TH E N EWSLETTE R OF TH E N EW YORK STATE SOCI ETY FOR CLI N ICAL SOCIAL WORK, I NC.
FALL 2009 | VOL. 40, NO. 2
W
ay back in 2001, all of the major
social work professional associa
tions, city and state agencies were
in support of social work licensing and
licensing the field of psychotherapy. The
final legislation, which included scopes of
practice for the LMSW as well as the LCSW,
was the result of a very long process which
required determining which of the various
disciplines and specialties outside of social
work were qualified to deliver mental health
services to the public. New York State was
among the last states to regulate psycho
therapy and when all was finished, there
were six licensed mental health profession
als including the Licensed Clinical Social
Worker, the Licensed Psychologist, the
Licensed Marriage and Family Therapist,
IN THIS ISSUE
3 Leadership & Nomination Process
4 Urgent Letter to Legislature
5 Policies & Procedures Manuals
13 Arts & Creativity Workshop
At the 40th Annual Education Conference in May (Left to Right) Keynote Speakers Carol Tosone, Ph.D.
and Jerome C. Wakefield, Ph.D., DSW, with Education Committee Chair Susan A. Klett, LCSW-R.
Story Begins Page 8.
CONTINUED ON PAGE 5
the Licensed Mental Health Counselor, the
Licensed Creative Arts Therapists and the
Licensed Psychoanalyst. Keep in mind that
there was a ground swell of support for this
legislation, essential for passage.
The LCSW emerged with an autono
mous, comprehensive scope of practice
which made clinical social workers very
competitive with the other mental health
professions and essentially equivalent to
the scope of practice for clinical psycholo
gists. Recently, we have been made aware
of efforts to weaken the LCSW behind the
scenes, to dilute the strength of the license
by reducing the required hours of super
vised psychotherapy experience (currently
about 3,000 hours) and adding non-clinical
experiences (i.e. case management,
counseling and discharge planning) which
are currently LMSW functions, as relevant
areas of clinical experience. As it stands
now, the LCSW is specifically for the
practice of diagnosis, treatment planning
and treatment of mental illness. The current
experience standards have been in exis
tence since 1978 when the “P” legislation
was enacted.
What rationales are offered for lowering
standards?
Claim: Shortage of clinical social workers
Response: The mental health field has
been increased by five additional licensed
professions who are competing for LCSW
jobs. Their licenses require more hours of
clinical education and supervised experi
ence than the LCSW. Why would we lower our
standards now? A shortage in the field?
…if there were a shortage, managed behav
ioral health care would be increasing our fees
to attract LCSWs to panels. We have not seen
an increase in two decades. If agencies can’t
locate LCSWs, perhaps they should look to
their salary scales and work loads.
Claim: Budget crunch – there is no
money for LMSW salaries so agencies
wish to offer experience credit toward the
LCSW in trade for salary increments. If the
Undoing Our Psychotherapy License
By Marsha Wineburgh, DSW, Society Legislative Committee Chair
Photo: Sandra Indig
2 The Clinician
social workers do? The image that comes to mind is of the
old proverb: I am standing on the banks of a river with a
man, and I decide not to give him a fish, but to teach him to
fish. That is, my job is to cultivate independence.
Is that what we do? Do we ensure that our work does,
in fact, lead to better functioning through independence?
And how do we capture that idea with a brief description,
given the multitude of ways in which we provide services,
even in our circumscribed role as clinicians?
This line of thinking stimulated a lot of self-reflection.
Now, I am hereby opening it up to you, as a Society
member. I am asking for your thoughts and feelings,
and beyond that, for actual elevator speeches you
compose. Please send them by e-mail to me.
We should be proud to be social workers and clinicians.
Yet the way we present ourselves often does not reflect
pride, but defensiveness. This can be the result of many
factors, not the least of which is a concern about the
shortcomings and reputation of the graduate social work
schools in New York State.
However, if we are to clearly define our professional
identity, then perhaps we must begin with honest
and direct discourse about our professional self
perception, whether we are satisfied with it, and if not,
what to do about it. The power to define ourselves can
strengthen our identity and our practice and improve
our working conditions, especially in the area of financial
compensation.
I invite you to contribute to the discourse.
Jonathan Morgenstern LCSW-R, mjonathanm@aol.com
The Clinician is published two times each year by
The New York State Society for Clinical Social Work, Inc.
www.clinicalsw.org
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NEW YORK
STATE
SOCIETY
FOR
CLINICAL
SOCIAL
WORK,
INC.
A
t the last State Board
meeting, I initiated
a discussion about
membership development
and the central importance
of professional and Society
identity to this effort.
The very next day, I found
myself at a social event
struggling to explain what
I do professionally. I made
a deliberate point to start
out by stating that I am a
social worker. When this was
greeted with a fairly blank
stare, I proceeded to describe what I do through my
professional roles in both agency and private practices.
And it occurred to me that I often struggle to produce a
good “elevator speech,” a focused message to a stranger
that captures the essence of my work and expertise and
its importance. It would be a “pitch” of about 30 seconds,
the length of an elevator ride, delivered in plain, memo
rable language.
I recall how my students often sum up the profession.
They say that they are entering the field of social work “to
help people.” What does that mean? And is that what we as
President’s Letter
Jonathan Morgenstern, MSW, LCSW, Society President
“...we must begin with
honest and direct discourse
about our professional self
perception, whether we are
satisfied with it, and if not,
what to do about it.”
Jonathan Morgenstern,
MSW, LCSW,
Society President
Fall 2009 3
A
s often happens with landmark legislation, unintended
consequences arise as the new laws begin to be
implemented. This is the third article intended to
provide an understanding of the basic problem areas and
report on progress in resolving them. The stakeholders
are the Office of the Professions of the State Education
Department, the professions involved, legislators and their
staff, and the Governor’s office. Two of the three key problem
areas have been addressed. Issues around authorized
settings for professional practice remain and we need your
assistance (see box on page 4 for how you can help).
The Society Board with the help of our lobbying firm
continues to be actively involved in the resolution process.
1. We have supported successfully a new policy for
LMSWs who have had a supervised private practice prior
to February 2, 2009. They will be permitted to use that
experience to fulfill their supervised clinical experience
Legislative Committee
by Marsha Wineburgh, DSW, Chair
providing it meets all other criteria. (For specifics:
www.op.nysed.gov/swprivatepractice.htm)
2. The 2002 Social Work licensing laws exempted programs
regulated, funded, operated or approved by OMH, OMRDD,
OASAS, OCFS, local social service or mental hygiene districts
until 1-1-2010 to allow any person to provide services without
being licensed. We supported a 6 month extension of the
exemption clause, which was passed in the 2009-2010
Executive Budget.
3. Authorized settings: When the State licensed those clini
cians who provide psychotherapy services, it also triggered
New York State’s corporate practice laws which require that
the setting where the services are provided must be also au
thorized by the State. Now that the practice of clinical social
work and the other mental health professions is restricted,
for-profit and not-for-profit businesses which provide psy
chotherapy services are now also restricted. The definition
CONTINUED ON NEXT PAGE
T
he Society governs itself by a specific process detailed
in the Society by-laws. Inherent in this process is the
dynamic of succession which involves the delicate
balance between continuity and change. We require both in
order to execute the charge of our mission statement which
is to preserve and protect the practice of clinical social work.
As a volunteer organization we have dedicated
professionals in our membership who practice clinical social
work in a variety of settings, teach in schools of social work
as well as at institutes, administer mental health agencies
and organizations and do research. Representation on the
State Board does not reflect this diversity and should.
The Nomination Committee is comprised of the chapter
presidents. Their contact with the membership puts them
in a position to identify and cultivate new leadership on the
chapter and state level. The challenge of utilizing the wisdom
and expertise of long standing leaders while promoting new
leadership on the State Board is interesting. Some chapters
have positions on their boards for a chapter historian or
advisor. Perhaps this could be considered for the state level.
