Provides information on all things social work, including direct practice (both clinical and community organizing), research, policy, education... and everything in between.
[Episode 42] Today’s podcast is the third of three interviews with Kia J. Bentley on psychopharmacotherapy. Kia J. Bentley is Professor of social work at Virginia Commonwealth University in Richmond Virginia and has published extensively in the area of psychopharmacotherapy (see references below). Psychopharmacotherapy refers to the treatment of psychiatric disorders with the use of medication. But, as Kia pointed out in our interview, psychopharmacotherapy is not just about giving people medication and calling it a day. It is an approach to treatment that acknowledges the strengths and limitations of medications.
In today’s podcast, Kia talked about a recent, and as of this date unpublished, study she did on the meaning that residents of an in-patient psychiatric facility made out of medication. Kia’s study was qualitative, meaning that she analyzed the text of interviews and drawings from the residents. One of the purposes of qualitative research is to develop a deeper understanding of the meanings that people make out of their lives and experiences. Our conversation turned out to be not only a fascinating view into the meanings that the residents made of medication, but it was also a wonderful sketch of Kia’s process of making meaning out of the interviews and drawings. In qualitative research, the researcher is the analytical tool, and Kia’s struggles with making sense of these meanings is central to qualitative inquiry.
[Episode 41] Today’s podcast is the second of three interviews with Kia J. Bentley on psychopharmacotherapy. Kia J. Bentley is Professor of social work at Virginia Commonwealth University in Richmond Virginia and has published extensively in the area of psychopharmacotherapy (see references below). Psychopharmacotherapy refers to the treatment of psychiatric disorders with the use of medication. But, as Kia pointed out in our interview, psychopharmacotherapy is not just about giving people medication and calling it a day. It is an approach to treatment that acknowledges the strengths and limitations of medications.
[Episode 40] Today’s podcast is the first of three interviews with Kia J. Bentley on psychopharmacotherapy. Kia J. Bentley is Professor of social work at Virginia Commonwealth University in Richmond Virginia and has published extensively in the area of psychopharmacotherapy (see references below). Psychopharmacotherapy refers to the treatment of psychiatric disorders with the use of medication. But, as Kia pointed out in our interview, psychopharmacotherapy is not just about giving people medication and calling it a day. It is an approach to treatment that acknowledges the strengths and limitations of medications.
[Episode 39] In this episode of the social work podcast, I continue my conversation with author Dr. Allen Rubin. We talked about how he came to co-author Research Methods for Social Work (the most widely used social work research text) and his most recent text - Practitioner's Guide to Using Research for Evidence-Based Practice. We talked about one of his current research projects - the development of a scale that can be used to evaluate how well social workers are learning evidence-based practice. We ended our conversation with Allen talking about a series of books he is co-editing with David Springer that will have practical "how-to" chapters on evidence-based approaches to today's most important clinical issues.
[Episode 38] In today's podcast, I continue my conversation with Dr. Allen Rubin about social work research. Allen shared his advice for young social work investigators - that is social work researchers who are just starting out in their career as researchers. Allen talks about the value of getting a postdoc, the importance of getting hooked up with a federally-funded investigator for social workers interested doing federally-funded research, having good relationships with social work agencies, and the challenges of actually doing social work research. Allen shared his thoughts on the problems with so-called hot methodologies and the realities of pursuing federal funding.
[Episode 37] In today's podcast, I talked with Dr. Allen Rubin about research and social work practice. You might recognize the name Rubin from the widely used social work research text "Rubin and Babbie," or as it is officially known, Research Methods for Social Work. In addition to the Rubin and Babbie text, he has authored well over 100 publications, most recently focusing on evidence-based practice.
Since so many of us have learned research from the Rubin and Babbie text, myself included, I thought it would be appropriate to interview Allen for the first social work podcast on social work research. I'm excited about offering a series on social work research because research is essential to good social work practice. Most practitioners I know have an impressive command of assessment, diagnosis, intervention and the myriad of factors that go into providing services to clients. These same practitioners get fairly lost in even the most basic research articles and couldn't distinguish an ANOVA from a logistic regression to save their life. So, I thought I would take this opportunity to find out what research concepts Allen Rubin thought were essential for social work practitioners to understand.
[Episode 36] Today's podcast is on Race and Social Problems. On January 15, 2008, I spoke with Dr. Larry E. Davis, Dean of the School of Social Work at the University of Pittsburgh, the Donald M. Henderson Professor, and Director of the Center on Race and Social Problems. In our conversation, Dean Davis defined racism, the role of race in understanding social problems, and about how issues of race may or may not change as the percentage of whites in the United States continues to decrease discussed. We talked about some of the racial and gender issues in the current election and talked about how race is different from gender as a point of diversity. We also talked about race and social work, and what social workers can do to fight racism. We ended our conversation with a discussion of the Center on Race and Social Problems and what the Center is doing to fight racism.
[Episode 35] In today's podcast, I talk with Dr. Christina Newhill, a nationally recognized expert on client violence and the author of Client Violence in Social Work Practice: Prevention, Intervention, and Research, published in 2003 by The Guilford Press. In today’s podcast, Dr. Newhill defines client violence, talks about why social workers should be concerned with client violence and identifies which social workers are at greater risk for violence. She discusses some ways to assess a client’s potential for violence, how to intervene with a violent or potentially violent client, and identifies some strategies for increasing worker safety. We end our interview with information about existing research and resources for social work educators.
