work psychotherapists, whether we have
a special interest in psychoanalysis, grief
counseling, EMDR, or marriage and family
therapy. There are nearly 26,000 LCSWs
in New York State, all potential members,
whose interests we advance and protect.
Ironically, after the passage of the
licensing law for clinical social work
(2002), wherein the function of LCSWs was
explicitly described, confusion grew about
what clinical social workers actually do and,
consequently, whose interests the Clinical
Society should represent. Many social work-
ers believe that any direct contact with a cli-
ent/patient is a clinical intervention. If one
subscribes to this belief, then the mission
of our organization could expand to include
T
his we already know: the practice of
social work is more than 100 years old
and highly diversified, across many
settings, across several levels of education,
and many areas of interests. One-eighth of
all the social workers in the United States
live here in New York State. We, the mem-
bers of the NYSSCSW, are a self-selected
group of clinical social workers within this
very large profession. We are not defined
by the setting we work in; rather we are
defined by our interest in and/or our exper-
tise in mental health and the treatment of
mental illness with all its derivatives and
nuances. Our knowledge base draws from
distant as well as allied professions, from
psychiatry and sociology to spirituality and
the creative arts. We are the clinical social
president’s message
My Work on the State Board
By Jonathan Morgenstern
T
he mission of the State Board is to
coordinate statewide activities and
insure that the Society is meeting its
purposes, which include:
• Establishing and maintaining high
standards of professional education
and practice
• Promoting post-graduate and/or advanced
training in clinical social work practice,
IN THIS ISSUE
4 Annual Membership Meeting
6 Inaugural Art Exhibition
8 Electronic Billing
14 42nd Education Conference
Continued on PAGE 12
Continued on NEXT PAGE
TH E N EWSLETTE R OF TH E N EW YORK STATE SOCI ETY FOR CLI N ICAL SOCIAL WORK, I NC.
FALL 2011 | VOL. 42, NO. 2
At the Annual Membership Meeting in September, Robert S. Berger, 1st VP,
presented a tribute to Dr. Jeffrey Seinfeld. Dore Sheppard, 2nd VP, chaired
the event (see page 4 for report). Photo by Ivy Miller.
At the 42nd Annual Education Conference in May, (l. to r.) Dr. Judith Siegel,
Keynoter; Suzanne Klett, Conference Chair; Jane Hall, Keynoter; and President
Jonathan Morgenstern (see page 14 for report). Photo by Morgan Evans.
Lest We Forget, We Are Clinical
Social Work Psychotherapists
By Marsha Wineburgh, DSW, President Elect
TWO SUCCESSFUL EVENTS: MEMBERSHIP MEETING and EDUCATION CONFERENCE
2 The Clinician
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NEW YORK
STATE
SOCIETY
FOR
CLINICAL
SOCIAL
WORK,
INC.
President’s Message
Continued from PAGE 1
teaching, administration and
research
• Collaborating with other social
work and clinical social work or-
ganizations in order to address is-
sues of mutual concern, to further
our common goals and to provide
a voice for clinical social work
• Informing the general public of the
specialized skills of clinical social
workers
• Protecting the rights of clinical social workers to practice
that for which they are trained.
Four years ago, I was entrusted with the role of seeing
that the Board does what the membership has entrusted it
to do. I assumed this role with the goals of strengthening the
Society’s administrative structure and its communications.
I had assessed the status of the Society’s administra-
tive support services and concluded that over time its
needs had changed and grown to the point of requiring a
change. Mitzi Mirkin, who had been the Society’s consulting
secretary, retired and after a process that included consid-
eration of alternatives, a search, and a selection process,
the Board retained Total Management Solutions to provide
all administrative services for the Society. Its most visible
face is our Administrator, Sheila Guston, who is supported
by Robin Cybulski, Administrative Assistant, who is the first
voice you hear when you call the Society’s number. We have
also benefited from the services of Debra Guston, Sheila’s
daughter, who has provided significant support, albeit in
the background. I am pleased to report that the transition
was made successfully and TMS not only provides us with
updated and strong support services but has also contributed
original suggestions that have been considered and accepted
by the Board, leading so such services as the Career Center
on our website.
The Society’s finances had previously been reorganized
by the past president, but it became necessary to revisit the
process of preparing the annual budget and the structure of
financial reporting to the Board, the state committee chairs,
and the chapter treasurers to insure fiscal responsibility, to
see that there were adequate funds to provide services to
the membership, and to maintain a balanced budget. TMS as-
sumed bookkeeping services and capably reorganized them
so that all expense requests have been efficiently processed
and paid; members no longer wait extended periods of time
to be reimbursed.
Published twice yearly by the
New York State Society for Clinical Social Work, Inc.
243 Fifth Avenue, Suite 324, New York, NY 10016
Website: www.ClinicalSW.org / Tel: 1-800-288-4279
Ivy Miller, Newsletter Editor
301 East 45 Street, Apt. 8d, New York, NY 10017
E-Mail: IvyMiller@hotmail.com / Tel: 917-620-3460
Helen Hinckley Krackow, Newsletter Chair
Ad Deadlines: February 15 and October 1
State Board Members 2011
STATE EXECUTIVE COMMITTEE
President
Jonathan Morgenstern, MSW, MED, MA, LCSW MjonathanM@aol.com
President Elect
Marsha Wineburgh, MSW, DSW, LCSW, BCD mwineburgh@aol.com
First Vice President
Robert S. Berger, PhD, MSW, LCSW rsb111@columbia.edu
Second Vice President
Dore Sheppard, PhD, MSW, LCSW doreshep@yahoo.com
Treasurer
Helen Hinckley Krackow, MSW, LCSW, BCD hhkrackow@aol.com
Board Secretary
Elizabeth Ojakian, MSW, LCSW e08@nyu.edu
CHAPTER PRESIDENTS
Manhattan (Met)
Ariane Sylva MSW, PhD, LCSW drsylva@drsylva.com
Mid-Hudson
Rosemary Cohen MSW, LCSW rosemarycohen@gmail.com
Nassau
Lorraine M. Fitzgerald MSW, LCSW lorraine@grieflistener.com
Queens
Fred Sacklow, MSW, LCSW freds99@aol.com
Rockland
Beverley Goff MSW, LCSW bevgoff@optonline.net
Staten Island
Mary FitzPatrick, MSW, LCSW fitzrodal@aol.com
Suffolk
Sandra Jo Lane MSW, LCSW sjlsunshine@aol.com
Westchester
Jody Porter, LCSW (Interim Contact) jodyp100@aol.com
MEMBERS-AT-LARGE
Metropolitan
Chris Farhood, LCSW chrisfarhood@yahoo.com
Mid-Hudson
Roberta L. Faulk, MSW, LCSW srfaulk@juno.com
Nassau
Linda Wright, MSW, LCSW lwrightlcsw@aol.com
Rockland
Monica Olivier, MSW, LMSW Mo444@nyu.edu
Westchester
Sheldon Blitstein, MSW, LCSW sabhidhammab@optonline.net
COMMITTEE CHAIRS
Annual Education Conference Susan A. Klett, LCSW-R, BCD suzannneklett@aol.com
Creativity & Transformation
Sandra Indig, LCSW, ATR-BC psych4art@hotmail.com
By-Laws
Beth Pagano, MSW, LCSW bethpagano678@msn.com
Chapter Development
Helen Hinckley Krackow, MSW, LCSW, BCD hhkrackow@aol.com
Disaster Preparedness
Fred Mazor, DSW, MSW, LCSW, BCD fredm25@aol.com
Ethics & Professional
Standards
David Phillips, DSW, LCSW dgphillips@nyc.rr.com
Independent Practice
Sheila Peck, MSW, LCSW sheila2688@aol.com
Leadership
Beth Pagano, MSW, LCSW bethpagano678@msn.com
Legislative
Marsha Wineburgh, DSW, LCSW mwineburgh@aol.com
Listserv Committee
Robert S. Berger, PhD, MSSW, LCSW rsb111@columbia.edu
Mentorship & Peer
Consultation
Helen Hinckley Krackow, MSW, LCSW, BCD hhkrackow@aol.com
Newsletter
Helen Hinckley Krackow, MSW, LCSW, BCD hhkrackow@aol.com
Nominations & Elections
Beth Pagano, MSW, LCSW bethpagano678@msn.com
State Membership
Shannon Boyle, MSW, LMSW shannonboyle@hotmail.com
Strategic Planning
To be announced
Vendorship & Managed Care Helen T. Hoffman, LCSW helenhoffman@verizon.net
Jonathan Morgenstern,
MSW, LCSW
Fall 2011 3
Our Treasurer, Helen Krackow, and our Finance Committee Chair, Shannon Boyle,
have helped the State Board and committee chairs gain a better understanding
of the Society’s budget and how to more effectively manage its finances. It is this
process that allows me to state that your dues are being spent in accordance with the
Society’s purposes and goals. The Society’s growing needs have also required differ-
ent accounting services and a more suitable accounting company has been retained.
The management infrastructure of the Society took a huge step forward through
the work of the Strategic Planning Committee (SPC), under the leadership of Judy
Crosley, who earlier this year relocated to New Hampshire. Judy coordinated the
work of the Society’s expert consultant, Marian Sroge, who reviewed decades of
State Board meeting minutes and integrated the SPC members’ input on current
policies and procedures for all aspects of managing the work of the Society. This
led to the first-ever-publication of the Society’s Policy and Procedure Manuals,
which now guide every aspect of leadership. This has strengthened not only cur-
rent management but succession, so that new leaders have a structure for learning
and expediting their responsibilities.
The State Membership Committee has been reorganized under the very capable
leadership of Shannon Boyle, and has linked its work to all other activities taking
place across the Society; this has resulted in a congruent approach to membership
development and growth. Currently, there is very active discussion at the State
Board level regarding the following issues that have direct impact on membership
development:
• What is the definition of clinical social work?
• What is the identity of the NYS Society for Clinical Social Work? Are we a
society of and for private practitioners, or do we represent clinical social
workers in all practice settings?
• How may the Society support LMSWs who are seeking to become LCSWs,
given the impact of licensure and the limited access to qualified supervision?
• What does the Society have to offer students in schools of social work?
