How Did That Make U Feel?

I've been so caught up in making sure that my patients were OK with me leaving, now that my internship is ending, that I forgot to check in with someone else who's of prime importance: me.

This posting is not about how much I'm going to miss my patients when I leave. Of course I will miss them, and I will always remember my first psychotherapy patients. But I've always known that I would be leaving at the end of April, so it comes as no surprise. I'm also excited about moving into my future.

I'm writing this to suggest that there are all kinds of hidden emotions that can trip us up as we prepare to leave. In a 2005 essay, "End-of-year Treatment Termination: Responses of Social Work Student Trainees," published in The British Journal of Social Work (vol 36, 2006), Nehami Baum discusses the frustration and anxiety that many of us experience as we prepare to end our work with clients.

One of the problems for us, as Baum makes clear, is that most of us are taught to practice what might ordinarily be long-term psychodynamic therapy, but we are expected to do so within a relatively short seven-month time frame. So we form powerfully intense relationships with clients--and then just like that, it's all over.

Student therapists dealing with their own unresolved prior losses or separations (I'm going to assume that would include most people) can suddenly find themselves acting out old dramas--to the detriment of the client and to themselves. I say all of this to remind myself and others that it behooves us to care for ourselves. That doesn't just mean taking a bubble bath or getting a pedicure, but of remaining mindful of how we're feeling, and to ask for support when necessary.

It was a case straight out of The Princess and the Pea. It was just a little thing, but it felt so big.

I'm talking about getting my application in the works for the Licensed MSW Application. Since I'd like to take the exam soon after graduation, I've been meaning to mail in my paperwork. I listed this chore on my mental to-do list, but I kept postponing.

When you're moving toward graduation--attending classes, writing papers, terminating with clients and finishing up all that office paperwork--even ordinarily reasonable chores begin to feel oppressive.

But I'm happy to say that I got it done. I thought it might help others out there who might also be suffering from senioritis, if I described the process step-by-step. So here's what I did:

1) One to two months before graduation (or later, if you're the laid-back type) go to op.nysed.gov/lmsw.htm, the website for the New York State Education Department's Office of the Professions. On the left-hand column, under "Licensed Social Worker," you can download an application form.

2) Download both Forms 1 and 2 (Put Form 2 aside, you won't need it until after graduation).

3) Fill out Form 1

4. Make a copy of your Child Abuse Identification Certificate to include with the application.

5. Get a passport photo made. I had mine in hand after only 15 minutes after going to a shop just a 2-minute walk from Silver's front door: Forum Foto, 29 Waverly Place. Glue photo to the last page of the application.

6. Have the last page of the application notarized. The Chase Bank Branch, located two blocks from Silver, at 32 University Place, has a notary available. The fee is waived for customers, and is $2.00 for everyone else.

7. Make copies of the completed form, just in case yours gets lost in the mail.

8. Enclose a check for $270.

9. I'm going to mail my application from a post office, so I can send it with a proof-of-delivery form. I know you can understand. As hard we've worked to get to this point, I just don't want any hold ups.

10. Two days after graduation, you can complete Section one of Form 2 and mail it to the NYU Registrar Office of Degree Verfication, 7 East 12th St., 4th fl, Ny NY 10003. Or you can hand deliver this form to the Registrar at 25 W. 4th Street, where they can verify your degree and forward the form to the NYS Education Dept free of charge.

Once you receive an approval letter from New York State, you can apply to the Association of Social Work Board to register for the exam, (www.aswb.org) for $175.

I don't even want to think about the exam itself. Not yet, anyway. Good luck, folks!

Today marks the 10th anniversary of the day I stopped eating out a sense of scarcity.

I'm told that one's earliest memory, the primal memory, should be explored for vital clues to one's unconscious. That certainly proved to be the the case for me. You have to wonder, if a child has thousands of experiences, why one memory seems to stand out as first. For this to happen, the mind would have to sort through any number of experiences and settle on this as being so important that it should remain fixed in place. It's as if you're sending a message to your conscious mind marked "urgent."

