Answer and Rationale for FREE Practice Question on Self-Harm

Posted by Heidi Tobe

September 28, 2017 at 11:59 AM

 

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Yesterday we posted the following question on self-harm, and today we have the answer and rationale for you!

Question:

A 25-year-old woman has been working with a social worker for two years around issues of anxiety, depression, and non suicidal self-injury. For the past 18 months, the client has abstained from cutting herself, but came into the most recent session wearing long sleeves on a hot summer day. The social worker inquired about this and the client lifted her sleeves to reveal several shallow cuts on her forearms that appeared to be healing. The client stated that she got into a fight with her best friend a few nights ago and in a moment of intense emotion engaged in cutting. What should the social worker do FIRST?

A. Discuss voluntary hospitalization with the client

B. Teach the client coping skills to utilize in moments of intense emotion

C. Explore the thoughts and feelings that preceded the client’s self-injury

D. Refer the client to an MD to take care of the client’s injuries

Answer:

After reading through the question and possible answers for this question, what answer did you come up with? This is a good example of a question that could show up on either of the ASWB practice exams to determine whether you are able to differentiate between the steps you would take with a client engaging in self-harm versus one who is actively suicidal. Let’s go through each of the answer options one at a time and think about them.

  • Answer A: does the client need to be hospitalized? Not at this time. Nothing in the question stem indicates that the client is having suicidal thoughts or is a risk to herself. The question stem specifies that the client engages in non suicidal self injury, meaning, she is engaging in self harm without the intent of killing herself. Further, the cuts are on her forearm and are described as shallow and healing normally, so there is no medical emergency that would indicate a need for hospitalization. Especially for therapists inexperienced with self-injury, seeing a client’s self-inflicted injuries can be alarming and upsetting. From a place of concern and wanting to make sure our clients are safe, we can jump to too extreme of interventions, such as unnecessary hospitalization.
  • Answer B: does the client need concrete coping skills to help her cope during moments of intense emotion? Definitely. This is something you would want to do, but is not necessarily what you would do.
  • Answer C: should we explore the thoughts and feelings the client had before engaging in self-injury? Yes! This answer option allows us to stay in the moment and respond to what the client has shared. Exploring her thoughts and feelings leading up to her self-injury will help us gain a better understanding of the precipitating factors and triggers for this behavior. From there we could discuss various coping skills for the thoughts and emotions that triggered this behavior (B).
  • Answer D: does the client need a medical evaluation? Probably not. The question indicates that the cuts were shallow and healing normally. Nothing else in the question stem indicates a need to seek medical attention.

Which answer did you choose? Does the rationale fit with your understanding of self-injury, or did you learn something new with this scenario? If you have any further questions, we encourage you to check in with a TDC Coach. We are here to support you! And if you came up with the same answer-great job! You are on the right track to getting licensed.

Still haven’t signed up for an exam preparation program? We look forward to helping you PASS your exam with confidence! Our structured, straightforward approach to exam prep will provide you with exactly what you need to pass your social work exam or MFT exam and nothing you don’t. . Once you pay for the program, we are with you until you pass: extensions are always free, materials are structured and comprehensive, and you have access to a coach for 1:1 support. You can learn more about our social work licensing exam prep HERE and more about our MFT licensing exam prep HERE. If you’d like to connect directly with one of our coaches, you can do that HERE

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Topics: Exam Prep, LCSW Exam Prep, Social Work Exam Prep, Suicide Prevention

LCSW/LMSW FREE Practice Question: Self-Harm

Posted by Heidi Tobe

September 27, 2017 at 1:56 PM

September is Suicide Prevention Month, and here at TDC we’ve been using our blog to begin conversations around this often-taboo topic. On both the social work and MFT licensing exams, this topic is sure to show up in several forms. We have focused our free practice questions this month on suicide and today we explore the topic of self-injury. These topics are highlighted on licensing exams because our licensing organizations want to ensure that we are equipped with the knowledge and skills necessary to recognize the signs and symptoms of risk to self, distinguish between life threatening and non life threatening behaviors, and take the appropriate steps based on the level of risk.