How may the Society work collaboratively with the schools to strengthen social
work education in general, clinical social work education in particular?
Communications are essential to the life of any organization and are the blood-
lines of the Society. State Board meetings have been reorganized so that relevant
issues are presented, informed discussions take place, motions are made, and
votes are taken on a variety of projects and issues. As a result, the Board has be-
come a better decision-making and action-taking body. Board members and com-
mittee chairs have been strengthened within their roles, have provided valuable
services, and are now better recognized at such events as our Annual Membership
Meeting. The Board’s work is recorded in minutes that are distributed through the
chapter presidents and committee chairs to the membership.
The Society now has an attractive and highly functional website, including a
membership database that provides valuable information that helps create ser-
vices for members and which is used for referrals, and a career center, where jobs
and resumes are posted. Weekly e-mail blasts are sent to the membership with
current information about Society activities. The website is primarily administered
by Robin of TMS; the Society does not incur what are customarily additional costs,
and changes are made in real time.
Robert Berger and the State Listserv Committee have facilitated the develop-
ment of listservs for every chapter and every committee that has requested them.
This has led to enhanced interconnectedness and support of a community of like-
minded peers with referrals, answers to practice questions, and even suggestions
about nonrelated services, including housekeeping services.
A
s I write, the season is beginning to
change and fall is definitely in the air.
To some this means the resumption of
organizational activities. We have had a short
summer hiatus, but have been working on NYS-
SCSW programs throughout.
The Career Center on the Society’s website
was launched just before the summer. A mailing
was sent to all institutions in the State of New
York that might hire clinical social workers in-
forming them of the availability of this means of
advertising open positions. To date, several insti-
tutions have used the site. Additionally, Society
members have the ability to post their resumes
(at no cost) for potential employers to view.
Your headquarters also worked on assist-
ing the Annual Meeting Committee, under the
chairmanship of Dore Sheppard, in putting on a
very successful meeting. The evaluation results
indicate that those in attendance appreciated
the meeting, the venue, as well as the education-
al component. In conjunction with that meeting,
the Creativity and Transformation Committee,
under the chairmanship of Sandra Indig, held an
innovative and exciting art exhibit. There were
13 artists, all members of the Society, exhibiting
their work.
We also have instituted a weekly e-blast that
goes out every Friday to all of the Society’s mem-
bers. It usually includes the latest news from
the various committees, reminders on pertinent
topics and other items of interest.
Additionally, we worked with the Finance and
Budget Chairs to establish a new formula for the
rebates that chapters receive from the State in
order to fund their activities. This rebate was is-
sued to the chapters in mid-September, and now
that we have an equitable formula, will be issued
in August of each year.
The office continues to assist those who
have questions about membership, membership
billing, dues, chapter finances, website updates,
the weekly e-blast , upcoming chapter and State
events and any other Society business. We are
available to help you at any time
Cordially,
Sheila Guston, CAE, Administrator
1-800-288-4279, info.nysscsw@gmail.com
Headquarters Update
Continued on PAGE 9
4 The Clinician
The 2011 Annual State Membership Meeting and
Conference was a memorable and meaningful event:
Memorable in so many ways, including the Inaugural
Art Exhibition showcasing our members’ artworks; the
President’s report by Jonathan Morgenstern, highlight-
ing improvements to our infrastructure, policies and
procedures; the ceremony recognizing our extraordinary
Chapter Presidents; the tribute to our esteemed col-
league, Helen Hinckley Krackow, for 30 years of leader-
ship in the Met Chapter and on the State Board ; and the
presentations by three noted speakers on “Contemporary
Perspectives on Object Relations Theory: Its Relevance
to Private Practice, Agency Work, and Clinical Social Work
Education.”
And meaningful, in that the meeting was dedicated to two
luminaries in the field of clinical social work, Drs. Eda
Goldstein and Jeffrey Seinfeld. Both were distinguished
members of the Society, keynoters at several educational
conferences, and sadly, they both passed away this year.
Several speakers reflected on this profound loss and their
enduring legacies.
The day-long event drew 134 attendees to the 18th floor
conference room of the Hotel Pennsylvania, with panoramic
views of the city. Distinguished guests included Dean Lynn
Videka, BSN, AM, PhD of the New York University Silver
School of Social Work; Dr. Susan Kavaler-Adler, Executive
Director of the Object Relations Institute for Psychotherapy
and Psychoanalysis and an affiliate member of the Society;
and representatives of the National Institute of the
Psychotherapies.
In brief remarks, Dean Videka expressed her appreciation
for being invited and interest in working with our Society to
promote clinical social work, both within NYU and beyond.
She also expressed her sorrow at the loss of Drs. Goldstein
and Seinfeld, and her deep gratitude for their contributions
as faculty members at NYU and leaders in the field of clinical
social work.
Contemporary Perspectives on Object Relations Theory: Its Relevance to
Private Practice, Agency Work, and Clinical Social Work Education
Creativity
Sandra Indig, Chair and Curator of the Inaugural Art
Exhibition, and her committee members arrived early to set
up so that the exhibition was ready for viewing when attend-
ees arrived. She deserves much credit and appreciation for a
masterful organizing job that resulted in a fine art show [see
accompanying article].
Also on display, at a recognition awards ceremony later in
the morning, was the extraordinary creativity of our Chapter
Presidents. In their acceptance speeches, they described
what it takes in energy and resourcefulness to build a
vibrant chapter. Beth Pagano, Chair of the State Leadership
Committee, led the proceedings.
President Elect Marsha Wineburgh presented a tribute
to Helen Hinckley Krackow, Past President, who currently
serves as Treasurer, and chair of the Newsletter, Chapter
Development and Mentorship committees, and is also a
member of the Finance and Strategic Planning committees.
Her contributions to the Society over three decades have
been so numerous, in fact, that Marsha created a special data
analysis system to outline them.
Helen took the podium to express her appreciation for the
recognition and for all the Society has given her. She went
on to present a heartfelt tribute to Eda Goldstein. Eda was
Helen’s consultant, and over the years they worked together
the New York State Licensing Bill committee, among other
efforts, and became close friends. Eda was a uniquely gifted
woman, Helen said, who created an indelible legacy for our
Society and the field of clinical social work.
Robert S. Berger, 1st Vice President, followed with a
tribute to Jeffrey Seinfeld. He spoke about the personal and
professional qualities Jeff possessed that benefitted his stu-
dents and the colleagues he taught, trained and supervised.
“We have lost a brilliant, creative mind; a man with an ability
to ‘think outside the box’ about theory and cases; a man
able to articulate complex concepts in clear, simple, direct
language; a man able to extract and convey the essential es-
sence of a theoretical concept; a man able to get to the heart
of clinical matters,” Robert said.
Honoring Drs. Eda Goldstein and Jeffrey Seinfeld
Annual Membership Meeting and Educational Program
Continued on PAGE 18
Fall 2011 5
september 18, 2011
Report by Dore Sheppard, Chair, State Membership Meeting Committee
Chapter Presidents Honored: (top row) Beverley Goff, Rockland; Lorraine
Fitzgerald, Nassau; (middle row) Sandra Jo Lane, Suffolk; Carol Kamine, Brooklyn;
(bottom row) Ariane Sylva, Met; and Fred Sacklow, Queens. Not pictured are
Rosemary Cohen, Mid-Hudson and Mary FitzPatrick, Staten Island.
Annual Meeting and Conference Committee
(l. to. r.) Leslie Altmark, Dore Sheppard, Chair, Linda Wright and Beth Pagano.
Special Honoree
Helen Hinckley Krackow.
Chair and Curator of the Inaugural
Art Exhibition Sandra Indig.
Speakers Neil Altman and Theresa Aiello.
Photos by Ivy Miller and Sherry Felix
6 The Clinician
1. Sarah Zahnstecher, Met
Chapter, Watercolor and
mixed media
2. Susan Kavelar-Adler,
Met Chapter, Poster of
her books, published
and forthcoming
3. Joan Feredi, Met Chapter,
Photographs
4. Sandra Indig, Met Chapter;
Chair and Curator,
Triptych, acrylic paint on
charcoal paper
5. Helen Krackow, Society
Treasurer, Met Chapter,
Jewelry
6. Beverly Goff, Rockland
Chapter, Crochet layette
7. Betsy Robin Spiegel, Met
Chapter, Stoneware plate
8. Judy Lynn Burns, Rockland
Chapter, Drawings, markers
and pens
9. Susan L. Edlis, Met Chapter,
Photographs
10. Sema Gurun, Met Chapter,
Paintings
11. Toby Seiden, Nassau
Chapter, Intaglio Prints
12. Marsha Wineburgh, Society
President Elect, Met
Chapter, Needlepoint
13. Naomi Miller, Met Chapter,
Painting
8
6
5
4
13
12
11
7
1
9
10
2
3
Samples of Members’ Artwork Exhibited at the Annual Membership Meeting
chair and curator: Sandra Indig, LCSW-R, LP, ATCB
exhibit photography: Sherry Felix. Visit www.ClinicalSW.org for more.
Inaugural Art Exhibition 2011
Fall 2011 7
Committee for Creativity & Transformation in Clinical Practice
Committee Report
by Sandra Indig, LCSW-R, LP, ATCB, Chair
T
here is a time for every season and this appears to be
the season for this committee to expand its scope,
develop ideas, and change some of its traditional
practices. For one thing, we are no longer pre-scheduling our
meetings. Meetings will be announced at least two weeks
before they take place. It was felt that this would allow for
greater flexibility in case of cancellations and the ability to
add speakers as the need or occasion arises. So, let us know
if you have an interest in presenting.
We had planned to start a Writing Workshop this fall, but
due to circumstances beyond our control, we had to post-
pone until, hopefully, the new year. It is something exciting
for us to look forward to and gives us time to hear from more
prospective participants. If you are interested, please contact
the chair or workshop committee members.
We held the “Inaugural Art Exhibition 2011” at the Annual
Membership Meeting and Conference on September 18 at the
Pennsylvania Hotel (see accompanying article). We appreci-
ate those who most generously shared their creative gifts
with us. Special mention goes to Susan Kavaler-Adler for ex-
hibiting a wonderful poster and video honoring the memory
and tremendous contributions of Dr. Jeffrey Seinfeld. Many
thanks are due to Jonathan Morgenstern, President and
Beth Pagano, Chair of By-Laws, Nomination/Elections, and
Leadership Committees, for their unstinting encouragement
in support of making the dream of this exhibit a reality.
