Major Breakthrough.

Wow. My head is still spinning from my experience today. Being new to the field, I haven't had too many "woah" experiences yet, but today...I woah'd.

I have a teenage client who has been with my agency for years. I'm actually her 4th therapist this year. Her parent's rights were terminated and her guardian isn't the most pleasant of creatures. I am not surprised she doesn't want to talk to anyone. Why should she trust adults?

I've been working with her for weeks and we have not moved past pleasantries, if you can call them that. I've tried everything I know to do, which might not be a whole lot, but at least I gave it my all. Lots of game playing to build rapport, lots of sitting in silence, lots of random questions, lots of validating, challenging, supporting. Nothing worked.

Until today.

I decided to try art therapy, since talking is clearly not on the agenda. It's a layered feelings activity that I facilitated it in a group setting during my internship. I provided her with a feelings sheet with different expressions and the feelings they represent. I gave her 6 sheets of paper, and asked her to draw these items:

• A feeling you often show to others
• A feeling you generally keep to yourself
• A feeling you wish would go away and never return
• A feeling you like to have
• A feeling that you can live with but that challenges you
• A feeling you rarely experience and wish you could have more of

She wasn't very invested in the activity, and drew some pretty basic faces. When I asked her to explain them all, she gave short answers and shrugged her shoulders a lot. One of her faces was confused, another lonely. I started to dig a little, to try and find out about her past experience that she still has not dealt with. She was hospitalized due to self-harm, but no one has been able to find out why. She has been closed-lipped for months and months. I brought up the incident and asked if she was feeling the same way now. As the one-sided conversation progressed, she began to cry, then she became really angry and stormed out.

I think my jaw was hanging low because she has never so much as laughed, much less show anger or sadness. And in a span of minutes! I let her leave, followed her outside. I validated her pain, determined if she was feeling suicidal, etc. She was angry but didn't leave the patio. She wouldn't look me in the eye or talk, but she didn't leave either. At one point she yelled "I'm sick of you people coming in and out of my life." When I tried to get her to open up about that, she was already gone (mentally speaking).

She asked to call her guardian, and I went to alert the school officer about her status, and left a message for her guardian. I immediately called my supervisor and asked for her suggestions, and she congratulated me on this breakthrough, even though the session ended pretty ugly. I often wonder if sexual abuse is a part of the equation. While it has never been brought up, her younger sister was abused, and the statistics show it's likely to happen to siblings. This is only a theory. I could be totally off.

Anywho, my head is still spinning. It may not seem like much, but I hit a chord.

Finally.

-SWS

Resources, anyone?

Is anyone willing to share their therapeutic interventions for hyperactivity and inattention? I've heard a lot of behavior charts are good, but there is bound to better ideas.

I would also like to know if anyone has techniques for working with oppositional / aggressive children, especially techniques for they are in a moment of rage. Needless to say, I do not have much experience with these types of behaviors and have a very challenging child that I just started working with.

One last question: Behavior Management Programs that aren't points-based. Got ideas? Please share.

Much thanks.
-SWS

Almost a month in…

My third week of seeing clients and I’m still alive. *fist pump* I will admit that I am quite enjoying the actual work with the clients, but dealing with parents can be tough. Real tough. Some parents/caretakers are resistant, even the ones that called in the referral. I won’t begin to try and understand what they are feeling, but I do my best to ensure them I’m not there to remove their kids, judge them, etc. Once I get in the door, I think they realize that, but getting into the home is the hard part…

We had a mandatory meeting at work on Friday. It was Cultural Heritage day so we got learn about each other’s backgrounds. They also invited some people from the UM Eye Institute to talk about working with deaf children. They taught us the science behind hearing problems, the kind of devices to assist with hearing, auditory verbal therapy, etc. I especially find cochlear implants to be quite incredible. We also talked about Deaf culture, and the very different opinions found within this population. It was quite interesting!

Now, on to the interesting topic. One of my cases is a 16 year old girl who was diagnosed with Undersocialized Conduct Disorder, Aggressive Type. The biopyschosocial also talked about some reported psychosis. When I met with the teen for the first time, she was quite fascinating and a bit scary in her perception/attitude. She does not like school and does her schoolwork only when she feels like it. She likes to fight with people and has no interest in friends. She socially isolates, sits in her bedroom alone and talks to herself. She reported hearing command hallucinations, "random" voices that make her laugh and sometimes tell her to do "dangerous things", like fight and do drugs. She denied any drug use or any thoughts/commands of self-harm. She also mentioned going to her boyfriend’s house and just sitting in the front room alone. I noticed she had psychomotor agitation as she constantly used her hands during the session. She made little eye contact with me and giggled to self occasionally. Her affect was pretty blunt but her mood was normal.

She lacks compassion for her younger siblings, as evidenced by her statement "I hate them" as she broke their crayons. She reported that she loves her mother, and when asked if she ever tells her mother: “I don’t tell anyone I love them.” She doesn’t follow rules, and I’m serious when I say this, she could give a bleep about anyone or anything. I encouraged her to be honest and gave her feedback on her interaction with her mother and siblings. She constantly reminded me that she does what she wants to, not what anyone tells her. I praised her substance-free choices and validated her report of hallucinations. I did not challenge them. I tested her insight and her judgment, and I think both are pretty poor. One great thing is that she is willing to comply with treatment/medication. I gave her mother the contact information for a pysch eval, and if she hasn’t called when I go back Tuesday, we’ll call together. She needs one, stat!

