The Arc of Therapy: Beginnings (Part 1)

Sven Scheuermeier

[Episode 110] Today's episode of the Social Work Podcast is the first of a three-part series on the arc of therapy – the beginning, middle and end.  In today’s episode I’m going to talk about the beginning phase of therapy. I'll talk about some conceptual issues like what do people want when they come to treatment, and how should you be with clients? I’m also going to review some of the more concrete aspects of the beginning of treatment like biopsychosocial and DSM assessment, talking about confidentiality and billing. I want this episode to be interesting whether you’re a first year social work student or a 35 year veteran of the field.

I’d like to thank TheraNest for sponsoring this three episode series. TheraNest is simple and affordable practice management software. To start your free 21-day trial and save 20% on your first 3 months, sign up at theranest.com/socialworkpodcast.


Download MP3 [46:28]

Parenting Teenage Girls: Interview with Lisa Damour, Ph.D.

Update April 4, 2017: Untangled has been released in paperback.

[Episode 102] Today's episode of the Social Work Podcast tackles one of the most difficult developmental stages in the parent-child relationship: adolescence. If you’re a long-time listener of the podcast, you know that I’ve spent most of my professional career working with or doing research on adolescents. Like most clinicians I have more experience with adolescents when things are going wrong in their lives than when they are going right. And as a parent, I can tell you that I seem to be much more clued into when things are going wrong than things are going right. Like earlier this afternoon… no, I’m just kidding, I wouldn’t do that to you. What I will do is introduce my guest. Dr. Lisa Damour (@LDamour), clinician, researcher, professor, parent, writer of the Adolescence column for the New York Times’ Motherlode blog, and most importantly for today’s episode, Dr. Damour is the author of Untangled: Guiding teenage girls through the seven transitions into adulthood.

I’ve read it. I think it is fantastic. I recommend this book without hesitation to anyone who is raising or will be raising a teenage daughter. The writing is engaging, scholarly without being boring, and full of practical tips that parents can adopt and implement immediately.

• How often should my kid be eating dinner with me? 
• When is the best time to have a serious and uncomfortable conversation? 
• My thirteen-year-old rolls her eyes when I try to talk to her, and only does it more when I get angry with her about it. How should I respond?
• Do I tell my teen daughter that I’m checking her phone?
• Where’s the line between healthy eating and having an eating disorder?
• My daughter’s friend is cutting herself. Do I call the girl’s mother to let her know?

Download MP3 [48:55]


I also think that any mental health professional who works with children and families should read this book. Dr. Damour basically hands you brilliant ways of explaining essential developmental concepts that will make sense to the parents and kids you work with. Plus, you’ll be able to legitimately recommend it as bibliotherapy for your clients. Check out the discussion guide: https://www.drlisadamour.com/untangled/discussion-guide/

In today’s interview we talk about why a teenage girl’s erratic and confusing behavior is actually healthy, necessary, and natural.  She talks about what’s going on in the minds of teenage girls and how parents can reframe their daughter’s thoughts feelings and actions. She talks about how society essentially abandons teenage girls and their parents. We talk about sex and the internet. And even though about 70% of the book focuses on how and when parents can know what’s going right, Dr. Damour draws on her extensive clinical experience to alert parents of when they have reason to worry. 

Attachment-Based Family Therapy (ABFT) for Depressed and Suicidal Youth: Interview with Guy Diamond, Ph.D., and Suzanne Levy, Ph.D.

[Episode 96] In today's Social Work Podcast I speak with two of the three developers of Attachment-based Family Therapy (ABFT), Guy S. Diamond, Ph.D. and Suzanne Levy, Ph.D. The third developer Gary M. Diamond (no relation to Guy Diamond) lives in Israel and was unavailable for the interview.

ABFT is the only family-based psychotherapy with empirical support for reducing suicidal ideation in youth. In today's interview, Dr. Diamond and Dr. Levy discuss the theory and practice of Attachment-Based Family Therapy. Dr. Diamond mostly covers theory and concepts, and Dr. Levy addresses the question of "what does the therapist actually do in the therapy room."

