Five Seconds To Spare: a Social Work blog.

Here we are at the end of the school year. I apologize for neglecting this blog these last two weeks, but you’ll have to forgive me for this lapse during the time of finals. Speaking of, I am now done with all of them. I have two classes and one day of internship left. I will be moving (most of my stuff) this weekend. I have some interviews lined up. Things are looking pretty good.

Despite this, it’s a big transition. It’s very hard to say goodbye to all the things that have been my life for the past two years – the school, the classes, the professors, the city, the internships, the friendships – and while those relationships are not necessarily ending completely (though some will, so it goes) and I will still keep in touch many of the above, it will not be the same.

I’ve gone into a very pragmatic mode because of this. I have so much change to deal with, so I have to take things one at a time and make sure to process them all. That’s what us social workers do. We think about this stuff. As I said to a friend recently who was wondering why I wasn’t more excited about the move, “I am excited about moving. But I have a lot of endings to think about first, so I don’t have time to be excited about moving right now. And that’s what social workers do. We think about endings.”

We had a very nice termination in my practice class today. It was very moving and it was a wonderful way to reflect on all that we’ve learned over the past two years. I do wish it was my last class though, as it would have been the perfect way to wrap up the past two years.

During this year’s internship, I learned a lot about myself. Earlier in this blog I talked about some of the challenges I faced in the setting with such a different treatment model. After having worked there for the past eight months, I found that I actually thoroughly enjoy the fast pace and intensity of hospital work. As I got used to the demands and became more autonomous, I found great ways to develop therapeutic alliances while doing the razor-focused work that acute inpatient demands. All in all, it was a great experience and I am sad to be leaving it, though feel thoroughly prepared to utilize the skills I’ve gained there in any other setting.

Anyhow, one thing I won’t be saying goodbye to is this blog. I’ve really enjoyed keeping it and will continue to update it periodically. I will probably be absent for a bit as I move and get settled, but once that transition is through I intend to keep posting here. I will probably move to posting every other week rather than once a week and will probably post about things other than social work as well, but will certainly keep this updated. Thanks to everyone who read and left comments. It’s been a lot of fun writing.

edit: Unfortunately, the demands of the real world have stolen my attention elsewhere. Despite good intentions, I have to say goodbye to the blog as well. Again, thanks to everyone who read and left comments...it was a lot of fun.

I just wanted to draw attention to fellow NYU grad student Kacie Kinzer's project, Tweenbots: http://www.tweenbots.com

This is utterly brilliant and incredibly cute.

I have never met Kacie (she is at Tisch and is not becoming a social worker) but this is just a great example of how NYU - and Washington Square Park - is just a constant source of cool stuff!

Down to the last month. Revisiting my checklist, thus far, I have done my taxes and found a place to live. Hooray! I’m also working on finding a job right now, have packed a few things into boxes (seven boxes down, one hundred more to go) and have a plan to tackle finals. I plan to have to papers done by the end of this weekend, a third paper and presentation completed by the end of next week, leaving me with a week and a half to finish my last paper.

Hopefully I will manage to find a job in that time, too. Yikes.

The job search has been kind of frustrating. I am moving away to Boston, so the many connections I have in Connecticut and New York are not as useful as they would be if I were staying here. Luckily, some professors have been able to help connect me to other faculty with some knowledge of Boston, so that should be helpful.

While there are jobs out there – a fair number of them, it seems – there are two main things standing in the way of my actually getting them. First is that I have to find where they are. Most agencies post their open positions on their websites, but seem to avoid aggregate sites like Monster and CareerBuilder due to the fees imposed for posting positions. That means that I have to find resources in a city I am not as familiar with as this area. However, I have been successful so far in finding a constant flow of positions to apply to, and this is partially thanks to sheer persistence, but also thanks to my friend Robb’s suggestion.

He instructed me that instead of searching for agencies to apply to, think about clients I have had that I would have to make referrals for. How would I find places to refer them to? The process of finding places to apply to is quite similar. I have also thought about what kinds of places in Boston would be helping people find jobs at this time of year…and accessed the parts of their databases that are public (anyone who can access the restricted areas of these databases, leave a comment please!).

The second barrier…

Well, first some clarification. In New York, the two levels of social work licensure are the LMSW and LCSW. In Massachusetts, the two levels are LCSW and LICSW. New York LMSW equals Massachusetts LCSW. New York LCSW equals Massachusetts LICSW. Got it?