[Episode 34] Today's podcast is a bit of a departure from the norm. Instead of doing a podcast on social work, we're doing a podcast on... the social work podcast. There are two reasons for this rather unusual topic. First, it is a way of celebrating the one year anniversary of the Social Work Podcast; The podcast started in February 2007 as a way to help students learn, but has grown into a resource for social workers at all stages of their careers. Second, UT-Austin's School of Social Work wanted to do an article on me because I am an alum of their social work program. Rather than doing a traditional interview over the phone, I suggested we do a podcast (big surprise, right?). Interviewing me today is Jennifer Luna-Iduñate, Director of the DiNitto Center for Career Services and Alumni Relations at the University of Texas at Austin's School of Social Work. In today's interview Jennifer and I talked about how the podcast got started, the goal of the podcast, how success is measured and what are some goals for the podcast. I thought this podcast was another example of how technology can be used to enhance communication and connection. Special thanks to Laura Wells and John Trapp at UT-Austin for the technical help in getting the interview together.
The Social Work Podcast has had a very successful first year. I consider it a success because, without advertising or promotion other than word of mouth,the number of visitors and downloads has increased significantly over the year. According to Google Analytics, a free webmetrics program, the social work podcast website has had almost 13,000 visitors – almost 10,000 unique visitors, who have viewed 25,000 pages, and downloaded over 250 gigabytes of podcasts. According to iTunes, the Social Work Podcast is the number one podcast on social work-related topics.
The most popular podcasts are on cognitive behavioral theory, developing treatment plans, person-centered therapy and DSM for social workers. People have accessed the podcast from all 50 states and the district of Columbia, and 113 additional countries and territories. Not surprisingly the most number of visitors have come from English speaking countries. But, there have also been visitors from Israel, Germany, Malaysia, Iran, Pakistan, Finland, etc.
Because the podcast is accessed internationally, it really makes me think more about how I’m contextualizing the podcasts. I’m more aware of how some topics might be very different in different parts of the country and different parts of the world. Perhaps one day we’ll have comparative podcasts, for example social workers in New Zealand, Canada, Great Britain and the USA talking about what is similar and different with case management and service coordination.
Singer, J. B. (Host). (2008, February 19). One year anniversary: Interview with Jonathan Singer [Episode 34]. Social Work Podcast. Podcast retrieved Month Day, Year, from http://socialworkpodcast.com/2008/02/one-year-anniversary-interview-with.html
[Episode 33] Today’s podcast is the last in a three part series on phone supervision. In Part I and Part II I spoke with Simon Feuerman and Melissa Groman about their experiences of providing phone supervision and consultation. In today’s interview I speak with Jody Bechtold about her experience receiving phone supervision as part of her process of becoming a Nationally Certified Gambling Counselor. We talked about the process she went through to find phone supervision, some of the pros and cons and likes and dislikes. Jody contrasted phone supervision with face-to-face supervision and talked about phone supervision etiquette.
There were some interesting similarities and differences between Jody's comments on Phone Supervision and those of Simon and Melissa. Compared to the phone consultation provided by Simon and Melissa, Jody’s phone supervision was very structured and targeted. Still, her description of the experience of phone supervision, and the apparent benefits of phone supervision to provide a focused and convenient forum for developing advanced clinical skills, was nearly identical to the description provided by Simon and Melissa, despite the fact that Simon and Melissa are the providers and work almost exclusively with clinicians who are not working towards advanced clinical license. The most significant difference was that Jody advocated for a very structured format with required pre-session reading, whereas Simon and Melissa described a more process oriented group, one that is probably more appropriate for the types of clinicians with whom they work.
Singer, J. B. (Host). (2008, February 18). Phone supervision (Part III): Interview with Jody Bechtold [Episode 33]. Social Work Podcast. Podcast retrieved Month Day, Year, from http://socialworkpodcast.com/2008/02/phone-supervision-part-iii-interview.html
[Episode 32] Today’s podcast is the second in a three part series on phone supervision. In today’s podcast I continue my discussion with Simon Feuerman and Melissa Groman about phone supervision. Simon and Melissa are licensed clinical social workers, clinical supervisors and consultants and founders of the The New Center for Advanced Psychotherapy Studies and The Good Practice Institute for Professional Psychotherapists. These businesses were established in 2006 and 2007 respectively, as learning programs for licensed clinicians from all training and theoretical backgrounds to learn together without geographic limitations. Simon and Melissa are two of a growing number of clinicians who use accessible and affordable telecommunications and internet technologies to eliminate traditional barriers to supervision, including geographical distance, time constraints, and lack of local clinical experts.
In this episode we talk about the technical details of setting up and participating in phone supervision, NASW guidelines for supervision and the benefits for supervision and consultation, and the future of phone supervision, including the emergence of webcam technologies. We end with an “off line” discussion about my experience conducting this interview over the phone. Download MP3 [17:58]
In the first part, I spoke with Simon and Melissa about the similarities and differences between face-to-face and phone supervision, advantages and disadvantages, the difference between clinical supervision and consultation, existing research on phone supervision and some thoughts about approaches to phone supervision. In the third episode I interview Jody Bechtold, whom regular listeners will recognize from the ever-popular series on pathological gambling. Jody and I spoke about her experience receiving phone supervision as she worked towards becoming a Nationally Certified Gambling Counselor.