Reflections on Leadership and the Nomination Process
What became clear during the nominations process
this year is that newer potential leaders preferred not
running against long standing leaders. This reaction may be
related to professional self esteem and seeing ourselves as
successful leaders, an issue that seems to plague clinical
social work in general.
But I think it is something we can creatively overcome.
Next year, the office of President Elect must be filled.
This person sits on the State Board for one year before
assuming leadership of the State Society. It is a system that
has been effective since we began in 1968. It affords new
leadership the opportunity to observe and learn established
system. Changes can then be incorporated in a wise
systematic way that preserves our solid foundation while
simultaneously moves forward.
I encourage our leaders and members to take some time
to reflect on the importance of succession. Grooming and
preparing for leadership is what will sustain our society and
our profession.
Beth Pagano LCSW, Nomination Chair 2009, Member-At-Large
Authorized Settings for Professional Practice
4 The Clinician
of an authorized setting for mental health services is under
discussion and will include a process to register entities that
are not currently approved by the Office of Mental Health
or another government agency. This directly impacts on the
settings and supervision requirements for acceptable clinical
experience for LMSWs seeking clinical licensure as well as
ensuring that patients receive quality services.
Legislative Committee
CONTINUED FROM PAGE 3
Legislation (A.8897) has been drafted to address this
issue. The purpose of this bill is to prevent the disruption of
services to the public in the professions of licensed master
social work, licensed clinical social work, licensed mental
health counseling, licensed marriage and family therapy,
licensed creative arts therapy, licensed psychoanalysis, and
licensed psychology by creating an exemption from corporate
practice prohibitions for not-for-profit corporations,
education corporations, firms, business corporations, and
other business entities that provide professional services in
these professions.
This legislation would require that such entities register
with the State Education Department by July 1, 2011. Upon
registration, the bill would permit these entities to employ
licensed professionals or contract with professional business
entities to provide such professional services. Importantly,
this legislation would recognize work experience gained by
individuals employed by such entities and would permit such
individuals to apply this experience towards the experience
qualifications for professional licensure.
(The bill can be found at Google:
www.New York State Assembly. Use bill number A. 8897.)
The NYSSCSW Board and the State Legislative Committee
request that you:
Immediately write to your Assemblyperson and the
Speaker of the Assembly to ask them to support A.8897.
• Your Assemblyperson can be found using your zip code at
the New York State Assembly site. Or call the League of
Women Voters in your area.
• Speaker Sheldon Silver, 932 Legislative Office Bldg., Albany,
NY 12248
See the box on the left for suggested content.
Please send copies to your chapter legislative chair
or to mwineburgh@aol.com.
Dear Speaker Silver:
I am (writing/calling/emailing) you on a matter of great urgency.
I am a (student/LMSW/LCSW/constituent) and I am looking to
you for leadership in managing a potential crisis in the provision
of critical mental health services.
[Insert brief description of who you are/where you work]
As you may be aware, in 2002 and again in 2004, the State’s
laws governing the social work profession were dramatically
changed. Two licenses — licensed master social worker (LMSW)
and licensed clinical social worker (LCSW) — were created from
what had been only a certification. For a number of reasons,
these changes have not been implemented smoothly and have
created many barriers for the acceptance of required professional
experience and the provision of mental health services.
Among other difficulties, the new laws created conditions
in which many corporate and community-based organizations
which have provided vital mental health services for decades,
often to New York’s most vulnerable populations, are now con
sidered to be operating illegally.
The State Education Department has worked with all
interested parties to craft an effective solution which is set out
in A.8897. This bill would allow entities to continue to provide
services by registering with the State Education Department
(SED), which would assume responsibility for assuring that
the integrity of the practice of the professions is protected as
provided by New York’s corporate practice laws. It would also
allow the SED to accept experience for the LCSW that was
acquired by many LMSW professionals in good faith at the
affected entities.
I am asking that you urge the enactment of A.8897 as soon
as possible when the Legislature returns this Fall. Without this
solution immediately in place, significant workforce and service
delivery consequences will likely threaten the mental health
service system across NY state.
Thank you for your consideration of this important matter.
Fall 2009 5
T
he members of the Strategic Planning Committee are
pleased to announce that all of the Society Policy and
Procedure manuals we set out to produce have been
completed. This has been a huge job and would not have been
possible without the help of our consultant, Marian Sroge.
The manuals fall into three categories: policy and
procedure manuals which delineate the role of the Society,
the State Board and the chapters; manuals for specific
jobs, such as for the treasurer and for nominations and
elections; and “how-to” manuals that provide guidance
and helpful hints for running a committee or organizing an
event. We also have written policies that are required by the
IRS and the government, such as a whistle blower’s policy,
nondiscrimination policy, and a conflict of interest disclosure
form. At the end of this article is a list of the manuals.
These manuals document the administrative and man
agement infrastructure of the Society and, in particular,
the relationship between the State Board and the chapters.
They will enhance that relationship and provide for more
open communication. They will be invaluable in recruiting
new leadership, as members will have at their fingertips the
information they need to do their jobs.
It is important to note that except for the policies, all of
which have been voted on by the State Board, the manuals
are guidelines to assist members who have taken on specific
roles in the Society. As such, they provide helpful informa
tion to get you started on a project and allow and encour
age you to use your initiative in developing the project.
Therefore, if a member has taken on the job of putting
on a conference in a chapter, he/she can go to the Event
Management Manual and find sample contracts for speakers,
how to get appropriate insurance, and check lists to be sure
that all contingencies have been met. In other words, it will
not be necessary to reinvent the wheel every time a chapter
has an event or a new person takes over a role in a chapter
or on the State Board. It is important to note that the manu
als can be amended at any time. Issues may be raised at a
State Board meeting and modifications can be made and will
be incorporated into the manuals.
In addition, the Strategic Planning Committee has been
working on developing a strategic plan for the 2009-2010 year,
as well as a five year plan. A primary goal for this year is to
review the Society by-laws and make revisions that will reflect
the new licensing law as well as other changes that will in
crease the clarity of the by-laws. The President of the Society,
Jonathan Morgenstern, is currently appointing this committee.
Other aspects of the strategic plan will encompass lead
ership development and succession and most importantly,
the retention of members and recruitment of new members.
You may contact the president of your chapter if you wish
to use any of the manuals.
The manuals available are: State Society Policy Manual,
State Nominating and Election Manual, State Society
Operating Procedures, State Treasurer’s Manual, Board
Policies and Procedures, Event Management Manual, State
Board Orientation Manual, State Society Committee Manual,
Chapter Policies and Procedures, Transitioning Manual and
Chapter Leadership Orientation Manual.
Strategic Planning Committee
by Judith Crosley, LCSW, Chair
Undoing Our Psychotherapy License Message
CONTINUED FROM COVER
definition of clinical services is generalized to ANY direct
service to a client, they claim that LMSWs might be attracted
to low paying, unpopular kinds of agency work because it
counts as LCSW supervised experience.
Response: The legislature, when it enacted the LCSW and
other five mental health licenses, meant to regulate medically
necessary psychotherapy services, not the general field of
human services.
Claim: New York’s LCSW license is limited to only
psychotherapy. This is too narrow. Other states have a
broader definitions for clinical social work.
Response: Other states have not regulated psychotherapy,
nor have they licensed six new professional groups to provide
mental health services.
What you can do: Protect our consumers from
inadequately trained LCSWs. Call/e-mail the executive
directors of other social work associations you are
a member of and ask if they are advocating diluting
the LCSW law by requiring fewer hours of supervised
experience or the types of experience required for the
license. Let them know how you feel about it.