I used to laugh about my earliest memory. I was about two or three years old, seated at a dinner table with my mother and sister for some festive occasion. In a fit of pique, I lifted the baby lamb chop from my plate and hurled it across the table. I thought the chop was too small, and I wanted a bigger one. My mother sent me to my room.

I always thought that one of the reasons this memory stayed with me was because my behavior was so uncharacteristic. I was the well behaved daughter, the one who smiled and worked hard to keep the peace. That behavior just didn't fit who I am.

Fast forward almost five decades, years when I seemed to wake practically every morning of my life and wonder if this would be the day that I figured out how to stop overeating.

It wasn't until I began working on my own issues that I unearthed a family secret involving me. From the age of eight months and until I was two and a half or so, I had been separated from my mom. This was a time when she was 23 and was on her own in Manhattan, broke after being fired from her job because her employer had learned that she was black. She had light skin, brown hair and green eyes, and was one of many black women who used to pass at work and return home to black neighborhoods.

Determined not to accept government assistance, she took me and my sister to live in Virginia with her sister. I didn't learn about this for another 30 years, long after my mom's death. I think she felt guilty about leaving us. My father had abandoned us when I was about a half year old and I think she feared that I would blame her.

Meanwhile, the Aunt I lived with had always felt like a mother to me, but I never understood why. In fact, as a teen, during a summer visit, I sobbed when my Aunt and her family drove off without me, headed to a portrait studio for a family photo. I sensed that I was supposed to be included in that family photo.

Here's what I later discovered. By the time my sister and I joined my mother again, I was about three. As I piece together aspects of my childhood, I realize that that festive dinner, when I was hurling that chop across the table, was a welcome-back celebration that my mother was hosting just for us. I must have been acting out because I was angry about being taken away from my Aunt Mary.

Aunt Mary is a wonderful cook, and serves food in copious portions. Seated at my urbane mother's table and staring at that baby lamb chop on my plate, I probably felt I would never get enough of anything I wanted. I was hurting.

I now believe that this memory has stayed with me because it was so rich with significance about who I had become.

So why hadn't I figured out the connection between this memory and overeating before? I do not know. All I do know is that it takes time to realize connections between our painful memories and our behaviors. Why should we be any different from our patients?

Ten years ago I awoke remembering my angry outburst at dinner. This time the pieces of my life came together. My heart welled for my mother, but mostly for my own grief. When I could eat again, I cut my portion in half. When the ravenous, unsatisfied aspect of my psyche cried out for more, I calmed myself with self-hugs and reassurances that there would always be enough of what I wanted. Therapy also helped. 12 Steps did too.

That was 10 years ago today. I seldom practice my ersatz calming ritual these days, but it did help when I needed it. By the way, and this is more of an afterthought--because the truly good news here is the growth I experienced internally--I did lose weight, lots of it, and I have never regained it.

That little insight was almost 50 years in the making. I will have to recall my slow rate of progress the next time I find myself feeling impatient with a client and wondering why he or she doesn't just figure out the root of the problem after several months.

When I was a toddler, I took my first steps.

When I was 14, I enjoyed my first dance.

In time, there were many other important firsts.

The funny thing about "firsts" is that you may not notice at the time that this might be the start of a new phase in your life.

It was like that for me when I visited NYU for the first time and attended one of Silver's Open House events, hosted by the school's Admissions Department.

Maybe you're wondering how an event such as this could be included on my list of firsts, but let me assure you that I'm serious.

At the time of this Open House, I was wrestling with the decision of where I should apply to social work schools. I'd made a lot of calls, visited different schools, and talked with social work students, but I was on the fence until I visited NYU in 2007.

Open Houses can be a lot like blind dates. You keep putting yourself out there, making the effort in the belief that one day your efforts will be rewarded. And then one day, someone changes the way you look at things. That's what happened for me.

What made this event momentous? My response had less to do with the building's considerable ambience or even the students' enthusiastic recommendations. One professor in particular made the difference for me. I'd always thought of social workers as do-gooders, but that night, I was offered an image of something more. The professor who spoke looked and sounded like someone highly empathic--but something about her personality suggested that she wouldn't tolerate a whole lot of nonsense from folks. She had what I've learned to think of as the essential social worker's personality. I listened to her and began to dream about what I could become. I never applied to other schools.

