Forest Bathing/Forest Therapy- My Experience Part 1

A few weeks ago, I tried forest bathing. If you aren’t familiar you what forest bathing or forest therapy is check this out (https://www.webmd.com/balance/news/20190611/forest-bathing-nature-time-hot-health-advice). Over the past month, several people have mentioned this to me and I was exploring it with a social worker I provide training supervision for. He found a local, certified guide and we scheduled our experience.

We met the facilitator and she seemed what you would expect. A nature love with overall shorts, a flannel shirt, and no shoes. She had introductions and she gave us a quick overview of our time together. We walked into the park and found a spot just off the trail.

Our first activity was a series of invitations. We stayed in this spot and experienced it with out senses. First our sight, and then we closed our eyes and listen to and felt the nature around us. We could move around however we felt appropriate like swaying or such. This lasted about 20 minutes. At the end we were encouraged to turn and find the direction that “called” us. Once we felt that direction we could open our eyes and contemplate why were we drawn to that direction and what could we learn from it.

Honestly, I didn’t feel called in any such direction. I did, however, chose a direction that was different than when I closed my eyes. I chose that direction because it was where I was able to feel the sun on my face. When we began, I was looking into trees and it was dark yet peaceful. This new direction was grassy and sunny. Maybe I did feel drawn to that direction, but I’m not sure it taught me anything.

After these invitations we sat on the ground and were encouraged to share our experience. Neither me or the individual I supervise really shared anything. He may have said something; I don’t completely recall. I know I did not say anything. Specifically, I remember shaking my head instead of actually saying I did not have anything to share. The facilitator didn’t prey anything out of us, which was nice. She did state that sharing was not required, and she maintained that throughout our time together.

To be continued…

Meeting Clients Where They Are

It was a common expression in social work school to "meet a client where they are" or "start where they client is". What does that really mean though? I used to think it refer to our language and how we spoke to those we worked with. We want to avoid professional jargon and use words that are readily understood. It also meant something else that I am struggling to find words to explain. This seemed to be an idea that was more assumed than practically taught. Over the years, I believe I've developed a more practical understanding of what it means to meet a client where they are. 

Home

This seems to be the most logical place, but it didn't dawn on me until I was in training supervision with a social worker who really believed in and practice home-based therapy. She explained that a client's home was really the place to get a better understanding of the client in their environment. It also cuts down on transportation issues which always seems to be mentioned as a top barrier to treatment. We can meet a client where they are by physically going to their home (however they define it). 

At least in my community, we seem to have a philosophy of build it and they will come. As we now see this does not work when their is a national pandemic. We need to be more mobile and flexible in how and where we meet clients. Telehealth has been great, but it's not for everyone. There are accessibility issues around technology that 

Then there is the ongoing issue of social workers just not wanting to do home-based. We need better advocacy and attention in getting social workers out into the community. 

Office 

Sometimes the home is not a space place for clients so they need to go to the office for services. We need places where we have control so we can make them safe for our clients. Not everyone client will feel comfortable with a social worker in their home. There is definitely a balance of home-based and office-based that needs to be made. 

But, can our offices meet clients where they are? I believe so. 

Include things in your office that reflects an element of the personal. Your office shouldn't be cold and sterile, but should help a client connect with you. It doesn't have to be a complete disclosure of your life, but some element that helps reflect who you are as a person. 

There are some cultural considerations to make here as well. If you work with a lot of Latinx clients, consider having some cultural elements reflected in your office. If you work with a lot of LGBTQ folx, consider having elements that reflect this group. Having elements in your office can help clients connect with the space and with you. 

Presentation

Recently in a supervision group I lead, a social worker said that we need need to present how the client feels comfortable. This makes total sense, but I don't think we often consider that in meeting a client where they are. Obviously, well maybe obviously, presentation includes our body language and attitude. We want to present in a way that is open and warm, and gives our full attention to the client in the moment; really to be present with that client. However, it could include the clothes we wear. Wearing clothing that reflects the client's comfort. If the majority of your clients are business professionals and wear that type of clothing then a social worker may do better in a suit and tie, but if the clients a social worker is working with are not wearing what society deems as professional attire then the clothes social workers wear should be more reflective of what the clients they are seeing wear. 

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Starting where a client is and meeting them where they are has to be more than lip-service. It is a multi-faceted approach. Social workers need to consider all they ways this can be done. I've listed a few here that just gives a deeper perspective than the often overused phrases. Social work schools need to consider how they are preparing the workforce to go out into the community and see clients in their homes. Insurances need more robust reimbursement so social workers can go out into the communities where their clients live. We have to move beyond office-based and utilize all the ways to meet the client where they are. 