WORKSHOP SPEAKERS/PRESENTERS 2011–12
[Schedule to be announced]:
Joy Sanjek, LCSW, Bob Schavrien, LCSW, Susan Kavaler-Adler,
PhD, ADPP, NpsyA, DLitt, George Hagman, LCSW, BCD, Sarah
Zahnstecher, LCAT. Volunteers and interns are needed to
help us continue to explore and present high quality and
frequent opportunities and presentations/workshops to our
society. Last academic year we offered six exciting and well
attended workshops. If you or someone you know would profit
from working with us, please don’t keep it a secret.
WHERE AND WHEN
130 Fifth Avenue, Suite 900, (18th Street is the cross street)
in Manhattan. 11:00 am to 12:30 pm, Sundays. Registration
starts at 10:45 am. Suggestion: Please leave 30 minutes for
evaluation and networking.
Contact: Sandra Indig, Chair, 212-330-6787, to verify address
and reserve a seat; Workshop Committee: Sema Gurun,
212-982-2489 and Joy Sanjek, 646-469-9733.
Objects in the Psychotherapy Environment—
A Dog in Therapy
Presentation by Paul Giorgianni, LCSW
Review by Sema Gurun, LCSW-R, Committee Member
P
aul Giorgianni, LCSW, does not believe in the neutrality of the
analyst’s office. He practices out of his home office, with warm,
character-filled furnishings. He has come to believe that the matrix
of the treatment is not only the analyst and the analysand, but also the
objects of the environment, which indelibly stir the subjective reaction of
the patient. He is aware, of course, that not only do the objects stir these
reactions, but also the words used and the quality of the therapist’s voice.
They can influence the decision of a patient to come to the first session or
continue treatment. Reactions may start before the initial treatment, often
in the anxiety-enhanced preliminary period of voicemail messages before
the initial telephone contact.
In his presentation, “Objects in the Psychotherapy Environment: A Dog
in Psychotherapy,” to the Committee for Creativity and Transformation in
Clinical Practice on March 13, 2011, Paul said, “Wherever our offices are
located, and no matter how they are decorated or maintained, psychothera-
pists find that the aesthetics, including individual objects, elicit transfer-
ential reactions from our patients. Patients often pay particular attention
to how well (or not) these objects look and how they are being cared for.
Sometimes, rather than speaking directly, patients feel more comfortable
using these objects to express how they are feeling on a particular day or
how they feel about themselves, their therapy, or us. They will often identify
with or project their feelings onto these objects as they form attachments
and relationships with both animate and inanimate objects.”
He recalled his training analysis and used his experience within it as a
model of what his patients’ initial reaction to him might be or what they might
be feeling along the way. He was aware that his appearance and the office
setting, where his patients’ selective attention picks up details of objects with
lightning speed, form a primary impression of the analyst in his setting.
He noted that during his first session with his training analyst, he was
seated with his back to a piano, an upright visible only to him at first. He
remembered having a similar piano, and his own feelings about pianos—
that they have a life of their own, a soul—and he was very protective of
them as representatives of himself. He also noticed that his analyst’s piano
had been restored and well-kept. The piano, as an object of transference or
projection, if you will, had already created an immediate positive reaction
to the therapist; Paul thought: since he has taken good care of the piano,
he will also take good care of me.
Paul also recalled his reaction to the clothing his analyst wore one day
when Paul felt certain that his analyst was ill. It was a dark blue cardigan like
the one Paul’s father wore when very ill, a sweater that Paul had given him.
He realized that he thought his therapist was terminally ill when he wore a
blue sweater, having made the connection to his father by his transference.
Continued on PAGE 18
8 The Clinician
Vendorship and Managed Care Committee
By Helen T. Hoffman, LCSW, Chair
I
n May 2011, we invited members of NYSSCSW to answer
an online survey polling them on their experiences with
electronic claims submission or their feelings of readi-
ness to explore it. We asked about resources they found
helpful, about HIPAA and privacy concerns, and about other
issues that might be deterring them from moving in this
direction.
A total of 157 persons completed the survey (Society
membership was approximately 1435.) Responses were
skewed toward “early adopters” of technology in clinical
practice. Considering that some members do not use com-
puters, do not receive electronic communications from the
Society, or do not accept any insurance reimbursement, this
sample probably represents those who are comfortable with
the computer and are at least thinking about whether to bill
electronically. Here were their responses:
• 63% of our sample indicated they were Medicare providers
and most of these said Medicare represented less than a
quarter of their practice.
• 73% indicated they were managed care providers.
• Direct electronic claims submission to an insurance com-
pany: 29% of our sample said they were filing some claims
electronically. (These did not include those billed through
a billing service.) 37 respondents have billed UBH/Oxford/
Optum directly; 21, Aetna; 20, Anthem Empire BCBS; 14,
Value Options/GHI/HIP/Emblem; 10, Cigna; 7, SEIU-1199; 7,
MHN; 5, Magellan; 4, Pomco; and 18, Medicare.
• We asked, “What were some of the difficulties, if any, get-
ting started? Have there been out-of-pocket expenses?”
Of the 52 people who answered the question, 16 said that
there were few or no difficulties. 7 mentioned that owning
a Mac computer made submission problematic or impos-
sible. Some mentioned the expense of software or the time
involved setting up. Others said they were too tired or too
busy to try electronic billing; found the process too time
consuming; were intimidated; lacked confidence in comput-
er skills; had privacy concerns; liked the feeling of control
represented by paper claims; had anxiety about change; or
had a practice too small to be worth it. They found certain
websites difficult to negotiate or were overwhelmed by the
complexity of having different systems for different plans.
What Members Say About Electronic Billing
and HIPAA Compliance
Some were discouraged by past experiences and seemed
to have given up.
• Billing Services: Some members had found that a billing
service was the answer. Services mentioned were Long
Island Medical Billing Services, Precision Billing, MRS,
Bill Shrinkers, Health Assets Management Kingston, NY,
Billing for Doctors in Rockland County, Solutions Medical
Billing (going out of business soon), MediQuik (not taking
new clients), Claims Management Consulting, Emdeon,
Computerized Office Services, and Claims Connect. At
least four respondents used private individuals to assist
with billing.
• Clearinghouse Websites: A number of members had had
positive experiences with clearinghouse sites, entities
that submit claims to hundreds or even thousands of
payers. 13 used Office Ally, and mention was also made
of Secure Connect (Therapist Helper), Beaconhealth
Strategies, Gateway EDI through Office Therapy, NaviNet
and MDon-line.
• Practice Management Software: Of the 16 who used prac-
tice management software, 11 mentioned Therapist Helper.
Other software mentioned was Therascribe Small Practice
Edition 5.0, Shrinkrapt, Notes444, EZClaim, Office Therapy
and Quicdoc by Docutrac. At least two people had created
their own system. One mentioned, “basic spreadsheet
programs customized for our business needs.”
Among those using Therapist Helper, there were mixed
reactions: “Not for the solo practitioner. Maintenance too
expensive.” “Only for note taking. I never mastered the claim
form part.” “Right now I only use it for billing.” “A steep
learning curve but worth it. “Paid for the software and for
monthly electronic billing.” “I have always done my billing
myself and I have a big practice.”
• Electronic Record Storage: We asked, “Do you store any
case records electronically?” This created some confu-
sion, since the survey did not distinguish between storing
records on one’s own computer and storing them on a
remote website, which has greater HIPAA implications. 32%
indicated that some records were stored electronically. 23
people stored only claims; 22 stored clinical material.
Fall 2011 9
• Paper Claims: For many members with just a few patients,
paper claims were still the mode of choice. We asked, “If
you submit paper claims, do you use any kind of program
for typing your claims?” 28% said yes. The most commonly
cited program (9 people) was Little Guy Software. Others
mentioned EZcms1500 from Queens City Computer Press
Instant Office Kit for Psychotherapists (3 people), EZ
Claim (3), Smart Forms, HCFA1500 Fill and Print, Omni
Forms, or Speedysoft for Medicare claims.
Still others mentioned the practice management software
provided by Therapist Helper (11 people), Notes444, Office
Therapy by Docutrac, or Office Ally. At least one person had
created his own form.
• Out-of-Network Providers: We asked, “If you file claim
forms as an out-of-network provider, which methods do
you use?” Of the 97 who responded, 63% filed hand-
written paper claims, 28% filed typed paper claims and
10% used a billing service.
• HIPAA: Because providers should not file electronically
without becoming HIPAA compliant, we asked, “Are you
HIPAA compliant?” 76% of respondents (106 out of 140)
said yes. We then asked, “If no, please state your ratio-
nale for remaining non-compliant.” 32 people answered
this question thoughtfully and honestly. 12 said they
were doing nothing patient-related online, were not a
“covered entity,” and therefore did not believe that they
needed to be HIPAA compliant. 6 were unsure if they
were in compliance. Other responses reflected confu-
sion, procrastination, denial, misinformation, or protest,
in response to HIPAA regulations.
Asked what procedures had been put in place to satisfy
HIPAA, respondents mentioned: Privacy policy fact sheet and
an acknowledgement signed by the patient that they received
it; Billing release; Patient bill of rights; Locked file cabinet,
fire and waterproof storage containers; Computer pass-
word protected, electronic records stored properly; HIPAA
statement included on each fax or email sent; Care taken in
transmitting information electronically (no names used, only
initials or numbers); and, Communication with the managed
care company discussed with the patient and permission
gained to share further information.
Overall the survey raised important questions. Members
wanted more information about HIPAA compliance, bill-
ing services, software, MACs, out-of-network billing, and
Medicare billing, and would be interested in a presentation
on these topics.
To this end, the Vendorship and Managed Care Committee
is compiling more information on billing services and software
and is planning a Billing Workshop in October to provide practi-
cal information on billing and HIPAA compliance.
