October 19, 2019

Welcome to the Field of Social Work

On July 20, I was privileged to give a brief talk to the 2012 summer graduates of the Ball State University School of Social Work program. Following is the essence of the speech to 20 students that will be entering the “Field of Social Work.”

“Seek to make your life long and its purpose in the service of your people.” Chief Tecumseh

Hello, I am a Social Worker. I want to formally welcome you to the field of Social Work. You now have your degree; I expect you are relieved and excited. You have graduated from a quality School of Social Work at Ball State University. Some have that first job lined up and others are looking — wondering where and when it will be.

Some years ago when I decided to become a therapist, I told my friends and family that I would enter the School of Social Work at the University of Tennessee. They said “Are you Crazy?” They did not understand the field and frankly neither did I. The truth is, I knew that working with people and adding value in terms of direct improvement of life was necessary for me. I knew Social Work would help me in that process. I wanted to be a psychotherapist (or as my son says psycho therapist). So off I went to the University of Tennessee at Knoxville.  I earned the Master of Science, Social Work degree that allowed me to practice psychotherapy.

In the school we talked about “What is Social Work?” Our definition was (and mine still is) “A Social Worker is what a Social Worker does.”

Partly, though I did not own my place in the field. The prestige was not great and I found I would call myself a therapist and identify as a Social Worker only occasionally. 

Then 20 some years into my career, I had occasion to present at a meeting for the Indiana Chapter, National Association of Social Work. NASW an organization I had not been a member of for years.

I was moved by the depth of involvement and the dedication of many I met at that first meeting. The saying a “Social Worker is what a Social Worker does” was relived with honor. It is a field with depth of character and nearly endless variety of involvement in the process of helping others. Shortly after I (re)joined NASW and am a proud member today.

In the 37 years since I earned my degree, I have worked with 9,000 different clients and completed about 34,000 hours of face to face contact. You are at zero.  Your numbers will accumulate soon.

Use your hours well. Each hour is important and, no matter what, the hours will add up.

You will have all these opportunities to practice. Be careful what you practice. How you practice will affect the rest of your career. You are in the field because you want to serve. Remember the quality of care you provide to the humans you work with must be job one.

You will be seduced by numbers of quota and production. While it is the case that agencies must financially survive, it is more so the case that we must serve with quality.

The helping field is growing and filled with clear research that shows we add significant value. We do not, however, have the marketing ability that drug companies have and must contend with the idea that solving problems is as presented on the drug advertisements. Just take a pill and the pill they advertise results in immediate rather passive progress.  

You have learned the importance of relationship with your client. If your clients trust you and you can help them find hope, they will do better. Hope is necessary in all of our lives. The research or relationship is clear. Relationship as rated by the client is highly correlated with successful outcome. In fact, we know that when you see your MD, if you have confidence in the MD, the medicine will work better. Honor those relationships episode by episode. Often the provider who does relationship well, but provides placebo treatment, is more effective than the provider with poor relationship who provides the so called “correct treatment”.

You will be pointed to doing more paper work than you can imagine. You may need to do that to keep your job. Do not let that get in the way of treating the humans you work with honorably and respectfully.

There is a movement in the field to do concurrent documentation. This involves looking at a computer screen and typing as you ask personal questions of human beings. It seems to me inherently disrespectful.  

Always respect your clients. Always remember your goal is to help, even as your organization may (WILL) insist certain information needs to be collected in way called “timely”.

As you do your hours, remember you are practicing? What you do you will get better at, even if you are doing activities that are not helping. If I practice for hours and years at bad golf swing, the hours of practice help me ingrain that bad swing.

In your first two years, you will create a basis for your habits of practice. You are looking for the best habits at working with people and will be seduced with the idea that paper and numbers are more important. Productions, timeliness of paper, quality of paper, in that order, are the most likely forms of feedback you will get from your supervisors. Your priorities must have clients at the top.

Research shows that helpers with lots of experience are not much better than new folks. (So much for my years of experience!)  In part this is because some start out and develop bad habits. They think they are doing well because their colleagues like them, they do great production and good paper work; their reviews will then be outstanding. Some though never improve the quality of their care; they just complain about the clients and the tough case load.