TDC’s study systems help prepare you for this topic in a number of ways: we provide concrete information on danger to self and others, risk factors, signs, behaviors, how to evaluate the level of risk, and a spectrum of interventions that will be reflected on the exam. We also provide numerous practice questions with rationales that help you think about this topic from all angles.

Let’s get into a practice question that explores this topic.

SAMPLE QUESTION:

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A 25-year-old woman has been working with a social worker for two years around issues of anxiety, depression, and non suicidal self-injury. For the past 18 months, the client has abstained from cutting herself, but came into the most recent session wearing long sleeves on a hot summer day. The social worker inquired about this and the client lifted her sleeves to reveal several shallow cuts on her forearms that appeared to be healing. The client stated that she got into a fight with her best friend a few nights ago and in a moment of intense emotion engaged in cutting. What should the social worker do FIRST?

A. Discuss voluntary hospitalization with the client

B. Teach the client coping skills to utilize in moments of intense emotion

C. Explore the thoughts and feelings that preceded the client’s self-injury

D. Refer the client to an MD to take care of the client’s injuries

So, what would we do here? Leave your answer in the comments below and be sure to tune in tomorrow for the answer and a discussion of the rationale!

 

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Topics: Exam Prep, LCSW Exam Prep, Social Work Exam Prep, Suicide Prevention

Pathways to Success: Ryan Lindsay

Posted by Heidi Tobe

September 25, 2017 at 11:23 AM

So often when I see a successful clinical social worker who is a leader in their area of expertise I find myself asking “how did they get where they are today?” and wondering what their first few years out of grad school were like. Each month we are interviewing and sharing the story of a clinical social worker’s “pathway to success” that has brought them to where they are today. It will share insights, hard earned wisdom, and tips that we hope will encourage and inspire you no matter where you are on your own pathway to success.

It’s incredibly fitting that our Pathways to Success interview during Suicide Prevention Month is with the Assistant Dean of Social Work at the Brown School of Social Work and co-founder of St. Louis Center for Family Development (STLCFD), Ryan Lindsay, MSW, LCSW. Ryan Lindsay is known for his leadership in evidence-based treatments, in particular Dialectical Behavior Therapy (DBT), a treatment modality used with clients who experience chronic emotion dysregulation, suicidal ideation, and self-injurious behaviors. We are excited to share his unique pathway to success and hope you will it as encouraging and inspiring as we do.

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TDC: What drew you to the field of social work?

Ryan: I understand now that I have a high compassion predisposition: I feel the pain of others, I see it in others, and I desire to make it less in others. Throughout my life, I’ve been sensitive to the difficulties that others experience. While I was originally focused on psychology in undergrad, I always felt it was too person focused. I was minoring in sociology and anthropology and found the contextual piece very interesting to me. People live in environments and contexts matter. I realized it’s not enough to look solely at the individual person. We must look at that person within the context of their environment. I decided to major in social work because it fit with my values and my understanding of the world, and was also a faster track to doing clinical work.

TDC: During graduate school where did you complete your internships?

Ryan: I went to graduate school at the University of Michigan and completed my internship at the University of Michigan Mental Health Center. I spent half of my time at the Department of Psychiatry in their outpatient clinic and the other half at a community mental health center on a DBT team. When I landed the internship, I didn’t know what DBT was, but it became formative for my career path. After I graduated with my MSW, I applied for and completed a post-master’s fellowship at the University of Michigan.

TDC: What came after your fellowship?

Ryan: After I completed the fellowship, I worked at an organization called Ann Arbor Consultation Services, which was a very, very large group practice. During my fellowship program, I helped get them prepped to start their own adolescent DBT program and when I went to work for them, I got the DBT program up and running. Once I became licensed, I started the Ann Arbor DBT Center with two friends whom I met through my internship. This was the first DBT oriented practice in Ann Arbor. While working at these two practices, I also applied for a half-time position with Washtenaw County in their Youth and Family Services and I started the first community mental health adolescent DBT program in Michigan. It was both a first for the state and something I genuinely loved doing.

