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.
Saturday, August 29, 2009
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,
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.
Wednesday, August 26, 2009
A Mature Person according to Virginia Satir
The more I read of from Virginia Satir's Conjoint Family Therapy, the more I appreciate her ideas, to say nothing of her skills in practice. Her focus on communication is right up my alley; and her emphasis on self-esteem sets her apart from other old-school systems and structural theorists, who tend not to look at the intra-psychic.
Her description of functional and dysfunctional communication and relational patterns describes pretty bluntly how we can all get so anxious, angry, and generally muddled up just going through life.
Here a longish tidbit on what maturity is:
Her description of functional and dysfunctional communication and relational patterns describes pretty bluntly how we can all get so anxious, angry, and generally muddled up just going through life.
Here a longish tidbit on what maturity is:
"A mature person is one who...is able to make choices and decisions based on accurate perceptions about himself, others, and the context in which he finds himself; who acknowledges these choices and decisions as being his; and who accepts responsibility for their outcomes.
The patterns of behaving that characterize a mature person we call functional because they enable him to deal in a relatively competent and precise way with the world in which he lives. Such a person will:(*This description of maturity emphasizes social and communication skills rather than the acquisition of knowledge and recognized achievement, which in my view derive from the first two.)
- manifest himself clearly with others.
- be in touch with signals from his internal self, thus letting himself know openly what he thinks and feels.
- Be able to see and hear what is outside himself as differentiated from himself and as different from anything else.
- Behave toward another person as someone separate from himself and unique.
- Treat the presence of different-ness as an opportunity to learn and explore, rather than as a threat or a signal for conflict.
- Deal with persons and situations in their context, in terms of “how it is” rather than how he wishes it were or expects it to be.
- Accept responsibility for what he feels, thinks, hears and sees, rather than denying it or attributing it to others.
- Have techniques for openly negotiating the giving, receiving and checking of meaning between himself and others.*
We call an individual dysfunctional when he has not learned to communicate properly."
- Virginia Satir, Conjoint Family Therapy
Tuesday, August 25, 2009
"The Rubber Room" - An example of systemic dysfunction in NYC Schools
I don't want to veer too far from the topic of concern - this is a blog about social work, not schools. But it is about social work in New York City; a lot of social workers work with kids, and if we're working with kids we're going to be involved with NYC school system.
The day after writing my last post on the educational system, I read this article in the New Yorker about what happens to teachers deemed too bad to be in a classroom.
Essentially, teachers who work for the NYC school system get tenure after three years. Once they have tenure, they can't be fired because the United Federation of Teachers, through intensive lobbying, has a stranglehold on the state legislatures ability to reform the system.
What do they do with a really terrible or possibly dangerous teachers who can't get fired? (as well as to innocent teachers who are accused of being terrible or dangerous) They these teachers to a sort of purgatory called the "Rubber Room," where they do nothing, get paid (one person getting $100,000 a year), and wait for arbitration of their case, which can take years. Some will get to retire and collect their pensions (which can be 50% of salary) before their case is ever resolved.
Are these teachers really terrible? Most of the ones interviewed claim to be victims of administrative wrath - written up for speaking their mind. Others point to race as a factor. I'm sure those sitting in the Rubber room are a mix of terrible teachers who screwed up and good-decent oneswho got falsely accused of something.
Frankly, most of the teachers quoted in this article sound like they have some serious personality disorders that they should be dealing with (I know that's not "strength-based," but this is my blog so I can engage in a little armchair diagnosis).
The sympathies of the author, Steven Brill, are clearly with the administrators, and not with the problem teachers and the U.F.T., which comes across quite badly.
Still, even if we accept that in many cases the teachers are the victims, we can agree, can't we, that this is a prime example of how screwed up the educational system is? We are talking about billions of dollars, and a teachers union that has the power to keep people getting paid not to teach. The system of arbitration is endless and byzantine.
This article demonstrates clearly how a system can morph develop a life of its own and become malignant- eventually it exists to perpetuate itself, not to fulfill its original intent.
It doesn't even resemble what it purports to be. And amid that mess, some kids still manage to learn things, and (most) teachers manage to teach them.
The day after writing my last post on the educational system, I read this article in the New Yorker about what happens to teachers deemed too bad to be in a classroom.
Essentially, teachers who work for the NYC school system get tenure after three years. Once they have tenure, they can't be fired because the United Federation of Teachers, through intensive lobbying, has a stranglehold on the state legislatures ability to reform the system.
What do they do with a really terrible or possibly dangerous teachers who can't get fired? (as well as to innocent teachers who are accused of being terrible or dangerous) They these teachers to a sort of purgatory called the "Rubber Room," where they do nothing, get paid (one person getting $100,000 a year), and wait for arbitration of their case, which can take years. Some will get to retire and collect their pensions (which can be 50% of salary) before their case is ever resolved.
