Quote of the Day: More Satir

I discovered long ago that people are always doing the best they know how to do at the time, although it may not be the best in hindsight or from an observor's point of view.

Satir, in Conjoint FamilyTherapy, p. 147

This is quite a radical statement, no? Do you agree? Does this apply to all of us, as we "err" through life?

Quote of the day: Failing to notice what we fail to notice

The range of what we think and do is limited by what we fail to notice. And because we fail to notice that we fail to notice there is little we can do to change until we notice how failing to notice shapes our thoughts and deeds.

- Daniel Goleman, Vital Lies, Simple Truths: The Psychology of Self-Deception

Social Work in the News! Week 4: More about the Brits

For a New York oriented Social Work Blog, NY SWOG has been heavy on British news of late...

But here is an interesting article from the Guardian detailing the debate about child welfare among our former colonizers. The recent discussion revolves around two brothers in Dorcaster, aged 10 and 11 and both abused by their parents, who were placed in foster care and who proceded to abuse two other boys physically and sexually.

The Guardian gives a good account of the various issues being debated, with a focus on "damaged children" (the term used in the article) and what to do with them.

In the view of some experts, the two boys in the Edlington case were already "neurally wired" to behave in a violent manner by the age they reached their foster parents.

I am curious why how one determines if a child is neurally wired to behave violently, and what that implies - lost causes?

Some are suggesting more aggressive intervention -Martin Narey, the head of Barnardo's (which sounds like some sort of drug store or tuxedo shop but is in fact a big child welfare charity in Britain) came out saying that more infants should be taken from "broken families at birth. Here a longer quote, from another article in the Telegraph:

“We just need to take more children into care if we really want to put the interests of the child first,” he said.

“We can't keep trying to fix families that are completely broken.

“It sounds terrible, but I think we try too hard with birth parents... If we really cared about the interests of the child, we would take children away as babies and put them into permanent adoptive families, where we know they will have the best possible outcome.”

What are these broken families? What does broken even mean when we talk of families as though they existed outside of the social and environmental context? Who decides what qualifies as broken and how? If they are broken, why not go straight for forced sterilization?

Fortunately, the Guardian quotes other voices:

Philippa Stroud of the think-tank the Centre for Social Justice refuses to accept that there is an "unreachable" underclass in society.

"I don't think we should go there," she said. "These children were clearly brutalised themselves. There should have been intervention from the time their mother was pregnant – the health visitor, social workers. She should have been seen again and again and if she had not been able to change her behaviour then the kids should have been taken into care in the first year.

"Early intervention is key. The mother could have been salvageable and retrained. Social workers come into their profession with noble aims, but before long they are carrying enormous case loads and are stuck in such box-ticking roles instead of being out there where they should be."

So perhaps there is actually something we as a society can do to help families? If only there were enough resources in the world to help Dorcaster social workers actually do their job. Oh, actually, there are enough resources, it' s just that we have other priorities.

Update from last week: SW Ad Campaigns work!

Per an article from the Children and Young People Now website, it seems that the ad campaign I discussed last week is working:

A Department for Children, Schools and Families spokeswoman confirmed that the 6,800 people who had enquired had all requested further information about a career in social work.

What I still wonder is, what type of training is needed in the UK to become a social worker?

As I noted a while back, Britain seems to be going through a bit of a social work crisis of late - more than half the articles I find online are about child welfare over there. And from what I read, the main role of social workers is safety monitoring and removal of kids.

Working in "prevention" (which means "connected to the child welfare system") in NYC, I am learning a lot about what doesn't work here, but I also see a lot of variety and depth - programs focusing on family systems and not just enforcement. Even ACS' Improved Outcomes for Children initiative (IOC) is an attempt at a family-orriented and strength-based approach (in my experience so far, its not really functioning, but that's another matter). Is child welfare more nuanced here, or am I only seeing one side of things through the British media?

More on this later, but in the meantime, maybe we need advertisements promoting social work here in the U.S. Anyone got any money for an ad campaign? Or know any celebrities?