President’s Message
Continued from page 2
Helen Krackow has insured that our newsletter continues to
keep members informed about essential issues, including infor-
mation about licensure provided by our Legislative Chair Marsha
Wineburgh and her committee of chapter legislative chairs. I ar-
ranged a presentation by the Society’s lobbyist at the last State
Board meeting so that the Board could gain a better understand-
ing of her work and positions taken on behalf of the Society.
The newsletter also features reviews of important Society
presentations as well as reports of relevant committee work.
In this regard, I want to recognize Helen Hoffman, Chair of the
Vendorship and Managed Care Committee, and her committee
members for providing essential and current information, and
Sandra Indig, who was responsible for our first art show at an
Annual Membership Meeting, and who is herself a model of
integrating arts and creativity into clinical practice through the
work and activities of her committee.
The Society is fortunate to have a renowned ethics expert
as its statewide Ethics Committee Chair in the person of David
Phillips. An ethics and professional practices blog is being devel-
oped to provide supportive practice information to the members;
keep an eye out for it as it promises to be very good. Those who
have called upon David’s expertise have reported finding him
accessible, eminently knowledgeable, supportive and easy to un-
derstand—rare qualities given the complexities of ethical issues.
In all, being president has turned out to be the meaning-
ful lesson in leadership and management I hoped it would be.
A seasoned administrator in the New York City child welfare
system and a private practitioner, I nevertheless found myself
challenged by the responsibility of managing a board of volun-
teers—people motivated by their commitment to something
larger than themselves and to making a contribution to their
profession beyond their own practice. Some on the Board have
been around long enough to have witnessed several administra-
tions come and go.
I previously spoke about the challenges of change, so I want
to commend the State Board for its willingness to consider, and
its responsiveness, to the changes that I have recommended
during my tenure, including my chairing State Board meetings,
appointments of state committee chairs, administration of the
Society’s support services and finances, as well as my work on
the Strategic Planning Committee and the By-Laws Revision
Committee. Regarding the latter, look for proposed changes,
coming your way soon, courtesy of Beth Pagano, By-Laws
Revision Committee Chair, and her committee.
I would like to make special mention and to thank a core
group of steadfast supporters who have meaningfully and reli-
ably supported me in my work as president. They include Judy
Crosley, Beth Pagano, Sheldon Blitstein, Shannon Boyle, David
Phillips and Marian Sroge.
And thank you, the members, for having elected me. I appre-
ciate the privilege you have given me to lead and to serve.
10 The Clinician
Chapter Reports
Metropolitan Chapter
Ariane Sylva, PhD, LCSW, President
The Met Chapter continues to expand its
membership and develop offerings through
new and existing committees. We’ve just
added two new positions to our board to
help meet the growing demands of coor-
dinating the increasingly rich program-
ming: Karen Kaufman, 1st Vice President
and Michelle Cuevas, 2nd Vice President.
Karen will take over as President of the
Met Chapter in May 2012.
We’re also actively seeking a new
Recording Secretary for our monthly board
meetings to take over from Elizabeth
Ojakian, who will remain our Treasurer.
Please let us know if you’re interested in
the position, which entails being part of
our board, attending monthly meetings and
taking minutes.
The Conference Committee has chosen
Richard Brown, M.D. as the speaker for our
March 3, 2012 conference, which will run
from 9:00 am to 4:00 pm. We have reserved
a space, to be announced, for up to 120
attendees. We are working toward offering
CEUs for attendance at all our educational
programs –another benefit of membership.
The next Education Committee brunch
presentation, “The Role of Forgiveness in
the Working through of Traumatic Events
– A Dialogue,” by Gwenn A. Nusbaum,
LCSW, will be held on Sunday, October 16,
from 11:00 am to 2:00 pm, at PPSC. Future
presentations are set for February 5 and
April 1, 2012.
The next Member Reception, welcom-
ing new and existing members to meet and
mingle, will be held at Richard Joelson’s
home on Friday, November 4, and will
include a special invitation to former
members of the Brooklyn Chapter, which
is no longer in operation. The Membership
Committee also has three Food for
Thought programs scheduled: for October
2011, and January and April 2012.
The Psychoanalysis Committee has
organized the next movie night, which
will feature “The Kids Are All Right,” for
October 28 at 7:00 pm at the Community
Church, Gallery Room, 28 East 35th Street.
The Student Award ceremony, for
students who wrote the best essay in a
contest in each school, is planned for
November 29 from 6:30 pm to 9:00 pm
at the Presbyterian Church, 7 West 55th
Street. Three schools, NYU, Columbia and
Hunter, were able to complete the project,
but all New York City social work schools
will be invited to the award ceremony.
Family, friends, and faculty will also be
invited, along with board members. We
hope all the schools will participate next
year with more advance notice.
The Mentorship Committee currently
has two mentorship groups running and a
third is in formation.
The Family & Couples Committee is
planning another series of three seminars
on sexuality and aging and has identified a
presenter from Adelphi University.
Our new Legal Issues Committee has
Michelle Cuevas connecting with two other
social workers who are also lawyers, and
the plan is to set up a series of meetings
where members can raise various legal
issues. This committee will not be offering
legal advice, but will be discussing legal
and other related issues.
To find out more about our commit-
tees and events, contact any board or
committee member. Find us at the Met
Chapter section of the Society’s website,
www.ClinicalSW.org.
Report by Lisa Beth Miller, LCSW,
Met Chapter Listserv Committee Co-Chair
Mid-Hudson Chapter
Rosemary Cohen, President
The Mid-Hudson Chapter and NASW NY
Hudson Valley Division co-sponsored
a conference on “Social Work Practice
with Veterans through the Life Span”
on September 23 at Marist College in
Poughkeepsie. The co-sponsors were
Adelphi University/Hudson Valley Graduate
School of Social Work, Marist College
Social Work Program and Department of
Psychology, and the U.S. Department of
Veterans Affairs.
In the winter-spring of 2011, three
workshops were presented by long-
time Society members: “Theraplay: An
Attachment Based Family Play Therapy,”
with Alan Spivack; “Ego in Motion: Play
Therapy,” with Gloria Robbins; and
“Borderline Personality Disorder: Two
Treatment Models (DBT, Linehan, and
Mentalization, Fonagy)” with Dr. Jacinta
(Cindy) Marschke.
Fall 2011–Spring 2012 Workshops:
• November 6, Dr. Kevin Kalikow, child
psychiatrist, “The Psychiatric Medicine
Decision,” (focusing on children and
adolescents).
• January 28, Cindy Dern, LCSW, “Helping
the Client Learn to Listen to and Trust His/
Her Body Signals.”
• April 28, Charles Burbridge, PhD,
“Treating Anxiety with Hypnosis.”
Queens Chapter
Fred Sacklow, President
The Queens chapter has begun a series of
monthly board meetings and educational
presentations. We meet at Holliswood
Hospital on Sundays. There is plenty of
parking, light refreshments and cer-
tificates of attendance. Join us for the
networking opportunity at 11:00 am and
presentation from 11:30 am–1:00 pm.
The Queens Chapter has a dedicated
Board and some very active members.
Please consult the Society website,
Fall 2011 11
C
metropolitan • MID-HUDSON • Queens • ROCKLAND • NASSAU • Westchester
www.ClinicalSW.org, for details of
upcoming meetings and presentations,
taking place on 10/16/11, 11/13/11, 12/11/11,
1/8/12, 2/12/12, 3/18/12, 4/15/12, 5/20/12,
and 6/10/12. We look forward to seeing all
interested Society members at our next
get-together.
Rockland Chapter
Beverley Goff, President
The Rockland Chapter is excited to
begin another fantastic year of provid-
ing professional services and programs
to our burgeoning membership and to
other chapters. Please check out the 11
programs scheduled for the coming year
on the Society’s website under Rockland
Chapter events.
Last year, in addition to monthly edu-
cational presentations chaired by Aimee
Ennis, we hosted two films with discus-
sions, Elsa and Fred and Damage. For our
full-day conference, we were fortunate to
host the internationally renowned speaker,
Dr. Patrick DeChello, who presented
“Treating Self-Injurious Patients and the
Upcoming DSM-V.”
The Rockland Chapter also provides
monthly group and peer support programs,
including a Clinical Case Discussion Group
for peer feedback on private cases or
social work issues, led by Beverley Goff; a
Mentorship Group for second-year MSW
students of the NYU School of Social Work
in Rockland, led by Dore Sheppard and
Orsolya Clifford; and a Private Practice
Support Group for members to network
and discuss cases and practice issues,
chaired by Sharon Forman.
Recently, we have added a Membership
Committee, headed by Monica Olivier,
which has been creative in expanding our
chapter with new members of all ages and
stages in their social work careers. We have
been reaching out to second-year MSW
students and they, along with several new
graduates, have been joining our chapter.
We always welcome new members and
those from other chapters, so please drop
in any time. For additional information or
just to say hello, please contact Beverley
Goff, President, at 845-735-7349 or Aimee
Ennis, Education Chair, at 201-848-5276.
Report by Orsolya Clifford, Vice
President and Beverley Goff, President
Nassau Chapter
Lorraine Fitzgerald, President
On September 25 we held the first board
meeting of the season. Our monthly board
meetings and educational presenta-
tions are held at Molloy College in West
Hempstead. When educational presenta-
tions are offered, board meetings begin at
9:00 am, followed by networking and our
educational presentation from 10:00 am to
noon. Our Intermediate Mentorship Group
for members contemplating, building, or
transitioning into private practice meets
from noon to 1:00 pm. A light brunch with
refreshments is served. CEUs are pro-
vided. When an educational program is not
planned, board meetings take place from
10:00 am to noon. We encourage Nassau
members to attend our board meet-
ings and think about joining one of our
committees.
Meeting Recap: We began with our
January 2011 program, “Clinical Issues with
Divorced and Separated Families,” facili-
tated by Carl Bagnini, one of our chapter’s
senior members. Our annual conference
on February 13, “Exploring Out-of-Control
Sexual Behaviors,” was presented by two
sex addiction specialists, Michael Crocker,
LCSW, a Met Chapter member, and Susan
Malewicz, LCSW.
