Something's got a hold on me....

Something's got a hold on me

I can't let it go

Out of fear I won't be free

-J. Cole

I was very impressed with the recent album release from artist/rapper J. Cole. That something he is speaking of, that something holding him, that something he can’t let go of, is trauma.  Rarely discussed among African Americans is the topic of mental health and even less scarce is a conversation on the impact of Adverse Childhood Experiences (ACES). The ACES Study[1]  was published over 20 years ago, a landmark study, with findings indicating a connection between 10 childhood experiences and many of the leading causes of death in adults. These 10 adverse childhood experiences include physical, emotion, or sexual abuse, having a parent in jail, having parents who are separated or divorced, living with a parent or household member who has a mental health or substance use disorder, emotion, and physical neglect. The study found the higher your ACE score, the greater risk you have for developing or experiencing a number of diseases, disorders, and consequences such as alcoholism, unintended pregnancies, liver disease, heart health related diseased, poor academic performance, and pulmonary disease. Your ACE score is calculated by counting the number of adverse experiences occurring during childhood. Cole breaches the topic of adverse childhood experiences by sharing his own experience. If you listen closely to the lyrics in J. Cole’s “Once an Addict,” he shares:

Step-daddy just had a daughter with another woman

Cole discusses here, his biological parents were separated and then his step-father and mother separated due to infidelity. Cole goes on to illustrate:

Growin' up I used to always see her up

Late as shit, cigarette smoke and greatest hits from Marvin Gaye

She kill a whole bottle of some cheap chardonnay

In reflecting on his childhood, Cole has the realization that his mother struggled with alcoholism or  at the very least her drinking was problematic. He continues reflecting on his childhood experience:

Mama cursing me out

Depression's such a villainous state

Lastly, Cole shares knowing his mother was depressed and enduring the consequences of that depression, verbal abuse. By my count, J. Cole has an ACE score of at least four. Now I am by no means diagnosing Cole, a true diagnosis can only be done through a thorough assessment. However, by his own account, these childhood experiences impact him as he shares:

Too young to deal with pain

I'd rather run the streets than see her kill herself

If you’re reading this and attempting to rationalize out the realization you too may have experienced adverse childhood experiences, the prevalence of ACES is fairly high with 63.9% of study participants having experienced at least one ACE. The study was limited by its diversity in that only 4.5% of the study participants were African American. If having a parent in jail or prison counts as one ACE and coupled with what is known about the disproportionate number of African American males who are incarcerated, the impact of ACES among African Americans should be a hot topic. If a study such as this was conducted with larger samples of African Americans, what might we find? What has a hold of us? What can we not let go of? How will these experiences manifest themselves in our lives and overall health?

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[1]   Felitti, Vincent J et al. “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults.” American Journal of Preventive Medicine, Volume 14, Issue 4 , 245 - 258.

Learning from your clients--

How many of us has this happened to? You sign up for a continuing education course only to arrive a find that one of the presenters is currently your client. More than likely, very few of us have had this experience. Should you encounter this situation, I'd encourage you to reflect on the ethical principles of your chosen profession as well as any policies your current employer has, if you are not in private practice. For social workers, the National Association of Social Workers (NASW) code of ethics simply discourages dual relationships that present risk of harm or exploitation. The code of ethics also advises social workers to engage in appropriate boundary settings in situations where the dual relationship is simply unavoidable. 

Now that I have covered all your liability concerns, here is where I believe allowing your clients to assist you in enhancing your clinical skills can be beneficial. Consider that one of the most prominent psychologist, author, and developer of Dialectical Behavioral Therapy (DBT) has struggled with mental health. Whom better to teach you then an individual who has had lived an experience. This very principle has been researched in the use of peer recovery specialist to engage and retain individuals in treatment. One study found individuals were significantly more likely to return to treatment with the use of peer coaching (Simon et al.). The reality check here is that the individual who’s been in the chair before is doing a better job at client engagement than degrees on the wall. We as clinicians and/or social workers may want to consider asking our clients, what can be done differently to help. Imagine what your client’s insights can do to enhance your ability to engage and retain them in treatment. 