NEVER complain about clients. The tough clients, I suspect, are the essence of why you are in the field. Many of the poor helpers think they are better than average. In the field of therapy, quality varies from 20% effective to 70%. Which do you prefer to be?  Always strive to improve and find ways to do that. It is important that you find ways to measure your progress. It is important that you work with other helpers that also want to improve.

Keep a Treasure Chest — way to remember successes and those that have been appreciative — for times you get discouraged.

So go forth and pay attention to the words that are often credited to Chief Techumsch:

 “Love your life, perfect your life, beautify all things in your life”…

“If you see no reason for giving thanks, the fault lies only in yourself. Seek to make your life long and its purpose in the service of your people”..

Read entire Tecumseh Poem from Act of Valor the movie (2012)

I am a Social Worker. We need your help. Congratulations and welcome to the field!”

 Bill

Ten Myths of Psychotherapy

“I therefore claim to show, not how men think in myths, but how myths operate in men’s minds without their being aware of the fact.” Levi Strauss

The process of psychotherapy is full of myths related to the process. This blog examines the most popular myths and clarifies what we know about therapy.

Myth: Clients get worse in treatment before they get better.
Fact: At the start of therapy, clients are often feeling their worst. Clients should expect noticeable positive change is 3 to 6 sessions.  It is not necessary or advisable to get worse first.

Myth: Clients become resistant to treatment because they are afraid to deal with emerging unconscious material or childhood experiences.
Fact: Clients want to change and often dealing with unconscious material is not necessary.  While it may be useful for some to do that it is also the case that many move forward looking primarily for solutions.

Myth: Client problems are usually the result of a biochemical imbalance.
Fact: In spite of drug company research, there is no substantial evidence that medication is better than therapy in changing lives. There is  evidence over the last 50 years that people who get therapy are better off than 8 of 10 people that do not receive therapy.

Myth: The appropriate diagnosis is essential for effective treatment.
Fact: Diagnosis is applied inconsistently does not correctly predict techniques to use or length of stay. What’s important for therapy is client – therapist agreement on goals and using an approach to the problem that makes sense to the client.

Myth: The clinician can change the client’s behavior with the proper techniques.
Fact: The client – clinician relationship, as viewed by the client, is the number one predictor of outcome of therapy. Only the client can change his/her behavior.  Techniques must fit with a client’s view of change. There are now over 400 different therapy techniques available. If your clinician can not find one or two that fit with you, find another clinician.

Myth: Client’s who pay directly for services benefit more in therapy.
Fact: Regardless of whether services are direct pay, insurance pay or no charge, research over the last 50 years is clear that clients
benefit from therapy.

Myth: If the clinician feels empathic towards the client an alliance is formed.
Fact: Ultimately an alliance is formed when a client determines it is formed. While empathy is often useful, it is more important to work with a therapist that fits with your needs in a broader context.

Myth: The most charismatic therapists get the best outcomes.
Fact: Therapists that have good and trusting relationships with clients, and trust that the clients can improve, have the best outcomes. Some of the most effective therapists are not charismatic. It is worth noting that there is dramatic difference in therapist ability.

Myth: Clients always know what they need.
Fact: Wouldn’t that be nice? Frequently   knowing or learning what one needs is a series of mental and behavioral experiments. The learning comes from talking or actions  the client tries, often secondary to the therapeutic interactions.

Myth: A good therapist always intuitively knows what their clients need.
Fact: A good therapist nurtures hope with clients and works with their needs. Finding and using reasonable hope is a prerequisite of effective therapy.

If you would  like more information on mental health and therapy, please contact my office: 765.288.7939 or use the contact form at www.solutiontherapycenter.com.

 

 

Finding a Mental Health Therapist

It is only when you exercise your right to choose that you can also exercise your right to change.” Dr. Shad Helmstetter

This week, with input from the internationally known psychologist Barry Duncan, I describe how to choose a psychotherapist.

There are lots of us out there; how can you know who best for you? Underlying the opinion of this blog is research of the last 50 years. Research is clear — therapy is helpful. We know that people who get therapy are better off than 80% of those that do not. Therapy is helpful in dealing with depression, anxiety, variable mood, trauma, attention concerns. It is also helpful for pain and physical problems that are exacerbated secondary to struggle to recover from stress. Working with a therapist that fits with you is the key. Also know there is great variability in clinician effectiveness.