Why haven’t the issues appeared in their newsletters or
on-line so you are informed about their positions? Let
your NYSSCSW chapter legislative person know what
response you receive or e-mail mwineburgh@aol.com –
“Protect our LCSW.”
6 The Clinician
R
ecent e-mails from members reveal that out-of-
network providers are still being pummeled by faxes
and calls from MultiPlan asking them to accept a
discounted reimbursement rate.
What is this about?
Corporate profits, pure and simple. At root is the fierce com
petition among insurance companies to lower their costs.
We have confirmation of this in MultiPlan’s own pitch to in
surers: “Millions of dollars are spent annually in uncontrolled
costs resulting from non-contracted healthcare services.”
(See http://www.multiplan.com/solutions/fee_
negotiation.cfm).
MultiPlan offers the primary insurer (UBH, Cigna, HIP)
a chance to manage these out-of-network costs. It can
“reprice” each claim with the click of a mouse. Recently, a
MultiPlan lookalike, A&G Healthcare Services, came on the
scene advertising to insurers, “Repricing your medical claims
can’t be any easier and faster!”
MultiPlan makes the claim that it “helps providers to
more effectively control reimbursements.” But the true gain
is to the employer, the primary insurer, the stockholder
(and possibly to you, if you own mutual funds). However
benevolent they try to sound, managed care companies are
attempting to provide the best service at the lowest price
to satisfy investors.
What has the Society done?
This committee wrote to MultiPlan on May 12, 2008
expressing our concerns, but a subsequent discussion
with the State Board discouraged pursuing this legally
with New York State Department of Insurance. Essentially,
the problem appears to be “a perfectly legal nuisance.”
This should not deter individual members from writing
MultiPlan, the New York State Department of Insurance,
the FCC, or the New York State Attorney General
(see addresses below).
What steps can members can take?
• Ignore faxes and calls. Many members say that this will
make them stop—at least for a while.
• Fax back the request. Draw a line through the fax and
write “REFUSED. FINAL DECISION.” One member wrote
“DECLINED” in black marker and faxed it back. She was
promptly paid.
• Contact the MultiPlan Service Advisor at Service@
Multi-Plan.com, 1-800-546-3887, Option 3, and ask to be
removed from the database. One member reports that he
was told he was removed from all Multiplan databases.
• Write to MultiPlan and cc the Attorney General or NYS
Department of Insurance: Provider Services, MultiPlan,
1100 Winter Street, Waltham, MA 02451-1440
• Write to the State Attorney General. This must be a
consumer-oriented complaint: Office of the New York State
Attorney General, Health Care Bureau, The Capitol, Albany,
NY 12223-0341; Healthcare Hotline is 1(800)428-9071.
A form provided by the Office of the Attorney General
Health Care Bureau is available at: http://www.oag.state.
ny.us/bureaus/health_care/about.html.
• File a complaint with the FCC at http://www.fcc.gov/
cgb.complaints.html. See “Telemarketing, Prerecorded
Messages and Do-Not-Call.” Telephone 1(888)CALLFCC
• Write to the New York State Department of Insurance.
New York State Department of Insurance, 25 Beaver
Street, New York, NY 10004-2319 Or go to “How to File a
Complaint” at http://www.ins.state.ny.us/complhow.htm.
At Stake: Autonomy and Confidentiality
Calls from MultiPlan are maddening but the greater issue
is the coercion of out-of-network providers to conform to
in-network protocols. UBH and Magellan are now demanding
OTRs from out-of-network providers. One out-of-network
provider for UBH was asked for medical records on his
patient after four visits.
Patients who have chosen to go out of network to preserve
confidentiality are now told that the therapist must send an
OTR to the insurer to continue reimbursement. This may be
legal but from a clinical point of view it represents a viola
tion of privacy. Letters to the New York State Insurance
Department should stress this issue of confidentiality.
We cannot have an impact unless we make
ourselves heard.
Vendorship and Managed Care Committee
by Helen T. Hoffman, LCSW, Chair
Managed Care Companies Continue to Target Out-Of-Network Providers
Fall 2009 7
Call for Proposals
For Workshops and Panels for the 41st Annual Conference of the
New York State Society for Clinical Social Work
LIVES DISRUPTED:
Contemporary Approaches for the Treatment of Trauma
Date of Conference: May 8, 2010
Traumatic experiences profoundly compromise development and have serious ramifications on one’s capacity to form and maintain
intimate relationships. Wars, natural disasters, terrorist attacks, a sudden death or unexpected illness, as well as, the discovery of
an extramarital affair and getting fired from a job shatters one’s sense of self and sense of safety in the world. This conference will
address the importance of identifying, differentiating and understanding various degrees of trauma. Clinicians will learn effective
approaches to healing trauma and significant ways to care for themselves in the process. We are looking for proposals for workshops
and panels from all theoretical orientations as well as all modalities reflecting this theme.
• PTSD: Treating returning veterans and
their families
• Medical conditions, the aftermath of a
medical emergency on patients and their
families
• The impact of suicide on a spouse
• The relationship between attachment,
trauma and neuroscience
• Exploring the assets and liabilities of
working with groups: such as victims of
natural disaster, war veterans, terrorists
attacks, domestic violence/physical and
emotional abuse
• Understanding and healing intergenerational
passage of trauma, children of Holocaust
survivors, Post Traumatic Slavery Syndrome
(PTSS)
• Birth Trauma/ maternal loss
• Addictions as affective regulators: alcohol,
drugs, food, gambling, shopping, sex,
excessive work, compulsive exercise, eating
disorders, self mutilation
• The relationship between trauma,
particularly childhood sexual and physical
abuse and depression/anxiety/social phobia
• Working with the traumatized couple
• Compassion fatigue/ burn out/vicarious
trauma
• Using EMDR, hypnosis, EFT, neuro-feedback,
biofeedback in the treatment of trauma
• Enmeshment and shared psychosis
• Dissociative Disorders/DID/Multiple
Personalities
• Supervising the traumatized supervisee
• Dreams as a pathway to facing and working
with severe trauma
• Understanding sadomasochism and self
injury as a form of traumatic bonding
1. Description: purpose, function, and teaching
objectives. Include clinical illustrations.
2. A workshop or panel outline describing original
concepts to be developed.
3. A bibliography.
4. Nine copies of the proposal, one copy of your
C. V. (and all other identifying information) on
a separate page. Underline one affiliation that
you would like listed in the brochure. Private
practice is not considered an affiliation.
5. On a separate page: A brief paragraph of @ five
lines stating purpose of workshop and listing
5 to 6 aims and objectives.
Mail to: Susan Klett, 157 East 57th Street, Apt. 6D, New York, NY 10022
Suggested Topics:
Proposals should be from three to five typewritten pages, double spaced,
and should include the following:
Deadline for Submission of Proposal: November 23, 2009
8 The Clinician
W
e were delighted this year that Dr. Carol Tosone,
Associate Professor of Social Work at New York
University Silver School of Social Work, was one
of our keynote speakers at our conference.
Tosone is the recipient of the NYU Distinguished
Teaching Award and a National Academies of Practice
Distinguished Scholar in Social Work; she was recently
selected for a Fulbright Senior Specialist Award for teaching
and research at the Hanoi University of Education in Vietnam.
Tosone is Journal of Clinical Social Work Editor-in-Chief
and serves on the editorial boards of Social Work in
Mental Health, Social Work in Health Care, Psychoanalytic
Social Work, Psychoanalytic Perspectives, and the Social
Work online journal, Beyond the Couch. The author of
numerous professional articles and book chapters,
Tosone has delivered over 100 professional papers and
presentations in academic, medical, and mental health
settings throughout the United Sates as well as in Asia,
Europe, and South America.
