Provides information on all things social work, including direct practice (both clinical and community organizing), research, policy, education... and everything in between.
[Episode 65] Today's episode of the Social Work Podcast is on the process of Evidence-Based Practice. I wanted to do an episode on Evidence-Based Practice because it has been the subject of a lot of debate in Social Work. One of the controversies is over how to define evidence based practice. In order to get some insight into the Process of Evidence-Based Practice, I spoke with one of social work's leading experts on the topic, Dr. Danielle Parrish, assistant professor with the University of Houston, Graduate College of Social Work. In today's interview, Danielle and I talked about the difference between the process of evidence-based practice and evidence-based practices, also known as empirically-supported treatments. We talked about why social workers should use the evidence-base practice process. Danielle identified some of the limitations of the EBP process, resources for social workers interested in accessing the evidence-base, and ways that social workers could support each other in being evidence-based practitioners.
Listeners of the Social Work Podcast, followers of the Social Work Podcast Twitter feed (@socworkpodcast), and fans on the Social Work Podcast Facebook page responded to a request to vote for their preferred definition of Evidence Based Practice. The results were surprising:
We've all heard the Serenity prayer. Even if you don't know what it is called, you'll recognize it by the first few words... "God grant me the serenity..." The serenity prayer is synonymous with Alcoholics Anonymous and 12-step programs that have transformed the lives of hundreds of millions of people. And it is only 25 words and three lines long.
Most episodes of the Social Work Podcast take huge topics - like stigma, suicide, and cognitive-behavior therapy, and try to distill them into 30-minute overviews. Today's podcast flips that on its head. Today we're spending over thirty minutes to unpack 25 words. My hope is that listeners learn something about the Serenity prayer - something that they can incorporate into their social work education or practice. In today's social work podcast, I spoke with Eileen Flanagan, author of the award winning book, The Wisdom to Know the Difference: When to Make a Change-and When to Let Go Her book was endorsed by His Holiness the Dalai Lama. She holds a B.A. from Duke and an M.A. from Yale and teaches at the University of the Arts in Philadelphia, Pennsylvania. You can read more about her work at her website, http://www.eileenflanagan.com.
And now, on to Episode 61 of the Social Work Podcast: The Wisdom To Know the Difference: an Interview with Eileen Flanagan.
[Episode 60]Today’s Social Work Podcast is on social skills training with children and adolescents. My guest, Craig Winston LeCroy defines social skills as “a complex set of skills that facilitate the successful interactions between peers, parents, teachers, and other adults” (LeCroy, 2009, 653). Social skills include everything from dress and behavior codes, to rules about what, when, and how to say or not to say something. Social skills training is a form of behavior therapy, and as such focuses on behaviors, rather than thoughts or feelings, as the targets for change. Traditional behavior modification is often thought of in terms of task completion, for example, using star charts to get kids to clean their rooms or do homework. But in social skills training, behavior modification principles are used to teach people skills that help them to be successful in social situations.
[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.
[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.
[Episode 50] In today's podcast I speak with Dr. Cynthia Conley,assistant professor of social work at the School of Social Administration at Temple University, about salary negotiation skills for social workers. Cynthia takes us through salary negotiation from the application to the job offer. Today's podcast is a follow-up to our December, 2008 interview in which Cynthia spoke generally about the importance of salary negotiation to both individuals and to the profession.
[Episode 49] In today's podcast I speak with Mark Meier, a licensed independent clinical social worker from Minneapolis, Minnesota about social workers and depression. Depression is biopsychosocial disorder that interferes with daily functioning, interpersonal relationships, and school/work. Depression is one of the most common psychiatric disorders, with 18% of men and women in the United States reporting at least one depressive episode in their lifetime (Kessler et al, 2005). Depression can be treated successfully in most people using either talk therapy, medication or both.
In today's podcast, Mark and I spoke about how social workers are three times as likely to be depressed as people in the general population. We talked about the personal and professional responsibility social workers have in addressing their depression, and the role that schools of social work, agencies and colleagues have in supporting social workers to get treatment. Mark shared his personal experience with depression, suicidal ideation, and the subsequent hospitalization. We ended our conversation with a discussion about what programs or workshops schools of social work can provide students to address the issue of social workers and depression.
