Becoming the Champion for Supported Autonomy

Autonomy is often used to mean independence. Though their dictionary definitions are similar and they are synonyms of each other, I like to talk about autonomy in a slightly different way.

For me, autonomy is having the choice over when I am independent and when I am dependent. It’s similar to the notion of interdependence, except the latter, interdependence, suggests an ongoing process of co-operation or collaboration. Perhaps autonomy could include the choice of interdependence as well, but for now, I want to focus on the aspect of choice.

Many disability services have, at their core, a desired outcome of independence. Functioning on one’s own, without the help of others, is considered success. Dependence on others, by comparison, is seen as undesirable, costly and, hence, unsuccessful in the wonderful world of disability service provision. In the even more amazing worlds of case management and needs assessment, however, dependence could be synonymous with abject failure — or worse: disaster!

This obsession to make disabled people independent has always seemed absurd to me. No one is completely independent, after all — we depend on builders for houses; lawyers and police for protection (sometimes one from the other); artists to adorn our walls — and so the list goes on. And while cleaning the house is a relatively simple chore, many choose — and still others actually need — to pay others to do it for them.

So if someone, on account of their unique function, can’t — or at least find it difficult to — get dressed in the morning, why is so much emphasis placed on finding ways for them to do it themselves, independently, no matter the time or effort spent?

When I began to live “independently” at around 20 years of age, I did so with no support, apart from a flatmate who was as — or more — often out than at home. I’d start my day spending an hour abluting and getting dressed, including donning the most horrendously style-destroying footwear — gray sneakers with velcro straps — because I couldn’t tie laces. Then I’d have breakfast, only to have to begin the tortuous task of washing dishes, usually from the day — or more — before.

By about 11 am I’d stop for a cigarette, all the while relishing the anticipation of cleaning the house — be it vacuuming, dusting, cleaning the floors or, god forbid, the frigging toilet. By the time 1 or 2 pm came around, I was physically knackered, often in pain and more or less good for nothing for the rest of the day.

But, I was being independent.

I can’t remember how long it was that it took me to unbrainwash myself — longer than it should have, given I tend towards masochism as one of my learning edges. But I finally managed to process the cognitive dissonance slowly creeping into my consciousness: if “independence” meant doing nothing more than menial chores in unfashionable shoes, well, I didn’t want to be independent.

So, I threw myself into the wonderful world of needs assessment and disability support services (WWNADSS), learning very quickly the two cardinal rules of getting one’s needs met: 1. never say you can do something but it’s difficult, and 2. never say you can do something but it’s difficult.

Because something being difficult meant there could be an assistive device, designed to make things easier (ergo increasing independence). It could actually be badly designed such as the unfashionable velcroed shoes or more than likely useless and more time-consuming.

Thus, I learned the valuable lesson of black and white ability — not the competence to change ethnicity but rather that, in the WWNADSS, there were only two answers: 1. I can; and 2. I can’t. Later, I learned a third answer, the dismal future speculation: if I keep doing this one thing now, it’s highly likely to fuck me up so badly that, in 5-10 years’ time, I’ll be unable to do 3 things. Ergo more, perhaps unnecessary dependence will now equate to less independence henceforth. Net result, more independence. Success! A great rule that folks, learn it.

I exaggerate in jest — this was the 1980s and things are slightly less black and white these days (though its legacy lingers). I write this off the back of a lecture I did with case management students at AUT University yesterday. My point was that they reframe their role, from being the champion of independence, to being a facilitator of supported autonomy. In other words, guiding people to choose where and when in their lives they want to be independent and where and when they want to be dependent. It may seem an obvious change in understanding, but the old independence imperative is still surprisingly prominent in the WWNADSS as well as case management.

Who knows, had I not realised the impact of its potentially paralysing grip on my life, independence could have stopped me writing this post as I look back on a successful 22 years’ professional career. I could still be washing the dishes.

Tending the Caregivers

Mothers who work as healthcare professionals – physicians, physician assistants and nurse practitioners – can significantly reduce their stress levels and burnout by participating in close supportive groups at work, according to a new study by researchers at Arizona State University and the Mayo Clinic. The shared experiences in these support groups provide a wealth of nurturance for the women.

The study, “Fostering resilience among mothers under stress: ‘Authentic Connections Groups’ for medical professionals,” is published in the current issue of Women’s Health Issues.

Groups in the intervention provided “comfort, solace and advice as needed, building what some called a ‘secret sisterhood’ of shared experiences with genuineness and reciprocity in the relationship,” said Suniya Luthar, a Foundation professor of psychology at ASU and the lead author of the study. “These factors help build resilience for professional mothers who are under great daily stress, with substantial dual demands at work and at home.”