I’m praying she isn’t developing Schizophrenia. I, of course, am not licensed or an expert, by any means, but doesn’t it sound like it? She’s having both positive (hallucinations/psychomotor agitation) and negative (blunted/flat affect, lack of interest, social isolation) symptoms. I read through the biopyschosocial and mother reported depression with psychosis and drug use on her end, but no mental illness that she’s aware of on dad’s end. I know there’s a strong genetic component. I think you have a 10% chance of developing it of one parent has it, and a 50% if both parents have it. But, what if mom’s diagnosis was wrong and she’s actually Schizoaffective? That would put her in the spectrum. Mom also used crack/marijuana for many years, so the child could have some prenatal factors, like stress, malnutrition, infection. And she was born in the Spring. Research shows that viral exposure in utero can up your chances of developing Schizophrenia. And then there is the environment piece. Living in an urban environment, social isolation, poor housing, family dysfunction and childhood exposure to trauma are all risk factors.

What do you think?

-SWS

Resources:

• http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml
• http://www.schizophrenia.com/hypo.php
• http://www.mayoclinic.com/health/schizophrenia/DS00196

First week on the job…

Well, my first week at my new job went off without a hitch. All the employees are really nice and helpful. I spent the entire week in orientations for everything from benefits to processes to trainings. Thankfully, their processes and procedures are streamlined. Amen! I sat with my supervisor for the clinical training and process piece. She is very nice and knowledgeable. She complemented my preparation (me, prepared??? heh) and said she can tell I will catch on quickly. To say the paperwork is overwhelming is an understatement, but that is social work for ya.


We discussed ethics, privacy, compliance and the like. The HR person described some ethical issues in the past, and honestly, I am shocked at some of the choices people make. One employee had to get something signed over the weekend, so she stopped by the home with a car full of people. Um, seriously? Major HIPAA breach. Another employee had a home for rent and rented it out to his client. Yes, this is a nice gesture, but it is absolutely forbidden to enter into any sort of dual relationship with your client, during and after service.


I was assigned my first 4 clients yesterday. I have not yet made contact because I am waiting to hear from the employee I will be shadowing next week. I plan to call Monday and set up first appointments at the end of the week. I also have to do a ton of online trainings next week on-site.


As far as my clients go, what a doozy! Four males. Three of them have been treated by the agency before, two of them have a Conduct Disorder Dx, two have ADHD/Anxiety. One of them is a refugee from Africa! THAT is way amazing, for me, because it is a population I am extremely interested in working with. To say I am hella nervous about meeting these people next week is putting it mildly…


-SWS

Addiction ain’t pretty.

As the world undoubtedly knows, the talented and troubled songstress, Amy Winehouse, passed away today at age 27. The jokes poured out when in reality, it is anything but funny. Addiction is a serious issue that affects millions of people. Some people mentioned having no sympathy for those that make the choice to do drugs. Everyone is allowed their own opinions, of course, but this close minded nonsense pisses me off to no end.
We don't know what drives people to make that decision in the first place. We've never been in their shoes and therefore, we should not judge. We are not a higher power and have no right judging others to be less worthy. There would be a hell of a lot less drama/trauma/chaos in the world if we tried to understand each other instead of point fingers.


Yes, doing drugs is a choice, but I highly doubt anyone picks up a needle or pops a pill hoping to become addicted. What they are looking for is an escape, and that is where the real mess lies. A lot of people who do drugs have a mental illness. Schizophrenia, depression, bi-polar, anxiety, etc. will lead people to drugs if they do not receive proper treatment. And I don’t just mean Px drugs and therapy. People need other people. We are social beings and the support of our peers is vastly important to our mental and emotional well-being. Society still has major stigma towards mental illness, and therefore, makes it even more hard for those people to cope. Until we take a moment to understand the emotional and mental challenges that our fellow humans face – instead of acting like we are somehow better and cannot be bothered – then those that turn to drugs will continue to be plagued by inner demons and their “quick fix” will continue to be a permanent one.


-SWS

Pre-Employment

Who knew pre-employment would be so much work! I understand the need for all of this information. Aside from the normal items, I need to do a bit more since I will be working with humans and more importantly, children. I get it.

• Drug test
• Electronic fingerprints
• TB screen
• Notarized Affidavit of Good Moral Character
• Original Diploma
• Official Transcripts
• Infant/Adult CPR and First-Aid Training
• CFARS Certification
• Proof of Eligibility to work in US
• Driver's License
• Proof of Auto Insurance

I’ve got most of this done already though, because that’s how I am. ☺

-SWS

I am employed!

I have secured my first job after graduation. I am extremely excited and nervous as hell! I will be a Therapeutic Behavior On-Site Counselor, which means I will be going in to homes and schools and working with children and adolescents who have diagnosed mental disorders. It sounds like a doozy for my first ever therapeutic job, but I just know the experience is going to be so beneficial to my growth as a social worker. And hey, getting my feet wet on the therapeutic side might just urge me to get licensed. We’ll see how much I enjoy the work. :)

I start 8/1 with a 2 week orientation. They gave me a slew of background checks I have to get completed prior. So, I need to hop on that.

Go me!

-SWS

Testing, one, two…

Hello! New blog for a new chapter in my life. :) This won’t be the most active of blogs, but I think it will be pretty good content. I plan to write about my social work / therapeutic experience. I recently graduated with my MSW and have a job prospect. More soon.

-SWS

P.S. I've imported my old social work posts from previous blog.