California Society for Clinical Social Work

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THE CLINICAL UPDATE | SPECIAL EDITION - COVID-19

This is a special Coronavirus Edition of the Clinical Update

A big thank you to our fellow members for generously sharing their thoughts, feelings, ideas and reflections. In this newsletter we hope you’ll find useful information, validation, new perspectives, and perhaps inspiration. We hope you enjoy the poems and humor. Although we can’t meet together in our districts, this newsletter may help you feel more connected to our colleagues around the state.

Jean Rosenfeld, LCSW, Editor

Letter from our President, Monica Blauner, LCSW

By Monica Blauner, LCSW             

Dear Members,

In this “Time of Corona,” CSCSW has strived to live up to its mandate to keep our members connected and informed of the fast moving changes as they occurred.  Thanks to all the members who have shared information and their experience in support of their peers. It is gratifying to be able to help our members stay connected to their clients, while also providing the support that we ourselves need. 

“Being where the client is” has taken a new form in the age of social distancing, in which “zoom” has become a lower case adjective.  We social workers are nothing if not resourceful and adaptable!  

Every crisis provides an opportunity, and Covid-19 has pushed our organization to adapt by moving all of our programs online for the duration of the need for social distancing. The District Coordinators are in the process of planning a series of online “District Meetings” and workshops, including Law & Ethics, so we can continue to meet your educational needs. (Our current plan is to do so through the end of December, depending on conditions.) Providing online programming enables us to give all our members around the state access to all our districts’ programming; this includes members in areas where we do not have an active district. We will also be able to record events and have them available afterwards in our “library” on the website.    

The move to online communication expands our professional community. The Listserv has been an effective tool for our members across the state to communicate and share resources, and as we get more comfortable with videoconferencing, we can use it to connect in other ways.  Since our Telehealth Consultation and Support Groups were well attended and provided much needed support, our members may want to consider organizing other statewide consultation groups that can focus on working with children, or couples, or any clinical topic of interest.  If anyone is interested in organizing such a group, contact myself (add email address )or Donna Dietz, our Administrator, for assistance (add email address).     

I want to express appreciation for CSWA and specifically Laura Groshong for keeping us informed about changes in regulations and advocacy issues that affect us and our clients. 

We wish everyone good health and all the emotional support we need, personally and professionally. 

Collected Grief

by Leah Niehaus, LCSW

We certainly are in an unprecedented time—and it’s hard to have much wisdom or perspective when we are in the midst of something big, as we are with this public health pandemic. The news and recommendations continue to evolve and change, the numbers of those affected with Coronavirus continues to rise, and the weeks that many of us have been at home is taking its collective toll. Our emotions are swirling right now—sometimes upbeat and enjoying the “new normal” and at other times, a sadness just rolls in and stays awhile. We are juggling work from home, homeschooling our children, adjusting to less social interaction and outdoor play, and trying to create some stability in an unpredictable world. This is if we are fortunate and not ill with COVID-19.    

I just keep coming back to the idea that we are in a collective grief process.  I feel it in my bones. 

While we’ve never had a flu epidemic quite like this in our lifetime, nor have we had our country on shelter-in-place orders--there is a familiarity with the emotions that we might be feeling right now. It is not unlike the feelings that arise when we feel threatened and scared, are forced to contemplate our own mortality or the mortality of those who we love, or when we’ve lost anything that we’ve valued. Grief can be in reaction to losing someone we loved, going through a divorce or break-up, moving away from somewhere beloved, infertility or miscarriage, losing a pet, retiring, coping with chronic illness….the list goes on. If you’ve lived through wars, recessions, or 9/11—we understand that life will never be quite the same again after this experience—and that is LOSS. If you’ve lived long enough, you’ve undoubtedly been touched in this way.  We are in true grief and anticipatory grief on an interconnected global scale.

Elisabeth Kubler-Ross, the landmark psychiatrist, who wrote the book ON DEATH AND DYING  (among others), articulated the Five Stages of Grief: Denial, Bartering, Anger, Depression, and Acceptance. These stages are not linear and when we grieve, we dance between these stages in our own individual grief process. David Kessler, a protégé, has added a sixth stage of grief, which is Meaning. The entire world is suffering and grieving in the present moment—our linked humanity is so clear right now. Some are grieving the lost lives of those they love due to this disease….others are grieving the collective losses of independence, physical proximity to friends and extended relatives, physical touch, routine, autonomy, job loss, financial pressures, leisure activities, travel, school rites of passage—proms, graduations, sporting events, spring plays...life as we have known it has changed—it is necessary and yet it is profoundly sad and overwhelming if we allow ourselves to feel it. Yet we must feel it, as it comes to each of us…over the coming moments and months. 