Identifying as a Professional Social Worker

The Counsel on Social Work Education has developed Advanced Social Work Practice in Clinical Settings. I find this super helpful when providing supervision for those working on their independent license because it helps differentiate between advanced social work competencies and basic ones. 

Under Educational Policy 2.1.1- Identify as a professional social worker and conduct oneself accordingly, the first advanced competency is to readily identify as a social work professional. I've been thinking about this for some time because on first glance, the competency seems to repeat the educational policy. The clear distinction between the two is the word readily. 

I didn't want to take the time to define readily because I think that often times it is used to add some length without adding content. In this case however, a simple Google search defines readily as without hesitation or reluctance. This provides more depth into this competency of readily identifying as a social work professional. 

Often times, I see social workers identify themselves as anything but a social worker. I often hear the terms therapist or clinical therapist for social workers in private practice or other mental health settings. Some social workers tend define themselves by their role or job description such as case manager or discharge planner. This begs the question, why? Why do social workers not say they are social workers? There are probably a few reasons. 

1. Describing Role

    Let's be honest, the public can be very confused by what social workers are and what they do. Sharing the primary job function may be helpful for someone a social worker is working with to understand what they are doing. A social worker may enter a patient's room and identify as a discharge planner to allow that person to know that they are there to to plan for discharge. It can also help a person understand the difference between their case manager and therapist who may both be social workers. 

2. Stigma

    Another reason social workers may not readily identify as a social worker is because there is some stigma within the profession. Perhaps people do not want to associate with the profession or know that some people do not think highly of social workers, so they say they are something else. Social workers often get a bad reputation by some who misrepresent themselves as social workers. Some people believe that social workers just take kids away or refer people to resources. To not associate with the negative views toward the profession, some may feel it's better to say something along the lines of what they do. 

Readily Identifying...

As someone who provides training supervision, this is a topic I like to bring up with those I supervise. It is an advanced competency, but as a professional social workers who do quality work I want those I supervise to be proud of being a social worker. I challenge them to say "I'm a social worker who provides therapy" rather than just identifying as a therapist. Even in my personal life I tell people I am a social worker knowing they will automatically think I work directly with clients. I want to help the public understand the depth and breadth of social work so I explain that not all social workers work with clients and that I work in administration. In all of my roles I am a social worker first. Some jobs we take as social workers may be appropriate for many different types of professional backgrounds, however if you have a social work education you bring that with you to any job. 

As professionals, we have a responsibility educate the public and other professionals on the profession of social worker. I am an ambassador for the profession and need to conduct myself accordingly. We can help reduce stigma against the profession when professional, competent social workers readily identify as such. 

A Hard Pill to Swallow

I've been contemplating on supervision and the difference between clinical supervision and training supervision. Training supervision (in Ohio at least) has really been for social workers working towards obtaining their independent license. Although training supervision should really be for anyone who is seeking to work on developing a new skill/area of practice.

Clinical supervision on the other hand is really a requirement for those practicing with a dependent license. Ohio Revised Code 4757-21-02 defines social psychotherapy as needing supervision which includes the diagnosis and treatment for mental and emotional disorders. The Best Practice Standards in Social Work Supervision development by NASW and ASWB provides a good description of what supervision is for the purpose of the discussion of clinical supervision. In a nutshell, clinical supervision clinical supervision refers to the responsibility someone with an independent license takes to ensure practice by those with dependent licenses is ethical and follows appropriate practices; the clinical supervisor is taking on responsibility for the practice of another licensee.

I hear many social workers say that they will use their clinical supervision hours as part of the training supervision needed for obtaining an independent license. I do not this this is totally inappropriate. However, the clinical supervision has to have their supervisory designation in order to do training supervision and this plan should be discussed prior to the licensee planning to use these hours in this way. Clinical supervision and training supervision are different. Clinical supervision is necessarily about your development and may not prepare you for an independent license.

Qualifying for an independent social work license is not an entitlement. Not everyone with a graduate social work degree should be an independently licensed social worker. The training supervision requirement is preparation for independent license and should challenge the status quo of practice. It should prepare the licensee to advance their practice; it is not about developing basic skills. Clinical supervision is a job requirement and the clinical supervisor may not have the time nor the skill to attend to a licensee's advanced skill development. Going through the motions of supervision isn't enough, a licensee needs to be actively trying to develop and advance their skill.

