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Today is the first day of my DSW program! The program begins with some wonderful cohort building, a thorough explanation of what is to come ahead through our formal onboarding (virtually) via our two day orientation, hope, and excitement.

The program also begins within the context of the United States closest to Civil War than it ever has been in anyone’s living memory; taking place in the greater context of a pandemic that is taking both a physical, economic, and mental health toll on the entire nation, and – on a Macro Level – the globe.

Context is important. Context helps us understand the whats and the whys of what’s happening now, and helps us put those questions into a framework that we can understand for patients when we ask “what happened?” when begining to explore trauma [zotpressInText item=”H4V6HWT7″ etal=”yes”]. Context is the difference between seeing the larger picture (as scary as it sometimes is), and staying stuck at the micro level. Context is what allows us to function at the three levels of our practice (Micro, Mezzo, and Macro). Context is what also allows us to address policy, and shut down bullshit when we see it (e.g. those bills that magically take away context when discussing funding important programs, or providing relief, etc.).

Context is key.

And in this context I begin some new habits; daily writing among them. Years ago, I used to blog profilically (back before LiveJournal was bought, and sold, and bought, and sold, and eventually bought by a Russian company and then had its data illegal transferred out of California (more on that in another post, because I think it has a lot of relevance to what we’re experiencing today).

In any event, my new routine is to write daily, whether academic, or personal…I am going to write…hopefully this will also put my studies, my thoughts on class (both economic and what I’m learning in my program), my life, and what we are experiencing in the United States right now, into context.

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I have always loved living in University Heights. From my first forays as a visitor making my way to Amy’s Place, to my first apartments it held a special place for me. The real magic, though, was when I finally started staying summers as an undergrad, instead of returning home. Taking summer courses, allowing my mind to expand and wander, while at the same time listening to music, walking, drinking iced tea and soaking in the neighborhood is still, to this day, one of my favorite memories. Equally, perhaps, as enjoyable as the memories I hold of sitting at restaurant tables outside watching students return and move back in. There was always excitement in the air, and I was happy having been firmly established in my apartment at the time that I didn’t need to do anything, or any heavy lifting: I could just people watch and soak up the energy.

I have always loved how much a part The Heights is with UB (though, sometimes to the consternation of the neighbors, the university, or both). I love the idealism, the activism, the antics of the frats (usually. Not the hazing, to be sure, but certainly the goofiness that goes on at all hours). I love the music, and the casual football, and the study sessions. I love the countless eateries. I love the constant-noise-but-not-too-big-a-noise-because-we’re-studying hum that exists.

I love the sound of UB’s clock tower. I love knowing my way around Buffalo by the position of South Campus. When looking to buy what is my first (and last!) house, I was happy to purchase it in University Heights.

Many years ago, when I was still in Israel, and still in Uniform, a friend of a friend who I had helped get into my unit (an elite nerd unit) remarked, as we were talking about whether or not we were going to stay in Israel, that he was going to place money on the fact that I wouldn’t. He shared ‘you can’t, you need to be in a small town, as a college professor to be happy…” and while not a college professor (yet?), and while I vehemently disagreed with him then (Zionist that I am)…he was right, I have to live in a University Town, with a University Vibe, and a University Library, and University Life to be happy…and so here I am, happy…but also quite sad.

I am sad that this year is, likely, to be more quiet than in the past. Much, much more quiet. I purchased my house in January looking forward to watching students move in, and University Heights come alive this autumn. Small, and certainly insignificant on the global and universal scale of the pandemic we’re facing, but still, a loss that I’m grieving this year, will be the cacophony of moving trucks and cars, worried parents and embarrassed students, long lines at the coffee shop and book stores…and other signs that my alma mater is the beating heart of the place I love to call home.

This is an updated entry from my previous discussion on the topic, which can be found here.

The genesis of this is that I was discussing recently with a friend and colleague, former professor, mentor, and one of the people who got me started on my path to be a Solution Focused Counselor/Therapist (that’s a lot of titles) what my notes look like as a Solution Focused Brief Therapist in public practice in the United States where, especially when billing insurance, we must justify our work through documentation, to say nothing of our ethical requirements to document appropriately…so I figured I’d share the template and format I use.

I have come up with the following format for therapeutic interactions which, with the exception of the MSE, I write collaboratively with my patients. This takes no more than five minutes at the end of our session, and ensures I don’t ever get behind on paperwork/case noting.

I do not take any notes during a session in order to foster open and direct communication. There is nothing between myself and the patient (no pad, no pen). This requires a great amount of practice in active listening. I recommend a lot of role play to become comfortable with the technique.

Below is an example of a contrived session I made up about John Doe, it should bear no resemblance to anyone living or dead since I just came up with it on the fly, sans-coffee, while waiting for my flight:

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MSE:

Patient presented on time, dressed appropriately, appeared alert and well-oriented. There was no evidence of disruption in speech flow or content, memory, or perception. Current mood observed as euthymic with affect congruent to mood. Thoughts were organized and goal-directed. Judgment appeared good, and insight appeared moderate.

Patient presented with:
– Desire to reduce symptoms is depression;
– Desire to reduce symptoms is anxiety;
– Desire to improve capability for regulating moods/emotions;
– Desire to reduce stressors regarding family;
– Desire to reduce stressors related to work.

Clinical Note:
WBTW (What’s Better This Week): John Doe shared that this week he was able to get out of bed and go to classes twice. John shared that he was also able to wash half of the dishes in his sink.

BHFTS (Best Hopes For Today’s Session): John shared that if he could work on finding a way to attend his classes, and finish doing his dishes, then today’s session would be helpful, useful, and productive.