Are these teachers really terrible? Most of the ones interviewed claim to be victims of administrative wrath - written up for speaking their mind. Others point to race as a factor. I'm sure those sitting in the Rubber room are a mix of terrible teachers who screwed up and good-decent oneswho got falsely accused of something.
Frankly, most of the teachers quoted in this article sound like they have some serious personality disorders that they should be dealing with (I know that's not "strength-based," but this is my blog so I can engage in a little armchair diagnosis).
The sympathies of the author, Steven Brill, are clearly with the administrators, and not with the problem teachers and the U.F.T., which comes across quite badly.
Still, even if we accept that in many cases the teachers are the victims, we can agree, can't we, that this is a prime example of how screwed up the educational system is? We are talking about billions of dollars, and a teachers union that has the power to keep people getting paid not to teach. The system of arbitration is endless and byzantine.
This article demonstrates clearly how a system can morph develop a life of its own and become malignant- eventually it exists to perpetuate itself, not to fulfill its original intent.
It doesn't even resemble what it purports to be. And amid that mess, some kids still manage to learn things, and (most) teachers manage to teach them.
How to visit NY SWOG while at work
***UPDATE***
This blog has been updated since I first posted it! See below.
This blog has been updated since I first posted it! See below.
Ever since the internet hit offices, I've wondered why exactly people are allowed to surf the web and get paid for it. If I dragged a TV into my office and flipped it on, it wouldn't go over too well, even if I were just watching the news. Yet the internet is in a strange liminal zone between utility and, well, un-utility: one could use it for work, so it would be difficult to ban completely, even though it is often used not to work (see the Onion artcle "48-Hour Internet Outage Plunges Nation Into Productivity")
I will add that as a social worker I use the internet all the time to find very valuable resources and services for clients, so if I were to look the WWW my productivity would surely decrease.
All of this is to say that I don't exactly want to endorse surfing the net at work, but if you do, why not read a stimulating, entertaining, and informative blog about social work issues?
HOWEVER - guess what: it turns out that all blogs are blocked from my work computer - because blogs are inherently unnecessary for social work, I suppose. Several readers have told me the same thing about their work servers, so I want to let you know that you can (probably) still access NY SWOG at work. Just follow these steps:
- Go to a blog feed site like Google Reader
- Get a ID and password, or use your Gmail account if you have one
- When you get to the main Google Reader page, click the button that says "Add a subscription" and type in or paste: nyswog.blogspot.com
- Click "add", and you are now a subscriber! You can go there any time and see if NY SWOG has new posts.
Enjoy...but not too much. Now get back to work!
UPDATE - I posted this last night, went to sleep, woke up, and went to work. I decided to see if I could see this post on Google Reader, and found that between yesterday and today, Google Reader has been blocked at my workplace!
I can see only 3 possible explanations:
- Some higher up is reading NY SWOG and responding accordingly
- By checking if I could use Google Reader at work yesterday, I somehow got it flagged and then blocked
- It is just a strange coincidence
Social Work Quote of the Day: "His freedom stretches so widely..."
Man’s freedom has roots that are in his very nature as man. It cannot be totally eradicated by circumstances, no matter how severely it is stifled under the stiff iron mesh of neurotic patterns. However, we may also use the expression “free, unique personality” to indicate the person in the fullness of being, when he has reached the top level of freedom. His freedom is such that he is able to give complete fulfillment to each of the facts that go toward making up his personality. His freedom stretches so widely into all corners of his life that he is able to turn each obstacle or adversity into a positive personal value. In freedom, he becomes able to experience his very illnesses in such a way that they help him grow.
– Adrian Van Kaam, The Art of Existential Counseling (p. 52)
Sunday, August 23, 2009
Correction regarding Social Work and Nobel Prizes
I recently asked, somewhat rhetorically, "Has a social worker ever won a Nobel Prize?" The implication was no, but, well, it turns out that the answer is yes. I forgot, or maybe never really knew, that Jane Addams, considered the mother of modern Social Work and leader in the settlement house movement in the U.S., was the first woman to win the Nobel Peace Prize.
To make up for this error, I will feature some of her quotes in my "Social Work quotes of the day." But let's start out with this one:
This is a great quote. It also ties in with my recent post on education, and my upcoming post ruminating on the relative merits of family therapy.
But I can't help wondering if is this true?
I wonder if America's future was really determined by the great teachers of our civilization, Television and the Internet. Maybe we should watch what TV we watch, what video games we give, and what social networks we join.
To make up for this error, I will feature some of her quotes in my "Social Work quotes of the day." But let's start out with this one:
America's future will be determined by the home and the school. The child becomes largely what he is taught; hence we must watch what we teach, and how we live.
This is a great quote. It also ties in with my recent post on education, and my upcoming post ruminating on the relative merits of family therapy.But I can't help wondering if is this true?
I wonder if America's future was really determined by the great teachers of our civilization, Television and the Internet. Maybe we should watch what TV we watch, what video games we give, and what social networks we join.
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