There is no quick fix to grief. There is no way to cope ourselves out of it by endless meditation, distraction, yoga, prayer, or talking with a friend. While all of these wonderful tools can help and are worthwhile, sometimes we need to still ourselves and sit with the sadness. It can be restorative to just give in to it for a time…feel it in your way…just don’t get stuck there indefinitely. This is the same for our children—in moments, they are sad and overwhelmed too.  Make space for them to express that part of their experience and know that it is normal. Children do have a wonderful way of being in the moment, not worrying about the future so much—and we could take a lesson from the way they naturally cope during this time. As time marches on, we will move between the different stages of grief…months/years down the road, we will move towards Acceptance and Meaning. In the meantime: 

  • Be curious about yourself. What is brought up for you during this time? It is common for previous losses to come back to our minds during a time when we are grieving. Be gentle with yourself. 
  • Consider your faith tradition if you have one. For some traditions, this is the holiest week of the year. What does it tell you about suffering, loss, struggle, and hope? What can you draw upon to help you cope during this time? If you feel lost inside your own tradition, is there another faith tradition that has a healing element for you—or could nature, prayer, or awe assist you right now?  
  • Cry “Let your tears come. Let them water your soul.”  --Eileen Mayhew
  • Consider a creative outlet—in times of challenge, often we feel compelled to journal, create music, paint, write.
  • Look for inspiration—it truly is everywhere right now. Find moments of joy and connection!
  • Get outside of your own head for a few moments—do something kind for someone else, donate to charity, focus on ways that you can contribute to humanity in your big or small way.
  • Remember that this too shall pass. You have survived hard things in the past and you can get through this. What ways could your past coping strengths be helpful to you now? How have your children coped in the past and how can this help them now?
  • Make space for your loved ones to have their own experience right now at their own pace. We all grieve differently.
  • Do less, put less pressure on yourselves and your children. Just BE. Just feel.
  • Acknowledge your own emotions and model that for your children.
  • Recognize if your children are relieved right now—with less rigor, club sports, etc. Recognize if you feel some relief from the pace of life as well. It is important to acknowledge this when we get back to a more normalized experience—what in our lives has not been serving us or our children? How can we shift if need be? How is our world going to change for the better after COVID-19?
  • Remember this quote: "When one door closes, another opens, but sometimes it’s Hell in the hallway."

While silver linings are already becoming apparent (thankfully!)…I keep thinking about how this experience has highlighted the collective “Yes” response to Life. It is an affirmation that we are grateful for health and our human experience each time we are socially distant, wear a mask, wear gloves, wash our hands, support our medical workers in their valiant effort, support our local restaurants and bookstores, watch our church services online, etc. In my work as a therapist, often I am sitting with someone who is struggling—sometimes with a more passive “yes” to life, or a “maybe” it’s all worth it, or a tragic “no” to life. There can be much ambivalence in the therapy office about whether their pain and suffering are worth it, if they can cope through it, and questioning whether there is a reason to hope. I see a shift in the collective, yes there is sadness and grief—but, most feel an increased connectedness, a resilience rising, and a bold “Yes” that life is to be lived.  

Leah M. Niehaus, LCSW has a private practice in Hermosa Beach, CA.  Her website is www.leahmniehaus.com.  She can be reached by emailing at leahniehaus@me.com or 310-546-4111.

I Couldn't Do What You Do

by Annie Wilson, LCSW

I couldn’t do what you do” is a phrase I hear multiple times a week. Often by the patients and families that I am serving. I work as an Emergency Room social worker in a suburb of San Francisco. Truth is, my job challenges me in ways that I could’ve never imagined. It causes me to question the social constructs of our society and stand up to foundational systems that have been in place for decades. It leads me to question my intelligence, my compassion, and my ability to advocate for what is right on a regular basis.

I sit with a husband as he says goodbye to his lifelong partner. I sit with domestic violence survivors after acute battering incidents and hear them justify their partner’s behavior. I sit with a homeless family with four children who haven’t bathed properly in weeks. I sit with a sexual assault victim, prepare her for the next legal steps, and work to make her feel safe in her body again. I sit with a parent after he receives news that his son’s drug overdose was fatal.

How fortunate am I to be in a position to sit with someone in their most vulnerable time and provide tangible assistance? I have joined dozens of patients and family members in their battles. The battle changes every day and I can never anticipate what my shift will bring. It isn’t a surprise that my work on the frontline has intensified since the COVID-19 pandemic. I feel stuck trying to instill hope and a sense of security in an unsettling social climate. The resources are stretched and changing weekly as the need for them magnifies. 

I see an immigrant who lost his job and his health insurance, finding himself hungry and on the street. I see concerned family members waiting in our parking lot for hours to hear any news, because they are unable to be present with their loved one at the bedside. I see an elderly woman unable to return to her assisted living facility because of the risk she poses to the other residents. I see more suicidal and homicidal ideation, more domestic violence, and more substance abuse. I have seen a lot, but what I have felt is more powerful. 

I feel a sense of belonging from an organization that checks my temperature and ensures I have a mask every day. I feel inspired by the resiliency of my ER team, cheering each other on despite the anxiety that accompanies bedside care. I feel a sense of mutual understanding from our community partners, who are doing their best to be available for support despite the present constraints. I feel loved by members of the community who are sending multiple catered meals to the hospital units daily.

I am humbled to be among the healthcare heroes who are incessantly working to save lives. We are collectively faced with the uncertainty of this pandemic, yet we continue tirelessly to change people’s lives for the better. How often can someone say that walking away from their day job? Now when I hear the phrase “I couldn’t do what you do,” I smile. 

Annie Wilson, LCSW, graduated from University of Georgia with her Bachelor’s degree in Social Work and from San Diego State University with her Master’s degree in Social Work. In addition to her work in the emergency department, she provides telehealth counseling to individuals with anxiety and trauma-related disorders. Awilson216@gmail.com

Brief Reflections from Around the State

From: Tracy Greene Mintz, LCSW | srcaretraining@gmail.com  (Redondo Beach)

A client called me today (healthcare worker) so scared and I experienced a little vicarious trauma. Here is what helps me: Keeping a daily routine, cooking, reading, and lots of group texts going right now.