Many therapists now have a website offering you the advantage of learning a bit about the person before contacting. Many will also offer, at no charge, time to get acquainted. Following are guidelines for that time.

First, trust your gut. If you find a therapist that you do not like, try another. Getting along reasonably and communicating well with your therapist is a key to success. Similarly, if you sense the therapist does not like you, move on. You need to know the counselor you work with is on your side. You can, of course, discuss your concerns before leaving but do not do this session after session. It is important to note that the number one predictor of success in therapy is client rating of relationship with the therapist early in contacts.

Second, you and your therapist should have agreement on goals. If that is not the case, work with someone else. If the therapist’s approach to your problem does not make sense to you, talk with him about trying a different approach. There are nearly 400 different approaches and he should know more than one or two. If he does not shift approach, find someone else to work with.

Third, research is clear that hope must be a part of the relationship. If no hope, what is the purpose? If a therapist treats you or your situation as ingrained or hopeless, look around and find another.

Fourth, look for change early in your sessions. You should notice positive change in 3-6 sessions. If not discuss with your therapist and if no change persists find someone else. It was just a match that did not work — no reflection on you or on the therapist. Keep trying for improvement. It is fair to expect positive results sooner rather than later.

Therapist effectiveness is also widely different. The most effective mental health professionals show significant gain with 70% of their clients. The least effective show gain with only 20%; this difference is dramatic. It is fair to ask about success rate. Even working with the most successful therapists there can be a mismatch for you. While change can still happen by using a different approach, often a change in therapist is indicated.

Whoever you work with, you should expect and notice positive change. Remember you are the boss. You get to choose and your being actively involved in the process is vitally important. Pick someone with a good track record.

And if you wonder: Over the last 6 years, 67% of (800 or so) clients that I have seen more than 1x, have surpassed the 50 percentile of change based on national norms.

Bill

What is Solution Focused Therapy?

My interest is in the future because I am going to spend the rest of my life there.” Charles F Kettering.

“When you discover you are riding a dead horse, the best strategy is to dismount.” Dakota Tribal saying

Now that I am in business as the Solution Therapy Center, I am frequently asked “What is Solution Focused Therapy (SFT)?” I am glad to be asked.

Solution Focused Therapy is uniquely positioned in the field of psychotherapy. By some estimates there are over 400 models of how to do therapy. There is ongoing debate and research about which models are most effective in helping clients change. Through research of the last 50 years, it is clear that people who get therapy are better off than 80% of those that do not. There is also agreement that for effectiveness hope must be a part of the therapy.

Finding hope and growing it is a key to SFT. The essence of SFT is ongoing conversation with the client about what is needed for progress. SFT recognizes that clients want to change; this is in contrast to approaches that are set on the idea that clients resist change. SFT recognizes that therapy can be done briefly and that small change can lead to large change. Search for identification of realistic hope is a key and ongoing process.

As part of finding and working with hope, Solution Focused therapists make particular effort to find client strengths and highlight those strengths in a way that encourages more use of what has been helpful in the past. The search for these abilities is centered on the client point of view. The client, not the therapist, is the expert on their life.

People come to therapy when some aspect of life is not working; the effort is to change gears. John Weakland, a well known Brief Therapist said, “The purpose of therapy is to move from the same damn thing over and over to one damn thing after the other.” Consider thoughtfully his words.

The work then is to get out of the rut of the current situation or the rut of the current feeling and to begin moving on with life. The therapy is a pit stop for the current stress, not a cure for life. Some therapies, at times get bogged down in the so called “whys”; the whys are often both bottomless and debatable. SFT notes people can, and do with some frequency, solve problems without understanding the whys.

As focus remains on solutions it is also the case that other (399+) psychotherapy tools can be called on. You have probably heard of some of them: Cognitive Behavioral Therapy, Social Learning Theory, Family therapy, Stress Management, Marriage Therapy, Financial Social Work and many other ideas? SFT is not dogmatic but rather flexible as it includes ability to shift focus and use the other tools to be on board with what the specific client needs.

If you consider therapy, stop and think about what your needs are and what you want to accomplish. How will you know therapy is done? Consider SFT and make sure you interview the therapist and have a sense that the therapist is a fit for you. Maybe the focus that is right for you or your family will include the hope and strength basis of Solution Focused Therapy.

Thanks for asking.

Bill