IN THIS ISSUE
4 New Members
7 CSWs as Diagnosticians
Part Two
14 Book Reviews
15 “Beholder’s Share”
CONTINUED ON NEXT PAGE
CONTINUED ON PAGE 6
TH E N EWSLETTE R OF TH E N EW YORK STATE SOCI ETY FOR CLI N ICAL SOCIAL WORK, I NC.
FALL 2014 | VOL. 45, NO. 2
president’s message
October 2014: Annual Progress Report
Presented at the 46th Annual General Membership Meeting
By Marsha Wineburgh, DSW, LCSW-R, President and Legislative Chair
By Marsha Wineburgh, Chair
Legislative/Regulation Update
Changes in practice regulations continue, in
cluding in these areas: continuing education
requirements, meditation as not acceptable
clinical practice, workers’ compensation
coverage, and telepractice and coaching.
Acceptable continuing education hours
will be required for LMSWs or LCSWs who
re-register their licenses after January 2015.
Thirty-six (36) units are required for each
3-year period. Those whose registration
falls in the first few months of 2015 will need
one credit for each month, for example:
January 1, 0 hours; February 1, 1 hour; March
1, 2 hours; etc. (Details will be available
at www.NYSSCSW.org and www.op.nysed.
gov/prof/sw/ ) Only courses taken with New
York State approved providers are accept
able. A list of providers will be posted and
updated at NYSED’s website. Because this
is a new program, approved courses are just
being registered by the state. To address the
inability to find approved courses, you can ask
T
he 46th Annual General Membership Meeting of the Society
was held on Saturday, October 18, in New York City. The purpose
of our annual meetings is to report the State Board’s recent
activities on the members’ behalf, as well as the fiscal health of our
organization, and to recognize several colleagues who have made
outstanding contributions to our common welfare during the year.
Most important, this year for the first time at an annual meeting,
Society members voted in person, adopting the new bylaws with unani
mous approval, and electing a slate of new state officers. They are:
President-elect: Shannon Boyle, LCSW; Second Vice President: Helen
Hinckley Krackow, LCSW, BCD; Secretary: Richard B. Joelson, DSW, LCSW;
and Members-at-Large: Beth Pagano, LCSW and Chris Ann Farhood, LCSW.
Legislative Committee
2015 Education Conference
Call for Proposals (Page 3)
2014 Education Conference
Keynote Reviews (Page 8)
Facing Impasses: Identification
and Working Through
annual education conferences
2014 Keynote Speakers Lawrence Josephs, Ph.D. and Louise DeCosta, Ph.D., LCSW.
2 The Clinician www.NYSSCSW.org
Each new officer has an impressive record of service to the
State Board, contributing time and energy to strengthen our
presence in the professional community and beyond. They will
take office on January 1, 2015.
Our colleagues, recognized for their contributions this
year, included Dore Sheppard, Ph.D., LCSW; Helen T. Hoffman,
LCSW; Richard B. Joelson, DSW, LCSW; and, Beth Pagano,
LCSW. The hardworking chair of the annual meeting commit
tee, Dore Sheppard, found a wonderful guest speaker for the
educational component of the program, Cathy Siebold, DSW,
LCSW-R. A noted author, teacher and clinician, she presented
after the business portion of the meeting.
Helen Hoffman wears many hats. She oversees the Friday
E-News, which appears weekly in your email inbox filled with
valuable information, including summaries of upcoming educa
tional events offered by all of our chapters, as well as legisla
tive and insurance news. As chair of the Website Committee,
Helen masterminded the new “skin” for the home page, and
continually revises the content to keep it as timely as possible.
The Vendorship Committee, also under Helen’s leadership,
organized webinars on those pesky PQRS regulations that
Medicare requires. One webinar was held in the spring, the
other this fall for 40 more members.
Thanks to Richard Joelson’s creative and down-to-earth
leadership as the state Membership Committee Chair, the
Society has grown by 238 new members. We honored him and
his committee at a luncheon following the meeting.
The Bylaws Committee is chaired by Beth Pagano, the
leader of a small group that systematically reviewed the
Society’s bylaws for six years. The group includes Past-
president Jonathan Morgenstern, M.Ed., MA, LCSW; David
Phillips, DSW, LCSW, who is the Ethics Committee Co-chair;
and myself. Our work entailed walking the fine line between
maintaining the historical simplicity of the 2003 version of the
bylaws, while adding changes resulting from the passage of
the clinical licensing law. We have had many colorful discus
sions during numerous conference calls. Our final draft of the
new bylaws was reviewed, discussed, revised and approved by
the State Executive Committee, and then by the entire Board,
before it was sent to the members. Ultimately, the final ver
sion was approved at the annual meeting. It should be noted
that Beth did a fabulous job of preparing the final document
on a recalcitrant computer.
Fiscal Health: I am also pleased to report that the fiscal
health of the Clinical Society is excellent. Shannon Boyle,
LCSW, our State Treasurer and soon-to-be President-elect, has
done an excellent job keeping us within our budget.
It takes many people to keep this organization function
ing on your behalf. In addition to Sheila Guston and Kristin
Kuenzel, our administrators at TMS, more than 80 colleagues
have donated countless hours of critical thinking, planning and
CONTINUED FROM PAGE 1
president’s message
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NEW YORK
STATE
SOCIETY
FOR
CLINICAL
SOCIAL
WORK,
INC.
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.NYSSCSW.org / Tel: 1-800-288-4279
Ivy Miller, Newsletter Editor
3 Sunset Drive, Sag Harbor, NY 11963
E-Mail: ivy.lee.miller@gmail.com / Tel: 631-725-9845
Helen Hinckley Krackow, Newsletter Chair
Ad Deadlines: February 15 and October 1
STATE EXECUTIVE COMMITTEE
President
Marsha L. Wineburgh, MSW, DSW, LCSW, BCD mwineburgh@aol.com
First Vice President
Martin Lowery, MSW, LCSW-R mlowery@maryknoll.org
Second Vice President
Helen H. Krackow, MSW, LCSW hhkrackow@aol.com
Treasurer
Shannon Boyle, MSW, LMSW shannonboyle@hotmail.com
Secretary
Richard B. Joelson, DSW, LCSW rbjoelson@aol.com
CHAPTER PRESIDENTS (P) & VOTING REPS (VR)
Metropolitan P.
Karen Kaufman, Ph.D., LCSW karenkaufman17@gmail.com
Mid-Hudson P.
Rosemary Cohen, MSW, LCSW rosemarycohen@gmail.com
Nassau VR.
Joseph Reiher, LCSW mitygoodtherapy@gmail.com
Queens P.
Fred Sacklow, MSW, LCSW freds99@aol.com
Rockland P.
Orsolya Clifford, LCSW-R ovadasz@optonline.net
Staten Island P.
Janice Gross, MSW, LCSW, ACSW JGross1013@aol.com
Suffolk P. (Past)
Sandra Jo Lane, LCSW, BCD, CGP sjlsunshine@aol.com
Suffolk VR.
Jamie Hatzis, LMSW Jamie.hatzis@gmail.com
and Richard Karelis,LCSW rkcsw84@juno.com
Westchester VR.
Jody Porter, MSW, LCSW jodyp100@aol.com
MEMBERS-AT-LARGE
Metropolitan
Chris Ann Farhood, MSW, LCSW chrisfarhood@yahoo.com
Nassau
Linda Wright, MSW, LCSW lwrightlcsw@aol.com
Rockland
Beth Pagano, MSW,LCSW bethpagano678@msn.com
Staten Island
Andrew Daly, MSW, LCSW-R apdalylcsw@msn.com
Westchester
Rita Smith, MSW, LCSW ritacopesmith2@verizone.net
STATE COMMITTEE CHAIRS (Appointed)
Annual Education Conference TBA
By-Laws
Beth Pagano, MSW, LCSW Bethpagano678@msn.com
Creativity & Transformation
Sandra Indig, MSW, LCSW, ATR-BC psych4art@hotmail.com
E-News
Helen T. Hoffman, MSW, LCSW helenhoffman@verizon.net
Ethics & Professional Stds.
