip/guiding_principles.html