Singer, J. B. (Host). (2008, February 10). Phone supervision (Part II): Interview with Simon Feuerman and Melissa Groman [Episode 32]. Social Work Podcast. Podcast retrieved Month Day, Year, from http://socialworkpodcast.com/2008/02/phone-supervision-part-ii-interview.html
[Episode 31] Today’s podcast is the first of a three part series on phone supervision. In parts one and two I speak with Simon Feuerman and Melissa Groman, licensed clinical social workers, clinical supervisors and consultants and founders of the The New Center for Advanced Psychotherapy Studies and The Good Practice Institute for Professional Psychotherapists. The New Center for Advanced Psychotherapy Studies was established in 2006 as a learning program for licensed clinicians from all training and theoretical backgrounds to learn together without geographic limitations. Simon and Melissa are two of a growing number of clinicians who use accessible and affordable telecommunications and internet technologies to eliminate traditional barriers to supervision, including geographical distance, time constraints, and lack of local clinical experts. Download MP3 [26:48]
In today’s podcast, Simon and Melissa talk about the similarities and differences between face-to-face and phone supervision, advantages and disadvantages, the difference between clinical supervision and consultation, existing research on phone supervision and some thoughts about approaches to phone supervision. In the second episode we talk about the mechanics of participating in phone supervision, how to set up phone supervision as the supervisor and the supervisee, risk management, and some of the benefits of on-going supervision or consultation for clinicians who have already obtained their advanced clinical license and are considered independent practitioners. In the third episode I interview Jody Bechtold, whom regular listeners will recognize from the ever-popular series on pathological gambling. Jody and I spoke about her experience receiving phone supervision as she worked towards becoming a Nationally Certified Gambling Counselor.
My interview with Simon and Melissa was a first for the social work podcast: it was the first time I interviewed two people at once and the first time I interviewed someone outside of the studio.
Today's interview about phone supervision was recorded using, what else, the telephone... or at least the 21st century version of the telephone - Skype. Skype is software that enables people to communicate for free computer to computer. I wanted to acknowledge the technical support of David Holzemer and the staff at the Faculty Instructional Development Lab at the University of Pittsburgh for figuring out how to set up Skype so that I could do this interview.
Interview Questions
1. I suspect that almost all of our listeners have had experience with face-to-face supervision. I was wondering if you could tell us what are some of the similarities and differences between face-to-face and phone supervision.
2. What are some reasons a social worker would use telephone supervision?
3. I’m wondering if you can discuss some of the advantages and disadvantages to using the telephone as a means of providing and participating in supervision. What are some of the common concerns about telephone supervision?
4. During my research for this interview, I came across a number of different approaches to supervision. For example, Baltimore and Crutchfield (2003) mention three models of supervision, each based on a different theoretical perspective – client centered, behavioral and family-systems. In the client-centered model, for example, the supervisor assumes that the supervisee has all the resources he or she needs to actively address the issues. In contrast, the behavioral model assumes that insight is less important than meeting goals and objectives, and using punishment and rewards to change the supervisee’s behavior. I’m wondering what approach you take to supervision and if you think that one approach is better suited for phone supervision than another.
5. Is there any research that supports the use of telephone supervision? Is less than, equal to, or more effective than traditional face-to-face supervision?
6. We’ve talked about some basic concepts related to phone supervision. I’m wondering if you could talk us through the process of becoming involved with phone supervision. Maybe we could start with the absolute basics - How does someone find phone supervision? Let’s say I find a phone supervision group, what are the next steps, the process of contracting, the logistics of the schedule, dropped calls, etc.
7. Part of risk management is receiving clinical supervision. However there are liabilities associate with supervision. Specifically, if your supervisee is sued, you can be held liable for inadequate supervision. As someone who does phone consultation, how do you address issues of liability and documentation of supervision sessions?
8. With the advent of sites like YouTube and Google Videos, it seems like people are rapidly becoming comfortable in front of the camera – at times embarrassingly so. As a result, people are using web cams like never before. How do you think that this increase comfort with video technology will change the way that distance supervision is conducted in the future? In other words, do you think that in 10 years we’ll be doing a podcast on the use of video supervision?
Singer, J. B. (Host). (2008, January 28). Phone supervision (Part I): Interview with Simon Feuerman and Melissa Groman [Episode 31]. Social Work Podcast. Podcast retrieved Month Day, Year, from http://socialworkpodcast.com/2008/01/phone-supervision-part-i-interview-with.html
[Episode 29] Today's podcast is the second in a two-part series on Clinical Hypnosis. According to the American Society for Clinical Hypnosis, hypnosis is a state of inner absorption, concentration and focused attention. Today I spoke with Dr. Elizabeth Winter about how and when to use clinical hypnosis. In the first episode, Dr. Winter and I spoke about the history of clinical hypnosis, key assumptions, goals, the client's role and types of problems that might be addressed with clinical hypnosis.
Jonathan Singer: So as a clinician, how do you decide when to use hypnosis?
Elizabeth Winter: Probably the first caution is to use only to do something that you’re already trained to do. And that may sound a little bit obvious but for example, it would be appropriate for me as a social worker to use it with somebody who comes to see me for work on addictions. It would not be appropriate as a social worker for me to help someone to induce analgesia or anesthesia with an intention of my performing surgery on them. I’m not trained to do that, I shouldn’t do it. And conversely somebody who is perhaps and anesthesiologist shouldn’t be doing psychotherapy using hypnosis. So it may seem obvious, but it’s really important that you don’t work outside your field or do anything that you’re not already trained to do. Having said that, not everyone is going to want hypnosis and it’s not going to be something that I would do with everyone. If somebody specifically comes and asks for hypnotic intervention, typically I would do that as part of a broader therapeutic relationship. And it may or may not be appropriate. For example, people will sometime specifically ask if they can use hypnosis to recover memories, typically memories they think they may have buried somewhere about past abuse. Now, I won’t do that kind of work and I won’t do it for a number of reasons, the primary one being memory is not history. And the fact that you recall something in a trance state doesn’t make it true, and in fact there is a fair amount of research that suggests that people who appear to remember things in trance have a higher degree of confidence in those memories but less accuracy. So that would be a time not to use it. If someone is motivated to use it for something like habit control, or anxiety, then certainly it’s worth exploring, and you would start out by teaching the skill before you would use it for the specific purpose. And I’ll give you a quick example of that. I once heard a story of a woman who had grown up in Europe and was towards probably her middle years looking to stop smoking, and she had smoked for many many years, and she wanted to use hypnosis to stop smoking. And what she found was she really got stuck going into trance, and kind of couldn’t go into trance, and when she was asked what her first memory of smoking was, when did you start smoking, it was when she had been smuggled out of Germany in the late 1930’s early 1940’s during the second World War. She had been smuggled out, she was a Jewish woman, and when she crossed the border into Switzerland, someone gave her a cigarette, and she took the first puff of that cigarette, they said this is what freedom tastes like. And so until she knew that she had you know her belief in freedom paired with her smoking habit, then no amount of teaching her to go into trance was going to make any difference, and sometimes you find those things out as you work. So it really depends, it depends on do you have the training and the skill set to do a particular piece of work, and if you wouldn’t without hypnosis, you shouldn’t do it with.