TDC: It sounds like you did a LOT during those first few years out of grad school. What gave you the confidence to accomplish so much so early on in your career?

Ryan: Arrogance. And stupidity. [Laughter] And strong supports that encouraged me along the way. I was never doing all of those things in isolation. I had supervision and a strong network of other social workers around me. It was definitely a lot, though. At one point I was working six days a week, in three different practices, at four different locations and had a part-time job with the county doing crisis stabilization.

TDC: Four jobs! Did that burn you out?

Ryan: Oh totally. Around three and a half years out, I was getting really burned out. I had recently lost some mentors that were no longer accessible to me. I had my fingers in a lot of things and I needed to focus, but didn’t really know how to do that. On top of that, there was this expectation of high, high, high performance. I had a lot of people on my caseload and started to burn out big time. I came to a place where I had to decide whether I was going to stay in this profession, go back to school, give up, or approach my work differently.

TDC: So you were considering being done with social work?

Ryan: Oh yeah. Part of what drove that was the realization that in order to make a living in social work, you have to hustle, and I didn’t know if I wanted to hustle for the rest of my life. Additionally, I was getting paid very little and was working with chronic suicidality, self-injury, and extreme trauma. So there was a value piece to that. Ultimately, I decided to go to therapy myself, which was extremely helpful. It helped me put priorities back in place and organize myself in new ways. By that time (about four years out) there was also a level of competency that was under my belt. Fortunately, every single day wasn’t a learning curve like it was those first few years out of graduate school.

TDC: So what brought you from Michigan to St. Louis?

Ryan: I moved to St. Louis in 2008 when my husband got into an MBA program. Since he moved to Ann Arbor for me during my fellowship program, it was time I invested in my relationship.

TDC: What was it like leaving behind everything you’d worked so hard on?

Ryan: It was a really difficult thing to pack up everything I’d built and leave a place where my name was established. No one knew who I was in St. Louis, so nothing I’d done back in Ann Arbor meant anything here. I was also moving to a system here in Missouri where evidence-based treatments and practices weren’t really talked about-people didn’t even have a clue what DBT was. The positive side to this was that there was a tremendous opportunity to fill that gap, which is what led to founding our organization, St. Louis Center for Family Development (STLCFD). We wanted to create a place where quality mental health services existed, ideally for the people who need it the most.

TDC: STLCFD is known for delivering quality mental health services, but it’s also known for the training it provides to its clinicians. What inspired that focus on clinician training?

Ryan: Back in Ann Arbor, I had an experience where I was sitting in the basement of Huron Valley Child Guidance Center playing ping pong with one of my clients after they did some really good work. There was this other therapist down there who was not there to reward his client for hard work, but who was instead engaging in shame based therapy. He was belittling the client and shaming him. I found myself thinking, “this is not just or equitable. Why does my client get a therapist who cares about him and knows what they’re doing, while this other client gets a shaming therapist?” After that, doing one-on-one therapy wasn’t as satisfying for me in terms of the overall impact I wanted to make. I realized I had a privilege; I had opportunities to learn from the best in the country in a very organized and structured way. I wanted to figure out a way to recreate that so other people could have opportunities to receive excellent training. So when we started STLCFD, it was both to create an organization that provides stellar quality services, but also to build and train phenomenal clinicians.

I also started working as an adjunct during that time at the Brown School of Social Work. While I like being able to provide training and consultation and help shape behaviors of providers who have been in the field for years,  it’s a whole lot easier to set a trajectory than change a trajectory.

TDC: You’re at the Brown School full-time now. How did that transition occur?

Ryan: It was really the universe coming together. I was at a place organizationally where I had six people doing what I used to do myself. In the year leading up to the transition I decided to take a year off from providing trainings after a previous very hectic year, so I actually didn’t have a lot to do. When the opportunity came to join the faculty here as the chair of the mental health concentration, it just made sense personally and professionally. Choosing between two very good things was probably the hardest decision I’ve ever had to make, but I had to do what was best for me. My own personal growth had stalled, so I needed to find a community that would foster that growth.