Training supervision is an opportunity to challenge yourself and grow as a professional with the goal of being ready for independent social work practice. In Ohio, they are currently re-evaluating the rules and in the future training supervision may be more prescriptive. It is vitally important for licencees to take this time seriously as they prepare for an advanced license and supervisors need to consider their responsibility as gatekeepers for the profession and those individuals the social worker will work with.

Graduating Social Workers

It's May and another group of BSW and MSW social workers will graduate and soon enter the field of social work. It is usually an exciting time, but I am sure there is anxiety due to the uncertainty that the COVID-19 pandemic has caused. May is usually a month for celebrating a major life accomplishment, but lots of celebration has been postponed.

I have been reflecting on my MSW graduation. There were difficult times for my class because it was the year we had a lot of snow and the university closed a lot and school-based and other internships repeatedly closed. Several of my classmates were stressed with not knowing how to complete their hours. I think that stress is nothing compared to what the 2020 graduates have experienced.

In an effort to support new graduates, I am moderating a virtual career panel with experienced social workers to provide some helpful advice as new grads seek employment during a pandemic. I am not sure if anyone will even register, however, I am excited that I am doing it and I am excited that several great community leaders are helping by serving on the panel. I've never done this before so I do hope it is helpful and that new social workers find some value if they choose to participate.

Online CBT Reduces Suicidal Ideations

In continuing the discussion on evidenced based practice, the following article came into my email recently.

Online Self-Help Tied to Less Suicidal Ideation 

https://www.medpagetoday.com/psychiatry/depression/86203

As people are accessing more online interventions, especially during the COVID-19 pandemic, it is important that social workers explore the effectiveness of these tools before recommending them to clients. Although research may be limited because a lot of these tools are new and emerging, that does not mean we need to completely wait before recommending them to clients. Understanding what evidence there is, understanding what science these tools are based on, and properly educating clients on the tools are important steps before just sending the client away with whatever tool it is.

The article states, "what was surprising was the majority of the web-based therapies were self-guided, but still effective" (Monaco, 2020, para 5). Self-guided, web-based cognitive behavioral therapy can be an effective form of therapy. I don't think web-based interventions, especially self-guided, will every completely replace in-person psychotherapy. There is something powerful to be a physical safe space where there is no judgement and one is able to bare their soul so to speak. However, it is another tool social workers have to offer clients with some evidenced behind it.

Gaps In Service

My previous posts seem a little more on the "academic" side of things, so I wanted to write something that is more of an opinion piece. After reading, please share your thoughts and perspectives on the issue as well. I am not married to the opinion...yet, so feel free to try and change my mind on the issue.

Today, as the title states, I wanted to discuss gaps in service. Not a specific gap in service other than an example to illustrate my point, but rather the overall concept. I often hear the term gap in service thrown around when social workers do not find a particular resource for a client; whether the would-be resource is sustainable or not.

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Example

Every now and then I am asked about detox services for youth in my county. There aren't any. One time in 2019 someone called me at working asking about this service. I explained that it was not available in county and provide some resources throughout the state and that insurance should be contacted. The caller stated that this was a gap in service and my employer needed to do something about it. I work for the county's behavioral health authority. I explained that in the time I worked there, this was one of two calls I had gotten about the service and that if she had data to back up the need I would love to talk more about it. She explained that people asked her all the time about detox for youth so I encouraged her to keep track so we could have some data. She hasn't called me back.

Recently there was a Facebook post asking about detox services for youth. There were several replies all saying basically the same thing; there aren't any. The original poster replied, "it seems this is a huge lack of resource in the community". Again with the gap in service.
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When a resource isn't available does it automatically become a gap? From a micro perspective I get it; a social worker has a client who needs a service that simply isn't available. From a macro perspective I struggle with this. How is a gap in service determined when no data on actual need is available? How do public and private agencies fund a service when known needs go unmet due to lack of funds? How is a service sustainable when only a relatively small number of people need it?

Data is really paramount in determining need. That "one client" isn't enough to change or develop a new system. We need more than anecdotal accounts. Data helps identify and substantive the need along with helping to determine how to plan to meet the need. The NASW Code of Ethics talks about the need for social workers to engage in social and political action to ensure that people have equal access to resources, employment, services, and opportunities that help them meet their basic needs. We live in a data driven world and to be able to effectively advocate for change we have to have the data that speaks to that need.

Just calling something a gap in service is not doing anything to fill that gap or increase opportunities for people in need in the future. As social workers we need to recognize the gap, collect data on the need, and then advocate for change.