Social Work In the news! Week 3: Re-branding Social Work

I recently wrote a somewhat rambling and verbose post about, among other things, what I saw as the difference between social work in the U.S. and in Great Britain, at least as seen in the media. Here's an interesting follow-up to that - a story in the Guardian about new advertisements in the U.K. to boost the the public image of social work, and to get new recruits:

The aim is to push the idea that social workers are often the "voice" of people in vulnerable situations.

"We hope to attract a new wave of talent to work in the profession and change public perceptions," said Karen Smalley, head of the department's marketing division. "Social workers help give a voice to many people across all ages and situations and we want to position social work as a career of choice."

The ad (click here to see it) starts a bunch of apparently famous people (I don't recognize them) acting as "clients," with other voices dubbed over. The campaign theme is "Help give them a voice." You can see the video at the link above.

It seems like a good enough campaign - the snippets of people's lives were pretty intense. I was a bit confused about the voices and the images - was the audio actual recordings actual clients recorded? Or other actors? What is the meaning of having them dubbed over video of the stars? Who is giving them a voice? The celebrities are there, but they are giving them a face, not a voice...

Am I over-thinking this? It would probably have made more sense to me if it included stars that I was actually familiar with. Is the unconscious message that as a social worker you get to work with movie stars?

It is hard to imagine a campaign to boost the perception of social workers in the U.S. - who has money and the motivation to do it? The closest thing I can think of is the ACS-recruitment campaign that ran a while back on New York City subways (no stars there though).

What do readers think? Is this an effective campaign? Do we give voice to vulnerable populations? And is that something that would attract you to the field?

"Delusions" of Identity

After reading an NYT article earlier this month about identity disorders,I've become interested in explanations for how the "self" comes to be a self, and amazed at how that sense of self can be disrupted. I recommend a new book by Todd E. Feinberg called From Axons to Identity about the different type of identity problems, and explores what these teach us about normal identity.

The more I think about these things, the more I am fascinated by what the brain and the mind do. But also, I confront the basic awareness that identity cannot really be explained or even defined. What we think of as ourselves is it is really just an idea based on familiarity, habit, and what we learn from those around us. The fact that my "identity" can think about this is even stranger. (This is why I put "delusion" in quotes in the title - since healthy identity is itself a delusion, as we can say about these disorders are that they stray from common wisdom, and probably cause challenges in interacting with the world around us.

A good example is a recent news story (discussed, in brief, here and here) about a man with body integrity identity disorder - he believed that his foot was a foreign object. No one would amputate it for him, so he stuck it in dry ice until it was so damaged that they had to cut it off. Now, he reports to be very pleased. His wife reports that their relationship has improved.

This story makes us consider what it would be like to believe that a limb attached to us is not ours. In what essential way is this different from believing that our hair can be cut, or that an artificial limb that performs the same functions as a leg is not a part of our body? Thinking broadly, this raises the question of what it mean to think that we are our bodies, and we end where our bodies end.

Thinking clinically (this is supposed to be about social work, after all), I could not help wondering what I would do if I was working with this family or individual as a therapist, pre- or post-operation, besides refer him to a neurologist. Could it have helped to explore his psychic history, or is this simply an issue of neuronal malfunction?

He is very happy that his alien limb is gone, and appears to have no psychiatric symptoms. Is there any reason to discuss the leg or to challenge him about it? What does his wife think about all of this? How do we explain it to their children?

I don't know, but my simple, basic conclusion (which summarizes a lot of what I see in the world) is: People are strange and amazing.

Family therapy – why I like it, even when I don’t

Subtitle: once you've tried it you can't go back

The reason I decided to study social work was because I thought it would be nice to be a therapist. Not necessarily a private practice therapist, but a therapist. I'd been interested in psychology since before I knew that I was interested in psychology, and I realized that it was much more interesting to talk to someone that to sit in front of a computer. At that time I envisioned being an individual therapst, because I didn't know a thing about family therapy.