Martin Lowery, MSW, LCSW mlowery@maryknoll.org
and David G. Phillips, DSW, LCSW dgphillips@nyc.rr.com
General Membership Meeting Dore Sheppard, MSW, Ph.D., LCSW doreshep@yahoo.com
Leadership
Beth Pagano, MSW, LCSW bethpagano678@msn.com
Legislative
Marsha Wineburgh, DSW, LCSW-R mwineburgh@aol.com
Listserv
TBA
Membership
Richard B. Joelson, DSW, LCSW rbjoelson@aol.com
Mentorship
Helen Hinckley Krackow, MSW, LCSW, BCD hhkrackow@aol.com
Newsletter
Helen Hinckley Krackow, MSW, LCSW, BCD hhkrackow@aol.com
Research
Jacinta (Cindy) Marschke, MSW, Ph.D., LCSW-R cindy210@hvc.rr.com
Vendorship & Managed Care Helen T. Hoffman, MSW, LCSW helenhoffman@verizon.net
Website
Helen T. Hoffman, MSW, LCSW helenhoffman@verizon.net
2014 board of directors
Fall 2014 3
president’s message CONTINUED FROM PAGE 2
CONTINUED ON PAGE 5
governor sign our workers’ compensation legislation, we will have
accomplished everything we set out to do 46 years ago.
Of course, the job of protecting our profession through legislative
efforts is never finished, but we have achieved the legal recognition
we pursued since 1968. As of June 2014, there are 234,114 licensed
clinical social workers in the country. If not for the initiative of the
clinical societies and the National Federation of Clinical Social Work
Societies, I do not know if we would be the autonomous providers of
mental health services we are today.
Unlike many state societies, which folded once the battle for
insurance reimbursement and clinical licensing was over, we are not
inclined to close up shop. Instead, we are setting new goals for the
Society. Fortunately, the New York State legislature has decided to
require continuing education for social work beginning in January
2015, requiring 36 hours of CE every three years. This presents us with
an opportunity to take the lead once again.
ACE Foundation of the NYSSCSW
Our State Board has funded an initiative to build a clinical continuing
education program for our members and the other 50,000 LMSWs and
clinical social workers in the state as well. We want to offer quality clini
cal education through our state and chapter programming. To do this,
we have established a separate corporation that will be responsible for
education, naming it the ACE Foundation of the NYSSCSW. ACE stands
for Advanced Clinical Education. It is now a registered corporation.
delivering of benefits such as educational and informational programs.
Visit www.nysscsw.org for a complete contact list for the State Board
officers and chapter representatives.
Taking the Lead
As some of you may remember, this clinical society was founded
46 years ago by a group of clinical social workers trained at the
Postgraduate Center for Mental Health’s adult analytic program
(Recently defunct, it is not to be confused with the Postgraduate
Psychoanalytic Society, which is doing well.) In the 1960s, national
NASW decided to expand its membership base by including BSWs,
identifying this group as the entry level into the social work profes
sion. By focusing on BSWs, NASW essentially abandoned the interests
of social work clinicians, particularly those in private practice (and
this continues today, but for different reasons).
Out of their discontent and deep concern for the practice of
psychotherapy/psychoanalysis by social workers, the NYSSCSW
was founded in 1968 with an eye toward permanently and legally
establishing clinical social work as one of the traditional mental
health professions. Our Society, along with colleagues in other state
societies, has been spectacularly successful in passing the essential
legislation that establishes clinical social work as its own profession,
on both the federal and state levels. We are reimbursed for mental
health services by federal agencies, behavior health companies,
insurers of all stripes, and New York State employees. Should the
Call for Proposals
For Workshops and Panels at the 46th NYSSCSW Annual Educational Conference
CONFERENCE DATE: APRIL 25, 2015
We are looking for presentations and/or panels on fresh, new approaches in clinical practice. These proposals can
be from any theoretical perspective, any modality or setting, but individual presentations cannot exceed 20 minutes.
Proposals should be from three to five typewritten pages, double-spaced, and must include:
• A description: purpose, function, and teaching objectives. Include brief clinical illustrations.
• A workshop outline describing concepts to be developed.
• A bibliography.
• On a separate page, your C.V., and all other identifying information. Underline one affiliation that you would like
listed on the brochure. Private practice is not considered an affiliation.
• On a separate page, a brief paragraph of about five lines, stating the purpose of the workshop and listing five
to six aims and objectives.
DEADLINE FOR SUBMISSION OF PROPOSALS: JANUARY 13, 2015
Please e-mail one set of submissions to: mwineburgh@aol.com
The subject line of your e-mail should read: 46th NYSSCSW Educational Conference
4 The Clinician www.NYSSCSW.org
please welcome the new members of the nysscsw*
NAME
CHAPTER
Allman, Joanna
MET
Angel, Catalina
MET
Auslander, Ellie, LCSW
MET
Bellows, Sarah
MET
Benedict, Anne
MET
Benjamin, Robin R., LCSW-R, LP
MET
Brodie, Janis E.
MET
Cannon, Lindsay N.
MET
Carlson, Susanna
WES
Charna Meyers, Jane, LCSW-R
MET
Colton, Leith A.
WES
Cornelius, Donald S., LCSW
MET
Cox, Julie
WES
D’Alisera, Michael
ROC
D’Amico, Philip
SI
DeCosta, Louise, LCSW-R
MET
Dumais, David J., LCSW
MET
Eklen, Helene, LMSW
ROC
Eschelbach, Elin
NAS
Espinal, Luis R.
MET
Forest, ClaudiaT., MSW, LMSW
MID
Fotheringham, Julie A.
MET
Geltzeiler, Rosann, LMSW
MET
Goldberg, Neal S.
MET
Goldfarb, Ranny, LCSW
MET
Gonzalez Ferro, Maria Victoria
MET
Gordon, Joan I.
MET
Grazer, Sage A., MSW
MET
Greer, Jane
MET
Hall, Danita
MET
Hall, Puja B.
MET
Hammer, Ida E., MSW
MET
Harris, Michelle C.
MET
Healy, Maureen
MET
Hiland, Gordon K.
WES
Himmelstein, Laura
WES
NAME
CHAPTER
Hvolboll, Eric
MET
Impert, Laura, LCSW-R
MET
Jaffe, Brad, MSW
MET
Jenkins, Paula
MET
Jeris, Darlene
WES
Johnson, Brooke
WES
Kalish, Elora L., MSW
ROC
Kapstein, Elizabeth
MET
Kassan, Lee
MET
Kiesling, Stephen, LCSW
ROC
Kindley, Louise, MSW, LCSW-R
MET
Kline, Janice
MET
Kohn, Martha C.
WES
Korsen, Meredith
MET
Labi, James, LCSW-R
MET
Lakis, Maria A.
MET
Landau, Laura
WES
Leeds, Kenneth, LMSW
MET
Lenkowsky, Eve
WES
Levine, Betsy, LCSW
MET
Lisi-Haas, Carolyn, LCSW
NAS
Lista, Janet A.
MET
Livingston, Elizabeth, MSW
MET
Locker, Emily K., LCSW
MET
Marchessault, Maureen, LCSW-R
MID
Markus, Carolyn B., MSW, LCSW-R WES
Marston, Maryann
MET
Mc,Farlane, Josephine A.
MET
Mccarthy, Donald S.
QUE
Mcdavid, Megan T.
MET
McGrath Murphy, Melanie, LCSW
MET
Moas, Timor
MET
Moked, Daphne
MET
Moore, Kelly
WES
Mosesso, Judith A.
WES
Nadel, Sue
WES
NAME
CHAPTER
Ng, Tracy
MET
Nugent, Jeanne A.
MET
Okuhn, Susan
MET
Opara, Ijeoma
WES
Patrick, Lisa
MET
Pertnoy, Fanny
MET
Raimo, Rosemarie F.
NAS
Rak, Eda
MET
Rivkin-Haas, Sofia C., MSW
MET
Rodriguez, Leslie
ROC
Rose, Jacqueline S., LMSW
WES
Rosenberg, Linda
MET
Rosengarten, Caitlin, LMSW
MET
Russell, Mark J.
SI
Schiliro, Margaret, MSW, LCSW-R
MET
Schneider, Mollie
MET
Scott, Amanda
MET
Seff, Sherie L.