Each year our Annual Book Authors
Brunch is held at board member Susan
Kahn’s home. This year’s author, Cathleen
Fanslow-Brunjes, M.A., R.N., who studied
under Elizabeth Kubler Ross, held an inti-
mate conversation about her book, “Using
the Power of Hope to Cope With Dying: The
Four Stages of Hope.” A group discussion
took place, with the opportunity for consul-
tation, as members presented cases.
Future Meetings: The 2011–2012 year
is dedicated to exploring social network-
ing. We hope to see new attendees at
these events:
• October 23, Annual Membership Brunch,
reviewing Linked-In.
• November 20, discussion of Facebook
and Twitter.
• December 3, Annual Conference, “The
Relational Brain and Psychotherapy:
Neuroscience in the Treatment Room,”
presented by Terry Nathanson, a
Westchester Chapter member
• March 18, 2012, State Ethics Committee
Chair David Phillips will present “What
Ever Happened to Confidentiality?”
For more information and to confirm
Nassau Chapter meeting times, please
contact President Lorraine Fitzgerald at
516-987-6931 or grieflistener@gmail.com,
or refer to the Nassau Chapter section of
the Society’s website: www.ClinicalSW.org.
[Special Note: Dolores Colgan passed
her licensing exam and has earned those
four wonderful letters after her name,
LCSW. Congratulations Dolores!]
Westchester Chapter
Interim Leadership Committee
The Westchester Chapter is pleased to
report that a successful transition to a
collaborative style of leadership is under-
way! We continue to have monthly meet-
ings on the first Saturday of each month.
Our day starts at 9:00 am with clinical
interest group meetings. These practice
groups are Integrating Neuroscience and
Psychotherapy, Peer Consultation, Child
and Adolescent Peer Consultation, Group
Therapy Practice, Career/Private Practice
Building Mentorship and Spirituality and
Therapy. From 10:00 am–noon, we have dy-
namic presentations on such topics as, “The
Impact of Divorce on Children,” “Therapy
with Men Who Have Been Sexually Abused,”
and “The Assessment of Bipolar Disorder.”
Our Interim Leadership Committee meets
monthly from 12:15 pm –1:30 pm.
Report by Jody Porter, 914-737-1732
12 The Clinician
this wider base of direct practice professionals and might
include medical social work, child welfare, or case manage-
ment. One of the problems with this expansion is that there
would be no professional social work organization represent-
ing the particular interests of social work psychotherapists.
And there would be internal conflicts of interest within the
organization about financial and legislative priorities stem-
ming from the legitimate tensions between these different
groups.
KEEP IT SIMPLE: My preference is to respect our his-
tory and stick to what we know best. We are the only social
work organization specifically representing social work
psychotherapists in this state. There is no other professional
organization that is able to represent and advocate for our
particular needs without encountering conflicts of interests
with other social work specialty groups. The history of our
organization validates the effectiveness of a narrowly focused
agenda.
Let’s review: in 1968 the New York State Legislature legally
recognized social work as a profession through the passage
of a title certification law which created the title “certified
social worker.” Title certification, since it only creates a
title designation, CSW, is a weak form of regulation and
there is no requirement for an MSW graduate to have this
designation (and many as one-third of MSWs did not bother
to get it). Further, the description of the functions of social
workers was so generalized and vague it made it difficult to
prosecute ethical and professional practice violations. This
statute, however, was a beginning for legally defining social
work as a profession.
The Clinical Society (NYSSCSW) originated in 1968, in
part as a result of national NASW’s embracing the BSW as the
entry level into social work. Here in New York, the leadership
of the psychology professional associations had introduced
hostile legislation to require social workers providing
psychotherapy services to be supervised by psychologists
(the Biondo bill). Founding members of the Clinical Society
were social work psychotherapists, graduates of advanced
training institutes, who opposed national NASW’s decision to
lower professional entry standards and also actively disputed
this psychology bill. From the beginning, the mission of the
Clinical Society was to have clinical social work recognized by
state and federal authorities as one of the traditional mental
health disciplines—along with clinical psychology, psychiatry
and psychiatric nursing.
The New York State Legislature, in the 1970s, was not
amenable to licensing additional professions, so passing
legislation for a clinical social work license was not a viable
Continued on PAGE 21
option. Instead, the Clinical Society prepared a bill to amend
the Insurance Statute that would allow employers the option
to cover mental health services rendered by certified social
workers (the “P” law). Employees could request this cover-
age from their employers if it was not already available in
their health insurance contract. The services of CSWs who
had three years (20 hours/week full-time) of supervised
psychotherapy experience would be eligible for insurance
reimbursement. This legislation was finally passed in 1978.
Optional coverage was a start, but we wanted mandatory
coverage for our mental health services within the state. The
rise of peer review for mental health services and managed
care’s acceptance of social work psychotherapists on their
panels was important to the field. Consequently, using the
insurers’ cost experience of covering mental health services
by P-CSWs, we were able to go back to the legislature and
change the statute requiring reimbursement by any group
policy that already covered psychologists and psychiatrists.
This is the “R” statute, which requires three additional years
of supervised psychotherapy experience. It was passed
in 1985, and still identifies the most experienced LCSWs.
(Note that both legislative efforts were initially drafted by
the Clinical Society and initially opposed by the other social
work professional groups.)
Time passed as we waited for an opportunity to pass a
scope of practice licensing bill that fully described the func-
tions of the clinical social worker providing mental health
services. Finally, in the early 1990s, the State Education De-
partment indicated the time might be ripe for legislative
consideration of a social work licensing bill. The Clinical
Society promptly drafted and introduced the LCSW legisla-
tion. NASW was invited to add an LMSW level. Fifteen years
later, after hundreds of hours of meeting with the BSWs, both
chapters of NASW, the deans of the social work schools, and
other social work groups, we all agreed to the legislation: two
licenses for the social work profession, LMSW and LCSW.
In meantime, the State Education Department and the
Higher Education Committees of the Senate and Assembly
decided to license the practice of psychotherapy in New
York State. Until then, anyone could use the title “psycho-
therapist,” including a barber, bartender, or psychiatrist who
lost his medical license. To license individuals to practice
psychotherapy would mean licensing all those who were
currently legitimately offering these professional services.
Psychoanalysts without mental health backgrounds, MFTs,
mental health counselors and creative arts therapists had
been lobbying for decades for legal recognition. If clinical
social work and clinical psychology were granted a scope of
Lest We Forget…
Continued from page 1
Fall 2011 13
By Richard B. Joelson, DSW
S
ome therapists are not sufficiently mindful of the impact their
office has on their clients—especially new clients—and how
it conveys something about them. One client told me the main
reason she elected not to work with someone else with whom she
had consulted: “There was a large spring protruding from the couch
I was invited to sit on. The couch was in terrible disrepair and so
was I. I was afraid that the broken couch might be a metaphor of
some kind so I decided not to go back.” Another oft-heard complaint
concerns inadequate soundproofing and, in the case of some home
offices, too many personal distractions that interfere with a sense of
privacy and optimal concentration.
Some clients have spoken of their unease or worse, confusion and
upset about not having been given clear instructions about how to
locate the office and, once there, which door to enter, whether or not
to ring the bell, and what to do when the therapist—especially a new
therapist—may be running late. Sometimes the issues that we see
as insignificant have a profound impact on our clients. If one agrees
that a first session is often a particularly anxiety-arousing event with
a more-than-likely vulnerable prospective client, then therapists
should do everything possible to insure that the journey from phone
contact to first visit is as smooth and reassuring as possible.
The office bathroom can be another problem area. Client com-
ments have included such things as broken toilets, no toilet paper,
general hygienic neglect, and broken locks or no locks at all to
insure privacy. To some clients, some of these things may be hardly
noticed, but to others, these moments have significant impact and
may influence or determine their feelings about continuing the rela-
tionship itself. This is generally more of an issue with new clients. If
one agrees that the therapeutic cathexis is likely to be to the office
as well as to the clinician, then appreciating the importance of an
attractive, appealing, “holding (office) environment” is crucial.
Communicating with Referral Sources
One of the most common complaints I hear from those who consult
with me for private practice help is that certain referral sources
have stopped sending clients for reasons unclear or unknown.
Curiously, some private practitioners resign themselves to the loss
and quietly regret it without ever inquiring why.
A guiding motto throughout my life has been “it’s all about
relationships.” Referral sources need and expect to be acknowl-
edged and thanked when they send a client to your practice. They
also like to be informed about the disposition of their referral and
some appropriate and discreet information about how the person
they sent to you is doing. When I was building my practice many
years ago, I sent referral sources and prospective referral sources
a one-page statement entitled, “My Treatment Approach,” which
enabled them to understand how I conduct the initial evaluation and
what the client would be experiencing when they came to see me. I
also contacted referral sources with appropriate information about
therapeutic progress periodically and sent information articles writ-
ten, changes in my professional life, office relocations, etc., so that
we were in touch whether or not we had a client in common. When I
have not received any referrals from a traditionally active referrer, I
inquire why. Sometimes the answer is as simple as, “you just didn’t
come to mind,” so my call or e-mail inquiry serves to reestablish my
presence.
Termination
The problem for many clinicians here, it seems, is when a client
announces a desire to end the treatment when they are ready and
their therapist is not. This is an unfortunately mishandled moment
in many treatment relationships that often sours or ruptures the
relationship, at times, irreparably. Some clinicians simply cannot
let go and, rather than explore the client’s desire to terminate as
the treatment issue it is, they wind up angrily challenging the client
and become an adversary, rather than remaining an invaluable ally.
This often leads to an abrupt severing of the relationship, and the
client does not return. He or she may simply seek a new therapist, or
worse, may be reluctant to ever seek therapy again. It is always un-
fortunate when an initial treatment issue with a new client involves
addressing the unresolved damage from a previous treatment.
We are all very busy mental health professionals who, at times,
run the risk of losing sight of the additional issues that have impact
on our clients. Our interpersonal skills and sensitivity to client
needs must go beyond our technical abilities. Attention to our office
space and the other ways we represent ourselves have significant
impact on the treatment and demonstrate our appreciation for the
people in distress who share their lives with us.
Part 1: Telephone Behavior appeared in the Spring 2011 newsletter.