From: Sally Weiler, LCSW | SallyWeiler1@gmail.com (Sacramento)

My most consistent observation is that I am carrying an underlying stress most of the time and often am not  aware of it. It can show up as anxiety, tightness and even mild depression. My clients and friends have reported similar experiences.It is a test of our emotional maturity to be able to hold such an array of feelings including hope and optimism. I strive to be mindful of that every day. And, For those who are missing the gym, YouTube has endless videos for most fitness needs.

From Stephanie Domek, LMFT |stephaniedomektherapy@gmail.com (Sacramento)

Providing telehealth therapy to children and teens is hard. With very little warning I began seeing my small private practice caseload over the 7x11 inch screen on my laptop after the California stay-at-home order went into place. It’s hard to engage kids in therapeutic conversations while navigating distractions including technical difficulties, interruptions from family members, brief breaks to use the bathroom, and unexpected visits from siblings and pets. It’s difficult to get a sense of what is happening in the room. Who’s under the blanket moving on the bed in the background? Is that your mom talking to you? I can’t see you anymore. Where did you go? I can’t manage things like I can when people meet me in my office, in the space I’ve created. I’m used to being able to share my toys, games, and supplies for activities. I like knowing that my office will be quiet and private, away from parents who are waiting down the hall. During video chats, I’ve had clients throw stuffed animals at the screen over and over. I’ve been spun around by my young clients who think it’s entertaining to take me on a virtual ride. I’ve had to give up some control.

Not everything is bad. Some aspects of telehealth can be beneficial. I’ve found that being in my client’s bedroom breaks down some of the barriers that can get in the way of a child feeling comfortable in my office. Kids who have been anxious meeting me in my office feel comfortable chatting with me from their bed. I’ve been reduced to the size of an iPhone screen and kids move me around their own space. Maybe the sense of comfort comes from kids being used to communicating between screens. Telehealth can be somewhat removed while being uniquely intimate. It’s not ideal, but I’ll make it work.

From: Lynette Sim, LCSW  | lynette@lynettesim.com (Culver City)

I have read the many useful posts about billing and looking out for our patients and clients but haven’t seen anything about taking care of us.  Please let us all take a breath and do whatever it is that we do to support ourselves emotionally and physically.  For me it is the garden, music, books, keeping in touch with friends, my cats, TV and puttering around the house.  I did say to myself that there are only so many times I can re-arrange the garage but whatever works.  Filtering the news is also helpful, and if possible really, really good sleep. The occasional pizza is also very nourishing for the soul and chocolate can provide solace.  When we support our own wellbeing we are also taking care of the people who depend on us. 

From: Kim Roser-Kedward, LCSW  | www.KimRoser.net (San Diego)

My quiet time in the garden is a good place for me to do my "thinking" while immersing myself in dirt digging, compost sifting, worm collecting.  It helps me feel a little safer about the risks of food insecurity.  It's what my ancestors did. I have also been enjoying nice, long, brisk walks or bicycle rides in my neighborhood.  It has been delightful seeing all of the "new" people out walking their dogs, children riding their bicycles (what? where did they come from?).   Of course it is nice to see my fellow "regulars" as well. Seriously.  People are out in my very walking (and riding) friendly neighborhood and practicing good social distancing.  I've seen families who live in apartment complexes set up their beach chairs behind their cars in their tiny parking lot to watch their little ones ride their bikes and scooters.   This helps balance out the news about people who are not taking this seriously. And while I may get lulled into a sense of safety in my home, it has also been good for me to make my trek out into the real world: Costco and the bank yesterday was an important reminder to me about the threat.  I think a daily dose of news in this case is helpful for anyone at risk for slipping into denial or this very strange, surreal feeling.

From Rosalind Monahan, Ph.D. | rozmonahan@dc.rr.com (Palm Desert)

Really enjoying reading about how my colleagues are taking care of themselves. I have been busier than ever since we can now bill for phone sessions and video conferencing etc. I have a 95% client population of seniors in their late 70s and 80s. Being able to be available for them by phone gives me a sense of helping in this time of need. I am passing along to them the many ideas many of you are utilizing. 

I live in Palm Desert where the weather is beautiful, the mountains are topped with snow, and the sky is blue most days. I walk and listen to an audio book while being grateful for where I am. Several family members have a group text that we utilize daily and post pictures and jokes, etc. I have family in Washington State that have found a way to gather. They had a tailgate party in a large backyard with three pickup trucks. Each truck kept a social distance with a couple in the back of each pickup. One is pregnant and concerned about delivery in May. One is a nurse and needs the family time and fresh air. We are being supportive of each member and enjoying staying connected. More connected than ever before.

I also teach tapping with EFT and encourage my clients to utilize it to keep their immune system healthy as do I, as well as encouraging meditation, and any exercise people are able to do that home. I wish everyone and their families good health and stay safe.

From:  Mary Best, LCSW | naturenotesandpeace@gmail.com (San Diego)

A resource I have used for some time and others have referenced, is Tara Brach. a mindfulness spirit healer, who generously shares meditational talks.  Recently she, as we, has moved to shelter in place, and I have appreciated these new ones, as well as clients' comments that they have been helpful.  Links to copy and paste into your browser.  Enjoy!