MET
Shelowitz, Randi B.
NAS
Simpson, Kaitlyn, MSW, LMSW
WES
Stein, Diana, LMSW
NAS
Tassone, Almira
ROC
Touray, Binturabi K.
MET
Trainer, Denise, LCSW-R
MET
Treder-Wolff, Jude
SUF
Turco, Stephanie
MID
Vittor, Brooke S.
MET
Ward, Rosemary T., LCSW-R
MID
Williams, Alexandra
MET
Wilson, Katelyn, MSSW, LMSW
MET
Wolf-Powers, Josh
MET
Woods, Margaret M.
MET
Youree, Rachel, MSW, LCSW-R
MET
Zemor, Michelle, LMSW
MET
Zigelman, Aviva, LCSW-R
QUE
Zisser, Jodi S., LCSW
MET
CHAPTER KEY: MET–Metropolitan, MID–Mid-Hudson, NAS–Nassau County, QUE–Queens County, ROC–Rockland County,
SI–Staten Island, WES–Westchester County.
*These new members joined between March 1 and October 1, 2014.
Fall 2014 5
This new entity is applying for CE accreditation privileges from
the state education department. If all goes well, ACE will be able to
approve quality educational offerings across a variety of settings,
e.g., conferences, workshops, and office based courses across the
state. The Foundation can pay teachers and be self-sustaining, in
other words, it can make a profit.
Our next step is to apply to the state for CE recognition, which
we are in the process of doing. We are submitting three short-term
office-based courses and a Nassau Chapter educational program, all
planned for early winter.
I want to stress that this is a program in development. We require
the teachers to be members of the Society, and they must have
expertise in the clinical area they are offering. Please check E-News
and CE website regularly for information on when these programs will
be offered.
Workers’ Compensation: We have been engaged in a 20-year-
struggle for social work clinicians to become providers of mental
health services for New York State workers’ compensation victims.
Our bill passed both houses of the legislature this year and, hope
fully, the governor will sign it into law.
Why did we fight so long and hard for this law? For many years,
only psychiatrists and psychologists were approved as providers.
However, there is a shortage of mental health professionals in the
state; Wyoming County, for example, has only one psychologist serv
ing the entire county. By including LCSWs as providers, availability
would increase by 400%. In addition, workers’ compensation is a
state-funded system, totally separate from federally funded or pri
vate insured insurance programs. Finally, because the system exists
at all, it follows that we should be providing clinical services.
Business Partnerships: We are also seeking to change New
York’s corporate laws to allow us to be full business partners with
other autonomous, licensed professionals, like veterinarians, den
tists, physicians, psychologists, etc. Each of these professions has
a psychological component and, with the new federal emphasis on
continuity of care and one-stop medical homes, we have a rationale
for changing the law. We need to be able to be full partners in men
tal health business entities, not just employees.
Obamacare: It remains to be seen how the Affordable Health
Care Act (Obamacare) will impact private practice and fee-for-
service, and what will happen to patient privacy and confidentiality.
As for out-of-network benefits, under Obamacare, the government
is reorganizing health care. Group practice is the preferred modal
ity, and the intent is for all of us to be in medical homes where all
medical services can be coordinated. These changes have shrunk
out-of-network benefits and/or radically increased the deductibles
before they can be accessed.
The Society’s intent is to make sure that clinical social work
ers are the providers for mental health services across any model
that emerges. For that reason, we have invited the administrator in
charge of New York’s health care marketplace to speak at our spring
education conference in April 2015.
Your Online Connection
Find it fast on our easy-to-use website!
Chapter Activities
Colleagues’ Contact Info
Continuing Education
Events Offering CEUs
Job Opportunities
Legislative News
Listservs
Insurance Updates
Meetings/Conferences
Members-Only Benefits/Perks
Mentorship Groups
News/Analysis
Networking/Social Events
Peer Consultation
Standards/Ethics
Practice Groups
Professional Resources
. . . and much more!
WWW.NYSSCSW.ORG
It’s all here. Visit today!
CSWA: Our Society is the largest state professional group of its
kind in the country. We have affiliated with the Clinical Social Work
Association (CSWA) in the hope of having access to national health
care information. They have an excellent website, www.cswa.org, with
Medicare information, PQRS updates, and more. For instance, they
reported that we do not have to use ICD-10 diagnoses until 10/1/15.
Online Learning: Finally, I commented on the quiet flowering of
distance learning, or online learning, which is replacing traditional
classroom learning and field placements in MSW programs. Two
national groups are working on stemming the tide, CSWA and a new
group called Excellence in Social Work Education (ESWE). We need
a representative from NYSSCSW to be involved. If you are inter
ested, please let me know: mwineburgh@aol.com.
CONTINUED FROM PAGE 3
president’s message
WWW.NYSSCSW.ORG
New York State Society for Clinical Social Work
6 The Clinician www.NYSSCSW.org
PQRS: The Committee offered a teleconference presenta
tion on October 15 by Linda Plastrik, LCSW on how to comply
with the extremely complicated reporting requirements from
Medicare called the Physicians Quality Reporting System. More
information about PQRS is available at www.NYSSCSW.org.
NYHealthcare Exchange: Also called “The Marketplace,”
the Exchange has a website at NYStateofHealth.gov. The
Committee followed the rollout of the Exchange on October
1, 2013, the offerings of the various plans, patient responses,
and the question of whether out-of-network benefits would be
offered next year. This year, the Exchange offered no out-of-
network benefits for medical or mental health services.
Out-of-Network Benefits: The Committee followed a bill in
the state legislature last spring that included sections requir
ing insurers to provide transparency, network adequacy, and
certain out-of-network benefits. This bill did not address the
lack of out-of-network benefits in any of the Exchange plans or
address mental health directly. However, one section that was
voted into law required that FairHealth be used as the database
for determining UCRs if out-of-network benefits are paid.
Vendorship and Managed Care Committee
By Helen T. Hoffman, LCSW, Chair
The Legality of Telephone Reviews, Online Reviews,
and OTRs: While several plans discontinued the use of
Outpatient Treatment Reports or 10-session authorizations
this year, they continue to use review of “medical necessity” to
manage utilization of the benefit. The Committee is following a
lawsuit, brought by the New York State Psychiatric Association
and others, that claims that mental health providers are unfairly
held to a more stringent standards than medical providers in
having to show medical necessity.
The Committee tracks trends in the insurance industry, gathers
and disseminates information, and considers what can be
done to improve the financial health of our profession. Short,
informative articles, such as “Electronic Billing,” “Opting Out
of Medicare,” “High Deductibles,” “Antitrust,” and “Peering into
the Future,” can be found at www.NYSSCSW.org. If you have
specific questions about your practice, please contact one of
our members, listed on the Website.
For news, articles and chapter contacts, please
visit www.nysscsw.org/vendorship-a-managed-care
Here are some of the issues the Vendorship and Managed Care Committee
has been following in the last six months.
for conditional registration, or request an adjustment based on
health issues that prevent compliance. If you are not intending to
practice, you can request inactive status.
These forms and additional information are available on the
NYSED website. Questions and answers can be found here:
Approved providers:
http://www.op.nysed.gov/prof/sw/swceproviderlist.htm
Provider requirements:
http://www.op.nysed.gov/prof/sw/swceproviders.htm
Social work website:
http://www.op.nysed.gov/prof/sw/swceinfo.htm
State Board for Social Work:
T. 518-474-3817, ext. 450; F. 518-486-2981;
E. swbd@mail.nysed.gov
Worker’s Compensation Reimbursement: Our bill has
passed both houses of the state legislature and is awaiting the
governor’s signature. A few LCSWs have been reimbursed inde
pendently by Worker’s Comp, but this law, if signed, will legally
expand the pool of providers across the state, making LCSW
mental health services available to injured workers.
Meditation: The State Board for Social Work has decided
that the use of meditation in practice is not a clinical interven
tion and therefore cannot qualify for continuing education
hours. It is considered a spiritual practice, not psychotherapy.