Jonathan Singer: So you use clinical hypnosis when someone asks for it, when it seems clinically appropriate, but also with the caveat that hypnosis is used within a treatment context that is within your scope of expertise and in your scope of practice.
Elizabeth Winter: Exactly.
Jonathan Singer: Let’s say they that all this criteria had been met with a client and you decided to use it. How do you actually use clinical hypnosis?
Elizabeth Winter: The first thing I do is to help someone learn how they best go into trance. There are a number of different inductions, so probably the one people are going to be most familiar with is fixing their eyes on a particular object, and it need not be a watch, and it need not be swinging in front of ones face, I will say that quite categorically now. But there is something called an eye fixation technique and this is one of what is known as the formal inductions. And when I talk about using hypnosis and what is ethical and what is appropriate, really talking about this sort of formal induction of hypnosis. Now the eye fixation may be helpful for someone who is more visually oriented and there are other forms of formal induction, one for example is an arm levitation induction. So that would be perhaps, and this is someone who is more comfortable with more physical and more body oriented rather than visual. There’s another, which focuses more on the ability to visualize things so that may be more appropriate for someone who thinks in that way. So there are different formal inductions. To use those help somebody to learn how to go into trance. Once somebody is in trance then a clinician would add what we would think of as a utilization, which would be what is it we are trying to accomplish, it may be suggestion in a fairly direct way, so you know one might say to somebody “You will be surprised at how much more comfortable you will be when …”. “As you monitor your breathing and slow down your next breath out, you will find that you’ve become calmer, more relaxed, and so on”. A simple example of just relaxation based, but that’s the utilization part of the trance. They then within that, or following that, perhaps be a suggestion for how that comfort or whatever it is will follow that person once the trance has ended. So just because the trance ends they don’t have to stop feeling comfortable you know, that comfort can go with you, that’s the post-hypnotic suggestion part of that. And then there is a termination of that, of the trance experience, which may sound something like “You return your attention to the room in your usual way in the next few breaths and so on”. So there is usually a structure to the formal induction of trance, but the induction, you know the induction of the early trance state is really just the beginning of that. And that will be completely really individualized for the person. There are some standard forms of script, actually some really really nice publications that have standardized scripts, and you know people often make their own but there are some really nice pieces of work for different applications. Now, formal induction is not the only way to use an understanding of hypnosis in the clinical setting. Now here’s the deal, since we go into trance spontaneously, I can intentionally work with someone to induce trance sitting in my office, but I can’t stop them spontaneously going into trance in my office. What I can do is recognize it and work with it because some spontaneous trances are useful and some are really quite harmful. So if there is a trance state which is what we would think of as a negative trance, so a highly focused attention perhaps in a relational situation, that is really really negative then my recognizing when someone has gone into hat sort of highly focused state that is not working well for them, is something that can be very useful clinically.
Jonathan Singer: So would this be something that you might recognize in a couples therapy session?
Elizabeth Winter: Oh sure, an induction into a trance state doesn’t have to be intentional obviously, so couples have a well worn path into an argument, into an old disagreement, into the you always do this, you never do that, so that can certainly operate as an induction if you like, with a focused attention or perhaps even more often focused disattenion, let’s say the induction "You never…"and then the other party disappears, they are not listening after that, they defocus, they have gone elsewhere. Could you view that as a couple’s trance? Certainly. I think it’s also helpful to consider negative trances that children go into and what operates as an induction for a child in a negative way might be the “You’re stupid, you never listen, you never get this right, you’re always so clumsy…” and at that point children often defocus and go elsewhere and they’re in their trance where they can’t get anything right, so of course the don’t. I think that can be a very helpful frame for parents to understand, for teachers to understand. Now on the positive trance side for children, I think it’s helpful again for parents, teachers, families to understand when a child is not being inattentive or disobedient, but simply highly focused in their internal world. So just useful ways to use that conceptualization of trance in a way that is helpful but does not involve necessarily a formal induction of a trance state, but really the recognition of naturally occurring states.
Jonathan Singer: So it does, it sounds like there’s a distinction between these naturally occurring and these formally induced trance states, and you’ve talked about positive and negative trance states. Are there limitations or strengths to clinical hypnosis in terms of the formal work that a clinician would do, not the naturally occurring trance states, but are there strengths and limitations or contraindications in terms of the clinical usage of hypnosis?
Elizabeth Winter: I think there are times when you absolutely wouldn’t use it, and we’ve certainly mentioned you know where you’re really not trained to. You may understand trance work but you may not be appropriate for you to use it in a particular area. Contraindications for me as a social worker seeing people for psychotherapy. I typically, probably would not use hypnosis for someone who has psychotic symptoms because they’re experiencing altered states in any case and adding in another form of altered state really is probably not going to be helpful, it just isn’t.
Jonathan Singer: That makes sense.