While your client's may not be functioning at a level where they can host CEUs any time soon, do not pass up the opportunity to learn from them as they sit in the chair across the room from you. As you continue to grow as a clinician, also consider adding literature to your library from authors with lived experience (I have added a few references below). 

https://www.nytimes.com/video/health/100000000877082/the-power-of-rescuing-others.html

Linehan, M. M. (1993). Cognitive behavioral therapy of borderline personality disorder (Vol. 51). New York: Guilford Press.

Saks, E. R. (2007). The center cannot hold: My journey through madness. Hachette UK.

Simon, G. E., Ludman, E. J., Goodale, L. C., Dykstra, D. M., Stone, E., Cutsogeorge, D., ... & Pabiniak, C. (2011). An online recovery plan program: can peer coaching increase participation?. Psychiatric services, 62(6), 666-669.

Workers, N. A. (2008). NASW code of ethics (Guide to the everyday professional conduct of social workers). Washington, DC: NASW.

Workers, N. A. (2008). NASW code of ethics (Guide to the everyday professional conduct of social workers). Washington, DC: NASW.

"Bit** you must be crazy," by Diana Martha Louis: A Literature review

Recently, I came across a publication in the Western Journal of Black Studies by Diana Martha Louis. The paper, "Bitch You Must Be Crazy: Representations of Mental Illness in Ntozake Shange's For Colored Girls Who Consider Suicide When the Rainbow is Enuf’ (Louis, 2013),  does a phenomenal job of noting the social constructs fermenting the thought of suicide among black women. The paper further highlights the suggestions made by Shange to treat and prevent mental illness.

If you are unfamiliar with Ntozake Shange's 1976 play, "For Colored Girls Only, Who Consider Suicide When the Rainbow is Enuf” it is an exceptional collection of 20 separate poems combined with music and dance. In 2010 Tyler Perry released a film adaptation of the play. Little known to myself, Shange, overcame a struggle with her mental health during her graduate years of college, attempting suicide several times after a split with her husband. This gives her even more creditability as an advocate for the need of cultural awareness when treating African American women who battle mental illness. Shange is able to empower not only black women but all women through her play.

Louis' review of Shange's most famed play as it relates to mental illness is relevant and highly recommended if you have an interest in women's studies. Louis begins by providing supporting statistics on the prevalence of suicide in the black community, which dispels the rumors that suicide among African Americans simply does not exist (Louis, 2013). The publication cites several sources of information creating the foundation for a discussion on mental health among blacks including a national report by former surgeon-general, Dr. Satcher (Louis, 2013). Louis then goes on to analyze what she identifies as three "overlapping issues" represented in Shange's play (Louis, 2013). These were identified as social context and physiological condition, constructions of womanhood, and self-reclamation and sanity (Louis, 2013).

One of the major points Louis makes in her publication is that Shange encourages a rejection of the language that suggests black women are "crazy bitches," because it is dehumanizing and further blames the victim for her experience (Louis, 2013). Louis also makes sure to point out the historical context of demeaning labels used to describe black women such as "Jezebel" (Louis, 2013). It is also pointed out in this publication that the marginalization of black women within society is a trigger to declining mental health and suicide (Louis, 2013). Louis, however, also references the work of Patricia Hill Collins, who suggests that the "outsider within" can be a source of strength (Louis, 2013). This source of strength can also be used as a coping skill to prevent self-harm. I would be remiss, if I did not also credit Louis for addressing the elephant in the room when discussing the abuse of black women when she eloquently stated, "...For Colored Girls depicts Black women's pain at the hands of black men...is criticized for airing the community's dirty laundry and demonizing black men...perceived as threats to the community as a whole" (Louis, 2013). The elephant being our own hand in our own destruction. Louis does point out that throughout Shange's play, empowering women to talk about their experiences and peer support as another noted suicide preventative factor and a necessity to healing (Louis, 2013). 

Overall, I highly recommend this publication by Diana Martha Louis. Louis provides great insight into the social constructs that the black community must address in order to reduce suicide among black women. Louis is also careful to note strengths and attempts by Shange to empower black women to take control of their own lives through self-love, fellowship, and talking about their experiences.

Go read it!!!

References

Louis, D. M. (2013). Bitch You Must Be Crazy: Representations of Mental Illness in Ntozake Shange's for Colored Girls Who Consider Suicide When the Rainbow is Enuf (1976). Western Journal of Black Studies, 37(3), 197.