Facing Pandemic Fears With an Awake Heart - Part 1  | 3/18/2020 

https://www.youtube.com/watch?v=PcZwg10WYx0

Guided Reflection on Bringing RAIN to Fear     

https://www.youtube.com/watch?v=5Bg3F214cFI

Sheltering in Love - Part 1 -  3/25/2020  Meditational Talk

https://www.youtube.com/watch?v=68xJ0gAlk00    

Pat Penn, PhD, LCSW | patriciapennphd@gmail.com (San Jose)

Also doing lots of gardening, long overdue projects of cleaning out drawers and closets when the mood strikes me, staying in contact by phone and social media with friends and loved ones but also giving myself permission to feel and experience both deep grief but also gratitude. I too am doing lots of walking and challenging myself with my Fitbit to walk longer distances each day. I thrive in nature as I’m sure most of you do too. Yesterday I hit the five mile mark so at least I’m staying fit!  Enjoying also doing more cooking and baking and watching the birds land on my hummingbird feeders and squirrels run around my garden, completely oblivious to the chaos that has currently befallen our world. Spring is bursting forth and such a welcomed sight right now! I find being glued to the TV news is not helpful. 

Although there is ample time now to read the books I’ve  been wanting to open, or watch a movie from the many offerings by Netflix etc. I’m finding I just can’t concentrate and escape into those activities as I have in the past. Classic symptoms of grief and loss I know! 

Stay well everyone and would love others to share their personal coping styles. Find it very comforting that this crisis is bringing so many together by way of the phone and the Internet in this time of social distancing. I know as a social worker my feelings are most probably shared amongst most of us.From: Sandy Hotchkisssandyhotchkiss@earthlink.net  (Pasadena)

Using FaceTime creatively with friends and family: bedtime story with my 5y/o granddaughter in London, a quiet moment and a cup of tea with a frazzled friend on the East Coast, sitting down together for a meal with a favorite couple across town; forming a peer supervision group with colleagues on Zoom....

From: Karen Moorehead-Jenkins, LCSW (La Mesa)

I have found the clients that I work with in my private practice are more open and comfortable in virtual reality with their familiar surroundings, and it feels less formal than meeting face-to-face in an office.  Using a computer makes our faces closer. In addition, I have the opportunity to see my picture on the screen to see how I respond to their comments; this give me a birds eye view of how I come across that I haven’t seen since my intern days!  I found my clients with alcohol abuse are struggling with their challenges to remain sober, so I am calling and checking on them more often. The couple I see do not want to use Telehealth so I am not seeing them now, but will resume therapy when I am back in the office.  During the first weeks of COVID-19 most of my clients were experiencing a lot anxiety; a lot of my counseling included encouraging relaxation skills, and less watching of news.  As time goes on, there appears to be a little less anxiety but more need for activities and ideas to keep them busy, as well as alternative ways to keep in touch with others. (Zoom, happy hour on the driveways with neighbors are some examples). Clients have rediscovered old hobbies (paint or read, for example) and getting closer to their families as they are home more.  One of my clients speaks about “ re-bonding” with their animals, and another has started fostering animals. I also work at Sharp Healthcare, an outpatient setting, where I am going in and calling my patients and using a conference call which they LOVE.  They share how important it is to hear everyone’s VOICES and how that connects and comforts them. 

So far I spoke about my clients - however for me, I have enjoyed a break from the routine and have enjoyed doing therapy from the comfort of my home wearing sweats on the bottom-half and out of site.  I am more grateful for the things I have taken for granted in my life such as the pure freedom of movement, my family time, touching people spontaneously, and those people who are sacrificing for the greater good.  I also am happy for the environment which may have time to heal from our human interaction with it.  

POETRY

Plea And Prayer to The Body
by Shauna Smith, MSW, LMFT

Dear complex, unknown and unknowable Body,

Please, I implore you, do what you're supposed to do,

Function as you were meant to on a good day,  

Yes, on the best of days.

Help us to live in health and in peace.


Dear delicate, fragile, ultimately terminal body

Wracked with trillions of microscopic bacteria, 

Viruses and countless other bugs

All unknowable and unknown,


Don't even consider going your own way

Diverging from your job of 

Protecting us from diseases,  

And keeping us alive.

 

Don't you dare - in a reckless moment -

Hang around with the wrong kind of friends,

Toxic invaders who will charm you for a moment 

And then steal our well-being and destroy us.

 

Don't be tricked, faked out, 

By false flags that seem like enemies

And over-react like an anxious child,

Messing up our metabolism, respiration, heartbeat, 

All because you didn't discern 

Imaginary threats from real ones.

 

Please, I beg you, take care of us!

Stay vigilant, but not hyper-vigilant.

Take care of us as you have done

When you were on your best behavior,

When you were at your peak,

When you were in your wisest time of our lives.

Hold those moments in your every cell;

 

And give us time to love longer,

Deeper, unselfishly, fully, 

Give us time to help repair 

Our tottering, broken world. 

Time to be present 

In balance and ease 

 

Knowing full well that all 

Of life's moments are

Complex, unknowable and unknown.

                    Namaste, Namaste. 