Telepractice and Coaching: The state’s position on these
practice areas will be one of the subjects covered by David
Hamilton, Ph.D., Executive Secretary of the State Board for
Social Work and Mental Health Practitioners, at our 2015 Annual
Education Conference on Saturday, April 25. Plan to attend!
Legislative Report CONTINUED FROM PAGE 1
Fall 2014 7
The following material is summarized from an article
published in Volume 41, No. 2 of the Clinical Social Work
Journal, June 2013, a special issue on the Implications for
Social Work Practice of the DSM-5.
Informed Consent
The principle of informed consent, like the principle of self-deter
mination in social work, is based on the moral principle of “au
tonomy.” This principle is discussed extensively in the classic work
by Beauchamp & Childress, Principles of Bio-Medical Ethics (2009,
Chapter 4) and much of the material in this section comes from that
source.
The autonomous individual is one who “acts freely in accordance
with a self-chosen plan” (p. 99) but, of course autonomy is always
limited, and respect for autonomy does not override all other moral
considerations. Initially the “simple consent” of a patient was
considered to be sufficient for the professional to proceed with
treatment, but as cases entered the court system it was seen that
there is a significant inequality of position and knowledge between
a professional and a patient. A frightened and uninformed patient
might easily agree to a treatment procedure without really under
standing what is involved and what the possible consequence might
be. A process of “simple disclosure,” in which the patient is simply
presented with a list of technical terms which he or she might not
be able to understand, is not an adequate process to obtain a mean
ingfully autonomous agreement for the treatment. If the patient
does not have sufficient information about the proposed treatment
and its possible consequences, then the concept of autonomous
decision making has no meaning.
Gradually, the American court system began to spell out what
is known as a doctrine of “informed consent,” and to expect that
professionals will fulfill this duty in their practice. This doctrine
requires that a prospective patient must be informed of the risks
and benefits of the proposed treatment, the risks and benefits of
alternative treatments, and the risks and benefits of no treatment.
It is recognized that it is impossible to anticipate every possible
risk and benefit of a proposed treatment, and it is adequate that the
patient be made aware of the central facts of the treatment (p. 127-
128). The prospective patient must, in other words, be made aware
of the information that a “reasonable person” would want to know
before deciding on a course of action.
It is obvious that not every individual is capable of making an
informed choice and the professional must also consider these
Clinical Social Workers as Diagnosticians:
Legal and Ethical Issues
PART 2: Informed Consent, Malpractice, and the Standard of Care
By David G. Phillips, DSW, LCSW, Co-Chair of the Committee on Ethics & Professional Standards
factors. The person making the choice must be competent and ma
ture enough to make an important decision; the information must be
presented to the individual in a manner, which he or she is able to
understand, and; the choice must be voluntary and not made under
duress. Although the doctrine of informed consent was developed
by the courts in cases involving physicians, it is no less a responsi
bility for non-medical professionals, and the obligation is spelled out
clearly in social work codes of ethics.
Being labeled with a psychiatric diagnosis is not a trivial matter,
and the doctrine of informed consent extends to this choice which
the patient might consider. A psychiatric label may affect many as
pects of the patient’s life including employment, potential decisions
in child custody disputes, and the ability to purchase other forms of
insurance, such as life insurance. Patients seen in psychiatric hos
pitals do not have a choice as to whether or not they will receive a
diagnosis, but voluntary patients seen in outpatient settings such as
private practice do have a choice. Professionals have an obligation to
explain this choice, and its possible consequences, to patients who
are considering using third party payers to support their treatment.
As Barsky points out in his discussion of the issues involved when
a patient gets a DSM diagnosis, the clinical social worker should,
“Provide patients with information and strategies to help them avoid
and/or cope with the risks of diagnosis (e.g., explain their rights to
confidentiality, equality, and non-discrimination…” (2010, p. 323).
Malpractice and the Standard of Care
Reamer points out (2003, p. 2) that it is unfortunate that we need
this knowledge, but “every contemporary social worker needs to be
acquainted with the nature of professional malpractice and liability”.
In order to understand how the issue of malpractice may apply to
clinical social workers in their activity as diagnosticians, it is first
necessary to explain some of the basic concepts. If a professional
person is accused of negligent practice (sued for malpractice) the
individual making the accusation (the plaintiff) must demonstrate
evidence of four points. Reamer’s outline (2003, p. 3) is a clear
summary of the requirements involved in proving professional
negligence:
1. At the time of the alleged malpractice, a legal duty existed
between the practitioner and the client…
2. The practitioner was derelict in that duty, either through an
omission or through an action that occurred…
3. The client suffered some harm or injury…
4. The professional’s dereliction of duty was the direct and
proximate cause of the harm or injury…
CONTINUED ON PAGE 16
8 The Clinician www.NYSSCSW.org
Reviews of the 45th NYSSCSW Annual Education Conference | May 10, 2014
Facing Impasses: Identification and Working Through
CONTINUED ON NEXT PAGE
L
ouise DeCosta captivated the audience at this year’s
annual education conference with an innovative and
fun presentation in which two child analyses (one
by Klein and the other by Winnicott) were performed on
stage. Differences in technique and theory were elucidated
in these dramatic period re-enactments in which Marsha
Wineburgh, NYSSCSW President, was featured in a star
ring role as Melanie Klein and Stewart Crane, Postgrad
Psychoanalytic Society president, as Donald Winnicott.
DeCosta cast herself in the role of the child patient.
Verbatim dialogue and interpretations taken directly from
the original sessions gave authenticity to the perfor
mances. Though a dramatization of Anna Freud’s work was
not performed due to time constraints, her theoretical
viewpoint and technique were presented, as well.
DeCosta provided a detailed clinical history of these
pioneers in child therapy and Object Relations theory that
illuminated the influences on their schools of thought.
Included was the complexity of their relationship, set
against the backdrop of pre- and post- World War II
Europe. Anna Freud and Klein were contemporaries
and rivals, battling matriarchs for 15 years, and although
they held shared beliefs, they disagreed on technique.
keynote review
Back to the Future: First Sessions with Klein, Winnicott, and A. Freud
How Their Approach to Treatment Speaks to Us Today
Keynote presented by Louise DeCosta, Ph.D., LCSW; Reviewed by Marie McHugh, LCSW-R
A. Freud’s observation of
children was a comprehen
sive diagnostic profile with a
treatment focus on building
maximum ego strength.
She argued that children
went through developmen
tal stages (with no ego or
super ego) and symptoms
were often transitory. In
contrast, Klein believed that
the psychic structure of the
child included both the ego
and the super ego.
Winnicott pledged alle
giance to both schools of thought and was noted to have
had a complicated and intertwined collegial relationship
with Klein. Klein was Winnicott’s supervisor when he was
in training, and these analysts lived in a time when it was
common to analyze themselves, each other, and their chil
dren. Of note, Winnicott was a male pediatrician who saw
60,000 children in the course of his career, and he went on
to develop his own original ideas.
Louise DeCosta, Ph.D., LCSW
impasses in treatment can signal the end of our work with a client, or the beginning of a new and deeper
transformative experience. The topic provided a compelling theme for the 45th NYSSCSW Annual Education
Conference. Our distinguished speakers approached it from many vantage points: different modalities—
individual, couple and group; different theoretical perspectives—relational, object relations, hypnosis,
neuro-psycho-educational, and ego state approaches; and different topics—social class, eating disorders,
transference/counter-transference collusion, politics in sessions, treatment dyad issues, sexual issues, and
substance abuse. The innovative and informative keynote addresses (reviewed here) and a wide array of
workshops made the conference an enlightening and enjoyable educational experience.
—Meryl Aster, MSSW, LCSW-R, 2014 Education Conference Chair
Fall 2014 9
Louise DeCosta, Ph.D., LCSW is a faculty member, supervisor
and training analyst currently affiliated with the Postgraduate
Psychoanalytic Institute, and a member of the C.G. Jung Foun
dation for Analytical Psychology. In private practice for more
than 30 years, her training includes work and study in the USA,
Mumbai, India and London at The Tavistock Clinic. DeCosta is
the Creative Director for both dramatic readings: The Freud/Jung
Letters (premiered New York City, 2011), and The Freud/Ferenczi
Letters, which premiered in Prague, August 2013.