Note to Readers: Your private practice-related questions or
comments are welcomed and will be responded to by e-mail or by
phone, if preferred. Richard can be reached at RBJoelson@aol.com
or 212-369-1239. Please visit www.richardbjoelsondsw.com and
www.rbjstorybooksforchildren.com
Private Practice Matters
The Self-Defeating Private Practitioner
Part 2: Office-Related Issues
14 The Clinician
New York State Society for Clinical Social Work 42nd Annual Education Conference | May 7, 2011
The Multiple Dimensions of Narcissism
A
wide and diverse audience of clinicians gathered at the
Nightingale-Bamford School Auditorium on May 7, 2011 for
the 42nd Annual Education Conference. Conversations
flowed over breakfast; clinicians were fascinated and challenged
by the narcissist, curious and eager to gain deeper understand-
ing into the multiple dimensions of this personality disorder
and to learn the most effective ways to reach and to heal the
suffering it creates.
After a warm welcome by Jonathan Morgenstern, President
and opening remarks and introductions by Susan Klett,
Conference Chair, Dr. Judith Siegel began her keynote pre-
sentation. She seamlessly integrated a psychodynamic object
relational approach with a systemic perspective, weaving in
psychoeducation to facilitate empathy and self understanding in
the couple in treatment. Dr. Siegel masterfully used the medium
of film to exemplify the narcissist character in action, within a
relationship, which further enriched this learning experience
for her audience. In her review, below, Ashanda Tarry, LMSW
captures Dr. Siegel’s expert skills in breaking through the
narcissistic defense and facilitating an emotional engagement of
a very challenging couple.
In her presentation, Jane Hall, LCSW, FIPA brilliantly
portrayed the narcissistic personality, the underlying causes
contributing to its development, and the behavioral manifesta-
tions. She courageously shared her countertransference while
discussing the course of her four-year psychoanalytic treatment
of a very challenging, difficult-to-reach, patient suffering from
pathological narcissism. Mary McHugh, LCSW has written an
in-depth review, included in these pages.
Afternoon workshops covered a wide spectrum of narcissis-
tic disorders. Topics covered ranged from working to nourish a
healthy narcissism within a patient to understanding and treat-
ing the continuum from normal/neurotic to severe pathological
narcissism within families, between siblings, within the couple,
and in the individual. Workshop leaders, including Joyce Edward,
LCSW, BCD; Sharon Farber, PhD, LCSW, BCD; Marc Wayne,
LCSW, BCD; Roberta Ann Shechter, DSW; Leah Pittell Jacobs,
LCSW, LP, NCPsyA; Gildo M. Consolini, PhD and Tripp Evans,
PhD, LCSW, addressed facets of narcissism and demonstrated
optimal treatment approaches from their various theoretical
orientations.
I would like to recognize and thank our outstanding
Education Conference Committee members:
Meryl G. Alster, LCSW-R; Gildo M.Consolini, PhD, LCSW;
Tripp Evans, PhD, LCSW-R; Gail Grace, LCSW-R; and Ashanda S.
Tarry, LMSW, for giving generously of their time and talents in
contributing to the success of this extraordinary conference.
—Susan A. Klett, LCSW-R, BCD,
Annual Education Conference Committee Chair
Call for Proposals
For workshops and panels at the 43rd Annual Education Conference in May 2012
Caught in the Grip: Obsessive Compulsions
Seeking proposals on compulsions/addictions –
different approaches and modalities – individuals, couples, families
examples: Eating disorders, gambling, addictions to: being in love, alcohol, drugs, pornography,
digital media/Internet, cutting and other self-injurious behaviors, plastic surgery, tattoos
Complete proposal information available soon at www.ClinicalSW.org and by mail
Deadline for Submissions is December 15, 2011
For more information, contact Susan A. Klett, LCSW-R, BCD, Education Committee Chair,
157 East 57th Street, #6D, New York, N.Y. 10022 and/or E-mail at suzanneklett@aol.com
Fall 2011 15
and How to Survive Them
D
r. Judith Siegel captivated the morning audience with a
provocative discussion of the psychodynamic interplay
between object relations and systems theories in her
treatment of narcissistically vulnerable couples.
Dr. Siegel, an Associate Professor at the NYU Silver
School of Social Work, is the author of over 20 journals
and four books on marriage and relationships including,
What Children Learn from Their Parents’ Marriage, and
Countertransference in Couples Therapy. In her work, she
integrates the classic analytic approach to psychotherapy
with the scientific perspective of neurobiology and emotional
regulation. This blended approach helps couples attend to an
organic responsiveness to which each partner had previously
been un-attuned.
Dr. Siegel shed light on the neuro-cognitive responses
in the brain that occur when an early memory is triggered,
and the unconscious reactions to an encounter based on
previously-recorded responses from encrypted sensory
experiences. She explores with couples their recollections
of early structural deficits as well as what each partner had
hoped their current relationship would provide to meet their
fundamental needs.
She discussed how primitive defenses of splitting and de-
nial found in the early family structure of each partner reveal
deficits in early attempts at soothing and attuning. According
to Dr. Siegel, “during splitting, the self and the object are
not experienced as not just good enough, but not enough.
What occurs is that the devalued self is separated from the
grandiose self, and then uses defenses to not experience
the devalued self—denial. In treatment, the goal is to make
room for the grandiose and the devalued self; to reconcile
the bad object experiences.”
To illustrate, Dr. Siegel showed segments of the 1952 film,
Pat and Mike, starring Katherine Hepburn and Spencer Tracy.
Pat was an expert tennis player who could not perform well
in the presence of her hyper-critical fiancé, Mike. Dr. Siegel
posited the concept of enactment through parallel experienc-
es as portrayed by the narcissistic partner and the devalued
partner. Pat repeatedly relinquished power and underwent
fluctuations in identity, intensified by the anxiety to perform
and the influence of the inflated grandiosity of Mike, the all-
encompassing lover.
At times, Dr. Siegel referenced Kernberg’s “peak experi-
ences” from the preverbal stage in childhood and Kohut’s
mirroring and valuing of the “good object which affirms a
child’s self object,” and adds to the emergence of entitle-
ment—the expectation that other people will know and
value the “me.”
She uses several creative approaches to enhancing
insights into a couple’s regulatory responses. One is the
analogy of a file cabinet in which each drawer holds a split-off
experience of a partner. Each partner “opens a drawer” and
cognitively recalls his or her earliest memories and the feel-
ings attached to the contents.
Dr. Siegel explained that splitting occurs not only in
couples but in individuals, and that we all split in various
ways throughout life. The file cabinet analogy helps make
the therapeutic engagement accessible to many of the most
defensive clients and couples.
Dr. Siegel also noted that the couple does not stand alone
in relating; the therapist also becomes an active witness to
Breaking Through:
Helping the Narcissistically Vulnerable Couple Engage
Presented by Judith Siegel, MSW, PhD / Reviewed by Ashanda S. Tarry, LMSW
Keynote presenters: Jane S. Hall, LCSW and Judith Siegel, PhD.
Continued on PAGE 20
16 The Clinician
T
he distinguished Jane S. Hall, LCSW, FIPA, began her
thoughtful and sensitive presentation by giving a brief
overview of the concept of narcissism from a psycho-
analytic perspective, with particular emphasis on pathologi-
cal narcissism, its manifestations, and its underlying causes.
Given that narcissism lies on a continuum from the normal
to the pathological, Hall raised the question of whether
patients with less severe forms of narcissism can be helped
by psychoanalytic work.
Hall is past President of the New York Freudian Society,
a member of the IPA, ApsaA, AAPCSW, Div. 39, and a train-
ing and supervising analyst who has taught, lectured, and
consulted on how to deepen psychoanalytic work for over
25 years. She is the author of Roadblocks on the Journey of
Psychotherapy (2004) and Deepening the Treatment (1998),
both published by Jason and Aronson, and other works. She
is a member of the faculties of three New York institutes,
and a founder of the New York School for Psychoanalytic
Psychotherapy and Psychoanalysis. She was also the first
director of the Psychotherapy Track at New York Freudian
Society. A graduate of the Institute for the Study of
Psychotherapy and the New York Freudian Society-Institute,
Hall consults and supervises in person and via Skype
and telephone. She is currently in private practice in
New York City.
Hall utilizes a developmental as well as an object relations
approach in her understanding of the concept of narcissism.
The manner in which the normative phase of separation
and individuation is achieved (or not) was examined in her
presentation in relation to narcissism. Hall made the point
that “the self we need to love is the separate, individuated
self made possible by a ‘good enough’ infancy and childhood.”
On the other hand, a traumatic childhood can result in
different levels of narcissism, with pathological narcissism
occurring in cases that are more severely disruptive. In such
cases, the child will grow up with little if any sense of a good
self and a fixation on the grandiose self with no sense of
“other” as separate.
New York State Society for Clinical Social Work 42nd Annual Education Conference | May 7, 2011
The Multiple Dimensions of Narcissism
The Hidden Pain in Narcissism:
Reaching Narcissus—A Developmental Approach
Presented by Jane S. Hall, LCSW, FIPA / Reviewed by Marie McHugh, LCSW-R
She provided examples on the pathological narcissism
spectrum, such as those occurring when the infant is treated
as an extension of the parent rather than as a separate
human being with needs of her own. Sometimes the child is
treated as the split-off bad part of the parent and is tortured
or even killed. When this happens, the internalized bad
object overshadows aspects of the good object. Often, anger
at the internalized bad object will be self-directed and mani-
fests as self destructive behavior or suicide.
In another scenario, the parent identifies narcissistically
with the child, creating an untamable sense of grandios-
ity by protecting the child from reality. Or the child feels
intense pressure to perform in order to earn the parent’s
love, creating what Winnicott would refer to as the “false
self.” Hall specifically cited her studies with G & R Blank,
and the writings of Shengold, Kohut, and Annie Reich
(as well as many unnamed others) as having shaped her
thoughts on the subject.
Hall posited that the understanding of countertransfer-
ence is crucial to treatment, given that induced feelings
of boredom, sleepiness, anger, and impatience, to name a
few, cause many therapists to make arrangements to end
treatment prematurely. Strong narcissistic defenses char-
acterized by omnipotence and grandiosity are often present
in these patients as part of an adaptive process for coping
with a troubling childhood experience marked by shame and
humiliation. The high degree of self involvement and inability
to recognize the other makes these patients difficult to reach
and can be frustrating to the therapist’s own narcissistic
wishes. The therapist must be able to see behind the façade
and recognize the hidden pain that lies beneath.