[Episode 48] In today's podcast, I speak with Dr. Elaine Congress, and Fernando Chang-Muy, JD about their 2008 text from Springer publications, Social Work with Immigrants and Refugees: Legal Issues, Clinical Skills and Advocacy(note: a second edition was published in 2015). We talk about why they thought it was important to have legal and social work perspectives in a book on working with immigrants and refugees. We also talk about the interface between social services and legal system, how social workers and lawyers can work together when helping immigrants and refuges, and some of the ways that professionals can advocate for immigrants and refugees at a policy level. Elaine and Fernando ended our conversation with some ideas about how the concepts discussed in today’s podcast and the book can be applied to people who live in countries other than the United States. Related podcast: Listen to Elaine Congress talk about using her visual assessment tool, the Culturagram, when working with immigrants and refugees.
[Episode 46] In today's podcast I speak with Dr. Elaine Congress about her creation, the Culturagram. Elaine and I talk about how and why she developed the culturagram, the ten assessment areas of the culturagram, and how social workers can use the culturagram to improve their services. We end the podcast with a discussion about research and resources about the culturagram.
Dr. Congress has provided a copy of the Culturagram that you can look at while listening to the podcast, or when thinking about your clients. Please see below to view the Culturagram.
[Episode 45] In today's podcast, I speak with Shaun Eack about schizophrenia and social work. We talk about some basic information that social workers need to know about the diagnosis of schizophrenia; Shaun identifies and describes the positive, negative and cognitive symptoms that are often present in people with schizophrenia. Around 13 minutes into the conversation we switch the focus from diagnosis to the role of the social worker in working with people with schizophrenia. We end our conversation with a discussion of treatment approaches, including a new approach that addresses cognitive content.
[Episode 43] Today’s podcast is the first in a two part series on measurement for clinical practice and research. In today's podcast I speak with Dr. Mary Rauktis about how she became interested in measurement; some key concepts needed to understand measurement including reliability, validity and error; and how to understand measures used in research articles.
In part two of the podcast we talk about the difference between measurement in the field and measurement in research settings. We talk about some of the ways that social workers can think about measurement as a tool to improve clinical practice, and some ways that social workers in the field can develop measures that will really benefit their clients. We talk about some of the challenges social workers have using measurement tools because of how rarely measures are integrated into social work courses. We talk about some ideas for how to better integrate measurement into social work education, particularly beyond the required research classes. We end Part II with a discussion of some resources for social workers interested in learning more about measurement.
[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 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 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 30] In today’s podcast, I talk about some basic concepts in supervision. I define administrative, clinical and supportive supervision, talk about differential uses of supervision, including improvement of clinical services and issues of liability. I also address the ethical standards for social workers providing supervision. Like many of the Social Work Podcasts, much has been written about the topic of supervision – more than can be covered in this short podcast. If you are interested in learning more about supervision or becoming a supervisor, schools of social work like the University of Texas at Austin and Smith College School of Social Work have continuing education programs dedicated to training clinical supervisors. There are dozens of independent continuing education programs as well as books and articles on the topic. As always links to further readings and resources can be found at the Social Work Podcast website at socialworkpodcast.com. Today’s podcast on supervision addresses a topic that is relevant to social workers at all stages of their career. It also sets the stage for an upcoming three part series on phone supervision in which I’ll be talking, over the phone, with two clinical social workers who provide phone supervision and consultation. The final episode in the series is an interview with a social worker who received phone supervision towards an advanced license because the resources were not available locally.
UPDATE October 20, 2008: University of Buffalo School of Social Work published a very engaging and informative interview with Dr. Lawrence Shulman about parallel process and honest relationships in supervision. Dr. Shulman's interview was full of practical tips for supervisors and clinicians in the field. You can hear this excellent podcast at the University of Buffalo School of Social Work Living Proof website.