The second barrier is that many of the positions I have found require the LICSW license. This seems to be a problem in any job search, though. Everyone wants to hire someone with experience. To get experience, you need to get hired. But no one wants to hire someone without experience. So to get experience, you need to get hired…

Obviously, some of these positions are ones that can only be held by an LICSW – supervisory positions, program directors, and the like. But others are positions that are otherwise identical to entry level positions. Oh well. I’ll have that I after my name some day.

It’s perhaps even more frustrating in niche services that require that you have worked with that population in the past. How does one gain experience working with a niche population if every agency serving that population wants someone with experience working with that population? Is having had an internship with one of those populations the only way to get into those areas of social work?

My dog died last week.

His name is Corey, and I got him when I was eight. My youngest sister wasn’t even born yet.

He is a very loved and important part of our family, and it’s very sad that he is gone. He slept at the foot of the crib after my sister was born, he loved finding and opening eggs on Easter (and becoming angry when we would not let him eat the chocolate inside) and was an overall happy, playful dog, enjoying running in the yard in the spring just as much as he did playing in the snow or laying with us and being pet. He lost energy in his old age, but even then, he still had puppy-like behavior every once in a while, jubilantly running about or playing with our other dogs.

In Death and Dying class (actual, less accurate name: Grief, Loss, and Bereavement), we have been learning about palliative care, and as of the latest class, the mourning process. I suppose it is timely that this topic is introduced now, since the material comes much more alive when I can point at different parts of the mourning process and see it ongoing in myself.

It’s strange, because one of my first questions when on the phone with my mother after she told me what had happened was “Do Zoe and Sammy know?” Zoe and Sammy are our other dogs. It is strange to me that my first instinct was to take care of them – I wanted to reach out to them, find some way to communicate with them that Corey is gone and is not coming back and to find out how they are feeling and to help them through the process.

While Sammy doesn’t really display a wide range of emotion, Zoe was noticeably different a few days later. When Corey left and did not come back, and family members were crying, I know she understood what had happened. Her role in the family became very different. Rather than being the silly energetic troublemaker she usually is, she toned down her energy very much. Her body stiffened a bit, and instead of enthusiastically licking faces, she was still and slowly and gently kissed our hands, letting us pet her. It is fairly remarkable how her instinct was to be a caretaker of us, while mine was to take care of her.

It’s been interesting to see the strange, somewhat silly things that people do after the loss of a loved one. Seemingly illogical or strange things become so important to processing grief and actively remembering.

Losing a pet is hard because while it is something many people have gone through, it is a fairly disenfranchised loss. It can be as hard as losing any other family member, but it is not commonly recognized as such by employers or even friends. There is no formal way to mourn the loss of a pet as there is the loss of a human family member, and what results is a somewhat fragmented and isolative mourning process. My mother and I have been helping each other a lot.

I know this entry was sort of fragmented and unfocused and not really on topic, but I wanted to write about it. Thanks for reading about my dog.

I’ve written in the past in this blog about my love of termination and how rich and meaningful it can be. Now, halfway through March, I (along with all my friends and fellow students at the school) am facing a big termination. It is the end of the year and the end of our time in the Master’s program.

In therapy, termination is a very rich time and a time when a lot of material is raw and available to work with. The same is true for termination with the school. The end happens no matter how we address it. However, it is very easy for us – those who have been trained to actively address endings – to have what I consider an “easy” or even “bad” termination.

What do I mean by that? Well, it’s very easy to say goodbye to someone or something by getting mad at it. It’s much easier to leave something you hate, right? Likewise, it’s easier to deal with an ending you don’t want to come by avoiding it rather than actively confronting it. And at this time of year, there is so much going on, that everything ends up being a hassle. Before I graduate, I need to complete the midterms I still have left, complete finals, finish my internship, get an apartment, get ready to move, and find a job. Oh, and do my taxes.

Neat little checklist, that. At least taxes only take an hour or so to get done, right?

The problem is, with all this stuff to keep track of and worry about, who has time to terminate? I really can’t find anything to be mad at the school about, but you can bet that I’ve been procrastinating all of the above. Why? Well, to avoid school ending, of course. If I don’t do the things I need to get done before school ends, school will never end, right?

Okay, so it’s more likely that school will end and I will be stuck if I don’t get the important ones done (i.e. all of them). As I mentioned, some of the next entries will be devoted to these topics – particularly job searching – and what it’s like to be going through this transition.