TDC: Shortly after becoming the chair of the mental health concentration, you had another pretty big transition. Tell us about that.

Ryan: After about a month at the Brown school, I was presented with the opportunity to be the Assistant Dean of Social Work. It wasn’t on my radar and I had no idea what it entailed at the time, but I decided I would give it a try. I had spent the previous 10 years building STLCFD and logging a lot of hours. The intensity of that work was worth it for the time, but I also learned that work is not everything. In terms of satisfaction in life, there’s really something to be said for not being tired all the time. Academia here is a well oiled machine and this job allows me to have a greater balance in my life.

TDC: What are you hoping to accomplish during your time at the Brown School?

Ryan: I want to build on the strengths of our program. My immediate goal for the mental health concentration was to ensure we could actually build competencies and create a more organized structure and path towards what people want to do. That wasn’t as clear when I landed here and I’ve done a lot of work on that. I’ve revamped a lot of required courses to make sure people are getting what they need by the time they graduate.

In terms of the assistant dean position, I actually don’t have a vision yet. My first year was spent really learning about the position and my second year will be about our reaccreditation process. After that, the next step will be revamping our entire curriculum and concentration options as a school.

TDC: Final question: What advice do you have, especially for social workers just entering the field or who are in the process of getting licensed?

Ryan: Dream big and take it one step at a time. Understand we are all vulnerable and fallible humans and no one expects you to be perfect. Learning is uncomfortable, but learning is what will get you there. Don’t hide your difficulties-that leads to fatigue. It leads to burnout. It leads to people leaving the profession.

Know that you don’t have to know it all. The people who we help care most that we care about them, and for the most part they aren't concerned that you’re still learning. As long as you have their best interest in mind- and they know that and you feel that- that’s the juice that’s necessary for change. The technique stuff comes over time. There’s a shift that occurs at some point, about six or seven years out. Eventually you’ll feel more competent and steady. You’ll get to a space where you stop worrying about being incompetent and start embracing it. If there’s anything I’ve learned, it’s that it doesn't scare me that there’s an infinite amount of knowledge; it excites me that there’s an infinite amount of knowledge.

We are encouraged and inspired by all that Ryan has done in his career so far and all that he will continue to do. If you know a clinical social worker or MFT who should be highlighted in an upcoming "Pathways to Success" story, email Heidi at [email protected]

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Topics: Professional Development, Suicide Prevention

Answer and Rationale for Practice Question on Assessment

Posted by Robin Gluck

September 23, 2017 at 11:59 AM

 

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On Friday we posted the following question on assessments, and today we have the answer and rationale for you!

A 50-year-old male client meets with a therapist on the advice of his husband. The client shares that he has been out of work for almost a year, losing his job after his company completed mass layoffs. He reports feeling discouraged by his job prospects, feels lost without a place to go each day, and feels increasing hopelessness with each passing month he is unemployed. He states, “I feel completely useless and am questioning the point of it all. I feel completely dependent on my husband and I know he’s sick of being the sole breadwinner.” Which of the following actions should the therapist take to assess this client?

A. Explore job history, identify existence of somatic concerns, identify familial coping patterns

B. Explore job history, determine current risk of self-harm, explore support systems

C. Explore mental health history, identify existence of somatic concerns, explore coping mechanisms

D. Explore mental health history, determine current risk of self-harm, explore coping mechanisms

This question provides information that should raise a red flag regarding the client’s safety and influence the therapist’s priorities for assessment. First, the client reports he is feeling hopeless and helpless, and makes the alarming statement, “I feel completely useless and am questioning the point of it all.” With this in mind, let’s look at the answer choices and evaluate which answer choice is the best.

Answer:

The best answer for this question is D.