Elizabeth Winter: So I probably wouldn’t, I wouldn’t do it. I think I’ve already mentioned that I wouldn’t do, I don’t do memory retrieval work, and again that is something to be really cautious of. Might somebody remember something during the course of psychotherapy, absolutely, memory is not a continuous thing. Might somebody remember something while they’re in trance, certainly, but I wouldn’t go fishing for it. I wouldn’t use trance if somebody said I only want to do this and nothing else, that’s like telling a surgeon all they can use is a scalpel, nothing else, no retractors, no forceps, you know you wouldn’t limit yourself in that way. One aspect of using clinical hypnosis that I think is important for people to bear in mind is that where there is a legal case going on the admissibility of your clients evidence can really be put in jeopardy by that person having done hypnosis. Not because hypnosis makes them a less credible, well literally makes them a less credibly witness, but the law certainly views it that way. You know when, if you’re a forensic, if you’re doing forensic work as a therapist or a psychiatrist, you probably would not want to be using hypnosis. And it’s appropriate if someone wants you to work with hypnosis or if you’re considering it, to bear in mind that if they have a case pending or they might have a case against an abuser for example, that their testimony could be set aside in court. If you’re thinking of using clinical hypnosis with someone to really discuss with them in a psychotherapeutic setting whether this is something they’re comfortable with, not everyone is going to be comfortable with it. And there are some real cultural differences on the use of hypnosis with some people being very comfortable and some people being extremely uncomfortable and not feeling ok with that at all.
Jonathan Singer: And you are talking about informed consent, essentially, yes.
Elizabeth Winter: Absolutely, yes, and obviously that applies to anything but particularly to this. Particularly because of the misconceptions around it. You know just because I think it’s a great idea, if my client doesn’t then we’re not doing it, it’s really simple. The obvious limitation I think for clinicians is that you don’t do hypnosis as entertainment and you don’t do it if you’re not trained, same as anything else. You really, really want to receive the appropriate training. Interestingly, training for hypnosis puts people often in a multidisciplinary kind of setting because if you go and get formal training in clinical hypnosis, you’re probably going to be… As a social worker, you’re going to be with other social workers, but you’re also going to be with physicians, with dentists, you know nosis and so on because typically those trainings are multidisciplinary. Which is actually a very very interesting you know in addition to getting the training, it’s a very interesting setting to get some learning.
Jonathan Singer: If somebody is listening to the podcast and they say ok this sounds like it would be really a useful skill for me to have as an adjunct to what I normally do in my treatment, are there other references, are there books, are there authors, are there specific places where people could go to get training that you would recommend or that you would say off the top of your head?
Elizabeth Winter: I think I would probably start with the American Society for Clinical Hypnosis, which has an excellent website and I know and also look at the Milton Erickson Foundation website. But the American Society for Clinical Hypnosis, which is fondly known as ASCH (pronounced Ash) runs a number of trainings across the country, and these are very experiential trainings. To be an ASCH approved training it has to not just have lecture content but it has to have practical, you know practical learning. So learning how to induce trance, being a recipient of that, and really is quite extensive training. There are many places that you can an online or a weekend course, or a and get a, I think you can even get a Doctorate in hypnosis, that really is not the kind of training I would recommend, I have to say. I would say start with the American Society for Clinical Hypnosis; it is one of the very few national and longstanding professional organizations for therapeutic and clinical hypnosis.
Jonathan Singer: Well Dr. Winter this has been fascinating for me and I hope for our listeners. Thank you so much for being here and talking with us today about clinical hypnosis.
[Episode 28] Today's podcast is the first in a two-part series on Clinical Hypnosis. According to the American Society for Clinical Hypnosis, hypnosis is a state of inner absorption, concentration and focused attention. In today's podcast, I talked with Dr. Elizabeth Winter about the history of clinical hypnosis, key assumptions, goals, the client's role and types of problems that might be addressed with clinical hypnosis. In Part II, Dr. Winter and I talk about how and when to use clinical hypnosis.
Jonathan Singer: Dr. Winter thank you for joining us today, I am really looking forward to talking about clinical hypnosis. I was wondering if first you could give us a brief overview of the history of clinical hypnosis, including perhaps some of the key figures in its’ development?
Elizabeth Winter: Certainly. Clinical hypnosis started early in the 19th century when the term was coined by a physician called James Braid, who had observed exhibitions of what was then known as mesmerism or animal magnetism, and Braid thought that rather than a magnetic force of any kind, he thought that this was suggestibility and a form of sleep, which so he then called it hypnosis after the Greek word hypnos for sleep. Hypnosis was used for anesthesia and analgesia by a surgeon by the name of Esdale in India where he had used this on Indian patients in need of surgery and it was very successful in reducing what were then very very high mortality rates. With the advent of ether hypnosis became something that was a skill that had to be learned rather than a chemical that could be applied, and became less popular. It was used later in the 19th century by some of the big names in psychotherapy at that time such as Jacque, and Jeanea, Joseph Boyer and Freud of course. Freud had an early interest in hypnosis which gave way really as he developed psychoanalysis, and so hypnosis kind of waned in popularity again. Probably the main name from the 20th century was Milton Erickson and we still have the Erickson Foundation and what is often called the Ericksonian methods of hypnosis in hypnotherapy.
Jonathan Singer: What are some of the key assumptions of clinical hypnosis?