But my point is, who has time to terminate, and why bother when there is so much else to do? I want to bother because I think it will be an important piece for me going into my career as an MSW. Just as proper termination not only provides more material to work with but is also a chance to remind clients of their independence and the growth they have achieved through their work, terminating with the school is a chance for me to be reminded of the same. It will be sad saying goodbye to beloved professors and classmates, and though I know I will make efforts to stay in touch, even if it’s just an e-mail once in a while, I will no longer have their support immediately at my fingertips. Of course, I will make new relationships and have new supports wherever I go next. But right now, I don’t want that. I want NYU. Termination can help me be more ready to say goodbye to NYU (at least as a student – and at least for now) and say hello to what lies ahead.

Just after I wrote the first two sentences of that last paragraph, I had to stop writing this entry for a moment. I did so so I could go register to attend the commencement ceremonies. I wasn’t going to go – “I don’t have sixty dollars to rent academic regalia,” “I will be too busy moving during that time,” “It just isn’t that important to me” – whatever. What I really meant was “I want to avoid termination.” While I don’t want to leave, avoiding commencement ceremonies won’t keep me from leaving. They will just keep me from having a chance to say one last goodbye.

I hadn’t even realized a week went by without an update. I offer my apologies for neglecting this blog.

The time slipped by quite easily over the last week, and it’s not much of a surprise. With the semester drawing to a close, I am dealing with planning to move and getting a job all while still working my internship and dealing with coursework that has not lessened at all. It strikes me that these are things that would likely be interesting to readers, whether they are going through the same thing right now, will be in a similar situation once they get to the end of their second year themselves, have gone through this situation already, or are just generally interested in what goes on for a social work grad student. So, I will tell you about these things.

But not in this entry.

Why not? I have an interesting story to tell instead.

I have a professor (who I know reads this blog, so I’d just like to give a shout out – what up Mrs. G) that I have had since September last year. Since the first day in class, I had a rather strange countertransferential reaction to her in that I was somehow convinced quite quickly that she was a member of a band. I had been dying to ask her about it but really just felt kind of silly and held it in. Yet every class session, I couldn’t help but fantasize about her other life as a musician.

Well, last week, I had an opportunity to ask her about it. We were talking in class about the things that clients wonder about their therapists, and she asked about what we would want to know about her. She answered some of the questions – after all, we are her students, not her clients – and did not answer any, but for each, she discussed what the hidden meaning in that question might be if it were coming from a client.

After the conversation had passed, I finally raised my hand.

“Since the first day of class, I’ve been convinced that you are in a band.”
“A band? Like-” She pretends to play a guitar.
“Well, I actually imagined more like an organ.”
“An organ!?”
“Yeah, but not like a church organ. A cool organ. A rock organ.”
“Ohh.”
A pause. “Well…are you?”

No, she is not in a band. And she does not play organ. But she could play organ.

“I could be in a band.”

Oh?

Turns out she had been playing piano since she was a young child and her mother made her take lessons, and she still has the piano she played when she was a little kid. She also plays guitar, and I think she mentioned one other instrument that I can’t recall right now. This was fascinating to me – how did I pick up on her musicality?

It seems we had some sort of conversation in the intersubjective space. Clinically speaking, this is all the communication that goes on through body language and psychic processes but is not said. Somehow, I understood that she was a musician. Classmates asked if I am a musician as well. I said yes, though I really don’t consider myself as such – I play a few instruments, but I don’t consider myself proficient enough to call myself a musician. Then again, I am always my harshest critic and others have enjoyed my playing so whatever. Perhaps there is some connection between musicians that allows them to pick each other out? Just a few weeks ago, a classmate in another class randomly asked me if I was a musician as well (that time, I said no, and she quickly corrected me and told me that I am).

What relevance does this have to social work in general? Well, it’s important to be aware of the intersubjective space in session with clients because you may communicate things you do not intend to, and if you are not alert, you may miss things that they are communicating to you but are not saying. There is a wealth of information communicated regularly that is nonverbal. Most communication is nonverbal. It was interesting to me to see such a clear example of this phenomenon in a way that was pretty much completely nonrelated to social work aside from the classroom context.

And while my professor is not in a rock band, she does play Rock Band.

All things considered, that might be even cooler.

Play, play, play, yeah, yeah, yeah, yeah!

In case you haven’t heard, last week a group of students took over Kimmel Marketplace as part of the Take Back NYU campaign. You can read about their cause here: http://takebacknyu.com.

This post is not meant to be an endorsement or opposition of their cause or their methods of protest. My reason for writing is because this action reminded me of my own days as an undergraduate fighting at my school for sexuality to be included in the school’s non-discrimination policy. Ultimately, the group I led did not get what we wanted, but the administration heard our displeasure loudly and clearly. I would find it hard to believe that there was a single person on the campus who wasn’t aware of what we were fighting for, and really, getting so many people aware of our cause was half a victory in itself. We had large faculty support (some of it from unexpected places) and it was a great experience for me despite that our efforts did not succeed.