Marie McHugh, LCSW-R, a certified psychoanalyst in private
practice in Manhattan.
The Case of Richard
Klein’s treatment of Richard, a ten-year-old boy, consist
ing of six sessions per week from April to August 1941,
focused on the resolution of the Oedipal Complex. Richard
presented as bright, articulate, and well mannered, with
a good upbringing. He had moved with his family from
London to a small Scottish town because of the war. In
session, he focused on the disruption of his outer world,
important figures in his life, and being unable to attend
school. On the surface, his anxiety appeared to be related
to his exposure to the war. But Klein focused on his inner
world, and giving deep interpretations right from the start
to provide the child with the opportunity to feel under
stood. She interpreted Richard’s latent content as anxiety
about unresolved Oedipal issues.
The Case of Bobby
In contrast, Winnicott’s patient, a six-year-old boy named
Bobby, is described as an emotionally deprived child who
had been in foster care since the age of two. Bobby’s
symptoms included mood swings, suicidal threats, and
violent outbursts. His treatment occurred during the 1960s
in London and lasted several years. In session, Winnicott
regulated the clock and made use of drawings and play
therapy in his analysis of Bobby, noting that there were
many sexual symbols, which he interpreted.
However, Winnicott’s concept of the value of being able
to tolerate “not knowing” in the analyst and replacing it
with the capacity to play were demonstrated. According to
Winnicott, this style of non-verbal interpretation allows
the child to gain insight by finding and ascribing meaning
to his experience, at his own level of development and
understanding.
Additionally, Winnicott’s emotional attunement and nur
turing of “the true self” were evident subtleties present in
his work with the child.
Summary
DeCosta concluded the presentation by emphasizing the
valuable and lasting contributions of these pioneers in
Object Relations Theory. A lively question and answer
period followed.
A. Freud, Klein, and Winnicott evolved as clinicians
throughout their lifetimes and made valuable and lasting
contributions to Object Relations Theory. Each one devel
oped a distinct viewpoint still clinically relevant, in some
cases with terminology that has been incorporated and
integrated into different theoretical frames. Winnicott’s
theory is one of the most widely accepted, and claimed by
many divergent schools of thought. A. Freud and Klein’s
contributions to Play Therapy continue to be used today.
Keynote Review
Conference Committee Members (l to r): Marie McHugh, LCSW; Daphne Leahy-
Matteo, LCSW, SEP; Meryl G. Alster, LCSW, Chair; and Dale B. Schneitzer, LCSW.
10 The Clinician www.NYSSCSW.org
CONTINUED ON NEXT PAGE
L
awrence Josephs presented a scholarly lecture on cou
ples therapy at this year’s annual education conference,
Facing Impasses: Identification and Working Through.
Combining psychoanalytic theory, research, and clinical
experience, Josephs’ discourse was an erudite study of a chal
lenging aspect of couples work, specifically, sexual disgust.
Using the basic tenets of attachment theory interwoven with
marital and disgust research, Josephs predicated that attach
ment styles tend to predict communication styles. Whereas
securely attached individuals tend to approach marital con
flicts in the most constructive ways, the avoidantly attached
tend to avoid conflict discussions, and the anxiously attached
tend to escalate conflict discussions into dysregulated angry
interchanges. Correspondingly, the quality of a couple’s commu
nication tends to be reflected in their sex life, and affects the
adjustment level of their children, as well.
Based on this premise, Josephs expounded on the two most
common processes observed in the treatment of couples in
conflict. While some couples are engaged in cycles of escalat
ing power struggles, others are in a more emotionally detached
place, appearing distant and indifferent to each other. Josephs
postulated that hidden beneath the façade of sexual indiffer
ence and boredom that characterize a declining sex life are
many repudiated emotions. Feelings of hurt and anger originat
ing from unmet needs for sexual intimacy and secure attach
ment are disavowed as a defense against shame. Rejection
and shame often underlie these negated emotions and passive
aggressive partners that reject, through sexual indifference
and emotional detachment, may be defending against their own
underlying, often repudiated, feelings of rejection. Josephs
proposed that sexual disgust is another repudiated emotion,
often disguised as sexual indifference.
Theory and Research
Citing research, Josephs segued into an in-depth analysis on
the nature and origins of disgust, defining it as a visceral feeling
of revulsion. With regard to sexual disgust, various theoreti
cal perspectives were presented. Freud linked sexual disgust
to its unconscious association with fecal matter and fears of
contamination. He noted that with the advent of toilet training,
feces and urine become core disgust elicitors, which current
keynote review
Working Through Sexual Disgust in Couples Therapy
Keynote presented by Lawrence Josephs, Ph.D.; Reviewed by Marie McHugh, LCSW-R
developmental researchers have
found to be true. According to
this perspective, sexual disgust
towards various forms of sexual
ity possibly could be overcome
through hygienic sexual
practices.
However, many forms of
sexual disgust appear not to be
related to fears of contamination,
but rather to issues related to
the Oedipal conflict. As Josephs
stated, “Oedipal splitting splits
the world of adult romantic
relationships into two competing
camps; disgustingly promiscuous individuals who are prone
to cheat on their partners or steal other people’s mates, in
contrast to morally pure and wholesome individuals who honor
monogamous commitments.”
Josephs noted how a more relational theory seems to
naturally evolve from Freud’s notion of Oedipal splitting.
Studies have shown that children seem to experience insecure
attachment based on their exposure to infidelity. Additionally,
sexual behaviors that involve a betrayal of trust and undermine
attachment security, such as deceit or coercion, elicit feelings
of disgust. Nonetheless, Josephs advanced the concept that
some forms of sexual disgust seem more related to narcissistic
dynamics than attachment dynamics, as in the case of Oedipal
shame, in which shameful feelings of sexual unattractiveness
and inadequacy derive from the Oedipal conflict. Other factors
noted that further complicate the treatment process were
disgust associated with aspects of a person’s sexuality that par
ents, peers, or the culture at large think is disgusting, as well as
the effects of trauma resulting from sexual abuse.
Treatment and Summary
Josephs asserted that the ultimate goal of couples therapy is
to increase attachment security so that each partner feels it is
safe to expose hidden vulnerabilities to the other partner, as
sexual disgust is a serious threat to attachment security. The
objective of treatment is to help the couple cultivate empathy
Lawrence Josephs, Ph.D.
Reviews of the 45th NYSSCSW Annual Education Conference | May 10, 2014
Facing Impasses: Identification and Working Through
Fall 2014 11
Lawrence Josephs, Ph.D. is a professor at the Derner Institute of
Advanced Psychological Studies of Adelphi University. He has served
on the North American Editorial Board of the International Journal of
Psychoanalysis and has been a Fellow of the College of the Inter
national Journal of Psychoanalysis. In addition, he has served as a
reviewer for Psychoanalytic Psychology. In recent years, Dr. Josephs
has published articles in the International Journal of Psychoanaly
sis, Psychoanalytic Psychology, and Dynamic Psychiatry, building
bridges between psychoanalysis and evolutionary psychology in
the area of adult romantic relationships. Dr. Josephs is in the private
practice of individual and couples therapy in New York City.
Marie McHugh, LCSW-R, a certified psychoanalyst in private practice
in Manhattan.
for each partner’s underlying vulnerabilities and frustrated de
sires. Empathy is achieved when there is a mutual understand
ing that nobody should be subjected to something that disgusts
him or her, or be made to feel like a shamed object of sexual
disgust. Furthermore, the partners themselves must negotiate
what is or is not disgusting. Josephs observed, however,that
from a relational perspective, the therapist’s own sexual
aversions and preferences will most likely be unconsciously
communicated, if only fleetingly, in facial expressions or tones
of voice.
Josephs illustrated his concepts through two clinical exam
ples from his practice, each with a different outcome. He noted
that many layers of hurt and anger have to be worked through
so that sufficient trust is developed in each partner, and in the
treatment process, before the shameful issue of sexual disgust
is allowed to openly emerge in treatment. He contended that
people in a successful romantic relationship figure out how to
have empathic sensitivity toward one another, despite their
conflicting preferences and aversions. However, sometimes
the result of couples therapy is divorce or separation, as each
partner concludes that romantic fulfillment is not possible in the
relationship. Nonetheless, Josephs posited that couples therapy
is still valuable, as it can help divorcing couples go their separate
ways with their dignity intact.