Feeling Majorly Depressed?

According to the Center for Disease Control and Prevention (CDC), the National Health and Nutrition Examination Survey reports that of those ages 12 years and older, 8% reported that they were currently depressed. This survey was conducted between 2007-2010.The survey further found that women reported higher rates of depression than men in all age groups. Current depression was defined by those experiencing symptoms within the two weeks prior to completing the health survey. 

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) list several symptoms that must be present in order for a person to be diagnosed as experiencing a Major Depressive Disorder. These symptoms include:

1. Depressed mood more days than not, for most of the day (this can be self-reported feelings or reported observations by others), 
2. Loss of interest in most activities throughout the day
3. Weight gain or loss that is significant and not attributed to dieting( this can also be an increase or decrease in appetite)
4. Problems falling asleep or staying asleep (insomnia) or excessive tiredness/problems staying awake during the day (hypersomnia)
5. Unintentional or purposeless motions such as pacing or tearing at the skin (psychomotor agitation)
6. Fatigue more days than not or a loss of energy
7. Excessive feelings of guilt or worthlessness most days 
8. Decreased ability to think or concentrate
9. Thoughts of suicide, attempts of suicide, or plans of suicide, that are recurrent

Of the symptoms listed above, five or more must be present within the same two week period, include item one and two of the preceding list, and impair normal functioning. Special consideration is given to a person's cultural expression of emotions, normal responses to significant losses (i.e within the context of a natural disaster), and an individual's history.  The DSM-V further outlines that these symptoms must cause distress in important areas of functioning (i.e personal relationships or work).

A licensed professional is essential in determining the cause of your symptoms which includes ruling out that the symptoms are not a result of another medical condition or substance use. There are also several other considerations, not outlined in this article, such as symptoms specific to children, which must be reviewed in order to be properly diagnosed. This article should not be used a diagnostic tool, only a licensed professional can properly diagnose.

Options for treatment may include antidepressant medication, group therapy, and interpersonal psychotherapy. Contacting your primary care physician, local mental health service agency, or insurance carrier may further assist you with identifying treatment options available to you. With millions of Americans living with a mental health disorder in any given year, Major Depressive Disorder is viewed as a serious health diagnosis warranting treatment. If you're feeling majorly depressed, seek treatment.

 

Resources:

Center for Disease Control and Prevention

Diagnostic and Statistical Manual of Mental Disorders (DSM-V)

National Alliance on Mental Illness Fact Sheet

Graduating with a Master's in Social Work: What's next? Choosing a Qualified Supervisor

If you’re looking to become a fully licensed clinical social worker in the State of Florida, soon after receiving your Master’s in Social Work, you’ll be faced with the task of choosing a qualified supervisor to work under. Common career goals of a Licensed Clinical Social Worker (LCSW) include opening your own private practice, working for a non-profit, or a community mental health agency. In choosing your clinical supervisor consider choosing someone whose experience will help foster and develop personal growth for your career.

Your supervisor should be board approved and have completed the Qualified Supervisor training which meets the standards set forth by Florida law. Your supervisor for licensure should provide the following, which I deem to be essential to the supervision process:

1.      Provide continuing education on evidenced based practice and application of therapeutic tools to assist in professional development.

 

2.      Offer assistance in understanding the legal statutes and ethics associated with practice.

 

3.      Be responsible for evaluating with the purpose of enhancing the future clinician's ability to assess therapeutic needs, develop effective treatment strategies, and properly document in the medical record.

 

4.      Deliver guidance and support throughout the process with an emphasis on learning to ask for help.

You can become a skilled clinician. I offer supervision using a variety of models. I seek to teach, support, guide, and evaluate those who desire a career in the field of Clinical Social Work. I offer supervision in an individual and group setting at affordable rates with discounts for group supervision. Wishing you all the best in choosing your supervisor.

 

Brittany Peters, LCSW

Qualified Supervisor for Clinical Social Work 

Contact: bpeterslcsw@gmail.com

352-519-1091

More on Clinical Supervision Can be found Here:

NASW code of Ethics

Munson's Handbook of Clinical Social Work Supervision