The administration did respond, stating that even though the school does not discriminate (though I argue that exclusion of sexuality in the non-discrimination policy is discrimination in and of itself), they would not add sexuality to the non-discrimination policy as there was “no need.”

Over the course of the fight, I came to learn that one of the primary reasons the school would not add this to their non-discrimination policy was because it would cause at least one prominent donor to pull their funding.

Now, I do stuff like this for a career.

Sometimes social work feels a lot like these fights. I currently have a client who is over seventeen years old whose outside service providers are not responding to her needs and whose mother has more or less given up on her. Meanwhile, she is sitting in a hospital with little outside support in finding appropriate placement for her, and I fear her mother will refuse her to return home. In this case, I need to yell the loudest (metaphorically) and fight for my patient’s life – with help from my supervisor – while others do not cooperate or act against her best interests. Our next action is to take a strong arm and set a discharge date – if she does not have a placement by then and her mother refuses her home, then at least we can refer to ACS and elicit their help in finding and appropriate placement for her.

Sometimes the fight is to keep a patient in the hospital. Insurance companies seek to keep inpatient stays as short as possible, often refusing to continue paying for care against medical advice. In these cases, the fight is again to make sure the client gets the care they need, but this time it is within the hospital.

Sometimes the fight is within the hospital itself. As a for-profit hospital, they need to carefully manage their census, which sometimes results in Medicaid patients (who do not require insurance reviews) to be held longer than may be necessary for acute inpatient treatment. In this case, the fight is to stick to discharging the patient when they are ready to leave the hospital instead of retaining them longer, while they only receive services they could be receiving outside the hospital.

In all these cases, it helps to be loud. Make a stink. Usually, you will eventually get what you want. Of course, in these fights, a protest doesn’t do much. But five or six phone calls per day usually does. Overall, it’s important to be heard.

And again, while I am writing neither to endorse nor oppose the actions or demands of Take Back NYU, I do wish to congratulate them on getting themselves heard. That said, I do believe they need to become more focused, as their list of demands is incredibly not so, and to scrutinize their methodology so that perhaps their concerns may be taken more seriously by the general populace.

edit 2/26: I was able today to see some video of the Kimmel occupation. While I believe strongly in the power of protest and dissent, some of the occupying students acted very foolishly. This is a shame, because while I do feel that some of their demands are important and reasonable (and others are less so, but again, I do not wish to get into that here), there is a difference between a peaceful protest after other avenues have been closed and a downright temper tantrum when you are not getting your way.

On Saturday night, I went with a couple friends – a fellow social worker and a special educator – to an open mic night to play a few songs we prepared for the night. This was a lot of fun for us and we got a very warm reception from the very welcoming group of people who were taking turns playing for each other.

One of these people was another performer named Jamie. She was remarkable not only because of her songwriting or vocal abilities, both of which were excellent, but rather because of the content of her songs. Both were written recently, and were, as she explained, about “the love of [her] life who [she is] separated from because of addiction.” He is in St. Louis and I’m not sure if he’s in treatment there or not. Jamie was the one who left him – she had to, she explained.

Despite the sad story behind the songs, the songs themselves were upbeat folksy tunes and Jamie did not have a hint of sadness about her while she was playing them. In fact, they seemed even a bit cheerful.

We got a chance to talk to her later on in the night – she approached us, having enjoyed our set as much as we enjoyed hers, and she told us a little more about the relationship that inspired her songs. Here her sadness was much more evident than it was on stage.

What struck me most about this performance was that this woman came out on February 14th – ostensibly a day for lovers – to get on stage and sing to a lot of people who were more than happy to listen about what she was going through. In a way, it was her own impromptu music therapy group. And from what I can tell, it was a healing experience for her.

The January 26 episode of The Moth podcast, “Notes on an Exorcism” told by Andrew Solomon, recounts his venture to Senegal where he engaged in a ritualistic exorcism of depression, the proper name of which I do not know how to spell. This episode, apart from being a wonderful and entertaining story, gave great insight into our country’s mental health treatment modalities as compared to others.

I won’t spoil the story for those who want to hear it, but the ritual involves the participation of a lot of other people who all come together to help lift this person out of their depression. At the end of the story, Solomon recounts speaking to someone in Rwanda who tells him of how they had to ask Western social workers to leave following the genocide because the methodology was not helpful. Those clients felt as though the workers did not recognize the immense pain and suffering the country had gone through, and did not understand why the entire process had to be private.

