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

And I will try to fix you.

This semester I am taking Psychopathology in Clinical Practice. If you’ve been following my blog, you know that I am not interested in Clinical Practice at this point. I would much rather be on the services or macro side of Social Work, although I am quite aware that counseling skills are needed across the board. That being said, I have yet to experience a mental health setting so I could very well change my mind. In fact, I will be in a clinical setting at my Domestic Violence internship. I will mainly be working with the children who have witnessed the abuse. The victims and their children will no doubt exhibit a myriad of issues. Maybe I will end up enjoy this setting…who knows. I will admit that I am uber excited to experience Play Therapy. :)

Anyway, in our first class of Psychopathology, the professor played the video below, which looks to remove the stigma that mental illness receives. I know all about this stigma, as I come from a family entrenched in abuse and mental disorders. It has never been easy for any of them to ask for help, or to even accept their situation. A lot of it is pride, not accepting their reality, etc. But, a lot of it is related to the stigma surrounding these disorders, I’m sure.

Take a moment to watch the video and reflect on how you feel about mental health disorders. You can help fight the stigma that these people have unfairly hanging over their heads.

Lights will guide you home
And ignite your bones
And I will try to fix you 

Re-birthing Technique

You really do learn something new everyday. I must say, learning about the above was horrifying, to put it mildly. In my Social Work Research class, we started off the class identifying the exact reason why social workers should stay abreast of research in the field: because the interventions may just be downright crazy ridiculous!

I don't remember hearing about this, although that doesn't say much b/c I really don't pay attention to the news much. However, in 2000, the Rebithing technique was used on a 10-year old girl because she had an Attachment Disorder, where she was having problems 'attaching' to her new caregiver - most likely b/c of problems that happened when she was younger. Somehow, this 'rebirth' was supposed to help the young girl bond with her adoptive mother.

Anywho, the new caregiver somehow found the idiots that ran this circus show, and agreed to try this technique. The young girl laid in the fetal position and was wrapped in blankets to simulate the womb, then covered with pillows. The therapists (ha!) then pushed on the pillows to stimulate birthing contractions. In the first 16 minutes, the child said SIX TIMES that she was going to die. She begged to be let out because she was going to vomit. The therapists responded with "You want to die? Ok, then die. Go ahead, die right now." She was like that for 1 hour and 10 minutes! When they unwrapped her, she was unconscious in a pool of vomit and died a day later in the hospital.

Many things can be said about this, as I am sure all of you are thinking the same thoughts I am. However, this is why it is very important to stay on top of techniques that do and DO NOT work. In short, you can not believe everything you hear. If you want to be an effective social worker, you must take the time to be 100% sure that you methods are HELPING your clients, not hindering their progress - or worse, KILLING THEM.

This dude summed it up best: "I don't know anything about rebirthing," said Forrest Lien, Director of Clinical Services at the Attachment Center at Evergreen, a pioneer agency for treating children with attachment disorder. "We really only want to use techniques that have been used and are researched and have proven outcomes." DING DING DING! Good thinking, Forrest.

http://www.freerepublic.com/forum/a39254c2414a8.htm