Senior co-author and collaborator on the project was Dr. Cynthia Stonnington, associate professor and chair of psychiatry at the Mayo Clinic College of Medicine, Arizona. Other authors of the paper are Alexandria Curlee, an ASU graduate student; Susannah Tye, Department of Psychiatry and Psychology at the Mayo Clinic, Minnesota; and Judith Engelman, a psychiatrist in private practice.

“Women medical professionals who are mothers often face the dual role of being the primary caregiver both for their patients and their children,” said Stonnington. “This puts them at higher risk for burnout than their male counterparts. Our study investigated how this supportive program might help mitigate stresses and promote their day-to-day health and well-being.”

The Authentic Connections Groups (ACG) intervention involved weekly sessions at work over a three-month period. The researchers randomly assigned 40 women at Mayo to one of two groups: either the 12 weekly one-hour sessions of the ACG’s or 12 weekly hours of protected time to be used as desired. The study was supported by a Seed fund from Arizona State University to Luthar, and the Mayo Clinic contributed release time to participate.

The study had several positive results.

It showed that those who participated in the ACGs had significantly greater reductions in depression and other global symptoms of stress than those given free time (the control group). Secondly, relative gains were still more pronounced three months after the program ended. Follow-up assessments showed significant between-group differences not only on depression and stress, but also on almost all other central variables, including parenting stress, self-compassion, feeling loved and physical affection. Participants in the ACGs also showed more reductions than control moms in cortisol levels (a biochemical indicator of stress) at both post intervention and three months follow up.

In explaining why this program worked, Luthar said that, in essence, the ACGs actively and continually fostered the development of close, mutually supportive relationships, and the resulting shared experiences and bonding helped to lower participants’ stress levels.

“Resilience research clearly shows the critical protective power of reliable close relationships,” Luthar said. “In this program, our focus was on developing and strengthening what we called ‘go-to’ committees for each woman. As topics were shared in the weekly group sessions over time, the moms each also shared them with their respective go-to’s. By the end of three months, each woman had developed great closeness not only with other moms in their work setting but also with at least two or three other women in their personal lives.”

A critical factor in enabling this effort was the institutional commitment to wellness. Stonnington reported that the ACG program was implemented as part of an initiative begun in 2015 at the Mayo Clinic in Arizona to address burnout and turnover among female physicians.

“Another major reason for the success of this program is that the groups were implemented in the women’s everyday settings, during their regular work-days,” said Luthar. “That the Mayo administration gave them the one hour per week free time to participate was a critical consideration, given how very packed these women’s schedules can be.”

The U.S. Surgeon General recently stated that efforts to promote the well being of medical professionals must become a major priority among health care organizations. This study demonstrates that facilitated colleague support groups can provide a viable, low-cost preventive way to mitigate burnout among women medical professionals who are also mothers.

More broadly, the authors note that the ACG program has the potential to be widely used in workplace wellness programs, given the high cost of worker stress and depression in contemporary America. Since completion of the Mayo project, Luthar and colleagues have successfully completed groups with military mothers, and are now offering it to women in the STEM (science, technology, engineering, and mathematics) disciplines, with both new projects implemented at ASU.

“It is our hope that over time, the ACG program will come to benefit women, mothers, and other adults in salient caregiving roles, as they routinely give so much of themselves to others while experiencing high everyday stress,” Luthar said. “It just makes common sense. Those who serve as first-responders, and who offer so much tending for many others, must themselves be tended – with this happening on a reliable and ongoing basis.”

A Students’ Guide to Making the Most of Field Placement

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Being a social work student on my final placement before I graduate, I know how daunting and challenging they can be. From my own student perspective, I have put together some tips that I hope will help you make the most of your placement.

All social work degrees in the UK require students to undertake compulsory placements. In Northern Ireland, where I am based, students must complete two placements of 85 days and 100 days in practice, respectively.

Once you have received your placement, the nerves may start to creep up on you but try not to let them affect your enthusiasm!

First things first, do your research. Read up on the area/specialism that you will be working in as this will provide you with knowledge about what to expect and what the role might entail. Although, social work has no set role and changes depending on what area you are in, so it is important to bear this in mind. Our expectations of how we view the social work role can negatively impact how we perceive our placement so it is best to stay positive and keep an open mind!