Now I'm nine weeks away from graduating.

I rode the elevator today and ran into that professor who, in my mind, had come to symbolize Silver School's unique blend of gifts. Because of my schedule, I'd never taken any of this professor's classes, but I still felt a special connection to her.

We stepped onto the elevator and I greeted her warmly. She returned my hello and gave me a pleasant smile, but she didn't seem to recognize me--and there was no reason why she should have. After all, she'd changed my life. To her I am just one of many admiring students. She will never know what a difference she'd made in my life, nor does she appear to be the kind of person who'd get all that excited about me gushing over her.

The next Silver School Open Houses are scheduled for Friday, 3/27 at 2-3:30 and Saturday, 4/25, 10-11:30. Call 212 998-5910 or email ssw.admissions@nyu.edu. for reservations. I'm tempted to attend one of them myself, just for old times sake.

If I had known when I earned my undergraduate degree what I know now, life would have been a lot easier for me. Back then, I knew a lot about English literature, but nothing about how to handle money.

Like a lot of people moving toward graduation, I worried more about how I was going to find a job and pay off my school loan than how to spend my future earnings. Boy was that a mistake. It turned out that I had a great wardrobe and a hot Italian sports car, but I spent the first two decades of my career in debt. It took me years to figure out that being smart and working hard is not sufficient: financial literacy is crucial for survival.

If you doubt me, think of all those people who purchased houses they couldn't afford or those who turned their life savings over to unscrupulous financial professionals. Many of these people are educated and were once prosperous, but now they're scrambling. They thought that having money meant they could keep it. Now we all know better. I have included below five financial essentials:

1. Make it Automatic: Think about those automatic doors that swing open at your approach. They make life seem so easy. Automatic savings work in much the same way. Even if you can only afford to pay yourself a little in the beginning, sign up for automatic deductions. You'll become so accustomed to not having that money that you won't miss it. With automatic savings it's almost as if you trick yourself into saving. And while you're at it, try not to think of putting money aside as saving; think of it as paying yourself.

2. Live Simply: Whatever you earn, for the first few years as you get a toehold, live as if you earn less than you do. When you first graduate, your first instinct might be to reward yourself. But the best way to reward yourself is to live beneath your means--and that might mean renting an apartment with two or three roommates and even going without a cell phone or cable for a while. This way, you'll be able to manage the unexpected.

3: Chill Out: Use a credit card only when you can afford to write a check immediately and pay off the balance. The interest on credit cards compounds and before you know it, you will be in hock to the credit card company. If you find it hard to resist using your card, stick it inside a Ziplock bag and freeze it inside a block of ice. That way, if you run into an emergency and have to use the card it will be there when you need it. If you already owe credit card debt, work an extra job if necessary, to pay your debt down. Credit card debt can start to feel like legalized slavery. You might find yourself working for the company and not for yourself.

4. Consider Your Future: The agency or firm that hires you may offer a pension plan in a 401(k) or 403(B) or in some other form. In the last several months, as millions of Americans saw the value of their retirement funds plummet, these plans have gotten a bad name. Don't be fooled. These investments can reduce your tax bill and they can really pay off in the long run. If you're in your 20s, 30s, or 40s your money has decades to grow--it's called having a long time horizon. And you will be buying into the Market when stock prices are low, which means you can get them at a bargain. But please, when you are five to seven years away from retirement, start moving some of that money into more conservative instruments so you don't have to risk losing your shirt just as your career winds down. And as your account builds, don't dip into it. The government will charge you high taxes and stiff penalties for dipping into it before you are 59 1/2 years old. If and when you change jobs, you can simply roll that money over into the new retirement plan, without dipping into it or paying penalties.

5. Protect Yourself: If your job doesn't provide health insurance, ask your parents to help you out and purchase some of your own. You may be young and healthy, but a ski accident or tumble down the subway stairs could leave you paying medical bills for years. If you are looking for bare-bones coverage, go to ehealthinsurance.com and compare prices.