Download MP3 [50:36]


If you're interested in learning more about ABFT, you can buy the treatment manual Attachment Based Family Therapy for Depressed Adolescents, watch a free webinar http://youtu.be/KcwHznzq-S4, or attend a workshop (details on their website: https://abftinternational.com/)

ABFT is listed on the National Registry of Evidence-based Programs and Practices, also referred to as NREPP. According to NREPP, 

"Attachment-Based Family Therapy (ABFT) is a treatment for adolescents ages 12-18 that is designed to treat clinically diagnosed major depressive disorder, eliminate suicidal ideation, and reduce dispositional anxiety. The model is based on an interpersonal theory of depression, which proposes that the quality of family relationships may precipitate, exacerbate, or prevent depression and suicidal ideation. In this model, ruptures in family relationships, such as those due to abandonment, neglect, or abuse or a harsh and negative parenting environment, influence the development of adolescent depression. Families with these attachment ruptures lack the normative secure base and safe haven context needed for an adolescent's healthy development, including the development of emotion regulation and problem-solving skills. These adolescents may experience depression resulting from the attachment ruptures themselves or from their inability to turn to the family for support in the face of trauma outside the home. ABFT aims to strengthen or repair parent-adolescent attachment bonds and improve family communication. As the normative secure base is restored, parents become a resource to help the adolescent cope with stress, experience competency, and explore autonomy. 

ABFT is typically delivered in 60- to 90-minute sessions conducted weekly for 12-16 weeks. Treatment follows a semistructured protocol consisting of five sequential therapy tasks, each of which has clearly outlined processes and goals:

1. Task 1: The Relational Reframe Task, with the adolescent and parents (or parent) together, sets the foundation of the therapy. After an assessment of the history and nature of the depression, the therapist focuses on relational ruptures. This shift pivots on the therapeutic question, "When you feel so depressed or suicidal, why don't you go to your parents for help?" The progression of this conversation leads parents and the adolescent to agree that improving the quality of their relationship would be a good starting point for treatment.
2. Task 2: The Adolescent Alliance Task, with the adolescent alone, identifies relational ruptures in the family and links them to the depression. The adolescent is encouraged and prepared to discuss these often avoided feelings and memories with his or her parents.
3. Task 3: The Parent Alliance Task, with the parents alone, explores their current stressors and their own history of attachment disappointments. These conversations activate parental caregiving instincts to behaviorally and emotionally protect their child, which helps motivate parents to learn and use new attachment-promoting parenting skills.
4. Task 4: The Attachment Task, with the adolescent and parents together, creates an opportunity for the adolescent to directly express his or her thoughts and feelings about past and current relational injustices. Rather than defending themselves, parents help the adolescent fully express and explore these emotionally charged topics. This conversation helps the adolescent work through trauma, address negative patterns in the relationship, and practice new conflict resolution and emotion regulation skills.
5. Task 5: The Autonomy Task, with the adolescent and parents together, helps consolidate the new secure base. In solving day-to-day problems, parents provide support and expectations and the adolescent seeks to develop autonomy while remaining appropriately attached to his or her parents." (http://legacy.nreppadmin.net/ViewIntervention.aspx?id=314)

Personal and Professional Perspectives on Religious Child Maltreatment: Interview with Bethany Brittain and Ann Haralambie, JD, CWLS

[Episode 93] Today’s episode of the Social Work Podcast is on Religious Child Maltreatment. Longtime listeners of the podcast will remember that I first addressed this topic in 2012 when I interviewed Janet Heimlich about her book “Breaking Their Will: Shedding Light on Religious Child Maltreatment.” In episode 72, Janet explained that religious child maltreatment is any abuse or neglect that was done in the name of religion, or that was encouraged, condoned, or assumed as a necessary practice by a religious community. Parents are more likely to engage in religious child maltreatment when they are members of authoritarian religious communities. Janet’s book is a wonderful primer on the topic, and her interview was a treasure trove of information for social workers.