Hall also made note of how easily-injured, narcissistic
patients can become wearing to the therapist, who must
at all times be extremely sensitive to any perceived or real
rejections, slights or criticism. In concrete ways, this is most
easily demonstrated in terms of starting a session exactly on
time (to the minute). Many subtleties and nuances are in-
volved in the development of a therapeutic relationship, and
the narcissistic patient will be especially sensitive to them.
Hall makes the point that closeness and trust are threatening
to this kind of patient and it will take a long time to achieve
attunement between therapist and patient in the treatment.
Fall 2011 17
and How to Survive Them
The Treatment
Hall set the stage for her presentation early on with a
synopsis of the Greek myth of the hunter, Narcissus and
the nymph, Echo. Echo is in love with Narcissus, but unable
to win him over due to her incessant chatter. Narcissus,
enamored of his own good looks, spends all his time gazing
at his reflection in a pond and, sadly, eventually wastes away.
A beautiful flower blooms each spring in his memory, or so
the story goes.
Hall was able to take this myth (with some poetic
license) and artfully interweave it throughout her lecture,
making it a metaphor for the treatment between the modern
day therapist and narcissistic patient. Significantly, the dif-
ference is that in therapy “Dr. Echo” knows how to listen and
is able to engage and lead the present day Narcissus into the
therapeutic space and away from his closed off, self involved
world. Hall elaborates on each aspect of the therapeutic
stance—the quality and curative powers of listening, convey-
ing interest and understanding, providing empathy, exquisite
attention, and benign curiosity—all without judging what is
being said. Major influences identified by Hall as shaping her
stance were Ella Sharpe, Carl Rogers, Hans Leowald, Ronald
Fairbairn, and again, “many unnamed others.”
Hall sees it as the therapist’s job to be a new object that
the patient can begin to internalize with the goal of being
able to love the self. She conceives that perhaps Narcissus
needed to gaze at his reflection not only because he thought
himself beautiful, but because he needed proof of his
existence. Hall made note of Rogers’ use of unconditional
positive regard to raise the self esteem of the patient and
Ella Sharpe’s concept of benevolent curiosity to deepen the
treatment. If patients are able to identify and internalize
these qualities from the therapist, they can become less
critical and more curious about themselves.
Hall notes Fairbairn’s contribution to the psychoanalytic
paradigm is in seeing the libido as object-seeking, versus
Freud’s pleasure-seeking. According to Fairbairn, early
relationships shape the child’s emotional experiences and
are bound to be repeated. However, according to Hall, cur-
rent studies reveal the plasticity of the brain, indicating that
present-day experiences do impact the brain. Hall heralds
this as important and hopeful news for long term therapy,
where the new internalized object can challenge the effects
of past negative experiences with caretakers. The book,
The Brain that Changes Itself (2007) by Norman Doidge, MD,
was highly recommended by Hall.
Conference Committee: (front row, l. to r.) Marie McHugh, LCSW Susan A. Klett, LCSW,
BCD, Conference Chair; Meryl G. Alster, LCSW. (back row) Ashanda S. Tarry, LMSW;
Tripp Evans, PhD, LCSW; Gail Grace, LCSW; and Gildo Consolini, PhD, LCSW.
Workshop Leaders: (l. to r.) Joyce Edward, LCSW, BCD, Roberta Ann Shechter, DSW,
Gildo M. Consolini, PhD, LCSW, Tripp Evans, PhD, LCSW, Leah Pittell Jacobs, LCSW, LP,
Marc Wayne, LCSW, BCD, and Sharon K. Farber, PhD, LCSW.
Continued on PAGE 20
Photos this page and page 16 by Morgan Evans.
18 The Clinician
Annual Membership Mtg.
Continued from page 4 A Dog in Therapy
Continued from page 7
Relating to all
The three presentations on object relations theory served to illus-
trate a larger theme of the conference: the importance of reaching
out to clinical social workers in education and agency practice,
while at the same time addressing issues relevant to those in
private practice.
Dore Sheppard, PhD, LCSW, presented the case of a severely de-
pendent, personality-disordered woman, in part to demonstrate how
the theories of Mary Richmond, Jeffrey Seinfeld and Eda Goldstein
were beneficial in providing clinical interventions beyond the usual
supportive psychotherapeutic approach. He discussed how these
theoretical and practice approaches helped his client make produc-
tive changes towards becoming less dependent on the therapist and
others in her life.
Theresa Aiello, PhD, LCSW, a professor at the NYU School of
Social Work, discussed how object relations theories are being
taught and applied in graduate programs. She spoke about how
evidence-based clinical research, particularly from attachment
theory, has been beneficial in verifying object relations theory.
She also described how Drs. Goldstein and Seinfeld worked to
make object relations theory meaningful for academic settings.
Neil Altman, PhD, a psychoanalyst and training/supervising
analyst at the NYU Postdoctoral Program for Psychotherapy and
Psychoanalysis, discussed clinical experiences in public clinics.
He spoke about his recent (“overdue”) incorporation of clinical so-
cial work theory into his theories on community-based applications
of psychoanalytic theory. Dr. Altman drew on an interesting case in
a psychiatric clinic in the Bronx, and people he supervised in India,
to discuss his latest thinking on incorporating social issues endemic
to both clinical social work and psychoanalysis. He also said he con-
curred with those who had criticized him for leaving clinical social
work theory out of his past writings. He said viewed the conference
as a way to “reparate” this omission.
Overall feedback from the attendees was extremely positive.
Credit for a smooth-running event went to the State Membership
Meeting Committee, whose members included Leslie Altmark,
Beth Pagano, Dore Sheppard, Chair, and Linda Wright. Sheila Guston
and her staff at TMS were also very helpful.
The proceedings reportedly helped strengthen the feelings of
camaraderie and community within the Society.
Paul realized his patients might have negative transferential
reactions to his home office as well, ones that could jump-start the
treatment process if heeded in time. One patient, he recalled, found
that the office had too many “nice things,” and thought that he would
be too envious to work with him. Another, who was paying a reduced
fee, thought that he was being seen in the less elegant area (the of-
fice, rather than the well-appointed living room); this was an opener
to discuss the patient’s feelings of self-worth.
Paul’s observations of his patients’ reactions to the office
environment came about during the natural life cycle of his home
practice. In his homey office of antique furniture and objects he had
collected or inherited over time, Paul found that people responded
to the paintings as they might to a Rorschach test, or to his many
plants, because they were alive. Where patients projected their
mood onto the painting (as a child might in play therapy) Paul found
a way of communicating with them in an eased-in manner.
A bi-polar patient, for example, thought that a woman depicted
in a painting with her head turned away was clearly crying. The
patient did not recall this observation six months later, when she
felt happier. Others played with the content of a painting as a way
of approaching their inner lives. In some cases, it was easier to
criticize a painting or an artist than to criticize the analyst. This use
of displacement appeared to be in the service of a somewhat higher
level of social consciousness.
Paul’s plants, like his own therapist’s piano, brought about trans-
ferential reactions beyond the comfort and less clinical aspect of the
treatment room. One patient wanted to bring him a sickly plant left on
the sidewalk to care for and to save; then it would no longer be aban-
doned. Another patient, who was feeling discouraged and hopeless
due to physical and emotional issues, reacted to a plant “in fallow,”
saying that it should have been dead by now. Paul decided to talk
only about the plant: that it was not dead, but only dormant, and with
proper care it would bloom again. The patient’s hopeful and smiling
reaction became the transitioning point from the plant to him.
Analysts have often discussed the many opportunities for speed-
ing up the process of transference or projection during the analytic
session. Most often, the objects in the analyst’s setting are there
without the therapist’s conscious intention to elicit a reaction; they
are part of analyst’s daily life. A familiar object can provide just the
right amount of relaxation necessary for the patient to be eased-
into the therapeutic alliance.
Winnicott’s patient
In Holding and Interpretation, Fragment of an Analysis, David
Winnicott describes the ease with which a 19-year-old applicant to
analysis (recommended by his mother, who made the initial appoint-
ment) fell almost naturally into the analytic stance.
“At 5 o’clock the next day the boy came into my room, lay down
on the couch and started analysis exactly as he would do a year or
two later. In other words, analysis for him meant something, which
he already believed in. As he left the room he went to my bookcase
and saw two books, which he said were in the bookshelves in his
Fall 2011 19
7
home. In this and in every way he showed that he placed in my chair
someone who already belonged in his inner world, and it is roughly
speaking true to say that I remained an object of his inner world
until the moment which I am to describe in the first of the analytic
hours which I took down verbatim.”
The young man fell into the familiar inner object world through
the appointment made by his mother and the books on Winnicott’s
shelf. He remained in that world, little realizing the outer world, a
frustration for the analyst as the emotional conditions that were em-
barked upon in the external world of work and love, such as jealousy,
were a continuing part of the resistance.
Winnicott goes on to say that the analysis “material was rich and
work done considerable but it was impossible to reach the dynamics
of the Oedipus situation… Moreover the patient had anxiety re-
garding the conclusion of the analysis. There were a number of ways
in which anxiety is produced by the idea of completion of a job, and
with the patient the accent was on one way, namely the disappear-
ance of the hallucinated breast or subjective good external object at
the moment of gratification and cessation of desire. For the patient
the cessation was worse than aggression towards the love object, it
annihilated it.”
The above case study offers excellent insights into the ef-
fects familiar objects in the treatment room have on our patients.
Nevertheless, one can’t help but think that Winnicott’s strong
adherence to orthodox models of treatment seems to have left him
without recognition of the emotional regression induced in the indi-
vidual when the home country is at war, as was England at the time
of the young man’s analysis, and said resistance to work and love in
the greater world.
Reactions to dogs
Paul that above all other objects of transference in his treatment
office—his clothes, furnishings, paintings, books, the color of the
walls, the lighting and plants—nothing has stimulated a rich source
of patient reactions as much as his dog.