And, somehow, she has managed throughout the time
she has devoted to her many other professional pursuits to
continue to find time to treat patients.
In keeping with the theme
of this year’s conference,
Tosone discussed compara
tive treatment approaches
to panic disorder and used a
compelling case illustration
from her own practice to do
so. The benefits of a care
fully planned and rigorously
implemented short-term
psychodynamic treatment
approach were highlighted
in the case — one that she
presented originally in the
chapter on short-term treatment she wrote for the book
she co-edited with Barbara Dane and Alice Wolson, Using
Long-Term Skills in Short-Term Psychotherapy.
She began by citing some pertinent statistics that indi
cated quite clearly how anxious we are in the United States.
• 40 million Americans are affected annually by an anxiety
disorder.
• The cost in the United States alone is $42 billion dollars a
year — one third of our $148 billion health bill.
• Anxiety disorders and panic attacks are more common than
bipolar disorder, schizophrenia, alcohol abuse, or depression.
New York State Society for Clinical Social Work 40th Annual Education Conference | May 2, 2009
O u t o f S o rt s :
Keynote Presentation by Carol Tosone, Ph.D. / Review by Gil Consolini, Ph.D., LCSW
Comparative Treatment Models for Panic Disorder: A Case Illustration
Gil Consolini, Ph.D., LCSW, who is Director of Behavioral Health for Personal-
Touch Home Care in Brooklyn and maintains a private practice in Manhattan treating
individuals and couples.
Carol Tosone, Ph.D.
A very large, vibrant group of clinicians gathered for the 40th Annual Education Conference at the Nightingale-Bamford School
in Manhattan. Two renowned keynote speakers, Dr. Jerome C. Wakefield and Dr. Carol Tosone, presented cutting edge research and
clinical examples of working effectively with depression versus sadness and panic disorders. Afternoon workshops covered a wide
range of topics addressing the needs of clinical social workers from various settings, working with a broad spectrum of disorders and
challenging situations faced by children, parents, individuals and couples.
The conference was dedicated to the memory of Eddie Mirkin, a long time contributor to the Society who was the husband of
Mitzi Mirkin, our Executive Secretary for the past 32 years. His recent passing was a great loss to us all.
The Education Committee, chaired by Susan A. Klett, LCSW-R, is planning next year’s conference, to be held on May 8, 2010 at
the same venue as this year’s event. A “Call for Proposals” has been mailed out and included in this issue as well. We welcome your
feedback and invite you to submit suggestions of topics and speakers by e-mailing suzanneklett@aol.com.
Fall 2009 9
• Those suffering are three to five times more likely to seek
medical treatment.
• These disorders are twice as common in women as in men.
She proceeded to list the numerous applicable DSM-IV
diagnostic categories familiar to most seasoned clinicians,
including panic disorder with agoraphobia (300.21), social
anxiety disorder (300.23), obsessive-compulsive disorder
(300.3), post-traumatic stress disorder (309.81), and general
ized anxiety disorder (300.02).
She then distinguished normal anxiety from pathological
anxiety, considered the role of signal anxiety in relation to
the mobilization of defense mechanisms, and used cognitive
behavioral and anatomical explanatory models to differenti
ate fearful reactions from anxious reactions. Throughout
her presentation, she used cartoons which helped bring her
conceptualizations to life in ways that only cartoons can.
In the case that she was able to go into in some depth,
she utilized a short-term psychodynamic approach developed
by Lestor Lubovsky, well-known for establishing the Global
Assessment of Functioning scale used by many practitioners
to evaluate the effectiveness of their work with psychother
apy patients. She began by outlining the four phases of Core
Conflictual Relationship Therapy (CCRT).
• Early Phase (1-5 sessions): The clinician establishes a
therapeutic alliance in relation to the Axis I presenting
problem by sensitively eliciting the patient’s descriptions
of interactions with others that are problematic.
• Middle Phase (6-11 sessions): The interpretive work
links CCRT to anxiety, worry, panic, and self-monitoring of
countertransference related to CCRT.
• Termination Phase (12-16 sessions): CCRT is dis
cussed in relation to termination and the internalization
of the analytic function (enhanced capacity for self-
awareness and self-healing).
• Booster Phase (one session per month for three
months): The clinician reinforces the CCRT-related
interpretive work.
She was then able to offer vignettes from each of the
phases to show how her patient — a middle-aged woman
coping with tragic loss — progressed and benefited from
this approach. What struck this listener was the rapidity
with which Tosone clarified the nature of this patient’s
internalized object relations and therapeutically addressed
this with her patient, someone who had had great difficulty
benefiting from past treatment efforts. This culminated in
a very emotionally powerful session in which her patient
re-enacted her son’s sudden, unexpected, and violent death
while being symbolically held by her therapist.
Although it was not a simple matter in any respect
to shift gears, Tosone was able to next talk about other
approaches one might usefully employ in such cases,
including the use of various key cognitive behavioral
techniques such as systematic desensitization. This
listener was further impressed by Tosone’s evenhanded
presentation of these other approaches — she was able to
highlight the benefits of other ways of addressing anxiety
disorders even after offering a very compelling illustration
of the approach she herself had chosen to take. She could
have easily used her case to criticize other ways of working
but did not do so, something which seemed to leave the
audience in the right frame of mind to think about the
relative value of the many different ways one might look
at the suffering of an anxious person and what one might
decide to do about this suffering.
Following her presentation, the engagement and enthu
siasm of the audience was apparent as Tosone responded
to the questions and comments of conference attendees
together with Dr. Jerome Wakefield, who had earlier talked
about the mislabeling of normal sadness as a depressive
disorder in his keynote presentation.
Meeting the Challenge of Working with Anxiety and Mood Disorders
Education Committee:
(Left to Right) Meryl G. Alster, Susan A. Klett, Tripp Evans,
Gail Grace, Ashanda S. Tarry, and Gildo Consolini
Photo this page and opposite: Sandra Indig
10 The Clinician
New York State Society for Clinical Social Work 40th Annual Education Conference | May 2, 2009
O u t o f S o rt s :
D
r. Jerome Wakefield Ph.D., DSW, discussed his work
focused on the conceptual foundations of the mental
health professions, especially the concept of men
tal disorder and the validity of DSM diagnostic criteria.
Wakefield is a University Professor, Professor of Social Work,
and Professor of Psychiatry, as well as an affiliate Faculty
in Bioethics at the Center for Ancient Studies, at New York
University; and Lecturer in Psychiatry at Columbia University
College of Physicians and Surgeons. He is the co-author
with Allan Horowitz of The Loss of Sadness: How Psychiatry
Transformed Normal Sadness into Depressive Disorder, which
was named the outstanding psychology book of 2007 by the
Association of Professional and Scholarly Journals.
The book’s central thesis is summarized nicely in the
forward of the text: “[C]ontemporary psychiatry confuses
normal sadness with depressive mental disorder because it
ignores the relationship of symptoms to the context in which
they occur.” Artfully integrating stories, literature, humor
and statistics, Wakefield explored the consequences of this
shift in thinking and how it relates to the social work field and
society in general.
He explained that social work professionals are at risk
of being squeezed out of the market due to other views and
ideologies. Historically there has not been a social work rep
resentative present at the discussions for DSM IV. The DSM
V task force does not contain a social work representative.
DSM V is looking at diagnostic criteria which may possibly be
changed. Wakefield stressed that social work should keep its
eye on this and make a commitment to voicing its concerns,
and being actively engaged in this process for DSM V and
diagnosis in general.