The question is asking which actions the therapist should take to assess this client. With this type of question, it’s possible several answer options include items we would want to assess, but we need to prioritize what is most important in this case. We’ve already noted that the client’s expressions of hopelessness and helplessness should raise red flags regarding danger to self. The client is expressing thoughts and feelings that are indicators of potential suicidality. Client safety is our priority and we must immediately assess for risk of harm to self. If an answer does not include a focus on the client’s risk of self-harm or suicidality, we can eliminate it. Therefore, answers A and C can be ruled out. This leaves us with answer B) Explore job history, determine current risk of self-harm, explore support systems, and D) Explore mental health history, determine current risk of self-harm, explore coping mechanisms.

A strong consideration when assessing risk is the client’s prior mental health as well as the coping mechanisms available to the client. These two items included in answer D would help the therapist better understand the client’s level of risk based on prior mental health AND help the therapist identify strategies to manage safety. While there is nothing inherently wrong with answer B, the client’s job history is not as important a factor to consider, making it the weaker answer choice between B and D.

Which answer did you choose? Does the rationale fit with your understanding of assessment, or did you learn something new with this scenario? If you have any further questions feel free to check in with a TDC coach. We are here to support you all along the way. And if you came up with the same answer-great job! You are on the right track to getting licensed.

Still haven’t signed up for an exam preparation program? Our structured, straightforward approach to exam prep will provide you with exactly what you need to pass your social work exam or MFT exam and nothing you don’t. You can learn more about our social work licensing exam prep HERE and more about our MFT licensing exam prep HERE. If you’d like to connect directly with one of our coaches, you can do that HERE.

We look forward to helping you PASS your exam with confidence!

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Topics: MFT, Exam Prep, Practice Questions, Suicide Prevention

Free Practice Question: Assessment

Posted by Robin Gluck

September 22, 2017 at 8:39 AM

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For this week’s MFT practice question, we explore the subject of assessment. If you are preparing for your licensing exam, whether the Law and Ethics or Clinical exam, you can expect to see multiple questions on this topic. The importance of conducting a thorough assessment cannot be overstated. Comprehensive assessments are necessary at the onset of treatment to help clinicians understand why their client is seeking treatment, what their client hopes to achieve, if any crisis issues are present and require attention, and ultimately allows them to develop an effective treatment plan. Knowing when to assess and what the priorities of assessment are will both be tested on your exam.

A crucial goal of assessment is to identify and properly manage potential crises. Therapists are legally and ethically required to both assess and manage their clients’ safety. Therapists put themselves, their clients, and sometimes even the public in harms way when they fail to identify and explore potential safety issues. It is important to note for both your exam and your clinical practice that assessments are not a one-time deal. Therapists are expected to conduct assessments when first interacting with a client and over the course of treatment. Clients are dynamic. Priorities and needs shift over time, and without continuously assessing clients, it will be hard (if not impossible), to best meet their needs. Therapist Development Center will help you understand how to approach these questions on the exam AND will allow you to carry this knowledge into your clinical practice.

Let’s move on to this week’s question:

A 50-year-old male client meets with a therapist on the advice of his husband. The client shares that he has been out of work for almost a year, losing his job after his company completed mass layoffs. He reports feeling discouraged by his job prospects, feels lost without a place to go each day, and feels increasing hopelessness with each passing month he is unemployed. He states, “I feel completely useless and am questioning the point of it all. I feel completely dependent on my husband and I know he’s sick of being the sole breadwinner.” Which of the following actions should the therapist take to assess this client?

A. Explore job history, identify existence of somatic concerns, identify familial coping patterns

B. Explore job history, determine current risk of self-harm, explore support systems

C. Explore mental health history, identify existence of somatic concerns, explore coping mechanisms

D. Explore mental health history, determine current risk of self-harm, explore coping mechanisms

The answer and rationale will be posted at noon PST tomorrow! We encourage you to post an answer in the comments section below or on our Facebook page (you can also post your reasoning behind your answer choice!). Then check back in tomorrow for the correct answer and rationale explaining why the correct answer is correct and why the other answers are not correct.