In Northern Ireland, we are required to arrange a pre-placement visit. This is just a meeting with your practice teacher to talk through the logistics. If your university does not require this I advise thinking about organising one anyway. They allow you to meet your practice teacher, the team and to get a real understanding of the environment you will be working in. This can be a good way to minimise anxiety!

Every placement is different. As students, we sometimes have an idea of the area we want to work in when we graduate. This is good but don’t let it put you off other placements! You may find that your mind changes with your experiences!images (1)

Be organised! Keep and maintain a diary that sets out your working hours. Do you have assignments? Make sure you know when they are due. You need to time-manage effectively. Some placements will allow you to complete assignments during your working hours, however that depends on the service users. They are your priority!

Make full use of supervision! Supervision is vital regardless of whether you are a student or professional, so don’t waste the opportunity it provides. This may be your only time with your practice teacher. Prepare what you want to talk about and set an agenda. They will be impressed if they know you are motivated, proactive and thinking about practice.

Not everyone hits the ground running, and it’s okay to have doubts about your placement and/or your own abilities. I doubted myself during my first placement, but don’t let one placement dictate your view of social work. Some placements can be challenging, but there are things you can do to make it that little bit better!

Find a staff member that you can work alongside. For my first placement, I wasn’t placed in a statutory setting, so I did not work with other social workers. This can be daunting, but you are not alone. There are many other members of staff more than willing to help you! Find one who you can communicate with and who you think could give you good ideas. Staff members know the service users, so don’t be afraid to ask questions as they may have knowledge you can utilise that you won’t find in a textbook.

Know yourself. Sometimes, as students, we get so overwhelmed by what all our friends are doing that we worry whether we aren’t getting a good experience. When you have spent many semesters reading pages upon pages, once you get out into the real world of practice, we sometimes have expectations set too high. We have thought about what we want and what we hope to do, but placements can’t change to our way of thinking. We need to adapt to theirs. Changing your mindset about how you view your placement can help you understand exactly what you need to achieve and how.

In the UK, there are evidence criteria that have to be met during placement. Usually these are listed in a huge table in a 288 page document. Break it down. Go through each standard, either on your own or with a team member, and jot down ideas as to how to meet it.

Placements aren’t meant to be easy. Social work in general isn’t easy, but don’t overcomplicate it. You can only work with what you are given. Adapt work to suit your placement and your learning needs. Think of things in the context of your own placement, this makes it easier to understand exactly what you need to do.

If you need to, talk to someone. Never keep an issue to yourself. Social work requires us to be available, physically, mentally and emotionally. We cannot work with people effectively if we are worn out or stressed. Talk to your practice teacher, or a university tutor as chances are the issue will have arisen before with other students and they will know exactly how to help!

Honesty is the best policy! As students we sometimes have the dilemma of, if we see something in practice that we don’t agree with, should we challenge it? Weigh up the risks. You are going somewhere on placement that some people may have worked at for years. An ethos can be drilled into an organisation and change is not a quick thing. However, don’t be afraid to ask why things are done a certain way and if you don’t feel comfortable doing this publicly, mention it in supervision. Supervision is a ‘safe place’ and a place for you to critically reflect on your practice.

Self care is important because placements can be tough and draining. Look after yourself! Do things that help you relax, maybe yoga, reading or exercise. Listening to music really helps me zone out but I would also recommend adult colouring books! These are great for alleviating anxiety and just channeling your energy for a while and there are also free apps too if you want to try it out!

Lastly, have fun! You are on your way to becoming a qualified social worker. This may be one of the last times you can do social work without the heavy case loads and the safety net of university! Be open to it, seek out your own work and view everything as an opportunity.

The Spiritual Social Worker: May Your Spirits Guide You

You probably became a social worker because of something personal that happened in your life. I remember starting my social work education and meeting my fellow students. At the introduction, they told their stories about having a difficult childhood, having a disabled brother, parents with addiction and so on.

IMG_4109We dreamed of being a social worker to help others who are facing the same problems. We were super motivated, young and willing to change the world. But, then our teachers told us that we only can help heal others if we first heal ourselves. They invited us to tell our stories, to share our personal pain, and as we now know healing starts with sharing.

My own story is about a difficult relation with my parents as I was not the daughter they would like me to be. I was rebellious and my parents got desperate. At one point, my father told me he wished I had never been born. In that moment, there was only one way to survive which helped me to develop a very strong belief in myself. It felt as if I was on my own and I had to give myself a happy childhood. And I did!

Becoming a social worker was another step in my healing. I learned to receive friendship and love, and I learned how to be vulnerable while at the same time still feeling this strong belief in myself. I was able to feel a deep compassion and build strong relationships with my clients who trusted me. This made me not only a good and qualified social worker but also a spiritual social worker.