He believes there are some conceptual problems distin
guishing normal sadness from depressive disorder, arguing
that making this distinction helps us better understand our
patients and what they are going through. How a patient gets
classified impacts the treatment they receive. The presenta
tion highlighted the skyrocketing diagnosis of depression and
how it has become by far the most common diagnosis today
in both psychotherapy and psychiatry. Statistics from the
CDC were presented that showed 11% of women and 4% of
men are on antidepressant medication. Advertisements for
depression stress that, if you are “out of sorts,” depression is
the cause and medication is the answer. The ads tell people
to call their general practitioner, not their psychologist or so
cial worker, and the pharmaceutical companies use ads that
list symptoms almost anyone can identify with. Distinctions
between what is intense normal sadness versus depressive
disorder have not been made clear in diagnosis. There is a
cultural tidal wave with depression replacing anxiety as the
“diagnosis du jour.” This is big business! As psychotherapy
rates go down, psychopharmacology rates go up.
How do you know when it is depression versus intense
normal sadness? The nuances in how people respond to
sadness are the key. Wakefield cited some of the thinking
historically about melancholia versus depression. Freud
distinguished grief from melancholia; melancholia was seen
as more pathological. This type of categorizing goes back
to Aristotle, Hippocrates, Kreapelin and Freud. Wakefield
went into some of the historical views on depression and
compared these to the current diagnostic criteria. It is only
recently that diagnostic criteria do not make distinctions for
cause and effect relationships.
Wakefield then pointed out that DSM IV said complicated
grief involved mourning that lingered beyond two months
following the loss of a loved one (no distinctions are made
for other types of losses); any sadness prior to that two
months was uncomplicated or normal grief. But what about
people who lose a valued job, significant relationship, loss of
status, loss of financial security, and physical illness — can’t
all of these cause people to feel sad? Could these people be
Keynote Presentation by Jerome Wakefield, Ph.D. / Review by Gail Grace LCSW-R
The Loss of Sadness:
Is Normal Sadness Being Mislabeled as Depressive Disorder?
Gail Grace, LCSW-R, Certified Psychoanalyst, NYSSCSW Education Committee, Part-
Time Social Worker Maternal and Child Health North Shore University Hospital, Private
Practice, Manhasset, New York.
Fall 2009 11
Meeting the Challenge of Working with Anxiety and Mood Disorders
labeled as “depressed?” It was pointed out that often, over
time, these situations eventually resolve and the depression
lifts. Most depression can be connected to life events and
resolves over time, but these distinctions are not currently
made when diagnosing for depression. Clinicians making
these distinctions can help determine what kind of approach
would be most appropriate.
Wakefield weaved in some stories that helped further
illustrate his theme. One such story he was from 150 A.D.,
when Aretaeus of Cappadocia made the distinction between
normal versus “without cause” depression. The story was
about a young prince who
became depressed. The king
called in a great physician
from another land to evalu
ate the prince. The physician
“talked” to the young prince
and discovered that he was in
love with a woman from the
court, a consort of his father
(Wakefield joked, “all Oedipal
issues aside”). The young
prince had made an overture
that was not responded to
and following this rejection
he had become depressed.
The physician made a distinction — this was not depression
but unrequited love — and counseled the prince on how to
speak to the young lady. The prince was able to talk through
his problems with the physician, eventually speaking to the
young woman, expressing himself and gaining her affections.
The talking and the behavioral changes he made helped
resolve his depression.
Historically, depression has always been evaluated by
looking at the emotional response and whether it was in pro
portion to what was going on in the person’s life. If it was not,
it was seen as pathological. Look at the environment and see
if there has been some major loss. If so, then assume it will
eventually right itself. In depressive disorder, there is often
not an environmental trigger, or the depressive response is
not in proportion to the loss.
In all cultures, certain situations contribute to sadness.
For example, subordination, inferior status in your group,
a sense of being trapped (in a job, marriage, country), or
loss of a valued project, all of these can impact mood. But,
Wakefield cautioned, if we create a society of people seeking
to get rid of the feelings these situations generate, what do
we lose? Do we distance ourselves from these very important
feelings? What are the implications? How will this affect the
relationships in our lives? Is this creating a culture of people
who cannot tolerate negative emotions? The presentation
cited research after 9/11 pointing to rates of depression
rising, but eventually normalizing over time without a spike in
patients seeking more mental health services.
Wakefield said that all of this impacts how we think about
our clients, and how we think about clients’ needs to be more
specified. He cautioned that some people respond more
intensely to loss than others, but he stressed this can at
times be seen as an evolutionary response to what is going
on in the environment. The relationship to the environment
is “cause and effect” and DSM does not make these distinc
tions. The DSM has no clause for the symmetry or asymmetry
of the symptom to the environment. Psychiatry has asked us
not to make these distinctions.
Wakefield asked, “Can you deal with these symptoms
in other ways than medication?” Think of the prince who
simply needed to talk. The DSM has an enormous impact
on how we see our patients. Many adolescents could meet
criteria for MDD, but would we want to put all of them
on medication? What are the implications of diagnosing
depression as a “syndrome?” He stressed the importance
of psychotherapeutic interventions such as CBT, dynamic
therapy, behavioral therapy, looking at people’s relation
ships, and he said he feels that the DSM should list other
circumstances/stressors and treatments other than medi
cation that can help when diagnosing depression. These are
the types of services we provide as social workers.
In conclusion, Wakefield highlighted the need to make
distinctions between biological versus “meaning-based”
depression. What are normal responses versus abnor
mal responses? How is the person coping with the loss?
Clinicians need to make room for all possibilities when
thinking about their patients.
Jerome C. Wakefield, Ph.D.
12 The Clinician
Brooklyn Chapter
Carol Kamine-Brown, President
On March 22, 2009, the Brooklyn Chapter held a
special educational/networking event (including
a sumptuous brunch) on The Fee: a Clinical Tool
in Therapy, resolving conflicting feelings about
therapy practice being a business.
The speaker, Shoshana Ben-Noam,
Psy.D, CGP, FAGPA, is a national presenter
in the areas of group therapy, trauma and
money matters. She is on the faculty of Pace
University, the Eastern Group Psychotherapy
Society and the Training Institute for Mental
Health in New York City. She is also a guest
editor of the Group Journal on Trauma and
Group Therapy, and the recipient of the
American Group Psychotherapy Association
2007 Affiliate Societies Assembly Award. Ben-
Noam is a psychoanalytic psychotherapist in
private practice in New York City.
She presented the following issues. Money
is transactional, interpersonal and symbolic.
It is a taboo topic in many cultures, often
evoking powerful feelings. Its symbolic
meanings are shaped by cultural, religious
and familial beliefs and attitudes. In therapy,
setting and collecting fees may trigger feelings
such as anger, jealousy and greed, both in
patients and therapists. To gain insight into
these feelings, the money taboo has to be
lifted, and money matters have to be openly
discussed. A clear fee and billing policy
has to be presented to patients, and policy
violations have to be therapeutically explored.
To effectively do so, therapists need to work
through any discomfort about discussing
money matters, and resolve conflicting feelings
about a therapy practice being a business.
The presentation was well received by the
group, and a lively discussion ensued.
Mid-Hudson Chapter
Rosemary Cohen, President
The Mid-Hudson Chapter is pleased to an
nounce the addition to its chapter interactive
listserv of Society members from the Albany,
Capital District Area; and the northern and
western areas of New York State, among
them from cities such as Ithaca, Fayetteville,
Saratoga, Syracuse, and many other towns and
cities in the state. The new listserv name is
Hudson Valley and Upstate. Our new listserv
e-mail address: nysscsw-hudsonvalley-and-
upstate@yahoogroups.com
At our chapter workshop this past winter
and in July in San Francisco, at the ICAPP-CSW
(International Conference for the Advanced
Professional Practice of Clinical Social Work,
Carolyn Bersak, DSW, a former Mid-Hudson
Chapter president and current chapter board
member, presented her workshop on her
innovative clinical treatment for couples, “The
‘Fatal’ Counter-Transference or, The Therapist
and the Triangle.”