Scaling (1-10/Zombies-to-Unicorns): 4.5; Goal (1-10): 5/John shared that he will be at a 5 when he is able to do all of the dishes and is able to go to all of his classes.

Discernment: John and this writer discussed barriers to doing his dishes and to attending classes, and how these barriers are negatively impacting his mental health symptoms**.

Exceptions: John shared that the problem of doing dishes and cleaning in general is not a problem when he comes right home after work. John shared that attending classes weren’t an issue when he got more sleep.

Experiment: John was able to brainstorm ways in which he can address his barriers to move to a 5 on the scale. John will try to do dishes twice this week right after work. John decided he will set a reminder on his phone to go off part way through his commute to remind him. John will set his bedtime back by an hour to get an extra hour of sleep.

Clinical/Psychoeducation: This writer provided psychoeducation on the importance of sleep hygiene and behavioral activation for reducing the sxs of depression.

Risk Assessment: John denied thoughts, plans, or intents or harming himself or others.

Follow Up: Follow up in two weeks. John to complete experiment as outlined above. John will call/come in if he requires additional support between now and his next appointment.

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**While problem talk is discouraged, linking the patients concerns, and treatment to their mental health symptoms in discussion is necessary for ethical treatment under insurance. This is possible even in SFBT when we look at the “preferred future” (i.e. “I won’t be so anxious,” or “I won’t be as depressed,” etc.). We have to show how they are negatively impacting mental health symptoms because that is the structure of the medical/insurance setup in the United States.

In any event, I hope this is helpful to the wider SFBT community who is forced to balance SFBT work and insurance (without which, only the wealthy could afford our services), and I look forward to turning this into some kind of presentation at some point (SFBT & Insurance: An Uneasy Truce?).

Friday, June 12, 2020

Personal Statement on Today’s Rally of Social Workers and Human Service Professionals in Support of Black Lives Matter

THE VIEWS EXPRESSED HEREIN ARE ENTIRELY MY OWN AND DO NOT REPRESENT ANY OF MY EMPLOYERS: PAST, PRESENT, OR FUTURE.

6. Social Workers’ Ethical Responsibilities to the Broader Society

6.01 Social Welfare

Social workers should promote the general welfare of society, from local to global levels, and the development of people, their communities, and their environments. Social workers should advocate for living conditions conducive to the fulfillment of basic human needs and should promote social, economic, political, and cultural values and institutions that are compatible with the realization of social justice.

6.04 Social and Political Action

(d) Social workers should act to prevent and eliminate domination of, exploitation of, and discrimination against any person, group, or class on the basis of race, ethnicity, national origin, color, sex, sexual orientation, gender identity or expression, age, marital status, political belief, religion, immigration status, or mental or physical ability.

(NASW Code of Ethics)

Today my colleagues will be rallying in front of City Hall in support of Black Lives Matter. I am there with them completely in spirit, though, unfortunately not in body: as someone who is Disabled, with chronic-illness, and two auto-immune conditions, and who is immunosuppressed, it is, unfortunately, not safe for me to be in large crowds right now due to COVID-19, even while wearing a face mask.

That said, to remain silent is to side with the oppressor against the oppressed. My field, my profession, can and does do a lot of good. However, the field of Social Work and those who work within it it also must work to de-colonize ourselves, and to de-link ourselves from systems of oppression, so that we are not the “friendlier face” of the police force, or the “friendlier face” of the State’s arm of enforcement and systemic racism and oppression.

My field, like all ‘helping’ fields, has much to answer for: from Orphan Trains in the United States, to the treatment of the indigenous populations in the United States, New Zealand and Canada, and more. We must do better. We must align ourselves with actively anti-racist practices, and we must do the work to educate ourselves, rather than rely on marginalized colleagues to take the work of educating us on their shoulders. We must remove barriers to diversifying our field, and we must work to ensure that those who have been kept out of leadership are placed in roles where they can lead and have their voices heard.

I propose no answers, and no solutions: we are no one’s saviors. Instead, I join together with my brothers and sisters in radical solidarity for tearing down systems of oppression, and replacing them with systems of healing, equity, justice, education, peace, housing, healthcare, and food security.

Yours in the Struggle,

Matthew L. Schwartz

As I began to complete treatment plans for my patients (while currently suspended as a necessity by the Office of Mental Health, I had decided I’d rather keep them current, so I don’t have a metric ton of paperwork to do when that requirement comes back in full force). Anyway, I was reflecting on how hard it can be to hold a healing space for my patients in the whirlwind of this crisis. Being a healer takes energy. And we work so hard to avoid burnout.

However, as I went through and began to review the 40 or so treatment plans I wanted to bring up to date and saw the incredible progress, and growth, and resilience, and strength of my patients, I felt this wonderful and incredible sense of awe come over me and I felt so refreshed and so recharged.

I realized that I am continually in awe. I am in awe of humanity. I am in awe of the power to overcome trauma. I am in awe of the ability to overcome torment and torture. I am in awe of our ability to battle our own minds. I am in awe of our ability to hold ourselves up and together amid countless storms. I am in awe of the holiness that exists between each of us when we work to heal one another.

I am in awe of the laughter that exists amidst tears. I am in awe of the ability to be surprised. I am in awe of recovery and the power to mend and to heal. I am in awe for the power to take apart and to separate and to move forward alone. I am in awe at the love that one another can show to total strangers. I am in awe when someone learns how to fall in love with themselves again after years of self-hate.

I am in awe of the universe and the power of community and networks, big and small: from the anthill to the cosmos. I am in awe at our individuality among our interconnectedness.

I am in awe at our individual and collective resilience.

“There is nothing as straight as a crooked ladder.” The Rebbe of Kotsk