It is well-known that animals of all sorts give comfort and help
relax people. They are a source of companionship, solace, and they
aid in therapy for those who are ill or disabled, including veterans
with brain trauma or PTSD. In a published study, therapists reported
that pet dogs, brought in immediately after the 9/11 attacks, pro-
vided relief and comfort to relatives of the missing or those who had
witnessed the horrors first-hand.
The transformative love of pets is a common theme in the arts.
My Dog Tulip, a 2009 animated film based on J.R. Ackerley’s 1956
autobiographical novel, is about a man whose life is changed when
he adopts an Alsatian dog. Another recent film, Hachi: A Dog’s Tale,
tells the story of an Akita puppy that befriends a music teacher and
becomes his loyal companion for life.
In his presentation, Paul said he did not remember when the
idea to adopt a dog came to him, but after surveying his patients to
determine whether any were allergic to dogs, he adopted a four-year
old, 13-inch beagle named Addie. She was well-trained, calm and did
not bark or jump on people. For the most part, she stayed outside
the office while Paul was in session.
Addie had a defense-reducing effect on his patients. Her pres-
ence speeded up the transference that even while experienced, can
often go unexpressed by the patient for months.
Paul shared his thoughts on this triadic relationship. He had
made a decision to adopt a dog, although he was not sure what
prompted it. Only later did he remember that a patient had dreamt
that he had adopted a dog. Where did his decision originate? Did he
think of it first, or did come from the patient?
A detour in might be useful here. Post Freudian, post Kleinian
psychoanalysis has reached a more evolved understanding of the
therapeutic alliance based on the realization that there is more
material in the dyad than previously thought. The analysts who stud-
ied this difficult-to-quantify experience in the therapeutic alliance
called it the intersubjectivity theory.
This newer theory, stemming from Heinz Kohut’s self psychol-
ogy model of the mind, was developed in the early 1990s by several
psychoanalysts, namely Stolorow, Atwood and Brandchaft. The
central metaphor of the paradigm is the larger relational system or
field, in which psychological phenomena crystallize and experience
is continually and mutually shaped. The observer, the psychoanalyst,
and the observed, the analysand, are in an interactive nexus, each
influencing the other’s unconscious, pre-conscious material.
In the case of Paul and his patients, the dog Addie was often
treated as a family member, talked about in a familiar and inclusive
manner. When Addie became ill and was not expected to live, Paul
handled her possible death with care and sensitivity (Addie actually
lived four years longer than expected). Later, Addie’s imminent
death brought out heretofore unexpressed grief in some patients,
those who had lost a parent or a pet or who were faced with the loss
of a friend or sibling.
For Paul, Addie’s presence in or near the treatment room brought
about acloseness with his patients that gave greater depth to the
analysis, and on the whole, added to more meaningful relationships,
perhaps actually defining the genuine therapeutic alliance.
References: Atwood, G.E. Brandchaft, B., and Stolorow, R.
editors (1994) The Intersubjective Perspective, Northvale, N.J.,
Jason Aronson, Inc.; Winnicott, D.W., Holding and Interpretation,
Fragment of an Analysis, (1986), New York, Grove Press
Paul Giorgianni, LCSW, BCD, holds masters’ degrees from Brown University
and Hunter College. He trained in clinical counseling at The Postgraduate
Center for Mental Health and attended The Training Institute for Mental Health.
He is a supervisor at the Institute for Human Identity and is in private practice.
Sema Gurun, MSW, LCSW-R, is a painter who exhibits from time to time.
In her private practice in New York City, she works with artists experiencing
creative inhibitions as well as international patients who are experiencing
difficulties around identity and adaptation to cultural and life cycle changes.
20 The Clinician
New York State Society for Clinical Social Work
How Will the Society Benefit You?
> Advance Your Professional Goals
> Create a Community of Peer Practitioners
> Increase Your Professional Excellence through Education Programs
> Advocate for a Strong Professional Identity
Through peer consultation groups, mentoring and educational programs, Society members
can showcase their talents and skills.
The NYSSCSW Offers Members:
Resources, Support, Professional Community, Education, Advocacy & More!
FOR INFORMATION ON HOW TO JOIN:
www.ClinicalSW.org
E-mail: info@clinicalsw.org
Phone: 1-800-288-4279
The Hidden Pain
Continued from page 17
Breaking Through
Continued from page 15
the narcissistic needs of the individuals. In therapy, it is optimal to
make the room safe while expressing a gentle curiosity about the
couple. But it is also vital for the therapist to act as a container for
the aggression which needs to be expressed, while making sense of
many simultaneous reactions. Utilizing countertransference, a form
of projective identification, is useful, she said, when therapists start
by being “centered and recognizing our own selves.”
The audience was eager to share comments and questions at
the conclusion of her presentation. In a lively discussion, Dr. Siegel
reflected further on techniques that incorporate theories of parallel
shifts of early childhood experiences with current object re-
enactments, all within the scope of neuro-biologically transmitted
references. Throughout her remarks, she was accessible, thoughtful
and dynamic in describing the application of theory to practice.
Ashanda S. Tarry, LMSW, is an Intensive Case Manager for EmblemHealth/HIP.
Several examples of clinical work with narcissistic patients were
given in which Hall demonstrated the practical application of her
theoretical base. She had worked with each patient she discussed
for a number of years. Reflecting on the outcomes, she gave an
honest and revealing look into the treatments, discussing her suc-
cesses and what might be considered, in one case, a stalemate with
a sadomasochistic reenactment. In this case, Hall’s frustration and
feelings of helplessness with the process were evident, and she
eventually chose to end the treatment. She then questioned herself
about what made her continue the treatment for so long and had ob-
vious conflicts about it. Nevertheless, she believed in the treatment
and realized that there had been a degree of success.
Hall ended her presentation on the hopeful, positive note that
new objects are internalized and that “the patients that you remem-
ber, remember you too.”
Marie McHugh, LCSW-R is a certified psychoanalyst in private practice in
Manhattan and Roslyn Heights.
Fall 2011 21
DR. FLORENCE LIEBERMAN, 1918–2011
Dr. Florence Lieberman, a pioneer of clinical social work and one of its leaders
for half a century, died in May. She was part of the core group that developed the
Society for Clinical Social Work. She battled breast cancer for 25 years, but still
was writing professional articles, editing a new book, and counseling clients up to
the day of her death.
A professor emeritus at Hunter College School of Social Work, Dr. Lieberman
was the author and editor of many works, including Social Work with Children,
and Clinical Social Workers as Psychotherapists. After the National Academies
of Practice was founded in 1981, Dr. Lieberman was elected the first president
of its Social Work Academy. She also served as president of the International
Committee on the Advancement of Private Practice (ICAPP), as editor of the
Clinical Social Work Journal, and established and edited a second journal,
Childhood & Adolescent Social Work.
A graduate of Hunter College and the Smith College School for Social Work,
she obtained her doctorate from Columbia University School of Social Work.
In addition to teaching and writing, Dr. Lieberman maintained a private
practice for more than a half-century in Westchester and Manhattan.
Lest We Forget...
Continued from page 12
practice license, it would be illegal for these groups to continue to
practice psychotherapy until they were granted the same authority.
The state ultimately recognized four new professions under a new
Board of Mental Health Practitioners.
When the smoke cleared in 2004, there were six newly licensed
groups providing psychotherapy services, i.e., diagnosis or diag-
nostic assessments, treatment and treatment planning. The only
psychotherapists who could practice autonomously, without physi-
cian consultation, referral or supervision were LCSWs and clinical
psychologists. These two licenses were subsequently found by
the Supreme Court of New York to be equivalent, which unquestion-
ably establishes LCSWs as one of the four traditional mental
health professions.
The Clinical Society has succeeded in establishing a legal identity
for clinical social work psychotherapists. We have parity with the
other mental health groups, a more comprehensive license than ex-
ists in most states, and insurance reimbursement for our services.
Attempts to erode these gains are continuous from forces both
within and outside of our profession. I believe the mission of the
Clinical Society is to protect and advocate for our continued right to
diagnose and provide psychotherapy services autonomously.
I invite your written comments about this issue and the
Clinical Society’s future direction. Please e-mail your thoughts to:
mwineburgh@aol.com.
22 The Clinician
New York Center
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Fall 2011 23
The William Alanson White Institute
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Certificate Program in Psychoanalysis
and in our
Child and Adolescent Psychotherapy Training Program
The Certificate Program in Psychoanalysis is a 4 to 6 year program providing coursework and
seminars, clinical supervision and experience in our Clinical Services, and a personal analysis
The Child and Adolescent Psychotherapy Training Program is a 3 year program,
including coursework and seminars, individual and group supervision,
and clinical experience in our Child and Family Center
Details are available on our website: www.wawhite.org or from David Appelbaum, Psy.D. (212) 875-1015
Training is available to New York State LMSW’s and LCSW’s
whose licensed scope of practice includes psychotherapy and/or psychoanalysis.
A Private Outpatient Group Practice
Dialectical Behavior Therapy
Dialectical Behavior Therapy
Cedar Associates is pleased to announce the
start of its track in DBT for adults
and adolescents with eating disorders.
Two locations in Westchester, New York:
Cedar Associates specializes in the
treatment of eating and related disorders.
Visit our website for more information
and support group schedules.
www.cedarassociates.com
Judy Scheel, Ph.D., LCSW, Executive Director of Cedar Associates
is pleased to announce the publication of her book this spring,
When Food is Family: Why Eating Disorders
Occur in Families and Help for Recovery (Idyll Arbor, Inc.)
in addition to the opening of her limited practice in NYC.
Please contact her at JScheel@cedarassociates.com for more information.
Offering New Strategies to Help People Heal
Mount Kisco Office
67 South Bedford Road
Mount Kisco, New York 10549
(914) 244-1904
Scarsdale Office
1075 Central Park Avenue, ste 412
Scarsdale, New York 10583
(914) 472-4019
NEW YORK
STATE
SOCIETY
FOR
CLINICAL
SOCIAL
WORK,
INC.
New York Society for
Clinical Social Work, Inc.
243 Fifth Avenue, Suite 324
New York, NY 10016
STD. PRESORT
U.S. POSTAGE PAID
PERMIT NO. 382
ROCKVILLE CENTRE, NY