Finally, if you're thinking of buying yourself a small gift for graduation, buy a subscription to a financial magazine or start reading one online; Kiplinger's is my favorite. The more financially literate you become the better your chances of spotting a financial rip-off when you see it.

Happy reading and may your financial future be a sound one.

I've written this post for your mom or dad, or maybe an aunt or uncle.

In fact, it may prove helpful to anyone you care about who may have retired recently, but whose plans have been waylaid by sinking investment accounts.

Or maybe you know someone whose career has been destroyed by the tanking economy. For instance, lots of my former colleagues, including journalists, authors and book editors, are unemployed because their industries are shedding jobs at a fast clip.

A lot of these newly unemployed or luckless retirees are experiencing grief reactions, including shock and despair. Their self-confidence might be eroding. They might be feeling "old" lately, but certainly not old enough to sit on a porch rocking.

That's why I'm writing this post. I hope you can interest someone you care about in considering a second (for some it may be a first) career in social work, the field that keeps on giving. I know a lot about career change. I enrolled in the two-year social work program at the age of 59, after working as a journalist and author for more than three decades. Changing careers was one of the best decisions I have ever made. It's hard to imagine now that there was ever a time when I felt spiritually depleted. Three days a week, I head out to my hospital internship with a spring in my step.

Of course social work isn't for everyone. It is not for someone who would rather be alone and not "bothered" by others. It is for someone who has a fighting streak, someone who is a good communicator, and can celebrate when other people win.

Few people truly understand the flexibility of a social work degree. It can open the way for a variety of different jobs in everything from corporate work, to politics, to hospitals, to social service agencies. And this is a field that honors wisdom and experience. I did experience some initial age discrimination--I was rejected at a couple of internship positions--but those incidents only strengthened my determination to succeed.

Why would I urge you to recommend social work and not another field for a loved one? It's not simply that social work students remain more employable than those in a lot of other fields, but of course that is significant. I have found it worked for me because of the profession's core value: respect for the person --for the individual. Social work isn't a cookie cutter degree. You are encouraged to bring your strengths to the table. And there's another big plus. By and large you will find that this is a profession dominated by people who are open, kind, ethical, patient and encouraging.

Versatile degree, wonderful professors and classmates--all of that is a huge plus, of course. But there is one more factor in terms of why I feel optimistic about my chances for success, even though the economy is shrinking.

I am not just studying social work, I'm studying social work at NYU. This is a school that has the spirit of a community. You're not just another face here. That can be particularly important for someone who is feeling a little bruised and uncertain during a time of transition. And the sense of connection to a community enhances self-esteem.

So to all my 40, 50 and 60-plus sisters and brothers, I say go for it!

I hear a lot of classmates sharing their dreams about how they'd like to use their skills after graduation. But I don't hear many people hoping to become family therapists specializing in couple counseling. And I think that's really unfortunate, because there are so many of us out there that need these skills.

When I say us, I mean it. My husband and I began couples counseling even before we were married. I don't know why I was convinced that it could make a difference. I didn't know much at all about therapy. What I did know was that as the single mother of a two year old I couldn't afford to get marriage wrong a second time. The first one had gone so horribly wrong.

By the time I met Mark, I was sore at heart and feeling so desperate that I was going to a chapel every weekday morning before work and praying for God to send someone who walked his faith, not just talked about it. So a year later, when I was standing in Grand Central Station with a friend who was waiting to meet up with a former roommate, and I looked out into the noontime crowd and saw a tall, handsome man wearing a clerical collar and walking in my direction, I hoped that this stranger was the answer to my prayers. He was--in some ways, at least.

A few years after a whirlwind courtship, we declared ourselves to one another, and then we began unpacking our emotional baggage. We loved each other, but couldn't figure out how to communicate our passionate differences without hurting one another. That's what brought us to our first couples therapist, Jules, a wild-haired, brilliant man from Berkeley. After months of working with him on improving our communication skills, Mark and I set our wedding date. On the day of our ceremony, Jules was one of our proudest guests.