                        Amen 

Shauna L. Smith, MSW, LMFT is a therapist in Sacramento. She is the author of the recently published memoir, Missing Father: A Daughter's Search for Love, Self-Acceptance, and a Parent Lost in the World of Mental Illness. To order: http://www.missingfather.squarespace.com "Missing Father...is beautifully rendered and filled with tenderness and compassion and clarity.... It reads like a dream." -- Laura Davis, co-author of The Courage to Heal.

Pandemic
by Lynn Ungar, 3/11/20 

What if you thought of it
as the Jews consider the Sabbath—
the most sacred of times? 

Cease from travel.
Cease from buying and selling.
Give up, just for now,
on trying to make the world
different than it is.
Sing. Pray. Touch only those
to whom you commit your life.
Center down. 

And when your body has become still,
reach out with your heart.
Know that we are connected
in ways that are terrifying and beautiful.
(You could hardly deny it now.)
Know that our lives
are in one another’s hands.
(Surely, that has come clear.)
Do not reach out your hands.
Reach out your heart.
Reach out your words.
Reach out all the tendrils
of compassion that move, invisibly,
where we cannot touch. 

Promise this world your love--
for better or for worse,
in sickness and in health,
so long as we all shall live.

(This poem was submitted by Paul Lesnik, LCSW – it has been shared widely on the Internet.)

Keeping Quiet
by Pablo Neruda

Now we will count to twelve
and we will all keep still
for once on the face of the earth,
let's not speak in any language;
let's stop for a second,
and not move our arms so much.

It would be an exotic moment
without rush, without engines;
we would all be together
in a sudden strangeness.

Fishermen in the cold sea
would not harm whales
and the man gathering salt
would not look at his hurt hands.

Those who prepare green wars,
wars with gas, wars with fire,
victories with no survivors,
would put on clean clothes
and walk about with their brothers
in the shade, doing nothing.

What I want should not be confused
with total inactivity.

Life is what it is about...

If we were not so single-minded
about keeping our lives moving,
and for once could do nothing,
perhaps a huge silence
might interrupt this sadness
of never understanding ourselves
and of threatening ourselves with
death.

Now I'll count up to twelve
and you keep quiet and I will go.

This poem was published posthumously in Extravagaria in the 1970’s; it was written in the 1950’s.  Submitted by Andrew Susskind, LCSW

Insomnia
By J, Seventeen years old

11:11, make a wish.

I wish I could fall asleep.

11:47, why can’t you sleep?

my alarm clock glares at me with neon numbers.

I don’t know!

11:58 - strain your eyes and watch it shift to midnight.

12:01 - stare at the ceiling with neon numbers in your retinas.

12:17 you’ll be tired tomorrow.

I know. 

12:24 - try counting sheep?

Maybe that will help you sleep.

my alarm clock decides to rhyme,

as many things do at this time. 

1:11

not wish time, but I wish anyway.

maybe it is the news that keeps me up this late. 

with red-ribbon headlines and numbers too big to understand.

1:26

maybe I am sick, I wonder.

is that a lump in my throat?

a tightening chest?

1:43 

no, I tell myself. 

I’m an insomniac, 

maybe a hypochondriac.

but I can’t be sick,

can I?

2:04

“death count rising,”

“more than half a million confirmed cases.”

I shut my eyes, but I can still see the news.

maybe if I pretend to be asleep they will go away.


A Compilation of Tele-Mental-Health Activities to Use with Children

Working with youth comes with extra challenges as we use telehealth, requiring us to find new ways to capture and maintain attention, entertain, and provide therapeutic activities.  Here is a potpourri of activities and resources that may spark ideas and that you may want to adapt to the particular needs of your clients. Thank you to a number of child therapists, many who work with MediCal clients, who have contributed to this list. 

Activities:  

  1. Simon Says             
  2. Mirroring – Take turns copying each other’s motions or facial expressions
  3. Feelings charades  
  4. 20 questions 
  5. Read stories, sing songs 
  6. Invite client to participate in session with the theme of spirit day, funny hat day, funny hair day, etc
  7. Co-writing poems, stories - take turns with each line.
  8. When kids have games at home that you have in your office, you can set up simultaneous boards to play with each other (examples: Sorry, CandyLand, BattleShip)
  9. If using Zoom or Teams format, share worksheets using screen share
  10. Have client teach you a new game
  11. You and client go to the same Youtube video
  12. Describe and Draw. Example: “I have a picture in front of me. I will describe how to draw it.”  Client draws and then therapist and client compare. This can also be done with legos. 
  13. Capture children’s artwork using a screenshot - Encourage clients to draw their day, draw the changes and fears they are experiencing, write a poem about their feelings, color a mandala, tell a story about a superhero.
  14. Home Scavenger Hunt - This can be done during the session or as homework. You and your client may want to make up your own list – here are some ideas: Something that brings you comfort. Something that you are proud of. Something that expresses your personality. Something that brings back a happy memory. Something you can use when you are stressed out. Something that is your favorite color. Something that reminds you of someone you miss right now. Something that helps you feel safe. Something that you could do for fun. Something that is tiny.