Haven't signed up for an exam prep program yet? Our structured, straightforward approach to exam prep will provide you with exactly what you need to pass your social work exam or MFT exam and nothing you don’t. You can learn more about our social work licensing exam prep HERE and more about our MFT licensing exam prep HERE. If you’d like to connect directly with one of our coaches, you can do that HERE.

We look forward to helping you PASS your exam with confidence!

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Topics: MFT, Exam Prep, Practice Questions, Suicide Prevention

The Wounded Healer

Posted by Heidi Tobe

September 18, 2017 at 2:55 PM

 

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September is Suicide Prevention Month. Here at TDC we are using our blog as a platform to start conversations around this topic. While suicide is still an oft taboo subject, it is encouraging to see a greater willingness to talk about suicide, self-harm, and mental health in recent years. While there is still a long way to go, we have seen improvements in reducing stigma, evidenced in the prevalence of people speaking out about themselves and loved ones, open discussion around these topics, and the increased presence of mental health issues in mainstream media. A piece of the conversation that I feel is missing for us as therapists, though, is an acknowledgement of the reality that many of us struggle with our own mental health issues, even suicidal ideation.

With 1 in 5 adults diagnosed with some form of mental illness in a given year, 7% of adults suffering from depression, and 34,000 individuals dying by suicide each year (nami.org), it is inevitable that these statistics include people in the helping professions, including therapists. Perhaps even at a higher rate than the general population. Psychoanalyst and psychiatrist Carl Jung introduced the term "Wounded Healer.” A Wounded Healer is someone who is compelled to help others after going through their own experiences of suffering. When an individual survives the wounds of their past, their lived shared experience can help provide deeper understanding and empathy for their clients and can motivate them to help others overcome similar struggles. We hear stories of therapists who have gone into the field because of their experiences with loved ones who have suffered mental illness. There are also countless, often untold stories of therapists who go into the field because of the mental illness they themselves have struggled with or continue to struggle with.

Despite our work to destigmatize mental illness, we as therapists can still fall into traps of believing we must hide our own suffering. I have dear friends in the profession who suffer in silence with their mental illness, hiding it from those around them in ways they wouldn’t if their issues were purely physical. They fear others may judge them, or worse, deem them unfit to continue serving their clients. As I was discussing this topic with a friend and fellow social worker, she shared that she has heard a number of people bring up the idea that if a therapist doesn’t "have their stuff together" how can they help someone else? Some even going so far as to say they wouldn’t see a therapist who sees a therapist. I say to that, I wouldn’t want to see a therapist who has never seen a therapist! Would we not see a doctor because they have gone to a doctor themselves? Certainly not. But these are very real concerns we as therapists can have. And these concerns can unfortunately keep people very isolated in their struggles.

There isn’t an easy fix for this, but we wanted to take the time to write about this topic for several reasons. First: You are not alone in your struggles, fellow therapists. While it may feel like you're on an island, know that there are many excellent therapists out there with past and present mental health issues who are serving their clients well.

Second: Recognize the strength and value your own healed wounds can bring to your work with clients. Your ability to empathize and genuinely understand where your clients are coming from, the compassion you possess, and the awareness you hold based on your experience can be powerful healing tools for your clients-even without any direct self-disclosure. Of course, if you do choose to engage in self-disclosure with your clients about your own mental illness, it is of the utmost importance to carefully consider what you are sharing and why. Consultation with colleagues or supervisors is an essential tool for ensuring that what we choose to disclose is in the best interest of our clients.

Third: who you choose to share your own struggles with is a deeply personal choice that only you can make-but we encourage you to share your struggles with someone. Regardless of when and with whom you choose to share with, be sure to take time to seek out spaces where you can receive support. Engage in self-care on a regular basis, whatever that looks like for you. Seek out your own counseling as needed. Nearly 60% of adults with a mental illness did not receive mental health services in the previous year (nami.org). Sixty Percent! That number is astounding, but not altogether unsurprising. The hour I spend in counseling every other week is one of my most treasured times, and I know that I am a better social worker because of it.