In today’s episode I spoke with two people who bring very different perspectives to this issue. Bethany Brittan is on the board of the Child Friendly Faith project and is a survivor of RCM. Ann Haralambie is a certified family law specialist and a certified child welfare law specialist practicing in Tucson Arizona. I had two goals for our interview. The first was to give voice to the experience of people who have survived RCM. To that end, I present Bethany’s story as un-interrupted tape. The second was to unpack some of the differences between the personal experience of RCM and the professional challenges associated with protecting children from religious maltreatment. You’ll hear Ann and me talk about legal, educational, and bureaucratic issues associated with child maltreatment. 

And now, without further ado, on to episode 93 of the Social Work Podcast: Personal and Professional Perspectives on Religious Child Maltreatment: Interview with Bethany Brittain and Ann Haralambie, JD.

Similarities and Differences between Social Work in the United States and the United Kingdom: Interview with David Niven

[Episode 85] Today's episode of the Social Work Podcast explores the similarities and differences between social work in the United States and the United Kingdom. I spoke with British social worker and podcaster, David Niven. David is the former National Chair of the British Association of Social Workers (BASW). He has over 30 years national and international experience in the field of social welfare and is recognized as an independent expert on matters of child protection and parenting. He is the founder and host of the Social World Podcast (www.socialworldpodcast.com).

There are many similarities between social work in the USA and the UK, but there are a couple of important differences. One of the biggest differences is that in the UK child and family social workers serve as child protection workers, whereas in the USA child protection and social work are separate professions.

Note: David interviewed me in November 2013 about cyberbullying and youth suicide for his podcast series. You can hear that episode here: http://socialworldpodcast.com/jonathan-singer-interview/

Sex, Relationships, and HIV: Interview with Gail Wyatt, Ph.D.

[Episode 83] In today's Social Work Podcast I speak with Dr. Gail Wyatt, pioneering sex researcher, award-winning teacher, mentor, and researcher, and the first African-American woman to be licensed as a psychologist in the state of California. I spoke with Dr. Wyatt in April 2010 when she was at Temple University giving a talk about her research with African American HIV serodiscordant couples. Serodiscordant couples are those in which one partner is HIV positive and the other is HIV negative. Dr. Wyatt and her co-investigators had just concluded an 8-years investigation of a couples therapy intervention that they hoped would reduce HIV/STD risk behaviors in African American HIV serodiscordant couples. They called the intervention Eban which is "a traditional African concept meaning 'fence,' a symbol of safety, security, and love within one's family and relationship space" (El-Bassel et al., 2010, p. 1596) The Eban intervention combined components of social cognitive theory, historical and cultural beliefs about family and community preservation, and an Afrocentric paradigm. If you want to read more about the Eban intervention or the results of this clinical trial I’ve posted the links to those and related articles on the Social Work Podcast website. So, you’re probably wondering, after 8 years did it work? Yes. At the end of 8 years, and 535 couples later, the couples that were part of the Eban intervention used condoms more frequently and more consistently and reported fewer sexual acts without condoms than the couples in the health promotion comparison group. And I have no doubt that when the researchers finished running those analyses, they went "Phew! Thank Goodness!"

For today's interview, Dr. Wyatt and I talked a bit about the research, but mostly we talked about two of the techniques that were used in the clinical trial. The first was a way of having couples plan and enjoy safe sex. The second had to do with addressing past histories of abuse within the context of a consensual sexual relationship.  It was at this point that the conversation moved away from couples therapy into a conversation about healthy sexual behaviors. Dr. Wyatt made the point that most health and mental health providers ask about a client's "age of first sexual contact" without distinguishing between consensual and non-consensual sexual contact. She pointed out that adolescents sometimes do not distinguish between the two. She encouraged providers to be more precise in their questions, and to find out if their clients are current victims of sexual abuse. We about how to include adolescent clients in mandated abuse reporting calls if current abuse is uncovered, and how to address the issue of sex among adolescents who are victims of past or current sexual abuse. And, as usual, I asked Dr. Wyatt if she could provide some resources for people who were interested in learning more, and she was happy to oblige.