Online resources that may be useful: 

    • PESI.com has a free video available on Play Therapy via telehealth :

https://catalog.pesi.com/sq/bh_001261evg_childtrauma_telehealthfree_email_sq-121393?utm_medium=email&utm_source=sp&utm_campaign=041820_bh_c_rt_CATP_ChildTrauma_Sales3-PLC-SQ_1pm_throttled&spMailingID=32136024&spUserID=Mjg2ODkwNjI5MDA2S0&spJobID=1683747515&spReportId=MTY4Mzc0NzUxNQS2

Two workbooks for kids specifically about Coronavirus: 

    • Thriving at Home – A Mental Wellness Workbook for Children and Their Parents During Quarantine 

“This workbook was compiled by a small group of play therapists in Albuquerque. These activities are intended to be a supplement to weekly tele-play sessions with a licensed mental health therapist via HIPAA compliant Telehealth software, and was created with the intention to be a tool to facilitate emotional regulation, open discussion, and healthy relationships in the home. The activities, worksheets and strategies are a compilation of play therapy techniques from around the world.”

    • Tolerance for Uncertainty: A Covid-19 Workbook. A guide to accept your feelings, tolerate distress and thrive.  

This workbook was created by Sachiko Nagasawa, H.B.Sc,, M.A., Ph.D., C.Psych to assist in “managing the strong emotions that will arise during this difficult time through a form of psychological treatment called Dialectical Behavior Therapy (DBT).”               

REAL TALK: Diversity, Equity and Transformation (DET)

Being Asian during the COVID-19 Pandemic

By Amanda Lee, LCSW

In this inaugural article for “Real Talk,” a column examining issues related to Diversity, Equity and Transformation (DET) in clinical social work practice, I would like to share my reflections on being Asian during the COVID-19 pandemic. May is Asian American and Pacific Islander (AAPI) Heritage Month, which was established in 1978 by a joint congressional resolution as Asian/Pacific American Heritage Week and was based on two important milestones in Asian/Pacific American history: the arrival in the United States of the first Japanese immigrants in May 1843 and contributions of Chinese workers to the building of the transcontinental railroad, completed in May 1869. In 1992, Congress expanded the observance to a month long celebration. 

Amid the pandemic, however, it is extremely difficult to feel celebratory when a key aspect of my identity is correlated, whether legitimately or not, to the cause of so much pain and disruption around the world. Over the past two months, I have cringed at every reference to COVID-19 as the “Chinese virus.” I felt a sense of dread as the media touted conspiracy theories of bioterrorism and portrayed the current threat as reminiscent of World War II and the attack on Pearl Harbor by the Japanese. I began to wonder, in horror, if my family and I, and others that look like us, would be carted off to internment camps as a result of mass hysteria. Would history repeat its ugly self?  

I know that I am not alone in my experience of increased stress and anxiety, as AAPI friends and colleagues share their encounters with micro- and macro-aggressions rooted in fear and ignorance around COVID-19. In fact, since its official launch on March 19, 2020, the STOP AAPI HATE reporting center has received almost 1,500 reports of coronavirus discrimination from Asian Americans across the country. I happen to have made 1 out of the 1,500 submissions on the website after I was verbally harassed in March by a white male stranger on public transportation for wearing a mask. 

It is true that the majority of the population faces significant struggles during these unprecedented times, owed to a menacing public health threat, skyrocketing rates of unemployment, food and housing insecurity as well as an overwhelming sense of grief and loss for so many aspects of what we knew as our “normal.” It is equally true, however, that certain groups, namely those within society who are particularly at risk and vulnerable, such as minorities, are impacted disproportionately by this pandemic whether it be in terms of health outcomes, financial status or scapegoating and discrimination. 

There are nuances to being AAPI during these times that deserve further consideration. As a clinical social work practitioner who has provided behavioral health services in direct practice and as an administrator to AAPI immigrants and refugees for the bulk of my professional career, I am gravely concerned about the short and long-term implications for AAPI communities. Many AAPI individuals carry the scars of historical and collective traumas that are being retriggered. Some AAPI individuals, without the added burden of the current crisis, face significant barriers to accessing relevant resources, such as physical and mental health care and health insurance, unemployment benefits, etc., owed to language, lack of familiarity with a complex system, stigma and discrimination. For example, stemming from misinformation about COVID-19, AAPI business owners, e.g. family owned restaurants in the San Gabriel Valley, suffered significant losses in revenue and patronage early on and are now struggling to access federal emergency funding. It is not so much whether there will be significant impacts to AAPI communities at every level of practice, micro, mezzo and macro, but rather to what extent and how. 

This may not appear to be, or feel like, a time for celebration; but when I reflect on the original purpose of celebrating heritage, that of being born out of the resilience of groups of marginalized people overcoming substantial challenges to obtain equity, it cannot help but spark encouragement and pride. Let two core social work values, Social Justice and Dignity and Worth of the Person, from the NASW Code of Ethics, be the focus for the profession at this time as we navigate the difficulties ahead. Please consider tuning into upcoming virtual events during Asian American and Pacific Islander Heritage Month such as a roundtable on Communities Respond to COVID-19: Implications for Asian Pacific Islanders on May 21, 2020, as a way to increase your awareness.  

Amanda Lee, MSW, LCSW, is the Director of Field Education and a lecturer at San Diego State University's School of Social Work. Amanda has practiced social work in a variety of settings over the years, such as, adult outpatient and inpatient mental health, home-based intensive treatment and PACE (Program of All-Inclusive Care for the Elderly), and has also practiced social work abroad in New Zealand. She has extensive experience working with cultural minorities, such as Asian and Pacific Islander (API) immigrants and refugees, and continues in her role as the Per Diem Adult/Older Adult Mental Health Director at the Union of Pan Asian Communities (UPAC) in San Diego. Amanda also currently serves on the Board of Directors in the role of Secretary for the California Society for Clinical Social Work (CSCSW). 