Now I’ve started a new episode in my spiritual journey. I’m connecting our Social Souls to build a strong community of social workers who really want to make change happen. In this community, we still share our stories and support each other on our journey. It’s a safe haven where you can work on your dreams feeling connected and supported.

This is my story, and I’m sure you have your own story. You are walking your own spiritual path, and it may sometimes feel hard to follow in order to hold on to your dreams. When things get difficult, you’ll feel your own pain again. That’s okay. It’s a part of your path. It reminds you of the place you came from. It makes you human and humble. But, also remember how this made you strong, but you must be sure to keep walking. May your spirits guide you 

If this speaks to you, you’re very welcome to join my our community.

Getting Comfortable with Discomfort When Helping Clients

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One of the most important lessons I’ve learned as a social worker is that, in order to excel, you must absolutely get comfortable being present in situations that make your skin crawl. You will encounter people, places, things, and circumstances that will test the limits of your ability to maintain a modicum of objectivity, but how do you become comfortable with discomfort. From my experience, three things will help you learn how to do this:

  1. Time on the job. Repeated exposure over a long period of time will familiarize you with the unpleasant particulars you will face. I always say that, while nothing surprises me, some things do shock me.
  2. Having a strong sense of yourself and your values. This will help you notice whether your discomfort is more about you then your client’s presenting issues.
  3. An understanding that the process of learning this skill will never be over. You can refine this skill, but you will never perfect it.

For instance, my very first client at my first “big boy job” was a 15 year-old boy with significant anger issues to whom I would be making home visits. When I pulled up to his family’s trailer, he was sitting on the front steps smoking cigarettes with his family. By family I mean his mother, 12 year-old sister, and 10 year-old brother, all of whom were smoking. His home was infested with fleas from the seven dogs that crowded the living room in which only a few of the dogs were his. The others were strays that had simply wandered in and were being tolerated by the family.

He had lit fire to a neighbor’s car because he was unhappy with the relationship between the man and his mother. While my own values and the way I conducted  myself in my personal life were completely at odds with much of what I was experiencing, I quickly learned this kid was a person with very real and alarming concerns that deserved a shot at help as much as anyone. I had to put my judgment on the shelf and realize it wasn’t about the life to which I was accustomed. The fact that I included this story from so early in my career, about 13 years ago, shows how deeply it affected me, and how so many years later, I am still conflicted about the way I handled the situation.

I could fill a book with stories of clients/patients that led me to places that challenged my ability to stay present while feeling extremely uncomfortable. Some of these situations involved people I was tasked to help in which I found very little about them to like or admire. However, I have made it a lifelong goal to practice Carl Rogers’ idea of “Unconditional Positive Regard” which states we must treat people as human beings regardless of things they have done. It is not always easy and it would be dishonest of me to say that I always succeed, but it is a work in progress. Remember, the things that make you the most uncomfortable are also your greatest potential learning opportunities. Do not shy away from them.

Most importantly, it is crucial to have a support person whether it be your own therapist or a colleague with whom you can process such events. This will help you more clearly see what it is in you that causes your discomfort. Your continued effectiveness as a social worker depends upon your dedication to ongoing personal growth. If you do not have a support person, please seek out someone with whom you feel comfortable. It will make all the difference!

7 Ways To Avoid A Holiday Relapse

Avoiding Relapse During the Holidays
Avoiding Relapse During the Holidays

The holiday season is upon us and can be extra difficult when you are working to stay sober and not relapse. When it seems like everyone else is enjoying drinks and parties, how can you still have a good time with friends, family, and other loved ones while avoiding the use of drugs and alcohol?

Here are some tips to try:

1. Connect with Your Sober Network

The community you have built may not be who you are around on the actual holidays. Time spent with family members, who support you but do not fully understand what you’re going through can not help in tough moments.

Staying in touch with your sponsor and sober friends throughout the holidays will prevent you from reaching the point of possible relapse.

2. Volunteer

Extra help is always needed around the holidays at soup kitchens and gift-giving centers. Spend some of your holiday time helping those in need. You won’t think about relapsing when you are serving others.

3. Be Socially Selective

Just because you are invited to a party does mean you have to attend. Choose carefully. Which events make you feel comfortable and which ones worry you a bit? Say YES to the first ones and NO, thank you, to the others. Sobriety must be your top priority.