The all-chapter Clinical Study Group read
The Center Cannot Hold, by Elyn Saks for
discussion following the September chapter
board meeting in Milton. On October 3, Ron
Robbins, Ph.D. will present his workshop,
“Fear and Panic: Rapid Treatment Methods
for Change.” He will introduce the Rhythmic
Integration (RI) developmental change model
and the results of the Rhythmic Integration
Panic Research Project, which he has di
rected since 1999. On January 9, 2010, Shelley
Tatelbaum will present her workshop on
“Bereavement and Grief.”
Queens Chapter
Fred Sacklow, President
The Queens Chapter held monthly Board
meetings and monthly educational presenta
tions from September 2008 to June 2009. We
are ready again to follow up on a busy and
meaningful past season with meetings and
presentations this season. We meet monthly
at Holliswood Hospital, which is centrally
located and easily accessible. Refreshments
are provided.
We will be meeting on the following dates
9/13, 10/18, 11/22, 12/13, 1/24/09, 2/28, 3/21,
4/18, 5/16, 6/13.
After the Board Meeting, we have a net
working break from 11:00 to 11:30 am. We then
have an educational presentation from 11:30
am to 1:00 pm. Our attendance is good and the
experience is lively and involving. Our board
members are involved in State committees
and we actively support State initiatives to
promote clinical social work.
Questions and comments can be
referred to Fred Sacklow, LCSW at Freds99@
aol.com or 917-747-3316.
Staten Island Chapter
Mary Fitzpatrick, President
We have had an interesting, educational and so
cial year. We had eight Chapter meetings hosted
by members where we welcomed old and new
members, and benefited from presentations
about treatment modalities and treatment-
related topics.
Among the presentations: “A Group
Therapy Approach to Mid-life Issues,” Michael
DeSimone Ph.D.; “Saying Goodbye to an Eating
Disorder,” Louise Parente, Ph.D.; “Coping with
Hopelessness and Helplessness in Patients,”
Dennis Guttsman, LCSW; “Individual and Group
Treatment Modalities with Suboxone Patients,”
Karel Angell, Ph.D.; and, “Introduction to
Advanced Integrative Therapy,” Glenn Soberman,
Ph.D. Our meetings also keep members informed
about legislative and vendorship issues, as well as
provide networking with colleagues.
We had a large and spirited turnout for our
Holiday Dinner at EsCa. Members and guests
socialized and mixed the personal with the
professional.
In April, we hosted our Annual
Educational Conference at the Staaten.
Laura Arensss Fuerstein, Ph.D., spoke
about her latest book, My Mother, My
Mirror, over brunch. Her presentation was
a thoughtful and engaging perspective on
the mother/daughter relationship. She
examined self esteem and body image and
how messages about them are transmitted
through generations. She offered insights
and ideas on breaking the cycle in your
relationships and in your own parenting.
Her case material was moving and elicited
many questions and comments.
Our chapter will began its cycle of Sunday
meetings on September 27th. For informa
tion, you may contact our President, Mary
Fitzpatrick, LCSW, at 917-882-9118 or
fitzrodal@aol.com.
Westchester Chapter
Martin J. Lowery, President
The Westchester Chapter’s Annual
Conference continues to be the highlight
of the year’s activities. Last April it at
tracted mental health professionals from
Chapter Reports
BROOKLYN • MID-HUDSON • QUEENS • STATEN ISLAND • WESTCHESTER
CONTINUED ON PAGE 17
Fall 2009 13
I
n a very lively, theoretically and clinically rich
workshop on November 23, 2008, Susan A. Klett, LCSW,
demonstrated the creative use of her psychoanalytic
self to deepen and enrich a dialectical behavioral therapy
(DBT) approach in treating a patient suffering from a
severe borderline personality disorder. Klett is the chair
of the Society’s Education Committee. She is certified
in adult psychoanalysis/psychoanalytic psychotherapy
and dialectical behavioral therapy (DBT). She is faculty,
supervisor and training analyst at Washington Square
Psychoanalytic Institute, and faculty of The Psychoanalytic
Institute, Postgraduate Center for Mental Health. She has a
private practice in Manhattan.
Throughout her presentation Klett adeptly integrated
different schools of thinking from an eclectic approach.
To better understand a severe borderline patient and
to effectively employ DBT techniques, she utilized
Freudian, self psychology, intersubjective, and relational
theories. Emphasis was placed on object relations and
developmental perspectives. Klett shared her thought
process when faced with her patient’s self destructive
enactments. It was evident that reflection on infant
research findings related to attachment theory, affect
regulation and, neuroscience has facilitated her ability to
persevere in providing a strong containing and holding
environment for her tormented patient.
The product or object of a creative process, whether it is
a work of art or a session in the practice office, usually has
a recognizable outcome, i.e., the patient who has resolved a
troublesome issue, the actor who is called back for multiple
curtain calls, etc. However, it is almost impossible to say with
any great certainty just how that outcome was accomplished.
In this case, we were invited to hear how the therapist
engages in the creative process in her treatment of her
patient (hereafter referred to as JR). As evident in the case
material presented and discussed, Klett breathed life into an
extremely structured, perhaps by some standards, rigid and
codified system for altering negative behavior in borderline
patients. She generously shared with us, but was not limited
by, the creative, innovative approach of Marsha Linehan,
Ph.D. (the creator of DBT), for treating BPD.
We were provided with a hand tailored booklet which
contained a definition of borderline personality disorder,
the differential diagnosis, and a biography of Marsha
Linehan, an overview of DBT, and the psychoanalytic
comparisons discussed throughout the paper. An extensive
biography and list of resources for patients seeking
DBT treatment was included. Best of all was a chance for
us to look at and respond to a copy of The Skills Training
Manual for Treating Borderline Disorder Personality
(workbook) by Marsha Linehan (1993, The Guilford
Press) which is used to provide homework assignments
and step-by-step instructions for running DBT groups.
Klett emphasized the importance of good training and
supervision when running a DBT group and working
individually with the borderline patient.
A very succinct definition of DBT was given. Linehan
had analyzed each aspect of the borderline’s behavior
and developed a systematized and integrated approach to
target each of them. She skillfully blended psychotherapy,
Zen philosophy, CBT, and the use of dialectics, along with
skill training for distress tolerance, affect regulation,
interpersonal effectiveness and core mindfulness.
By way of information and/or review, we went over some
key concepts, including the fact that The Diagnostic and
Statistical Manual of Mental Disorders (fourth edition)
defines Borderline Personality Disorder: 301.83 as “a
pervasive pattern of instability of interpersonal relationships,
Tolerating and Containing through Creative Application of Learned and
Intuitive Skills: A Dialectical Behavioral Therapy (DBT) Approach
Presentation by Susan A. Klett, LCSW / Review by Sandra Indig, LCSW, ATR-BC, Committee Chair
Arts and Creativity in Clinical Practice Committee
Sandra Indig, LCSW, ATR-BC, is chairperson of the Arts and Creativity in Clinical
Practice Committee. She is: an exhibiting painter and member of the Abingdon Square
Painters, performs with Dances for a Variable Population, on staff and writes for the
E-Zine, Manhattan Arts. She maintains a private practice in Manhattan.
CONTINUED ON NEXT PAGE
14 The Clinician
self-image, and affects, and marked impulsivity beginning
by early adulthood and present in a variety of contexts, as
indicated by five (or more) indicators.”
Klett stressed the importance of exercising caution
when diagnosing a person with a borderline personality
disorder. Referring to the DSM I-V (p.653): This disorder
often, but does not always co-occur with mood disorders.