CARTOONS


Coronavirus Must Die - Song Parody

Sung to the tune of American Pie Chorus
By Jean Rosenfeld, LCSW

Die Die Coronavirus must die.

There ain’t no toilet paper or Purell left to buy.

I’ve washed my hands ‘til they’re red, cracked and dry,

Singin’ where’s the test to identify?

Where’s the test to identify?

Die Die Coronavirus must die.

I’m locked in house arrest and there is no alibi.

Social Distancing has kissed my friends all goodbye,

Singin’ there are rules I’d like to defy.

Will I be here on 4th of July?




Lessons from Fig Trees and Pandemics

by Paul Lesnik, LCSW, TEP

Early in March we had what used to be a rare rain shower in San Diego.  Overnight, the almost imperceptible knots along the branches of the fig tree outside our window untightened into the beginning thought of leaves.  A thunderstorm a few days later coaxed them out even further, and the wide expanse of its limbs began to look like the stick figure and green crayon trees I drew as a small child - more the hope of a tree than a tree. The rumblings of a Corona Virus began shaping our shared reality along with a pulsing energy that seemed to ignite those leaves and then the fruit of that fig tree, in the seasonal progression of dormancy, activation, proliferation and finally back to stillness once again.  The Virus moved in its own sequence over the next few weeks, as it attempted to devour whole countries in an insatiable march of its own.  Along the way it got a name, COVID-19, and its biological need to survive and to grow reached into the very depths of who we are, challenging us to reexamine all we hold dear, all that has meaning. I am reminded of another fig tree and another virus, both of which have become in their own way etched in my DNA.  That other tree was in the driveway of the home I shared with my partner, Jerry in Houston in 1988, and that other virus was AIDS.  I too watched the seasonal cycle of that tree, taking for granted the preciousness and wonder of the world, just as I learned to abhor the uncertainty and fear that AIDS heralded in its wake.  In that 1988 world, it was not unlike now, as I hear the pronouncements of deaths of friends-of-friends and then the casualties circling and coming closer and then home: the dead now having names, the dead now taking something of who we are in knowing them as they die.  Spaces opened in our lives that used to be filled, the holes in our hearts futile to attempt to fill, their frequency too great.  The cumulative loss of that pandemic is still with us and we need to look at what we learned from it.  As we live now with the uncertainty of this new intruder, we must decide who we will become in its aftermath.  We will be charged to resolve the fear and loss that is all so real for each of us.  We will come back to stillness again.  Ultimately, it is a choice in how this crisis will nestle into who we are, individually and as a global community. Last year I was in Houston and that fig tree was still there all these years later; it made it through the AIDS crisis as I did, but Jerry did not.  Diagnosed with AIDS in 1988, Jerry died at home – a view of that fig tree out the bedroom window – in April of 1989.  He had just turned 31.  April 5, 2020 would have been his 62nd birthday.  He has now been off the earth for the same number of years he walked it.  The essence of who I was in 1989 was altered in knowing Jerry and negotiating life after his death, and he, like so many of the fatalities of AIDS, shaped the person I am today.  Outside the fig leaves have unfolded into the size of open hands, shading the fruit that will become a June harvest.  The scene feels both rich with bounty and terrifying as I contemplate the other yield that will come as COVID-19 moves through its angry progression.  As we take our unknown place as victim or survivor of its impact, I wonder what choice most of us will make in how we treasure or squander this time together, but apart.   Will we choose ways to find real connection to others as we internalize the inconsistencies that make up our new world?  Or, will life merely become more certain in its uncertainty, the threat of loss too great to risk connection? Certainty is a fickle virtue, promising one truth and then another. We cannot disarm the tragedy of loss by staying off the risk of encountering love.  Just as the fig tree will once again each year, burst in its promise of life, so will we wake up to each day, each person, each tragedy with the choice to choose life, the choice to choose love. 

Spontaneity and Creativity

by Paul Lesnik, LCSW, TEP

It isn’t easy converting a counseling and training practice highly dependent on group interaction and arts-based interventions to a screen sized version of a world once so rich in resources. But it would be hypocritical as a social worker and expressive arts trainer not to:

  1. get over my view of Telehealth as an inadequate form of communication;
  2. mourn the loss of one-on-one connection and all the other grieving that was fostering in its wake and finally;
  3. look for creative responses to connect to clients and training colleagues, not to mention friends and family, I so desperately missed.