We thought we'd learned everything we needed to know about communicating--and then our family began to multiply, along with our problems. Old habits die hard. Again, we turned to professionals for help. Not everyone was highly skilled. One woman wanted us to spend much of our time staring into one another's eyes without giggling. But even with her we learned something. The best therapists somehow convinced us that they didn't take sides. And because we trusted them we learned to trust ourselves. Therapy helped solidify our commitment: we didn't want to lose one another, so we managed to negotiate our differences and grow. Marriage can be solid ground beneath your feet that allows you to stand strong, even when the earth trembles.

I know the world is full of people who would point out that lots of couples stay together without ever even thinking about therapy. You know what though? Mark and I will be celebrating our 25th anniversary in June. We made it at a time when more than half of marriages end in divorce. Longevity isn't everything of course, but maybe this is:
Mark came to school today to take me to lunch. Since I knew he was coming, as soon as class ended, I ran to the women's room, fixed my makeup and rushed outside to see him. I gotta tell you folks. Standing at the top of the steps and watching him walk toward me was even more thrilling today than that afternoon when I first spotted him in Grand Central Station. On that long ago day he was only a figment of my imagination.

What is he today? My Valentine, now and forever.

Thank you, Jules.

I hear horror stories that detail experiences of neglect, pettiness, and worse.

This has nothing to do with the secrets that patients share with me. I'm talking about the stories that students--from NYU, Hunter, Columbia, and other schools of social work--have shared with me about their supervisors at the agencies where they work.

I have been fortunate in getting great supervisors, and so have many of my classmates. But supervisors come in every emotional stripe, so some interns aren't as fortunate. The problem with the not-good enough supervisors is that they have the power to make or break your internship experiences.

Or do they?

Do we as interns have the power within us to make the best out of what may appear to be nightmare situations? I can speak from experience when I say that I know what it's like to be involved with someone who holds all the cards and who's making your life miserable. I'm speaking now about my (now deceased) mother in-law.

From the minute she met me, she seemed to dislike to me. And as the years wore on, she only grew more contemptuous, never missing an opportunity to belittle me (I've heard at least one intern say the same about her supervisor).

I might have never made peace with my mother in-law, if I hadn't been working with a colleague who happened to be a social worker. I was recounting my mother-in-law's difficult ways, when this social worker interrupted me and said that I needed to find a way to get over it. "You're wasting so much energy hating her that you've got to be exhausted," she said. "And what about your children? No matter how much you dislike your mother in-law, it's not their fault. They shouldn't have to deal with a wall of tension whenever they're around you and their grandmother."

I asked this woman what she would do if she were in my place. Her advice might be helpful if you're stuck with a not-good enough supervisor.

"First and foremost," she said, "figure out which parent she's become for you. I've never had a mother in-law, but I've had difficult bosses. And I used to make my bosses parental stand-ins. One boss reminded me unconsciously of my mother, the same mother I wanted desperately to please, but never could. I worked so hard for that boss that I ran myself ragged. Guess what? She never appreciated my efforts. And another boss, who tended to be cold and distant, was my father substitute. I was crestfallen if he didn't greet me with a big smile. .. Are you getting the picture? These folks aren't your parents. Your mother in-law is just an ordinary person who happens to have raised your husband. You can detach from her--beat pillows when you're home and pretend they're your mother, or whomever she symbolizes; get the anger out before you see your mother in-law--so that when the two of you get together, the moment isn't emotionally fraught."

It turned out to be useful advice. I can't say that I ever learned to like my mother in-law, but I did make peace with her. Our war ended, because I stopped dragging my baggage into our time together. I made myself less vulnerable to her. Over one festive Christmas dinner, when she sneeringly suggested that I was a spendthrift and had paid too much for the meat I was serving, I was shocked by her rudeness, but did not take her words to heart. Perhaps disappointed that I was no longer overreacting, she began to back off.

What about you? If you're stuck with a supervisor that enrages you, find out who she represents in your life and try some self-therapy. I can't promise that you'll ever like this person, but maybe, just maybe, you will find ways to make your internship more constructive, in spite of him or her.