As workers in the mental health field, we have a responsibility to take care of ourselves first before caring for others, and we here at TDC believe our own mental health care is a big piece of that. Even in our coaching, we talk to many individuals preparing for their social work or MFT licensing exams who suffer debilitating anxiety (not just regarding the test, but in other areas of their lives as well), who have never sought out counseling services. We know it is a hard step to take, but it is one that is worthwhile. If you’ve been suffering on your own, consider reaching out for help. Whether that is talking to a friend, family member, classmate, trusted colleague or supervisor, or making a call to schedule a therapy appointment, we encourage you to take the necessary steps to keep yourself from suffering in silence.

And lastly we share because we want to hear your wisdom and experience. What has your experience been like caring for your own mental health while also caring for others? What has helped you open up and seek help when needed? Or what has kept you from doing so? What can we as a community of therapists do to support one another? We encourage you to share in the comments below or join the discussion on our Facebook page.

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Topics: Self Care, Suicide Prevention

Project Semicolon

Posted by Heidi Tobe

September 15, 2017 at 6:02 PM

“A semicolon is used when an author could've chosen to end their sentence, but chose not to. The author is you and the sentence is your life."-Project Semicolon

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As many of you know, September is Suicide Prevention Month. Here at TDC we are using this month to start conversations around this topic and highlight organizations who are working tirelessly to prevent suicide. One such organization is Project Semicolon, a nonprofit whose mission is to help reduce the incidents of suicide around the world through connecting communities and providing greater access to information and resources. Project Semicolon believes suicide is preventable and recognizes that each and every individual on this earth has a role and responsibility in preventing suicide. Project Semicolon works to equip people with the tools necessary to engage in suicide prevention, including educating communities and raising public awareness around the topic of suicide.

Amy Bleuel created Project Semicolon in 2013 in honor of her father who died by suicide. Amy was courageously open about her own struggles with mental illness and suicide, and in doing so inspired others to share that same vulnerability. Since the inception of her organization, the symbol of a semicolon has come to represent hope and inspiration for those who are struggling with thoughts of suicide, self-injury, depression, addiction, and other mental health diagnoses. It is a reminder that this is not the end, but can be a new beginning. Tens of thousands of individuals have since gotten tattoos or temporarily draw this symbol on themselves as a personal reminder, to support loved ones, or to mark themselves as an ally for those who are struggling. A community of semicolons now lives and breathes as an encouragement to keep living and to not end stories prematurely. Founder Amy Bleuel lost her battle with suicide earlier this year, but her passion continues on in the movement she started through Project Semicolon.

To learn more about Project Semicolon, visit https://projectsemicolon.com. Their website has a lot to offer, including interactive sections and resources:

  • You can sign up to share your story here.
  • To read about others who have chosen to continue their stories, click here. 
  • To discover tangible ways to take action, click here.
  • To learn about mental health, click here.
  • If you are concerned about someone, click here.
  • If you are having suicidal thoughts, click here.
  • If you are a suicide attempt survivor, click here
  • If you are interested in purchasing Project Semicolon products, click here.
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Topics: Suicide Prevention

Answer and Rationale for LCSW/LMSW Practice Question on Suicidal Clients

Posted by Bethany Vanderbilt

September 14, 2017 at 11:59 AM

Yesterday we posted the following question about suicidal clients, and today we have the answer and rationale for you!

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A 66-year-old man is referred to a social worker by his adult daughter. During the initial assessment, the man reports poor sleep, decreased appetite, and increased feelings of agitation and restlessness after being laid off from his job. He goes on to tell the social worker that “things just seem to keep going downhill since my wife died a year ago.” What action should the social worker take FIRST:

A. Refer the client to an MD to rule out any medical issues

B. Teach the client relaxation skills to help him sleep

C. Ask the client if he’s having any thoughts of suicide or self harm

D. Normalize the client’s feelings of grief and loss

After looking at the question and answer set yesterday, what did you think? This is a good example of an item that could show up on any of the ASWB exams, and one in which there are multiple answer options that look “right.” So, let’s go through the answer choices one at a time and think about them.