[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 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 14]In today's podcast, we're going to talk about the therapies that take a cognitive-behavioral approach to working with people. I review the theoretical assumptions, therapeutic process, techniques, use in culturally competent practice, and strengths and limitations of CBT. This podcast is longer than most because I use a lot of clinical examples and dialogue to illustrate the concepts.
Her book was endorsed by His Holiness the Dalai Lama. She holds a B.A. from Duke and an M.A. from Yale and teaches at the University of the Arts in Philadelphia, Pennsylvania. You can read more about her work at her website, http://www.eileenflanagan.com. 
[Episode 60]Today’s Social Work Podcast is on social skills training with children and adolescents. My guest, Craig Winston LeCroy defines social skills as “a complex set of skills that facilitate the successful interactions between peers, parents, teachers, and other adults” (LeCroy, 2009, 653). Social skills include everything from dress and behavior codes, to rules about what, when, and how to say or not to say something. Social skills training is a form of behavior therapy, and as such focuses on behaviors, rather than thoughts or feelings, as the targets for change. Traditional behavior modification is often thought of in terms of task completion, for example, using star charts to get kids to clean their rooms or do homework. But in social skills training, behavior modification principles are used to teach people skills that help them to be successful in social situations.
[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.
[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.
[Episode 50] In today's podcast I speak with Dr. Cynthia Conley,assistant professor of social work at the School of Social Administration at Temple University, about salary negotiation skills for social workers. Cynthia takes us through salary negotiation from the application to the job offer. Today's podcast is a follow-up to our December, 2008 interview in which Cynthia spoke generally about the importance of salary negotiation to both individuals and to the profession.
[Episode 49] In today's podcast I speak with Mark Meier, a licensed independent clinical social worker from Minneapolis, Minnesota about social workers and depression. Depression is biopsychosocial disorder that interferes with daily functioning, interpersonal relationships, and school/work. Depression is one of the most common psychiatric disorders, with 18% of men and women in the United States reporting at least one depressive episode in their lifetime (Kessler et al, 2005). Depression can be treated successfully in most people using either talk therapy, medication or both.
[Episode 45] In today's podcast, I speak with Shaun Eack about schizophrenia and social work. We talk about some basic information that social workers need to know about the diagnosis of schizophrenia; Shaun identifies and describes the positive, negative and cognitive symptoms that are often present in people with schizophrenia. Around 13 minutes into the conversation we switch the focus from diagnosis to the role of the social worker in working with people with schizophrenia. We end our conversation with a discussion of treatment approaches, including a new approach that addresses cognitive content.
[Episode 43] Today’s podcast is the first in a two part series on measurement for clinical practice and research. In today's podcast I speak with Dr. Mary Rauktis about how she became interested in measurement; some key concepts needed to understand measurement including reliability, validity and error; and how to understand measures used in research articles.
[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 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 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 30] In today’s podcast, I talk about some basic concepts in supervision. I define administrative, clinical and supportive supervision, talk about differential uses of supervision, including improvement of clinical services and issues of liability. I also address the ethical standards for social workers providing supervision. Like many of the Social Work Podcasts, much has been written about the topic of supervision – more than can be covered in this short podcast. If you are interested in learning more about supervision or becoming a supervisor, schools of social work like the University of Texas at Austin and Smith College School of Social Work have continuing education programs dedicated to training clinical supervisors. There are dozens of independent continuing education programs as well as books and articles on the topic. As always links to further readings and resources can be found at the Social Work Podcast website at socialworkpodcast.com. Today’s podcast on supervision addresses a topic that is relevant to social workers at all stages of their career. It also sets the stage for an upcoming three part series on phone supervision in which I’ll be talking, over the phone, with two clinical social workers who provide phone supervision and consultation. The final episode in the series is an interview with a social worker who received phone supervision towards an advanced license because the resources were not available locally.
[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.
[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.
[Episode 14]In today's podcast, we're going to talk about the therapies that take a cognitive-behavioral approach to working with people. I review the theoretical assumptions, therapeutic process, techniques, use in culturally competent practice, and strengths and limitations of CBT. This podcast is longer than most because I use a lot of clinical examples and dialogue to illustrate the concepts.
