The "Sameness" of Intimate Partners

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Moral Injury Among Social Workers?

I recently came across an article titled, "Reframing Clinician Distress: Moral Injury Not Burnout." Moral injury is a concept that refers to the psychological, social, and spiritual impact of challenging events on individuals who uphold strong values, such as providing quality care for patients, especially in high-pressure situations where they may have to compromise these values. Common symptoms of moral injury include feelings of guilt, shame, anger, and contempt towards a system that may prevent individuals from delivering proper care.

The concept of moral injury sheds light on many of the difficulties we currently face in our profession. As clinical social workers, an understanding of moral injury can help us to identify the root cause of our distress and burnout within a flawed system, rather than attributing it solely to individual shortcomings. This perspective allows us to recognize and address larger systemic issues at play. By acknowledging our role within the system, we can work towards implementing meaningful changes.

Whether we work in private practice, academia, or healthcare settings, it is important for all of us to understand the factors that contribute to moral injury and how the existing system perpetuates it. This understanding can guide us in advocating for systemic improvements that promote well-being for both clinicians and the individuals they serve.

Exploring Feelings

Many types of mental health treatment include some form of exploring feelings.  In Neurodynamic Couples Therapy, exploring feelings is the pathway to metabolizing and integrating them into a cohesive sense of self and relationships and creating a bond of empathy and understanding between partners.

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Addressing Burnout Among Clinical Social Workers: A Path to Resilience and Well-Being

Burnout among Clinical Social Workers has emerged as a critical issue, reflecting their work's intense emotional and psychological demands. A comprehensive systematic review spanning twenty years of research highlights several key aspects of burnout within health social work[i]. The review underscores the prevalence of burnout as exceeding that of other health professions, influenced by work setting, job turnover, physical and mental well-being, and the importance of coping skills training[ii]. Notably, workload and work setting were the primary job demands contributing to burnout, with personal characteristics such as age and gender also playing significant roles. 

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“Staying Woke” an Approach to Practicing with Cultural Humility

The term “woke” means to be aware. It is the opposite of slumber and suggests a person is consciously aware of their role, its influence on others, and the associated societal climate. It is an act of submission which recognizes the importance of the patient’s agency.  The term “woke” was first introduced in the 1940’s to emphasize the importance of being aware of social injustices (Ng, 2021). At the height of the racial tensions within the last ten years, the term was used in a pejorative nature to undermine another person’s stance on issues that he or she identified as worthy cause(s) to elevate. To be deliberate in addressing systemic issues that impact the underrepresented members of our communities as well as granting them the authority to narrate their stories clinicians must practice “staying woke.” Wokeness suggests an active pursuit of knowledge and consciousness. Wokeness is a deliberate practice of taking action to better inform a clinician’s practice. It requires introspective engagement, minimizing judgment to promote social change.

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Understanding vs. Succumbing to the System

Couples have a nonconscious, intersubjective system between the two partners that has been existent and developing in complexity since they first met each other.  It has been well-established in recent years that this type of system gestates during childhood and becomes the template that dictates who we will be attracted to and commit to as a life partner.

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Couple Frame vs. Individual Frame

I have written many times about the radical intersubjective stance that Neurodynamic Couples Therapy takes regarding the treatment of couple relationships.  In essence, we are treating what happens between the partners–not individual psychologies.  The theory holds that it takes two brains in each other’s presence to access the affective material that has been generating the couple’s conflicts in order to heal historical wounds.  The individual psychologies heal and change through the couple work.

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Grief doesn’t vacation during the winter holiday season

It is said to be ‘the most wonderful time of the year,’ however, we must recognize that the winter holiday season is not a season of festivities and joy for everyone, especially those grappling to live with the loss of a loved one. As social workers, this truth offers us opportunities to reflect on the pain, loneliness and sorrow some may feel and offer to hold space for those in need of hope and comfort in knowing that they are not alone.  Pausing and remembering the past weeks, months, and for some years of difficult times, we can remember the poignancy of memories, the grief, the sadness, the hurts, the pain of reflecting on our own mortality.

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Transformation as Change

“You can’t go back and change the beginning, but you can start where you are and change the ending.”

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Thank You - Thank You - Thank You. Expressing Gratitude

Expressing Gratitude
Task Force 5 COVID-19 Response Assignment (2020)

One of my patients recently informed me that November is the National Month of Gratitude.  This makes sense given the date of our Thanksgiving Holiday.  It reminded me of some basic mannerisms and courtesies associated with general civility but also within the context of professional social work.    Patients often express gratitude for the care they receive at my clinic.  Their topics of discussion are typically too delicate to share with family and friends.  Many feel socially isolated or disenfranchised to openly discuss such sensitive and personal matters.  Similarly, I try to remain grateful to my patients for inviting me to discuss their private thoughts and feelings.