I’ve had the same criticism of American culture in general for a long time. Emotions, both positive and negative, are meant to be very private. Someone crying and wailing intensely in public is just as distressing to others as someone jumping for joy, hooting and hollering might be. People are expected to keep their sorrow and their celebration hidden, and for the most part, American social work practice mirrors these values.

There is certainly a reason to mirror these values – after all, we intend to work with clients within their culture, not to change their culture. It would be inappropriate for us to encourage clients to broadcast their emotions unless it is their desire to do so. However, I do wonder how much good might be gained if public displays were more common. The great thing about groups and family sessions is that it is very much about people working together towards a common goal and cheering each other on. What if some of the benefits of groups could be gained in the general community?

Several years ago, I decided that I was not going to be ashamed of who I am or how I feel, and sometimes this is disorienting to people. When asked how I am, people will typically expect a brief answer, and sometimes this is what they get from me. However, if I am feeling a certain emotion particularly strongly, I tell them. Checkout clerks don’t necessarily expect to be told that I’m having an awful day or that I’m excited about something, but it is refreshing to me to have a genuine conversation with someone else instead of one that seems rehearsed, and based on peoples’ reactions, I’d say most people find it refreshing, too (some obviously did not appreciate my honestly and likely thought I was an ass for disrupting their well-rehearsed day with my emotions). Mostly though, I think sharing experience helps lead to commonality of experience, which is just overall healthier for a community.

Finally, thinking about the workers in Rwanda, I couldn’t help but chuckle at how much emphasis social work educations puts on cultural competency, yet the workers that went to another country were unable to work within that culture’s values. Cultural competency can be very challenging, and if a Rwandan came to America for social work services, I certainly wouldn’t fault the worker for not knowing that private therapy would not be helpful to this client. But heading to another country with the intent of helping the people who live there? No excuses.

The other day, I was on a long drive and was listening to the most recent story on The Moth’s excellent podcast (http://www.themoth.org/podcast), entitled “Notes on an Exorcism.” Storyteller Andrew Solomon recounts a time when he was depressed, and one of the things that eventually helped lift his depression. I mention this here because I will be writing an entry reacting to this story later this week, and I figured it’d be helpful to give people a heads up so that they might listen too (it’s a great listen either way). If you don’t have time, it’s not like an assignment or anything – you’ll still be able to follow along with my next entry.

Anyhow, to get to the entry that I meant to write last week but was resistant to writing. It’s really not that I didn’t have time or just never got around to it, it’s just that I didn’t want to get around to it. Which pretty much perfectly mirrors some of the resistance I’ve been feeling to my work at the hospital.

I sat down with my supervisor and talked about how I was feeling – that the work is empty, is not really what I want to be doing, is not something I enjoy, that I usually end up feeling like I cannot accomplish anything – and he shared a lot of ideas with me, including ways I might be able to approach my current cases, but perhaps the most important thing he shared was that he too still has days when he feels ineffective and that he can’t do much with the patients at the hospital. In fact, it took him a year and a half just to accept how little could be done during the brief hospitalizations. Knowing that someone who has been doing this for over a decade still struggles with this once in a while did a lot in helping me understand that the minimal progress was not a failure of mine, but a success.

Really, I already knew this though. Social work and therapy is all about the little victories – every small step matters. Eventually those small steps turn into a big step. I know last year, apart from a couple obvious milestones with some clients, it wasn’t until the end of the year when I looked back and realized how far my clients had come while working with me that I believed that I made a difference. The problem with the work at the hospital is that there isn’t a lot of time between point A and point B and it’s much much harder to see what change has been made in one week as compared to one year.

That day, I began working with a new patient who is fairly cognitively high functioning, which is a nice change. I get to use complex interventions and language with this patient, who has a good deal of insight that we can work with to help her. My supervisor and I also made some changes my caseload in order to give me more variety in the cases I work with, which is a good thing. I’m taking on more managed care cases, and after just one I’ve found that it’s quite different than handling a Medicaid case in many ways.

Finally, I’ve just realized some things in general about hospital social work that another intern at the hospital has also noticed. They are not necessarily positive or negative, but they are things that are more or less opposed to the work I wish to be doing in this field. This could also explain my dissatisfaction with the work, but understanding that these things are present also helps me feel more content with the work I am doing, knowing that there are factors out of my control that are influencing my mood in this situation.