Elizabeth Winter: There are a number of things to consider here, one is that trance, or the hypnotic state is usually conceptualized as highly focused attention so that a person in trance is very highly focused on a certain thing, and conversely defocused on other things. So it’s a very tightly focused attention on the inward rather than in the outward, not exclusively but certainly, probably most commonly. What it is not is perhaps also extremely important. It isn’t sleep as we said earlier, it isn’t a form of mind control, which is perhaps how it’s popularly portrayed in terms of stage hypnosis, so it really does need to be distinguished from hypnosis, as a form of entertainment. A person who is going to be working with hypnosis clinically really needs to be I think well trained in the use of that. So perhaps one of the assumptions if you like is that the person doing this has had appropriate training. Other assumptions are that a trance state enables a person to perhaps address both their mind and their body at the same time. People may have come across this stage before, is that every psychological event is a physical event and every physical event is a psychological event. So it’s never one thing or the other, we perhaps have a slightly dualistic concept of the mind and the body. But working in trance really tends to draw on the idea of a holistic single thing. Again, one of the ways I think of that is you can look into a building through one window and see a particular view, you can look into a building from another window and see another view, but it’s the same building, it’s the same contents. Other assumptions would be that obviously, the obvious things like informed consent and so on and so forth, so the same kinds of assumptions that you would have for any forms of treatment.
Jonathan Singer: So it sounds like one of the main assumptions of clinical hypnosis is that it’s an internal focusing, possibly to the exclusion of the external world, and that there is an understanding of the mind and the body as a Gestalt.
Elizabeth Winter: I think that’s right, and I think that I’d also add that there’s an assumption that trance is a naturally occurring phenomenon. In other words, when you use it clinically you’re intentionally using something that we all know how to do anyway, and to give you an example of that, if you have ever watched a young child glued to a television set or to a computer screen, to the exclusion of all else, they’re not perhaps focused internally, but they are very very tightly focused on that thing, and you can talk to them sometimes for quite some time and they have absolutely no idea that you are there, not because their ears don’t work but because they have defocused on that particular form of input. So that if you like is a naturally occurring trance state. Likewise, if you’ve ever driven home and completely spaced the drive, and you know that you knew where you were going, but you have no recollection of how you got there, chances are that was a naturally occurring, and what is often called the driving trance. It is a naturally occurring thing, the difference is when you are using it clinically is that you have an agenda. So you have a therapeutic intention and an agenda for that trance, and if you can enter trance spontaneously, then you can enter it intentionally, and that’s also I think an assumption of practice. For research purposes, people often use hypnotizeability scales, which will show that some people are more hypnotizeable than others, and that can be tremendously useful for research work. From a clinical practice perspective, most people who work with this particular skill, will make the assumption that if someone can go into trance naturalistically or naturally if you like, then they can do it intentionally.
Jonathan Singer: Is clinical hypnosis a stand-alone treatment or is it something that can be used in conjunction with other forms of treatment, such as behavior therapy or solution focused treatment?
Elizabeth Winter: Hypnotherapy is not a treatment per say, it really is a skill or a tool; it’s a sort of scalpel if you like, it’s analogist to that, so does it stand-alone? Well, not really, it depends on what you want to do with it. So you can use trance work or hypnosis as part of cognitive behavioral therapy, as part of psychodynamic therapy, as part of couples therapy, individual, group, self-management, you can really use it a variety of different ways. So no it’s not a stand alone, in my estimation best used as part of an ongoing planned psychotherapeutic intervention. People will often say well can you just teach me how to go into trance so I can quit smoking, well yes you can absolutely teach it as a skill, and it certainly might preference to teach it as a skill that someone takes away with them rather than as something that the clinician does to them, but it’s not going to be something that will stand alone without looking at what, you know someone wants it for habit cessation, why do the smoke, what’s the context of that, obviously it’s not you know a magic solution but sued within an appropriate course of treatment, then yes it’s a very useful tool.
Jonathan Singer: What is the role of the client when the clinician is using hypnosis?
Elizabeth Winter: That’s really an interesting question and I think it depends as much on the clinician in question as much as it does on anything else. Clinical hypnosis is used really by a broad variety of folks, so that may be social workers, it may be psychologists, it may also be dentists, physicians, chiropractors, nurses, so how the clients role is conceptualized is really as much a function of whether and to whom they’re presenting for service as it is of hypnosis itself. So I’m speaking personally as a social worker, I will usually be working with someone on the basis of using hypnosis as a personal skill, for example, typically in the first session with someone who wants to learn hypnosis, we will do some trance work in that first session with the goal that this person can then induce trance for themselves, whether or not I happen to be there. So really for me it is something that someone takes away, not something that they have to come to me to get.
Jonathan Singer: So it sounds like the clients role differs based on the setting, so if I was a patient in a dentist’s office, it would be different than if I was in a psychotherapy office.
Elizabeth Winter: I think that’s right and I think that, as we talk more about how it’s used, I think perhaps that will become clearer too. I am thinking of people that I’ve worked with over the years, some of whom practice it and practice a great deal because it’s a skill, practice is important, and so they have sort of taken it as their own and do what they need to do with it, and I’m thinking that there are other people who use it more rarely but will come in and say I’m having trouble with this, can we do some trance work around this particular thing. One example that comes to mind is somebody who is getting some quite distressing physical discomfort and couldn’t work out whether this was stress related or not, well of course as a social worker the first thing you do is send someone to get a complete medical workup, but in terms of preparation for that workup one of the things that we did was to have this person go into trance, and they were very good at that, they had done it many times, and to do what you might call a full-body scan, what was paining them, how was it paining them, what was the quality of that, so that when they went for their medical workup, they could really give some high quality information to the physician, and also be a little calmer in themselves about knowing what was going on for themselves.
Jonathan Singer: What are some other types of problems that can be addressed using clinical hypnosis?
Elizabeth Winter: Well, if we look at that in a very general way, those are going to fall into the more medical kinds of things, and then what we would think of as the more psychosocial kinds of areas. Hypnosis certainly can be used both with adults and with children, and actually since children, their natural ability to go into trance is really really high until we train them not to, and so they are very very susceptible and very comfortable going into trance. And there’s a lot of medical work done with kids around pain control, and to prepare children for procedures, particularly painful procedures. Karen Ulness actually has written a very very nice book and done a great deal of work on working with children in medical settings using hypnosis. Obviously pain control or shifting perceptions of pain is certainly a way to use hypnosis and there is a fair amount of evidence actually looking at using hypnosis to reduce the need for using analgesic medication post-operatively to reduce subjective perception of pain and to decrease wound healing time also, so some quite nice evidence out there for that.