Josephs ended his presentation on an optimistic note,
asserting that it is often possible for couples to discover a way
of transcending the sexual disgust that inhibits sexual inti
macy and undermines the secure and trusting attachment that
romantic partners hope to achieve.
Workshop Speakers (l to r): Cathy Siebold, DSW; Sari Eckler Cooper,
LCSW; Sandra Indig, LCSW, LP, ATCB; and Inna Rozentsvit, M.D., Ph.D.,
MSciEd, MBA.
Workshop Speakers (l to r): Betsy Robin Spiegel, LCSW; Susan Pinco,
LCSW, Ph.D., BCD, CCR, Certified EMDR Consultant; Robert S. Pepper, LCSW,
Ph.D.; Susan Kavaler-Adler, Ph.D., ABPP, D.Litt, NCPsyA; and Teresa Solomita,
LCSW, PC PsyA.
Conference photos by K. C. Tawfik
Keynote Review
12 The Clinician www.NYSSCSW.org
Chapter Reports
Queens Chapter
Fred Sacklow, LCSW-R, President
Freds99@aol.com
The Queens Chapter will present five speak
ers this year. The four remaining events
will take place at York College on these
Sundays: November 16, January 11, March
15, and May 17. Each day’s agenda begins
with our board meeting, followed by a net
working session, from 11:00 a.m. to 11:30
a.m., and then the speaker’s presentation,
from 11:30 a.m. to 1:00 p.m.; ample parking
and convenient public transportation are
available. Complete details can be found
at www.NYSSCSW.org, and on the Queens
Chapter listserv. In addition, please note
that the chapter offers peer consultation
and mentoring groups.
Mid-Hudson Chapter
Rosemary Cohen, LCSW, President
rosemarycohen@gmail.com
The Mid-Hudson Chapter will continue this
year to hold four annual workshops. They
will take place in the conference rooms of
Mental Health America of Dutchess County
in Poughkeepsie and Benedictine Hospital
in Kingston. On September 13, Michael
Blanschen, Ph.D. presented his workshop,
Self Psychology: The Impact of Regression
and Narcissism on Psychotherapy, on
recent developments in the field of
Psychoanalysis/Depth Psychology,
especially on how Self Psychology has
altered the course of analytical thinking and
influenced the development of new ways of
working with individuals.
On November 15, Anton Hart, Ph.D. will
offer his workshop on Entanglement with
Adolescents: Enacting and Addressing
Resistances to Curiosity. Hart will explore
the concept of “cultivating curiosity” in
psychotherapeutic work in order to develop
an understanding of resistance to curios
ity as a central dynamic in many forms of
psychopathology.
The Mid-Hudson Chapter again co-
sponsored, with Adelphi University
Graduate School of Social Work and the
NASW NY State Hudson Valley Division,
a third conference on the clinical treat
ment of veterans and their families; and
a conference was held jointly with the
Hudson Valley Chapter of Gay, Lesbian
& Straight Education Network on LGBTQ
clinical issues. Gloria Robbins, LCSW, now
our Treasurer and Chair of the Membership
Committee, serves on the planning
committees.
In addition, we gave our support to
the Hudson Valley Guild for Mental Health
Professionals in Ulster County for their
November 1 conference, Advances in
Psychotherapy: Mind-Body Approaches to
Attachment Disorders, presented at SUNY
New Paltz.
Our Mentorship Group, led by Carolyn
Bersak, DSW and Crystal Marr, LCSW, sup
ports second-year social work graduate stu
dents and recent LMSW clinicians. Monthly
meetings are held at Adelphi Hudson Valley
in Poughkeepsie.
Metropolitan Chapter
Karen Kaufman, Ph.D., LCSW, President
Karenkaufman17@gmail.com
The Met Board continues to expand to serve
the membership with a vast array of edu
cational, social and networking programs.
This fall, the LGBTQ Committee welcomed
Seena Freedman, LCSW as its new Co-Chair,
serving with Judy Gringorten, LCSW.
The ever-popular groups and events:
Education Brunches, Speed Networking,
Trauma Studies, Family Practice, Substance
Abuse, The Aging Client and Clinician, and
Mentorship groups for new and recent
graduates, are all continuing with new of
ferings throughout the year.
Our fall and spring Member Receptions
have proven to be very popular as well.
Please encourage friends and colleagues
to attend. The receptions are open to all
members and prospective members and are
a great way to meet board members and
committee chairs. In addition, the ListServ
Committee continues to work with members
to get the most out of this valuable com
munication tool.
Met Chapter: Four MSW Students Win Writing Scholarships
By Chris Ann Farhood, MSW, LCSW, Coordinator
The Met Chapter is pleased to announce the recipients of the 2014 Diana List Cullen
Memorial First Year MSW Student Writing Scholarship Awards. The scholarship
program, now in its fourth year, was named in honor of Diana List Cullen, a past
president of the Met Chapter, a dedicated member of the Education Committee,
and a lifelong believer in the power of education.
Four metropolitan area graduate schools of social work each submitted three
student papers, which were reviewed by the Education Committee. The students
selected for scholarships are Devan Zambito, from the Graduate School of Social
Service at Fordham University; Antonia Maeck, from the Silberman School of Social
Work at Hunter College; Sebastian Shaw, from the Graduate School of Social Work at
Lehman College; and Dana Kelly Nadel, from the New York University Silver School
of Social Work. An Awards Ceremony on November 5 will be attended by deans and
faculty of the schools of social work, Met Chapter Board members and committee
members, as well as family and friends of the scholarship recipients.
Fall 2014 13
Members of the Met Board and our com
mittee chairs are always happy to hear from
you about your interests and professional
needs, and we invite you to get involved in
a stimulating community of clinicians. Find
an area of professional practice that piques
your interest and join us. Share your ideas
and expertise and get involved in the lead
ership of your chapter. Contact information
for board members is available in the Met
Chapter section at www.NYSSCSW.org.
Rockland County Chapter
Orsalya Clifford, LCSW-R
ovadasz@optonline.net
We are off to an exciting start with a new
slate of stimulating educational programs.
Presentations for the rest of this year will
address these topics: treating eating disor
ders, utilizing coaching in clinical practice,
and spending and wellbeing. The line-up
of presentations for 2015 can be found at
www.NYSSCSW.org.
One highlight of our schedule is an event
in December, which will include dinner,
the viewing of a movie, The Story of the
Weeping Camel, followed by a discussion.
The event is dedicated to Sylvia Porter,
LCSW, a respected and beloved board mem
ber who died last year.
Our educational presentations were so
well attended last year that we are now
offering one every other month in a larger
space. We continue to hold clinical case dis
cussions before the presentations, which
generate supportive dialogue among newer
clinicians and seasoned practitioners.
We maintain an ongoing focus on men
torship programs for students and those
entering the field, on growing our chapter,
and on supporting our mutual growth as
social work professionals. [Report written
by Catherine Bailey, LCSW.]
Staten Island Chapter
Janice Gross, LCSW, President
Jgross1013@aol.com
The past months have been very busy.
In March 2014, we held our Annual
Educational Conference, Working with the
Difficult Client. The two speakers, Dore
Sheppard, Ph.D., LCSW and Lynn Saltiel,
LCSW gave very informative presentations.
In April, two of our own marital thera
pists, Andrew Daly, LCSW and Janice Gross,
LCSW, squared off on treating couples from
their respective theories. Daly uses the
theory of Murray Bowen, and Gross spoke
about the approach of Emotionally Focused
Couples Therapy. Our attendees engaged
them both with many questions.
Our calendar year ended with a very
informative presentation by a local psy
chiatrist, Dr. George Tawfiq, who presented
Natural Approaches to Psychiatric Illnesses.
His described the effect adrenal fatigue
may have on clients we work with, which
proved to be an informative and beneficial
discussion.
The 2014-2015 year began with an eve
ning educational presentation and dinner
at Staten Island University’s Regina McGinn
Educational Center. Constance Salhany,
Ph.D. provided an overview of Cognitive
Therapy to a large attendance of members,
prospective new members, and students.