JL Moreno, the creator of Psychodrama, defines Spontaneity as an adequate response to a new situation or a novel response to an old situation.  It is the spark that ignites creativity.  Creativity is the ability to make something or otherwise bring into existence something new.  Every one of us is inherently creative.  For some of us, this may be the way we combine the various disciplines and methods we are trained in to form – through the alchemy that is creation – a practice that is rich in your own brand of individuality.  We often miss our own creative process or deny or question our ability to be creative.   It may take a bit of mining the day-to-day to discover or remind us that the meal we prepared, the garden we tilled or the photo we so thoughtfully snapped on an afternoon walk are all acts of creation.  My belief is that any gesture in which we connect – to ourselves or others – is a creative act. So back to my quest to harness my creativity in at minimum an adequate response to this new situation we were all facing: COVID-19 and Shelter in Place.   Days 1 through 5 were ones of resentment, denial and a bit of feeling sorry for myself.  I had just started my first Psychodrama client group, and I suspended it after only the opening session.  It had taken me three years of marketing and an agonizingly slow build-up of a private practice, and I felt cheated by the universe.  Although many of my colleagues were taking the leap from in-person to cyber groups, without exception their group members had been meeting regularly, were psychodrama savvy and had coalesced as therapeutic agents of one another. Other trainers were almost immediately offering Zoom classes and Zoom groups and embracing rather than resisting technology.  On day 6, after taking whatever webinar I could find on telehealth and checking in with whomever would listen about the injustice I was experiencing, I had my first Zoom individual session.  It was successful, but still lacked the feeling of connection I was so used to.  I had sent out an email to all my clients stating my availability by phone or telehealth platforms, but felt I needed to reach out in more interesting ways to manage both their and my feelings of uncertainty with where the world was going. On day 7 I woke up after a dream of exotic locals and a spark of spontaneity was the catalyst for me to gather together the unused postcards I had accumulated over years of travel.  I developed a message for clients and a separate one for friends and family and started   sending out the cards (in envelopes for confidentiality to clients) and when I ran out of unused cards, I went to the basket of postcards received from others over 40 years and pasted over the original message and sent those out.  Within a week or so, I started getting postcards and invitations to events postponed by COVID’s arrival and homemade cards back from others – an unexpected bonus. Zoom sessions continued, now enhanced by the snail mail connection we shared.  I started working with my sister, a website developer, on re-creating my site to more reflect who I am and what I do.  I found myself on Facebook for the first time, writing poetry and essays on COVID-19 and its resurgence of feelings from the AIDS pandemic of so many years ago.  I created Sandtray vignettes about COVID’s intrusion in our lives and posted them on social media and emailed them to clients and colleagues, captioning them with encouraging messages. After the success of my first snail mail campaign (and I must confess I love getting cards and letters in the mail – nothing like it) I came up with campaign number two: The Invisible String that Connects Us.  I sent out over two hundred of these messages to psychodrama, social work and mental health colleagues, friends, family members and clients.  In the interim, I started receiving colleagues and friend’s creative ways of coping with COVID shutdown.  My friend and fellow therapist Gail Gerbie sent me a letter with lovingly created affirmation cards and writing prompts she had sent out to her clients and colleagues.  All over social media people were posting their artistic efforts exploring living in shelter and uncertainty.  Amidst the drawings, collages and paintings there were also bread-making, Zoom Seders and Easter dinners and sidewalk chalk universes.  There were essays and poetry coupling COVID-19 to unexpressed grief and unresolved pain, all such beautiful acknowledgement that we were not alone in trying to sort out some meaning and to hold onto connection to one another.  On-line support venues from the social work and expressive arts communities started to blossom as well. Moreno also stated, “All creators are alone until their love of creating forms a world around them.”  Now, on day 30, I have a new view of telehealth.  I will take creativity and connection however I can get it.  Some say COVID-19 will alter the way we do business in the mental health field forever.  Some clients will prefer the distance provided by their computer screen, and others just manage to feel connected no matter what the medium.  Although I will always be in the latter category, I take solace in the world that has opened up to me through technology and I look forward to finding creative, connecting ways to make it more a part of who I am.  But I’m not surrendering my art supplies anytime soon.

Paul Lesnik, LCSW, TEP, is a Clinical Social Worker and Psychodrama and Expressive Arts Trainer based in San Diego.  He works in many Expressive Arts modalities, including Psychodrama, Sandplay and Soul Collage® with clients. He conducts training groups for clinicians and mental health professionals in infusing the arts into their practice.  He is the only Board Certified Psychodrama Trainer in San Diego County.

He has presented nationally on many topics, most recently on Exploring Gender Identity as an Aspect of Spirituality, Scene Setting in Psychodrama, and Exploring Identity Development through the Arts.  He can be reached at paul.lesnik@gmail.com  619-780-7670  digdeepertherapy.com

Some Ideas to Help People Who Are Struggling to Meet Their Basic Needs

by Laura Groshong, LICSW

I hope you are all making the adjustments that most LCSWs have made to preserve the safety and health of ourselves and our patients.

In addition, there are many people struggling to meet basic needs and solve the ways to prevent COVID-19.  Here are a few that could use your help in doing their good work:

Helping others is a big part of our clinical social work values.  I hope everyone can find a way to chip in for those who are in need.

Laura Groshong, LICSW, Director, Policy and Practice 

Clinical Social Work Association
The National Voice of Clinical Social Work
Strengthening IDENTITY | Preserving INTEGRITY | Advocating PARITY
www.clinicalsocialworkassociation.org

About the Clinical Update

The Clinical Update is published for the members of the California Society for Clinical Social Work. The articles contained in this publication do not necessarily represent the views of the governing board of the California Society for Clinical Social Work or its members. For reprint permission, please contact info@clinicalsocialworksociety.org

Editor: Jean Rosenfeld, LCSW

The next issue of the Clinical Update will be published in Summer 2020. We look forward to publishing relevant, educational, and compelling content from clinicians on topics important to our members. We welcome your contributions. Please email jeanrosenfeld@gmail.com if you are interested in publishing your writing -- please write "Newsletter" in the subject line. 

Ad placement?  Contact Donna Dietz, CSCSW Administrator - info@clinicalsocialworksociety.org



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