After some investigation and indecision, I decided that social work was the quickest route to becoming a therapist, and indeed it was - I was doing therapy about a week into my first year internship. Now, about 2 years later, here I am, a family therapist. As far as I can recall, nowhere along the line did I actually decide to be a family therapist. However, over time, it just seemed like the best thing to do. Here is why.

First of all, there are the practical reasons: Fresh out of grad school with an MSW, you have to work in an agency. Let's say you want to do clinical social work and you are not focused on working with people with severe mental illness. My unscientific, ballpark estimate is that there are about 10x more opportunities for jobs in the child welfare/family services arena than in individual counseling. For reasons I'll discuss below, I never really tried to find a job at an agency providing only individual counseling, but my impression is that it would have been a lot more difficult, and I'd probably still be searching.

On to why I didn't bother trying in the first place. I am, I should note, personally inclined towards individual therapy. I see an individual therapist and value her greatly. I am generally more interested in the interworkings of the mind, the layers of conscious and unconscious material, symbols and structures, archetypes and object relations, and selfobjects. All that stuff has an inherent allure - the "mysteries of the mind".

However, once I got a taste of (doing and reading about) family therapy, I have had trouble letting it go. It just makes so much sense, practically - especially for someone like me who enjoys working with kids (stay tuned for a future post on "Why working with kids alone is the easiest thing for a family worker to do, and that's why you shouldn't do it"). In my opinion it is hard to exagerate the importance of family on development. Kids spend most of their lives with their families except when they are in their school-prisons and asleep); the family atmosphere and structure have a huge impact on how a child develops.

Of course, an individual therapist can make all the difference with a child in spite of their family difficulties. As Clare Winnicott wrote,

my recent experience with young adults has brought home to me
very vividly how much suffering might have been avoided if there had been someone outside the family to whom the boy or girl could have turned for help and understanding when things began to get difficult. (Winnicott, C. "Communicating with Children")

This is true for adults as well (although perhaps not as easy, since over the years we develop shells and defenses that seem so familiar and safe that change can be quite difficult, however many years of therapy we've been in).

A therapist/social worker can help a child individually, but the question still remains: Given the choice of working with the family or in spite of the family, what is best for the child? Then, the answer seems obvious: family therapy.

When we come to adults, the answer is not so obvious. In many cases, life difficulties can be due to problems with partners or children, and individual therapy can be like an escape from that system, rather than addressing the key problems, e.g. a breakdown in communication.

At the same time, many people want personal growth, self-understanding, and self-actualization; whatever all that means, they want it. That is a big reason that I see a therapist. When it comes to actual growth (as opposed to problem solving), I am of the opinion that everyone who feels that impulse could benefit from seeing a (good) individual therapist. Not that everyone needs to or should see a good individual therapist.

So my the verdict is: Family therapy is better than individual therapy for children, especially because children are often blamed simply for reacting to stressful family and social environments. This should be the standard intervention, long before meds are discussed.

For adults, I think good family (or couples) therapy can help with the communication and interpersonal patterns that keep us arguing, feeling judged, or stuck - all the things that take up time that could be spent meditating or writing our novel. However, this is not a replacement for (good, non-stagnant) individual therapy for people who want to dig down into their souls a bit and see what happens.

All that being said: Will I stick with families? I don't know. How am I supposed to make a decision like that? It kind of looks that way... In my idealized future, I develop two specialties: one, in family work of one kind or another (in NYC, Ackerman and Minuchin are the big theorhetical perspectives); and another with an individual, psychodynamic perspective - I lean more towards the object-relations field. Then I'd have all my bases covered and I could really begin raking in the dough.

Alternately, I could split the difference and go into Internal Family Systems. This is a model, developed by Richard Schwartz, that I know very little about, but it sees to apply systems thinking to inner life. That would kill two birds with one stone, as it were: Schwartz claims it can be applied to familes, groups and societies too. I'm sceptical but interested, and one of his books just came in from Amazon, so I'll probably write more about it soon.