Perinatal Loss: Interview with Sarah Kye Price, Ph.D.

[Episode 79] Today's Social Work Podcast is on perinatal loss. Perinatal loss includes ectopic pregnancy, spontaneous abortion (which most people call miscarriage), late-pregnancy loss or stillbirth, and neonatal or newborn death.

In today's episode, I spoke with one of the profession's leading scholars and experts on perinatal loss, associate professor of social work at Virginia Commonwealth University, Dr. Sarah Kye Price.


We talked why it is important to do a thorough assessment of pregnancy and pregnancy-related loss during a biopsychosocialspiritual assessment. She talked about the importance of allowing mothers / parents to tell their story. She pointed out that, although no loss is worse than any other, there are different intensities and needs depending on the loss.  She also noted that families in which there was a perinatal loss, there can also be growth. We talked about the different types of interventions and treatment approaches for individuals and families who experience perinatal loss. We ended our conversation with resources for people interested in learning more.

Religious Child Maltreatment: Interview with Janet Heimlich

[Episode 71]In today's Social Work Podcast, Religious Child Maltreatment, I speak with award-winning journalist and author, Janet Heimlich about her book: Breaking Their Will: Shedding Light on Religious Child Maltreatment published in 2011 by Prometheus Books. I was really interested in talking with Janet because her book focuses on something that is rarely discussed in social work - the role of religion in child abuse and neglect.

In today's interview, Janet defines religious child maltreatment, we talk about religious authoritarian cultures; discuss examples of religiously motivated physical, emotional and sexual abuse, and medical neglect; talk about the laws that are in place that encourage religious child maltreatment, and discuss some ways that social service providers can talk with parents about authoritarian religious communities and religious child maltreatment.

Lonely at the Top: Interview with Thomas Joiner, Ph.D.

[Episode 70] In today's episode of the Social Work Podcast is about loneliness. Since social workers don't talk much about loneliness (we'd rather talk about social isolation or social withdrawl), I spoke with Thomas Joiner, Ph.D., Robert O. Lawton Distinguished Professor of Psychology at Florida State University, and author of Lonely at the Top: The High Cost of Men's Success, published in 2011 by Palgrave Macmillan.

Cultural Considerations in Military Social Work: Interview with Dr. Anthony Hassan

[Episode 69] Today's Social Work Podcast, Episode 69 – Cultural Considerations in Military Social Work, is the second in a two-part series with Anthony Hassan on Military Social Work. In Part I, Anthony and I spoke about The Training and Education of Military Social Workers.

Any discussion of culture and culturally relevant practice begins with the idea that we are all cultural beings. We see the world differently depending on which culturally-informed lenses we have on. In the United States, where military service is not a requirement, being in the military offers a unique set of lenses.  I got a glimpse of the very practical, day-to-day implications of seeing the world through military lenses when I asked today's guest what I thought was a very straightforward question – a question I ask all my guests before the interview starts – "what do you want me to call you?"

The Training and Education of Military Social Workers: Interview with Dr. Anthony Hassan

[Episode 68] Today's Social Work Podcast, The Training and Education of Military Social Workers, is the first of a two-part series. Part II, is a discussion of Cultural considerations in military social work. I'm doing this two part series because whether you agree or disagree with America n's involvement in what has now become the longest continuous combat engagement in its 235 year history, "There is an urgent need to understand and engage with the military service members, veterans, their families, and their communities in effective [social work] practices…" (CSWE, 2010, p. 2). I hear some of you right now; I'm reading your thoughts: you don't work for the Veterans Administration; you're not contracted by the military to provide services; you don't wear the uniform and serve in the armed forces. And yet, according to my guest, Anthony Hassan, you could still be a military social worker.