Please visit www.NYSSCSW.org to view our
full calendar.
We are happy to announce that Staten
Island’s membership is growing. We are
also proud of two of our members who
will be adjunct professors in the new MSW
program at CUNY College of Staten Island,
Catherine Putkowsi O’ Brien, LCSW and
Janice Gross, LCSW. The program empha
sizes disability issues.
QUEENS • MID-HUDSON • METROPOLITAN • ROCKLAND • STATEN ISLAND
The leaves are turning beautiful colors and
beginning to cover the ground. We will soon
be welcoming the festive end of the year.
The Society has a lot to welcome as 2014
ends and a new year begins.
The past few months brought to fruition
the idea of establishing a foundation to
serve as the educational arm of the Society.
The ACE (Advanced Clinical Education)
Foundation of NYSSCW was formed in
August and recognized by the IRS as a
501(c)3 organization. Its new board will
begin to plan educational opportunities to
enable members and non-members alike to
obtain the needed credits for licensure and
re-accreditation.
The revised By-laws of the Society
were adopted by a unanimous vote at the
Annual Membership Meeting in October.
This brings the Society into compliance
with the new state Non-Profit Law, enabling
electronic notification and in-person voting.
It also updates the procedures for other
aspects of the Society’s activities.
In November, we begin to think about
2015 and dues renewal time. The renewal
form has been redesigned to allow you to
make a tax-deductible donation to the ACE
Foundation. Please be on the alert for it,
and pay your dues for the coming year as
soon as you receive it.
The staff of Total Management Solutions
is pleased to assist members of NYSSCSW
in any way we can. Please feel free to
contact us. As 2014 comes to a close, we
wish you and your loved ones a very happy,
healthy and peaceful New Year.
Cordially,
Sheila
Sheila Guston, CAE, Administrator
Kristin Keunzel, Admin. Assistant
800-288-4279, info.nysscsw@gmail.com
Headquarters Update
14 The Clinician www.NYSSCSW.org
D
aniel Shaw, LCSW, a training analyst at the National
Institute for the Psychotherapies, has written an
illuminating work on traumatic narcissism that fully
describes the personality structure of narcissists, their
victims, and the relationships over which these abusers
often reign.
Shaw addresses the treatment of victims using Ferenzi’s
analytic love and relational analytic techniques. The great
strengths of the book are the generous number of clinical
examples, transcripts of actual treatment sessions, and
personal material from the author’s life.
Shaw spent many years as a member and an administrator
of a cult based on spirituality and yoga. During his post-cult
analysis, he developed a deep understanding of the narcissis
tic dyad. He was able to separate from the cult as he began to
recognize the cult leader’s abusiveness toward others.
Shaw’s experience regarding the dynamics that enable
members to leave these groups rings very true to me. I have
had a number of clients who left political, religious, psycho
therapeutic, and sexual orientation cults, and the influence
of abusive cult leaders. Like most clinicians, I also work with
many clients who were victimized by narcissistic family mem
bers. I believe Shaw’s work will be helpful to therapists in
resolving this dominance, freeing our patients in the process.
Shaw draws an accurate picture of vulnerability to the
dominating narcissist, who is, in fact, quite dependent on his
admiring followers or partners. He also offers a rich chapter
on couples treatment. His discussion in the last chapter, on
the nature of analytic love in healing narcissistic wounds, is
valuable for all therapists.
BOOK
Books Written by NYSSCSW Members
REVIEWS
Reviewed by Helen Hinckley Krackow, LCSW, BCD
T
his is a superb text for both eating disordered clients and
the psychotherapists who treat them. Mary Anne Cohen,
LCSW, BCD, has written a work that is both scholarly
and accessible. The founder of the New York Center for Eating
Disorders (EmotionalEating.org), Cohen has specialized in the
treatment of eating disorders for over 40 years, helping women,
men, and adolescents recover from binge eating, chronic diet
ing, bulimia, anorexia, and body image dissatisfaction. Complex
treatment issues are clearly illustrated in her book, with
many clinical examples drawn from her practice and from her
personal life. She richly demonstrates her warm and empathic
therapeutic style with patients. I found the many footnotes and
annotations helpful as well.
As I write this review, I think about my work over the past
week and how many of my clients have referred to their strug
gles with emotional eating. One man, feeling more at peace
than he has in some time, reported that he stopped consuming
his habitual pint of ice cream at midnight. In contrast, another
client is a woman who gained 50 pounds over the course of
the year, while her mother was dying. She recently rejoined
Overeaters Anonymous, but she must continue to work through
her grief as well. A third client is a 20-year-old who is struggling
for an adult life and an adult woman’s body.
So much pain is enacted through the body because we do not
have words for it. Cohen’s work is very helpful in this regard, par
ticularly her chapters on grief, body image in our society, abuse,
addictive behaviors, and pathological attachments. She also
includes very fresh material on impasses and client resistance.
I urge you to read this book, written by a clinician who is a credit
to clinical social work.
Helen Hinckley Krackow is a former president of the Society.
She chairs the state Mentorship and Newsletter committees, and
co-leads a practice committee on The Older Clinician and the
Older Client.
Traumatic Narcissism—
Relational Systems of
Subjugation
By Daniel Shaw
Routledge Press, 2014, pp.167
Lasagna for Lunch—
Declaring Peace with
Emotional Eating
By Mary Anne Cohen
New Forge Press, 2013, pp. 346
Fall 2014 15
T
he “beholder’s share” (originally
“beholder’s involvement”) concept
was developed by art historian
Alois Riegl, and his great disciples Ernst
Gombrich and Ernst Kris. They described
the workings of the mind of the viewer
(the beholder), including decoding the
visual information, determining its mean
ing, understanding it, and interpreting it—
depending on one’s prior life experiences,
emotional memories, and idiosyncrasies.
Rene Magritte said once, “Everything
tends to make one think that there is
little relation between an object and that
which represents it.” Magritte’s painting,
La Clairvoyance, which was a part of the
recent MoMA exhibition, “The Mystery of
the Ordinary,” confirms his words. In this
picture, we see the artist sitting at the
easel, looking at an egg on the table, while
painting not the egg, but the bird (!) with
its wings extended and ready to fly away. In
other words, the artist is painting what this
egg will become, and not what the visual
percepts (the oval smooth contour and the
solid white color) allude to.
This picture is a great representation
of the concept of the beholder’s share, the
very unique share that each separate human
mind brings to the “opinion table.” While
none of the opinions could be measured
and compared, and all of the opinions are
“valid,” they represent one’s own creation.
The Nobel laureate, neuroscientist Eric
Kandel tries to tackle the issue of the be
holder’s share—from the scientist’s and the
art lover’s points of view—in his 2012 book,
The Age of Insight: The Quest to Understand
the Unconscious in Art, Mind, and Brain.
His book is not just a psycho-historical
endeavor; it is not a textbook, where all the
theories are provided and are proven; it is
not a memoir. This book stimulates one’s
mind to connect the dots and to find one’s
own answers, the answers that might be
proven “wrong” after a while, but which
contribute to one’s personal development,
one’s “work-in-progress.”
Kandel, who had to make a choice
once—between psychoanalysis and hard
core neuroscience—made his choice in
favor of science, and now he shares with us
the production of his cross-pollinated mind,
his beholder’s share. “...[P]ainting is not
complete until the viewer responds to it...,”
says Kandel. In his interview with BigThink
after the book was published, he admitted
that we actually do not know what exactly
the “beholder’s share” is. Then, he pro
ceeded to say that our knowledge of brain
pathology (or brain conditions), traumatic
or not, provides us with some “outline” of
what the beholder’s share possibly is, and
what kind of processes are involved in it.
In The Age of Insight, Kandel offers a
tour of neuroanatomy, especially of neu
roanatomy of the visual system, which is
very important in our perception of visual
art. The images created in our brain are
not the same as what we “perceive” when
looking at the object. In other words, the
vision is the information processing, and
not the image transmission! What our visual
receptors perceive is called (by the modern
visual neuroscientists) “a percept” rather
than “an image.” Then, our brain runs the
percepts through the labyrinth of its unique
memories of prior experiences, emotional
Neurobiology of the Beholder’s Share and
the Mystery of the Ordinary
By Sandra Indig and Inna Rozentsvit
responses, and mirror neurons, and it cre
ates the image, which we decide to like (and
empathize with) or to hate; to put it on a
pedestal or to throw into the wastebasket.