Jonathan Singer: I also know that hypnosis is used in birthing, there’s a whole area called hypno-birthing, and in hypno-birthing they reconceptualize pain as pressure and suggest that if you’re in a state of deep relaxation you won’t be fighting your body’s natural process. So the idea is that the fight is what causes the pain, and hypno-birthing points to cultures where the birth experience is not discussed in terms of pain, like it is in the United States. Interestingly this approach seems to be very different than other birthing classes, like Bradley or Lamaze, even though those classes include basic hypnotic techniques, like breathing for relaxation.
Elizabeth Winter: Interestingly Lamaze was trained in hypnosis, so you know there are probably some very strong links around what Lamaze did in childbirth and his training in hypnosis, as I understand it. But yes, certainly, that’s a very nice cognitive intervention to reconceptualize pain as something that is not pathological, but quite appropriate for the process, and there’s again a lot of folks working with childbirth preparation with hypnosis so to help somebody to understand what to expect and again going back to that assumption that you’re not just talking to the mind but you’re talking to the body. So one of your suggestions may be as you feel a certain kind of pressure, than that will be your cue to allow that muscle to relax and lengthen or the ligament to soften and lengthen and do what it needs to do in the childbirth process. So that would be a very nice example. In the sort of psychotherapeutic world hypnosis is used in a number of different ways. Anxiety, and of course that could well be related, well it could be related to anything at all, but I am thinking of your example of childbirth, so you would deal not only perhaps with the physical sensations of that but also fear of pain, fear of the process, whatever the process is. So anxiety certainly, depression, ADHD actually. There’s some of use of that in terms of filtering input, if you consider hypnosis again as a state of highly focused attention, and if you think of Attention Deficit Disorders as the inability to not focus, something that would help somebody filter input would be very very helpful. Addictions, as a skill in terms of perhaps understanding and identifying some of the triggers for addictions, and also in dealing with cravings when they arrive. Some very good applications there, and then some really general things, like general ego strengthening, general relaxation, stress reduction, and actually I tend to use hypnosis for folks who have post-traumatic symptoms, helping people to find a way to ground and to deal with some of the physiological anxiety symptoms that really hit people hard in Post-traumatic Stress Disorder.
Jonathan Singer: It sounds like a wide variety of issues that can be addressed with clinical hypnosis and it sounds like with the examples that you gave there are similarities but they are really targeted to whatever the most distressing symptom is, so with the ADHD with be attention, with the childbirth it might be what does this pain mean, you know what is this triggering, what is this telling you to do at this point as opposed to “Oh my God make it stop”.
Elizabeth Winter: Right, and what you’re dealing with is our ability to focus. So whatever one focuses on or chooses not to focus on, I mean that’s why it’s a wide variety, because focus itself can be applied to absolutely anything. I think it’s also important to add that contrary to the misconception that hypnosis reduces somebody’s control, or has control over the person that you’re working with, the goal if you like of the many uses of trance is to increase control. So that somebody has more control over emotional responses, over physiological processes, and can again given the childbirth example, feel more control of what is happening in that particular process. So control over levels of perceived pain, control over how long something appears to take. There’s a concept in hypnosis called time distortion, and if you think about being a kid on the last afternoon on the last day of school before summer vacation, how long does that afternoon stretch out? Subjectively for a kid, it’s forever, now if you want to make something last longer, that’s great, you then might cue somebody to remember that long long long time, if you’re dealing with something like discomfort or pain, then you might want to do the opposite, and talk about how quickly time can pass, so that our ability to experience time in this very subjective way is something that we can use in a trance state to have some control over procedures, and some of the procedures that you know things that involve like bone marrow procedures, and so on where there’s a high degree of discomfort, and use trance to sort of go away and you know change the length of time that that seems to take can be very very helpful to people. But the whole idea of this is to have more control over what’s happening. So for anxiety for example, the control that one might like to have is control over some of the physiological aspects of anxiety. Things like reducing your heart rate, calming your breathing down, and when you do that then your subjective experience of anxiety changes because you’ve dealt with some of the physiological things that you know are part of it and that then feed that whole process of becoming anxious and maintaining an anxious state. So it really is about putting control, you know giving control to the person who is learning to do this, and again importantly, taking that away out of the office so they can do it as and when they need to or want to.
[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.
[Episode 26] In today’s podcast, I speak with Sabrina Heller, a social worker in Pittsburgh, Pennsylvania who has used Dialectical Behavior Therapy, (DBT) in a variety of clinical settings, including an inpatient eating disorders clinic and an outpatient substance abuse treatment program. In today's interview we spoke about the goal of DBT, clinical techniques, the role of the client and clinician, the skills training workshop, the three mind states: reasonable mind, emotion mind, and wise mind, and how Sabrina incorporates DBT into her work with clients. Download MP3 [52:12]
[Episode 24] Sex addiction has been defined as "engaging in persistent and escalating patterns of sexual behavior despite increasingly negative consequences to self and others" (Ewald, 2003). In today's podcast I talked with Chris Wolf, a licensed marriage and family therapist and a certified sex addiction counselor. She received her masters in counseling psychology from the University of Pennsylvania, and trained with pioneering sex addictions researcher, Patrick Carnes. She currently works at Gateway Rehabilitation Center in Pittsburgh, Pennsylvania and has a private practice where she works with primarily with couples dealing with sex addiction. Our interview covered a broad range of topics, including how sex addiction is similar to and different from substance use addiction, common characteristics of sexually addicted clients, basic skills and competencies clinicians need when working with sexually addicted clients, and some resources for further study or learning.