National Runaway Switchboard: Interview with Maureen Blaha

[Episode 67] Today's episode of the Social Work Podcast is an interview with Maureen Blaha, the Executive Director of the National Runaway Switchboard (http://www.1800runaway.org). So, if you're a social worker and you work in outpatient or inpatient or residential or you're in a school-based setting and you have a client who says I'm out of here. I am running away from home or maybe they don't even say I'm out of here. Maybe they're saying I don't know how I can live with my parents here. So, what do you do? What are some resources for you? If you're in a school setting and you're working with groups of kids, are there curricula that you can get a hold of, free curricula that you can use with your clients?

Coming Out, Coming Home: Interview with Michael C. LaSala, Ph.D.

[Episode 66] Today's Social Work Podcast is about helping families adjust to a gay or lesbian child. According to the website, comingoutcominghome.com, "The discovery that a child is gay or lesbian can send shockwaves throughout a family. A mother will question how she's raised her son; a father will worry that his daughter will experience discrimination. From the child's perspective, gay and lesbian youth fear their families will reject them, and that they will lose financial and emotional support. All in all, learning a child is gay challenges long held views about sexuality and relationships, and the resulting uncertainty can produce, for all parties, anger, resentment, and concern for safety and acceptance." So, how can social workers help families adjust to a gay or lesbian child?

To get some answers, I spoke with Dr. Michael LaSala author of the 2010 book, Coming Out, Coming Home: Helping Families Adjust to a Gay or Lesbian Child, published by Columbia University Press. Dr. LaSala is director of the MSW program and associate professor at the School of Social Work at Rutgers University. He has been in practice for more than twenty-five years and he currently treats LGBT individuals and families at the Institute for Personal Growth in Highland Park, NJ. (http://www.ipgcounseling.com/). Dr. LaSala recently completed a Fulbright Fellowship in Estonia where he investigated the impacts of stigma on Estonian lesbians and gay men. In addition to his book and numerous scholarly publications, you can read his blog on Gay and Lesbian Well-Being on PsychologyToday.com

Adoption Policy and Practice in the U.S.A.: Interview with Ruth McRoy, Ph.D.

[Episode 63] Today's Social Work Podcast is a broad overview of current policies and practices associated with adoption in the United States. According to the Evan B. Donaldson Institute, 6 in 10 Americans have had experience with adoption, meaning you, or a family member or close friend was adopted, adopted a child, or put a child up for adoption. Although most Americans have experience with adoption, as you'll hear in today's interview, the world of adoption is incredibly complex. For example, is it ever acceptable to consider the race of a prospective adoptive family when making placement decisions? For example, you're looking to place an African American child. You have three prospective adoptive families - two African American and one White. Assuming all things are equal, could you use race as an exclusionary criterion? What about if the child was White, Latino, or Native American? If you know the answer - congratulations. If not, keep listening. And even if you know the answer, keep listening.

Concerns of Parents of Lesbians and Gays: Interview with Cynthia Conley, Ph.D.

Risk for suicide among gay youth has caught a lot of attention in the American media as of late. There have been a number of youth who have been bullied because they have been gay or perceived to be gay and who have consequently died by suicide. Dan Savage and friends and colleagues and supporters have put together an amazing project called "It Gets Better" (http://www.itgetsbetterproject.com/) focusing on the issue of youth suicide for gay, lesbian, bisexual, transgender, question and queer teens.

Now there is good reason for this. According to the U.S. Government’s Report of the Secretary's Task Force on Youth Suicide, gay and lesbian youth bear an increased risk of suicide, substance abuse, school problems, and isolation because of a "hostile and condemning environment, verbal and physical abuse, rejection and isolation from [peers and family]" (Gibson, 1989). Social worker and pioneer gay and lesbian researcher Caitlin Ryan, found that lesbian, gay, and bisexual young adults who reported higher levels of family rejection during adolescence were 8.4 times more likely to report having attempted suicide, 5.9 times more likely to report high levels of depression, 3.4 times more likely to use illegal drugs, and 3.4 times more likely to report having engaged in unprotected sexual intercourse compared with peers from families that reported no or low levels of family rejection (Ryan, Huebner, Diaz, & Sanchez, 2009).