I just read and another news story concerning deliberations over proposed new psychiatric diagnoses for the Diagnostic and Statistical Manual of Mental Disorders-the D.S.M. (Alan Feur. January 28, 2009. Attention, shopaholics: Your weakness may be a proper disease. New York Times, A24)

I came up with a few tongue-in-cheek designations of my own.

Post Election Stress Disorder could be described as a subtype of post-traumatic stress. You may have found that you're struggling with the symptoms yourself.

For example, starting in the year 2000, did you begin experiencing intense fear, shame, horror and feelings of helplessness?

Do you find yourself repeatedly reliving events from the last eight years in at least one of these ways:

Intrusive, distressing recollections, including images of war and the ravages of Katrina?

Do you suffer from nightmares that suggest the November election results are just a figment of your imagination?

Do you experience angry outbursts or irritability when the new administration's attempts to turn this country around are resisted by members of the same party that's responsible for getting us into this mess in the first place?

If you are experiencing these symptoms, beware of another more dangerous malady:

Post Election Exhilaration Disorder (PEED) can delude you into believing that now that the election is over your work is done. With this disorder you may have experienced intense exhilaration over the election results, but rather than continuing to participate in grassroots activities you just smile when read about the new administration's efforts and then get on with your own life.

If you want to keep those nightmares at bay, keep the momentum going. Hope is not the end but the beginning.

Like a lot of folks, I was delighted when I opened my gifts on Christmas morning. But as much as I loved receiving my new sweater and spending time with family, I have to say that one of my favorite gifts caught me absolutely by surprise. It was on Christmas morning that I realized how much my patients had come to mean to me.

At first I was somewhat embarrassed to realize that I was even thinking about them at all. In school and at work, for good reason, you hear so much about the need to maintain a professional distance. Then I told myself to just go with the feeling. After all, I wasn't obsessed with thoughts of my patients. From time to time though, I caught myself wondering whether they'd enjoyed their holidays and I wondered how they were feeling. That next week, when I might have ordinarily gone into work, but didn't, because I was still on vacation, I looked forward to seeing them again.

If someone had told me when I first started my master's program that even though I would be working harder than I ever had before in my life, that although I would enjoy my time off, I'd still look forward to going back to work, I might have doubted it.

When I did return to work and had a chance to talk to a few of the other interns, a couple of them shared similar stories. And later, one of my classmates, a single mother who is stretched to the limit, and who works with juvenile offenders, told me: "I absolutely missed my clients. I love them!"

When I told my supervisor about the great respect and gratitude I have developed for each client--12 of them in all--he wasn't surprised. He reminded me that at the heart of the therapeutic experience is the relationship we establish with the client.

I remembered his words when I glanced at the reviews of a book for my Integrative Practice Seminar: The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients, by Irvin Yalom. One of the central messages in this highly praised book is Yalom's reminder that nothing should be given precedence over our relationship to the patient and how we regard one another.

It's particularly interesting to recall this message as we begin another slate of classes, and we gear up by printing syllabi and thinking about all the work that will be required of us--in addition to all that is required on the job. At times like these, you find yourself wondering how you can ever get everything done. There is so much to learn and do, and yet it all seems doable if we only remember, as Yalom suggests: that "therapy should not be theory-driven, but relationship-driven."

I'm not suggesting for a moment that we disregard the vital information that can take us from do-gooders to seasoned professionals and which can help us understand where the patient is coming from. But as I told a group of new 16-month social work students when I was invited to share my thoughts with them earlier this week, you will recognize just how vital the therapeutic relationship is when its just the two of you (or more, depending on whether you work singularly or in a group) are sitting in a room that fills with intimacies.

These moments don't unfold in every meeting and sometimes they can be rare. But at some point, a patient whom you have come to know, will reach out to you, and you may have the right words that unlock a door that can lead to his or her transformation.

These moments are as close to miraculous as you may ever come. As it turns out, theory actually makes the moment more poignant to you, not less. And when you walk away from that room, you will know, that all that work, all those papers and the exhaustion and the frustration... all of this stuff matters because this moment does.