As with the podcast with Jody Bechtold on pathological gambling, this interview is intended to be an overview and introduction to the topic of sexual addiction. It is not intended to be used as a substitute for supervision or clinical training.
[Episode 21] In today's podcast, I speak with Dr. Lambert Maguire about social networks. Dr. Maguire discussed the development of his interest in the topic, as well as some historical context for understanding social networks. We discussed the theoretical assumptions and differential applications in research and clinical work. Dr. Maguire relates the traditional understanding of social networks to contemporary uses of "web 2.0" social networking sites such as MySpace.com. We end out interview with a description of how social networks can be conceptualized throughout the life span.
Dr. Maguire's primary interests are in direct practice and the use of social support systems and networks in treatment, prevention, and rehabilitation. He has been the P.I. on NIMH grants for both research and training, and has experience as a researcher and practitioner in mental health and substance abuse. He is currently on the editorial board or serves as a reviewer for four journals. He teaches courses in direct practice, human behavior, groups, and advanced systems. Dr. Maguire is a member of the Society for Social Work and Research, the National Association of Social Workers, the Academy of Certified Social Workers, and the Council on Social Work Education, and has presented papers at over 30 national conferences. He has also served as a consultant to the National Institute of Mental Health and the Council on Social Work Education. He has chaired the direct practice concentration in the past and currently chairs the faculty search committee. His recent research interests are related to social systems and their relation to substance abuse.
Dr. Maguire has a joint doctorate in social work and psychology from the University of Michigan and received his master's degree in social work from the University of Chicago's School of Social Service Administration. He has 25 years of practice experience with children, groups, families, and couples.
Example of a Social Network Diagram (click to enlarge)
References
Books by Dr. Maguire that address Social Networks:
Maguire, L. (1983). Understanding Social Networks. Beverly Hills, CA: Sage Publications.
Maguire, L. (1991). Social Support Systems In Practice: A Generalist Approach. Washington, D.C.: National Association of Social Workers (NASW) Press.
Maguire, L. (2002). Clinical Social Work: Beyond Generalist Practice with Individuals, Groups, and Families. Pacific Grove, CA: Wadsworth Publishing Company.
Singer, J. B. (Host). (2007, July 30). #21 - Social Networking: Interview with Dr. Lambert Maguire [Audio Podcast]. Social Work Podcast. Podcast retrieved from http://socialworkpodcast.com/2007/07/social-networking-interview-with-dr.html
In this podcast, the last of four on pathological gambling, I speak with Jody Bechtold, LCSW, NCGC-II, PC about the process for becoming a nationally certified gambling addictions counselor. Jody compares the national certification process with the process to be designated as "competent" to treat pathological gambling in the state of Pennsylvania. If you are interested in becoming nationally certified, you might want to listen to the podcast a couple of times, as there are a number of steps in the process.
June, 2012: Journal of Social Work Education publishes Jody's article on graduate education and gambling:
Engel, R.J., Bechtold, J., Kim, Y., & Mulvaney, E. (2012) Beating the odds: Preparing graduates to address gambling-related problems. Journal of Social Work Education, 48, 321-335. doi: 10.5175/JSWE.2012.201000128.
National Testing Corporation for the NCGC exams: http://www.ptcny.com/clients/NGCCB/
The following is an example of costs associated with becoming a certified gambling counselor:
Singer, J. B. (Host). (2007, June 11). How to become a nationally certified gambling addictions counselor [Episode 20]. Social Work Podcast. Podcast retrieved Month Day, Year, from http://socialworkpodcast.com/2007/06/how-to-become-nationally-certified.html
Today's podcast is the second in our four-part series on pathological gambling. I talk with Jody Bechtold, LCSW, NCGC-II, PC about treatment basics for clinicians who work with pathological gamblers. We'll start with a quick overview of crisis intervention and then move into some of the assumptions and techniques of the treatments with the most empirical support in the treatment of pathological gamblers - behavior and cognitive therapy. We end with a brief overview of some challenges that can arise during the treatment of pathological gambling.
This interview targets practicing clinicians or students in clinical courses. If you are not familiar with the approaches discussed in this podcast, you can find more general overviews of crisis intervention, behavior therapy and cognitive-behavioral therapy on the Social Work Podcast website. Disclaimer - this podcast is intended to be a general overview of treatment approaches, rather than a clinical training. If you are currently working with, or intend to work with people with gambling addiction, proper education and training is essential. In the fourth part of this series, Jody and I talk about some of the requirements for obtaining the NCGC-1 - the national certified gambling counselor certification.
Download MP3 [27:00] This series on pathological gambling includes the following podcasts:
June, 2012: Journal of Social Work Education publishes Jody's article on graduate education and gambling:
Engel, R.J., Bechtold, J., Kim, Y., & Mulvaney, E. (2012) Beating the odds: Preparing graduates to address gambling-related problems. Journal of Social Work Education, 48, 321-335. doi: 10.5175/JSWE.2012.201000128.
Singer, J. B. (Host). (2007, May 28). Treatment of pathological gambling [Episode 18]. Social Work Podcast. Podcast retrieved Month Day, Year, from http://socialworkpodcast.com/2007/05/treatment-of-pathological-gambling.html
[Episode 42] Today’s podcast is the third of three interviews with Kia J. Bentley on psychopharmacotherapy. Kia J. Bentley is Professor of social work at Virginia Commonwealth University in Richmond Virginia and has published extensively in the area of psychopharmacotherapy (see references below). Psychopharmacotherapy refers to the treatment of psychiatric disorders with the use of medication. But, as Kia pointed out in our interview, psychopharmacotherapy is not just about giving people medication and calling it a day. It is an approach to treatment that acknowledges the strengths and limitations of medications.