As Kandel wrote in The New York Times
after The Age of Insight was written, “the
real ‘eye’ of the beholder is the brain itself.”
Abraham Maslow said in 1966, “I suppose
it is tempting, if the only tool you have is a
hammer, to treat everything as if it were a
nail.” In his book, The Psychology of Science:
A Reconnaissance, he praises science
for providing us
with the ability to
measure, compare,
and verify things in
the quest for “truth”
regarding some
specific parts of the
whole; to get to the
Weltanschauung, the
“world view”—or
the point of view, depending on interpreta
tion. However, the same Maslow confirms
that “this impersonal model failed with the
personal, the unique, and the holistic. Nor
has an alternative model yet been offered to
deal validly with the fully human person.”
When dealing with the whole person,
as Maslow saw it, science has to abdicate
because of its “hidden but fatal weakness—
its inability to deal impersonally with the
personal, with the problems of value, of
individuality, of consciousness, of beauty,
“There really is no such thing as Art.
There are only artists.” —E. Gombrich
“We don’t see things as they are,
we see them as we are.” —Anais Nin
Sandra Indig, LCSW-R, LP, ATCB is a Chair of
the Committee for Creativity & Transformation
(CC&T) in Clinical Practice, NYSSCSW.
Inna Rozentsvit, M.D., Ph.D., MSciEd, MBA is a
leader of the Neurobiology and Creativity work
shops at CC&T, inspired by Eric Kandel’s book,
The Age of Insight.
CONTINUED ON PAGE 17
16 The Clinician www.NYSSCSW.org
Clinical Social Workers as Diagnosticians
CONTINUED FROM PAGE 7
It is easy to see that any one of these points may give rise
to a number of complications, but for now, we will just con
sider the second point. What defines the legal obligation that a
professional person owes to a client, and what are the criteria
by which it can be judged that the professional was derelict
(negligent) in meeting that responsibility? This legal concept
has been the subject of a series of court decisions dating back
many decades in this country and is clearly summarized in the
following quote (Holder, 1983, p. 220):
When a physician or surgeon assumes to treat and care for
a patient, …he is held in law to have impliedly contracted
that he possesses the reasonable and ordinary qualifica
tions of his profession and that he will exercise at least
reasonable skill, care and diligence in his treatment of him.
This implied contract on the part of the physician does not
include a promise to affect a cure and negligence cannot
be imputed because a cure is not affected, but he does im
pliedly promise that he will use due diligence and ordinary
skill in the treatment of the patient….
This legal concept means simply that when a professional
undertakes a legal duty or establishes a professional relation
ship with a client, then the client is entitled to expect that
the professional possesses a reasonable degree of skill and
qualifications to treat the condition for which the client is seek
ing help. There is not necessarily a presumption of negligence
if the client doesn’t make progress, because the law recognizes
that not every client benefits from treatment. But if the client
doesn’t progress or is harmed because the professional doesn’t
exercise a reasonable degree of skill or doesn’t have reason
able qualifications for the treatment of the condition (doesn’t
meet the relevant standard of care) then the professional may
be liable for his or her negligent practice. There is, in other
words, a tacit, legal contract established between the client
and the professional when the professional undertakes the
treatment of the client. This legal concept applies equally to
non-medical professionals:
Non-physician health professionals are held to the stan
dard of skill, care and knowledge possessed and used by
the “reasonably prudent member” of the professional
group as long as the activity undertaken is one com
monly performed by members of the group… (Holder,
1983, p. 222).
In addition to possessing a reasonable degree of skill, care,
and diligence in treating the condition for which the client is
seeking help, the professional must also practice within his or
her “scope of practice,” another important concept also de
fined by law. A licensing law, such as the one that clinical social
workers now have in New York State, is referred to as a scope of
practice law, since it defines and gives legal sanction to the area
in which the professional is entitled to practice. But although
licensure is one important component, it is not all that goes
into defining the professional’s scope of practice. The other
components include the professional’s knowledge, training, and
experience and the possible limitations and requirements of
the setting in which the professional functions. The important
point here is that diagnosis has now become part of the scope
of practice of licensed clinical social workers in New York State
and that activity is now subject to the same legal concerns and
warnings that apply to their other professional functions. Just
as licensed clinical social workers should not treat outside
their scope of practice, they should not diagnose outside of
their scope. Barsksy (2010, p. 323-24) points that misdiagnosis
is common type of malpractice for social workers in the mental
health field and offers the following clear warning:
Do not provide DSM diagnoses unless you are compe
tent to do so. Competence to diagnose may be achieved
through relevant education, experience, licensing or
accreditation, specialized DSM training, consultation and
supervision. If you are not competent to conduct a diag
nosis and one is needed, refer the patient to a properly
accredited mental health professional who is competent
to provide one. Further, when conducting a diagnosis, you
may need to refer the patient to certain specialists for
areas requiring special expertise….
References
Barsky, A.E. (2010) Ethics and Values in Social Work.
Oxford: Oxford University Press
Beauchamp, T. & Childress, J. (2009) Principles of Bio-Medical
Ethics (6th ed.) Oxford: Oxford University Press
Holder, A. R. (1983) The Duty of Care, in N. Abrams & M.
Buckner (Eds.) Medical Ethics: A clinical textbook for the
health care professions. Cambridge Mass: The MIT Press
Reamer, F. G. (2003) Social Work Malpractice and Liability.
New York: Columbia University Press
Fall 2014 17
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of transcendence, of ethics.” Then, he
talked about the modern process of
“trans-humanizing science.” He spoke of
the “unfortunate” circumstance that Freud,
who was a scientist and a humanist, was
raised in the era of 19th century science,
with its limitations related to determinism,
causality, and “reductiveness.” Most of
Freud’s followers of those times were not
scientists, so they could not contribute to
the subject of “trans-humanizing” science
by some constructive criticism; they just
shied away from it.
Kandel does not shy away, but does the
opposite. His tools include not only neuro
science, but psychoanalysis and his love for
arts, and his socio-cultural roots. His book
is an example of “trans-humanizing sci
ence,” as he shares with us his beholder’s
share.
Neurobiology CONTINUED FROM PAGE 15
18 The Clinician www.NYSSCSW.org
he
Layered
Self
CMPS Annual Conference
Saturday, December 6, 2014 — 9:00 AM-5:00 PM
Linking Motivation and Intervention
in Modern Analytic Technique
NYU's Rosenthal Pavilion, Helen & Martin Kimmel Center for University Life, 60 Washington Square South, New York City
To obtain information, a conference brochure, or to register: CMPS: 212.260.7050 • cmps@cmps.edu • www.cmps.edu
:
Center for Modern Psychoanalytic Studies
16 West 10th Street, New York, NY 10011 • 212.260.7050 • cmps@cmps.edu • www.cmps.edu
cmps
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The One-Year Program is a two-semester course designed to enhance the work
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The Extension Division offers courses, workshops, and special events that bring
a modern psychoanalytic perspective to a wide range of topics. Each semester
an “Introduction to Modern Psychoanalysis” class is offered to those interested in
learning more about psychoanalysis and psychoanalytic training. All offerings
are open to professionals and the public. Most are free of charge.
For information or to request a CMPS Bulletin: 212.260.7050 • cmps@cmps.edu
Certificate Program in Psychoanalysis
Monthly Open Houses n TueSDaYS: December 9, March 17, May 17 at 5:30PM; January 20, april 14, June 9 at 1:30PM
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The William Alanson White Institute
Welcomes Applications from Social Workers (LMSW’s and LCSW’s)
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The Certificate Program in Psychoanalysis is a 4 to 6 year program providing coursework and
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Visit us at instituteofcfs.org
Psychoanalytic Training Institute
Contemporary Freudian Society
Formerly New York Freudian Society
20 The Clinician www.NYSSCSW.org
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INC.
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Clinical Social Work, Inc.
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