4. Bring Your New Drink of Choice

Is there a sparkling cider or grape juice you really enjoy? By having your go-to beverage on hand, and ready to pour into the extra glass at your place setting, you can avoid an awkward moment of a full glass of wine placed in front of you.

5. Exercise

Build in time for a walk, a jog, a yoga class, a trip to the gym, or any other way you get your body moving. The extra stress, and food, this time of year add additional reasons to return to substances. Give yourself some natural endorphins through activity as a way to proactively avoid a relapse.

6. Self-Care

This time of year can take us away from the routine that works the rest of the months. Eating more than we normally eat at one sitting, having more social engagements which takes time away from exercise and relaxation, and being around more people on a regular basis can make us feel off-track.

Without proper self-care around the holidays, things can feel out of control. At moments of difficulty, remember what you like to do. Self-care can be as simple as finding a quiet room and meditating for 10 minutes, going for a walk around the block, or listening to a calming song.

7. Create an Action Plan

Picture yourself at a family event or a holiday get together feeling uncomfortable. What do you do? How do you take care of yourself in that moment and do what is best for you? By developing a plan of action when you need to remove yourself from a difficult situation, you will avoid feeling pressured, annoyed, irritated, or in need of an escape that will lead to a relapse.

Stay in touch with how you feel at any given moment, and do your best to reduce feelings of hunger, anger, tiredness, or loneliness to avoid a relapse this holiday season.

Separating from an Abusive Partner

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If you are in a relationship and are seeking to separate or divorce from an abusive partner, your safety may be at risk and your ability to achieve a reasonable separation agreement may be compromised.

Abusive relationships are characterized by one party seeking power and control over the other party. Sometimes, the objective of power and control is the power and control itself. To some persons, this alone is gratifying. To other persons, the power and control is a means to obtain their needs and wants either ahead of or in lieu of their partner.

The strategies or tactics of the persons seeking power and control over the other include manipulation and mind games, coercion, threats and intimidation, and varying degrees of violence. The control can be exercised against the partner directly or indirectly through the children, by threatening to harm loved ones and evening threatening to hurt pets or by destroying your possessions. At times, the risk of harm may be self-directed as in the threat of suicide while at the same time holding you hostage through guilt.

Typically when exiting a relationship, the person lording power and control over the other will escalate their tactics out of fear of losing their grip on the one leaving. As such, where there may not have been a display of violence before, the first episode may erupt when seeking departure. Where violence has been a feature of the relationship, the severity or intensity or dangerousness may escalate at this point too.

Power and control tactics are designed to instill fear or guilt in the partner through which the abusive party gets their way. These tactics are powerful and can fully immobilize their victim. In some cases the victim’s concern for their mental and physical well-being is very real and as such, victims  learn to exercise extreme caution, so as not to set off their abusive partner. Hence, these persons learn to walk on eggshells, are very mindful of their own behaviour as well as their partner’s mood and act so as to avoid raising issues that may increase risk.

The first objective in a departure from an abusive situation is your safety and that of your children. To leave safely, it is necessary to plan first. The first step in planning is finding supports. A support is a service or persons you can trust and turn to for help with departure. Many communities have shelters or counselling services where you can go to discuss your situation and get help to develop a plan for leaving. If you cannot go in person, phone and talk with a worker. Be careful about emails if there is a concern that your abusive partner may access your email records and learn of your plan. If a community service is not available, consider contacting your clergy or physician. Your local police and even your local child protection agency may be able to direct you to appropriate services or may help you directly with your plan.

After you have departed and you are in a safe place, then you may consider achieving a settlement agreement. A settlement agreement spells out how your mutual assets will be divided and if there are children between you, how you and your partner will continue to care for the children and what financial supports may be forthcoming.

If you are seeking to achieve a settlement agreement with an abusive partner, it is more than likely that you will need specific support here too. You must act with concern for safety. Further, the risk when trying to achieve a settlement on your own is that you may give up too much out of fear or guilt or for the purpose of achieving peace at any cost. When one person gains more than the other in a settlement, these are known as lop-sided agreements. A lop-sides agreement may leave you with too few resources to manage for yourself or children. Further, a lop-sided agreement may provide un-safe access to children in view of an abusive partner.

Regardless of you method or achieving a settlement agreement, chose a service provider, whether a lawyer, mediator, arbitrator or social worker, with specific expertise in abuse issues to help you through the settlement process. Your service provider should ask about abuse issues and your safety. If your service provider doesn’t ask, this may be a sign that this person is not equipped to provide necessary support and you may be better off finding another service provider.

Leaving an abusive relationship requires appropriate supports, and your safety and that of children comes first.

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