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Accepting Derailing

Most of the time most of us therapists work as hard as we can to keep a treatment going, knowing that attempts to derail therapy have many meanings that can be explored and understood.  I know that I have always been extremely reluctant to “give up.”

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Lets Talk About Self-Care

I have been thinking a lot about self-care in my work with patients experiencing high-stress circumstances.  In my practice, with peers and patients, I tend to ask, “what are you doing to take better care of yourself?”  The frequent response is so common it could be considered universal …blank stare, awkward silence, and a sheepish, “I don’t know,” usually accompanied with a shrug. 

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Interrupting Derailing

Most therapists have had the experience of feeling that a treatment is being derailed and perhaps headed for failure.  Even when we are able to see it coming and try to redirect the treatment, it can be like attempting to turn a battleship around (as the saying goes).

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Suicide Prevention and Social Connectedness

September is Suicide Prevention month.  Suicide continues to be among the leading causes of death in the U.S.  This public health challenge affects various population groups ranging from youth to White men and Native Americans to Veterans.  According to the American Foundation for Suicide Prevention, 94% of adults believe that suicide can be prevented. When considering this and protective factors such as social support, relationships are an area to further explore.  A question is “how can we be more intentional to support meaningful social connectedness?” Social connectedness is recognized among the pillars of lifestyle health.  Being connected well has been researched through the quality of interactions, belonginess and longevity.  Social connection was recently discussed in relation to near-term suicidal ideation (Ammerman & Jacobucci, 2023).  Preliminary evidence suggested the need to assess for current social contact in conjunction with the risk for suicidal ideations.  This could facilitate timely interventions.

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“There is Nothing Wrong With You”

In previous blog posts, I have written about the importance of understanding a couple’s persistence in seeing one partner as the identified patient.  Quite often, couples will enter treatment with both partners having decided that there is something wrong with the other, and that they themselves are in fact “normal” or “innocent.”

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Curiosity

A major goal of Neurodynamic Couples Therapy is to help partners complete the metabolizing of troublesome emotions, which they have already been nonconsciously attempting to accomplish through their conflicts.  Some forms of therapy purport that this metabolizing can be done nonverbally, but we believe that it takes the translation of right-brain experiences into words in order to adequately and fully create the understanding of self and the other that is necessary for genuine empathy.

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Training Imitating Actual Practice

John Donne penned the often-quoted line “No man is an island entire of itself”. Similarly, most of us are familiar with the African proverb “it takes a village”. One of my personal favorites is a quote from Aristotle “nature abhors a vacuum”. As clinical social workers we come alongside individuals, couples, and families at some of their most challenging times; but we don’t do the work alone. We collaborate with our clients, their families, support systems, community resources, other providers and the list goes on. We recognize that healing happens best when we engage our clients within a larger restorative community.

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Life in Transition

The Corona Virus Pandemic taught us numerous life-long learning experiences.
Three years later, we continue transitioning.
Mandatory masking was finally lifted a few months a- go.
Some of us working remotely returned to the office for increased socialization.
Others found remote work was perfect and won’t look back.
Virtual modality of conducting business is a new norm.
As things return to their new “normal”, a  greater emphasis is now placed on not solely existing.
But Living and finding a good work and life-balance.
Compressed schedules have gained popularity.
Work meetings are integrating a few minutes for meditation and social interaction.
Self-care and being happy are now cultivated and encouraged.
Finding joy in life again is a new must.
So I’m working on re-shifting my life-long process of self-sacrifice for the cause of serving others..
To focus on helping myself.
And find joy again.
Have you found yours?

Simple–not easy

As I was growing up, I remember one of the mantras that I heard from some of the adults in my world.  They would say one of the best approaches to difficult situations is encapsulated in the acronym KISS–Keep It Simple, (warning! pejorative word coming up) Stupid.  I found this to be quite helpful as I grew and developed.

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Juneteenth: Social Well-Being and Health Equity

Juneteenth became a National Holiday in June 2021.  For years, this observance also known as Freedom Day was celebrated across African American communities and into others.  Juneteenth is widely becoming an American observance and provides an opportunity to learn the full narrative.  Enslaved people in Galveston Bay, Texas were informed of their freedom on June 19, 1865, however, enslavement continued in some U.S. border states.  At the end of the year, the 13th Amendment abolished slavery in America. As we reflect on the past and embrace how far society has come, optimism and open perspective can guide mindsets.  Social well-being and health equity are central to ongoing progress.  The underserved and under resourced people are part of a humanity, deserving of social parity and access to care.  The disparate conditions affecting them can be seen as remnants of practices such as redlining.  Similarly, maternal health disparities largely impacting Black women have some origins in implicit bias.  As clinical social workers and human service professionals, what is your call today for the cause and how can you activate it?  Does the practice setting provide space for advocating, mediating, or bridging the gap as a trusted professional?

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