A clinician must be sure to investigate whether the
behavioral pattern has an early onset and long standing
course in order to diagnose appropriately. The most
common misdiagnosis occurs with histrionic, schizotypal,
paranoid, narcissistic, antisocial and dependent
personality disorders, because of an overlap of some
personality features.
From here on, we will review some salient points
gleaned from Klett’s discussion of her patient. Throughout
a heart wrenching and difficult “story”, reference was made
to the psychoanalytic concepts, supporting techniques, and
treatment strategies utilized in this case.
JR was referred to Klett following her unsuccessful
suicide attempt after her prior therapist refused to take
her back. The first session begins with dialogue loaded
with feelings of tension, anxiety and restrained rage,
reminiscent of Ingmar Bergmann’s Persona. A Kleinian
might say that murder is in the air. We shadow Klett as she
stays closely attuned to JR, listening with even hovering
attention as she assesses JR for suicidality, challenges her
level of commitment, covers and explores her feelings of
terminating with her prior therapist. We gain a succinct
snapshot of her internalized object relations and her
early attachment style. Klett closes the first session
with JR contracting for safety and signing of a DBT
working agreement.
The second session with JR consists of taking a thorough
history. Point by point, it was a powerful illustration
of Lineman’s Behavioral Patterns in BPD (Cognitive-
Behavioral Treatment of Borderline Personality Disorder
(book) p.10, Guilford Press.)
The clinical case material covered in the meeting
clustered around six descriptors identified by Linehan:
1) Emotional vulnerability
2) Self-invalidation
3) Unrelenting crises
4) Inhibited grieving
5) Active passivity
6) Apparent competence
The patient’s family and developmental history appeared
to stir up feelings of distress and general discomfort in
the participants. There was increased squirming, facial
grimaces,and general unrest. That history revealed exposure
to a pervasive, invalidating environment and biological
loading for emotional dysregulation. JR has a history of
major depression and bulimia which transitioned into an
eating disorder of restricting her diet at age thirteen.
JR reported hating her developing body and having a strong
need to control it. Her history consisted of multiple suicide
attempts and self mutilation, at times, severe mutilation,
sadistically imposed upon herself as the victim of her own
self inflicted torture. JR had vague episodic memories of
her childhood and adolescence which raised the question
of exposure to trauma. She described her early relationship
with both caretakers; her father was unpredictable, his
impulsive temper resulted in her experience of her home as
a chaotic environment. JR recalls reacting by curling up in a
ball beneath her blankets, hiding in fear and vomiting during
points of tension throughout her childhood. Her environment
never felt safe, she reported that her father was sexually
inappropriate. She described her parents relationship as
cold and distant. JR believes that her mother is narcissistic,
she reports that her mother always made her feel like
a burden. While JR states that both of her parents were
very critical and verbally abusive, she denies any history of
familial sexual or physical abuse. JR’s portrait of her parents
character structure/personality provides insight into her
emotional vulnerability.
No discussion would be complete without asking what
happened in the sessions following the therapist’s vacation.
JR’s reaction was expectable, none the less shocking in
its severity and, I might add, repulsive for some to hear
described. Borrowing from the self psychology vernacular,
the rupture and repair process, while stormy, constituted
a pivotal point in the treatment. The following session
illustrates the use of DBT in action. Klett reported that
the patient arrived in her office following a recent self
mutilating episode on her first day back from her vacation.
In session Klett encouraged patient to express her
feelings in hopes of releasing her anger and inhibited
grieving. JR was defended, resistant to engage in
exploration of feelings.
Following this session JR’s behavior was discuss with
the DBT team, and an addendum was added to patient’s
contract, whereby, she would not be seen if she arrived
after a self mutilating episode other than for ten minutes,
Arts and Creativity in Clinical Practice Committee
Fall 2009 15
CONTINUED FROM PREVIOUS PAGE
for an assessment on whether she should be hospitalized.
During the following session, therapist revisited JR
therapy interfering behavior (self mutilation) and discussed
this decision with RJ. She responded with rage against
this limit setting. RJ felt like a victim, reporting that when
she needed therapist the most, she would be turned away.
Klett discussed “observing the limits” and informed JR that
there were limits to what she could tolerate. In reaction,
RJ devalued therapist, perceiving her as weak and limited.
Klett challenged her thinking, as setting limits requires
self respect, self awareness and strength. She continued
confronting JR’s maladaptive interpersonal behavior.
While JR reported turning anger toward herself, she
also spoke of self injury as a way to show her parents
how much pain she was in and the damage they caused
her. Klett validated patients’ biological loading, having
difficulty regulating intense emotions and receiving relief
from self injury, however, she also confronted patient’s
aggression toward her, by exposing her to raw bleeding
wounds with intent of evoking guilt. Klett questioned JR’s
ability to separate her self from others, as when she is
angry with someone, she turns the anger toward herself
and back at that person, accusing the person of causing
her self damage. Klett encouraged patient to articulate
her pain, as she had in prior sessions and through the use
of a behavioral chain analysis. Therapist disclosed her
subjective experiencing of patient, who often appeared as
two separate persons (addressing her splits and increasing
her awareness of this ego
defense) One that wants
to get better and one
that wants to remain ill.
This led to exploration of
patient’s fear of getting
well.
Klett spoke of not
tolerating the JR’s
unhealthy self attacking
her healthy self.
In time, JR began to
demonstrate cognitive
restructuring and
developmental progression
in her ability to synthesize
good and bad aspects
in herself, others and
situations. There has
been a marked decrease
in her splitting between
staff members. She
demonstrates a more
cohesive sense of self and
began setting boundaries
herself in relationship
outside of session for
the first time. Klett no
longer experiences JR’s
split selves (in the room)
the one intent on self
injury/destruction and
the half who seeks help,
SCHEDULE OF MEETINGS 2009/2010
October 4 – Gloria Robbins, LCSW, BCD
“Ego in Motion: Examining Patterns of Ego Structure in Child’s Play”
November 8 – Gary Prottas, LMSW, LP
“Containment of Trauma and Shame with Survivors of Sexual Abuse”
January 24 – Hilary Ryglewicz, LCSW
“Color Me Green: Using Graphic Metaphors in Dialectical Behavioral Therapy
Related Group Work and Other Therapies”
March 28 – Roberta Ann Shechter, DSW, LCSW
“Source Material of the Writer: Reflections on Jane Austen”
May 16 – Bryan Hazelton, LCSW,CASAC,BCD
“Embracing Empathy Through the Use of Imagination in Treatment”
Where and When:
Sundays from 11:00 am to 12:30 pm
130 Fifth Avenue, Suite 900 (by 18th Street)
Please call Sandra Indig to verify address and to reserve a seat:
212-330-6787
Chair: Sandra Indig, LCSW, LP, ATR-BC: 212-330-6787, psych4arts@hotmail.com
Committee: Joy Sanjek, LCSW: 646-469-9733, joyoveranger@bigplanet.com;
Sema Gurun, LCSW: 212-982-2489, gurunsema@verizon.net;
Bryan Hazelton LCSW, CASAC, BCD: 516-678-4079, Klynnworks@aol.com
THE ARTS AND CREATIVITY IN CLINICAL PRACTICE CALENDAR
New York Sate Sociey For Clinical Social Work
CONTINUED ON NEXT PAGE
16 The Clinician
Arts and Creativity in Clinical Practice Committee
CONTINUED FROM PREVIOUS PAGE
completing all homework assignments and never missing
a session.
After 18 months of treatment JR now enjoys
contributing to Intensive Personality Disorder Program,
this contradicts her negative self talk that she is
worthless. JR struggles to break her behavioral pattern
of self invalidation, one way she validates her self worth
has been by contributing to our learning. She has provided
a list of DBT skills training sites on line and has critiqued
each one, she also provided therapist with an anagram of
DBT techniques (which Klett has photocopied and passed
out to the audience) Klett continues to validate patient,
who has begun to smile and at time to laugh, referring
to her favorite DBT concept of “Radical Acceptance”
and “Making Lemonade out of Lemons”.