So, here’s the thing. Families who reject their kids are doing their kids a huge disservice. And that’s the point of today’s podcast. Today I’m talking with Dr. Cynthia Conley about the concerns of heterosexual parents of gay and lesbian youth.

Communities that Care: Interview with Richard F. Catalano, Ph.D.

[Episode 57] Today's Social Work Podcast is on community-based prevention services for children and adolescents. I spoke with Dr. Richard F. Catalano, who along with J. David Hawkins, developed Communities That Care, a prevention-planning system that promotes the positive development of children and youth and prevents problem behaviors, including substance use, delinquency, teen pregnancy, school drop-out and violence. It is a system for identifying community needs, matching those needs to evidence-based prevention programs, and evaluating the outcomes. The system has been used in dozens of communities around the United States, and has demonstrated effectiveness in reducing problem behaviors and promoting positive youth development.

Download MP3 [30:47]

Pediatric Oncology Social Work: Interview with Barbara Jones, Ph.D., MSW

[Episode 55] Today’s Social Work Podcast is about social work with children who have cancer, also referred to as pediatric oncology social work. Although pediatric cancer is relatively rare event, making up less than 1% of the cases diagnosed annually, that single case affects the lives of countless others. From a treatment perspective, when a child is diagnosed with cancer, the whole family is diagnosed with cancer. Children are most likely to get cancer in their first year of life, and least likely between the ages of 5 and 14. If you are white kid in the United States you are nearly two times more likely to get cancer than if you are black. One in 300 boys and one in 330 girls will develop cancer before the age of 20. Every year 2500 children die from cancers with names like Acute Lymphoblastic Lukemia (cancer of the bone marrow - the most common childhood cancer), Hepatoblastoma (cancer of the kidney), neuroblastoma (cancer of the central nervous system), Ewings sarcoma (bone cancer), Hodgin’s Lymphoma (cancer of the lymph nodes), and Wilms tumor (cancer of the kidney). Notice that the most common forms of adult cancer such as lung, breast and colon are not included on this list. And it is not just that children get some cancers and adults get others. Among children, the cancers most often found in infants and toddlers are not the same as the cancers most often found in teenagers. For children today, getting a diagnosis of cancer is not the death sentence it once was. Before 1970 most children who got cancer died. Today, survival rates are nearly 80%. Currently there are about 270,000 survivors of childhood cancer. Consequently pediatric oncology social workers need to know as much about working with survivors of cancer as they do about issues of death and dying.

Download MP3 [36:03]

Theories for Clinical Social Work Practice: Interview with Joseph Walsh, Ph.D.

[Episode 52] Today's podcast looks at the relationship between theory and clinical social work practice. I spoke with Joseph Walsh, professor of social work at Virginia Commonwealth University (VCU), and author of the Brooks/Cole text, Theories for Direct Social Work Practice, which came out in a third edition in 2014. We talked about why social workers should learn practice theories, the differences between practice, developmental and personality theories, the difference between a theory and a model, and why there are so many different practice theories. We talked about how knowing theory makes for better social work practice and how being "eclectic" isn't about eschewing theory, but being well grounded in a few theories and making intentional choices about when and how to draw from them. Joe suggested that social workers in the field can contribute to theory refinement by thinking seriously about how well the theories they use work with the clients they serve. We ended our conversation with some information on resources for social workers who are interested in learning more about practice theories.

Family Psychoeducation: Interview with Carol Anderson, Ph.D.

[Episode 27] In today's podcast, I speak with Carol Anderson, who along with Gerry Hogarty, developed a family-based approach to working with people with schizophrenia called Family Psychoeducation. Family Psychoeducation is only one of a handful of treatments that has been empirically validated to improve the lives of people with serious mental illness. According to the American Psychiatric Association, when people with schizophrenia are involved in family psychoeducation while taking medication, there is a significant reduction in relapse and unemployment. In today's podcast, Carol describes the 5 stages of psychoeducation, distinguishes between psychoeducation and other forms of family therapy, provides some anecdotes about family psychoeducation treatment, and provides some information for people interested in learning how to do family psychoeducation.