A thoughtfully applied DBT approach with JR, the
interpretation and relationship to therapist has led to
a transformative experience. The timing, listening to
self and patient on multiple levels simultaneously led to
uncovering and working through of JR’s uncontrollable
rage. JR’s ability to experience increased self awareness
and ego strength was, I believe, due to empathy on the
part of both therapist and patient, an awareness of her
undifferentiated self state, and the recognition of a strong
need for boundaries. In treatment JR was offered the
experience of a reliable, consistent object which had
contributed to her ability to separate and to experience
the continuation of a relationship without loss of the
object. She developed object constancy and the ability
to contain her own frustration.
A sense of closure was offered through Klett’s generous
disclosure of her own countertransference. Reference to
Winnicott’s paper on “Hate in the Countertransference”
helped to normalize feelings stirred up in most thera
pists when working with psychotic, severely disturbed
borderline patients with self injurious behaviors. The nega
tive transference expressed by enactment in the treatment
was discussed. Participants were encouraged to share their
own countertransferences.
The excellent quality of sharing and having, as a
group, come through participating in a very meaningful
event seemed to have energized us. It was especially
encouraging for those of us interested in receiving training
in DBT to learn that it is used in private practice as well
as agency settings. After one to two years at the most
of DBT in an out-patient hospital setting, a patient such
as the one discussed could conceivably be transitioned
to (out of hospital private practice or clinic setting) for
psychodynamic psychotherapy.
Sandra Indig, LCSW, ATR-BC, is chairperson of the
Arts and Creativity in Clinical Practice Committee. She is:
an exhibiting painter and member of the Abingdon Square
Painters, performs with Dances for a Variable Population,
on staff and writes for the E-Zine, Manhattan Arts.
She maintains a private practice in Manhattan.
Editor’s Note
Our last issue featured Part 1 of
“Borderline or Bipolar?”
by Brian Quinn, LCSW, Ph.D.
Part 2 will appear in the
Spring 2010 issue
“It was especially
encouraging for those of
us interested in receiving
training in DBT to learn
that it is used in private
practice as well as
agency settings.”
Fall 2009 17
far and wide to a presentation by Dr. Sue Johnson,
co-founder of Emotionally Focused Therapy (EFT), titled
“The New Science of Love and Bonding: A clinical map for
couple therapy.” We are grateful to the volunteer commit
tee for putting together such a rewarding day.
The monthly meetings of the chapter on the first
Saturday of each month from September to June continue
to strengthen our supportive bonds and advance our skills,
from the special interest group meetings that start the
day to the educational presentations that end it. The last
presentation of the year, as an example, was by Marin
London, LCSW, CEAP, titled “Web Secrets for Clinical
Social Workers.” In an engaging and challenging way, she
helped us leap into the 21st century, so to speak, by opening
up the Internet and the new media as a way to enhance
our individual private practices and our visibility as an
organization. The most immediate use of the Internet is the
Chapter Listserv, which facilitates ongoing communication,
providing an opportunity for exchanging information
and making referrals. As we gathered this September to
begin a new year, we looked with particular interest to the
Membership Development Committee, one of the various
committees that support our efforts at strengthening our
identity, fostering networking, promoting expertise and
advocating for clinical social work. The Committee’s role
in attracting and retaining members is key to growth for
the year. Thanks to all who have volunteered to make the
Westchester Chapter what it is.
Chapter Reports
CONTINUED FROM PAGE 12
Continuing
Professional
Education
2009-2010
A unique series of workshops on key clinical issues and
controversies with leading contributors in the field.
Susie Orbach
The False Body and The Significance of the Therapist’s Body
Saturday, October 3, 2009 10 a.m. to 3 p.m.
Robert Bosnak
Embodied Imagination: Exploring Creative Imagination Through
Dreams
Saturday, November 14, 2009 10 a.m. to 3 p.m.
Christopher Eldredge, MA, LCSW
Relational Psychotherapies, Attachment Theory, Neuroscience
and Body-Oriented Treatments in an Expanding Conversation
Saturday, December 5, 2009, 10 a.m. to 3 p.m.
Ron Balamuth, PhD
The Odd Patient: Relational Psychoanalysis Meets the Asperger
Patient
Saturday, March 20, 2010, 10 a.m. to 3 p.m.
Robert Grossmark
Heterosexual Masculinities in Clinical Practice
Saturday, March 27, 2010, 10 a.m. to 3 p.m.
Donnel Stern, PhD
Partners in Thought: Working with Unformulated Experience,
Dissociation and Enactment
Saturday, April 17, 2010, 10 a.m. to 3 p.m.
To register on-line, visit: www.nipinst.org
and click on ‘Events Calendar’
~~~~~*~~~~~
NIP TI’s 21st Annual Conference
Saturday, May 8, 2010
New York City
Please visit our website periodically for updates
~~~~~*~~~~~
National Institute for the Psychotherapies
Training Institute
250 West 57th Street, Suite 501
New York, NY 10019
Phone: (212) 582-1566
Fax: (212) 586-1272
Web Site: www.nipinst.org
E-mail: Info@nipinst.org
All workshops take place in Suite 501 on the 5th floor at
250 West 57th Street (between Broadway & 8th Avenues)
New York City
CEU Credits offered
Chartered by the Board of Regents of the University of the State of New York
+
18 The Clinician
for advanced clinical training in
Adult Psychotherapy
Adult Psychoanalysis
Child and Adolescent Treatment
NYSPP offers an ego structuring and object relations curriculum
that deepens the craft of Psychotherapy by integrating traditional
and contemporary analytic thinking.
• Small interactive clinically oriented classes, outstanding faculty
integrating supervision, academic work and clinical practice.
• Undertaking of personal treatment to deepen therapeutic
self-awareness.
• Collegial and supportive membership society that fosters
networking, mentoring and continuous professional growth.
• Ongoing intellectual pursuits through an annual program of
seminars and scientific presentations.
• Opportunities for clinical experience through the Institute’s
Referral Service.
THE NEW YORK SCHOOL FOR
PSYCHOANALYTIC PSYCHOTHERAPY
AND PSYCHOANALYSIS
200 West 57th St. NY,NY 10019 212 245 7045
www.nyspp.org - or - www.nyspp.com
Absolute Charter by the New York State Board or Regents
NYSPP
BUILD YOUR PRACTICE AND EARN SUPERVISED LCSW HOURS
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NYSPP
Fall 2009 19
NYFS New York Freudian Society
& Psychoanalytic Training Institute
Two-Year Psychoanalytic
Psychotherapy Program in NYC
To meet today’s career and training
demands, this innovative program of
once-a-week evening classes features:
a curriculum that spans the life cycle
from a developmental perspective
a theoretical foundation in dynamic
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an integration of theory with technique
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distinguished lecturers and
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Free weekly supervision is included in
tuition, and a certificate is awarded upon
program completion.
For more information call
Loretta Hayes at 212-463-8036.
Visit us at www.nyfreudian.org
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We offer programs in:
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Work)zTrauma Program featuring EMDRz
NIP TI are the exclusive editors of the journal,
Psychoanalytic Perspectives, call for a complimentary issue
and subscription information
________________________________________________________
National Institute for the Psychotherapies
Training Institute
250 West 57
th Street, Suite 501, New York, NY 10019
Phone: 212-582-1566 Fax: 212-586-1272
Web site: www.nipinst.org Email: info@nipinst.org
Chartered by the Board of Regents of the University of the State of New York
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We offer:
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involving mentoring with senior faculty
For more information call
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