    • Answer A: does the client need a medical evaluation? Probably. He’s having symptoms (sleep disturbance, change in appetite, restlessness) that could indicate a medical problem, so we would want to rule that out. In many cases, this answer would take priority, but let’s see what else we have going on here.
    • Answer B: does the client need concrete coping skills to help address his stress and sleep issues? Probably. This would be something you would, in most cases, do with a client in this situation, but it wouldn’t be prioritized over an answer like A.
    • Answer C: should we ask this client if he’s having thoughts of suicide or self harm? ABSOLUTELY. He has a number of factors that put him at an extremely high risk: he’s an older male, he’s had multiple losses (spouse and job), he’s experiencing symptoms consistent with depression, and maybe most significantly, he’s expressing HOPELESSNESS (feeling like things are going downhill). This is the best answer, and would take priority over the medical referral because the suicidal risk is imminent (we want him to live to make it to the doctor’s office).
    • Answer D: should we respond to his feelings? Of course we would want to demonstrate empathy and compassion for this client. C is still a better answer to the question, though, as the social worker should feel comfortable directly addressing the potential for risk in this situation.

Do you want to be TDC’s next success story? Our exam prep materials provide you with everything you need to pass your exam and nothing you don’t. Once you pay for the program, we are with you until you pass: extensions are always free, materials are structured and comprehensive, and you have access to a coach for 1:1 support. We’ve taken the guess work out of studying so you can focus on the real task: PROFESSIONAL DEVELOPMENT.

You can find more information about our social work exam prep programs HERE.

Be sure to tune in next month for another practice question and discussion!

 

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Topics: Exam Prep, LCSW Exam Prep, Social Work Exam Prep, Suicide Prevention

LCSW/LMSW FREE Practice Question: Suicidal Clients

Posted by Bethany Vanderbilt

September 13, 2017 at 9:37 AM

As you all know, September is Suicide Prevention Month, and here at TDC, we are using the month as a platform to begin conversations around this often-taboo topic. If you’re studying for your licensure exam, whether a social work exam OR a MFT exam, you’ve probably found that this topic is front and center. There’s a good reason for that: at some point in our professional lives we will almost certainly work with at least one client who wants to end his or her life. Our state boards and licensing organizations want to ensure that as competent professionals we can recognize the signs and symptoms of potential suicide, assess for it accurately, and take the necessary steps to help our client’s stay safe.

Our study systems help prepare you for this topic in a number of ways: we provide concrete information on danger to self and others, risk factors, signs, behaviors, how to evaluate the level of risk, and a spectrum of interventions that will be reflected on the exam. We also provide numerous practice questions with rationales that help you think about this topic from all angles.

Let’s get into a practice question that looks at this topic:

SAMPLE QUESTION: 

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A 66-year-old man is referred to a social worker by his adult daughter. During the initial assessment, the man reports poor sleep, decreased appetite, and increased feelings of agitation and restlessness after being laid off from his job. He goes on to tell the social worker that “things just seem to keep going downhill since my wife died a year ago.” What action should the social worker take FIRST:

A. Refer the client to an MD to rule out any medical issues

B. Teach the client relaxation skills to help him sleep

C. Ask the client if he’s having any thoughts of suicide or self harm

D. Normalize the client’s feelings of grief and loss

So, what would we do here? Try to help him with concrete issues? Address the potential for medical problems? Leave your answer in the comments below and be sure to tune in tomorrow for the answer and a discussion of the rationale.

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Topics: MFT, Exam Prep, LCSW Exam Prep, Suicide Prevention

The S Word

Posted by Heidi Tobe

September 12, 2017 at 11:59 AM

Recently the TDC team had the honor of screening a new film, The S Word Documentary: Opening the Conversation About Suicide. And for our team it did just as the title indicated-it opened up a space for us to have conversations about suicide and the ways it has impacted our lives personally and professionally.

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I want to share a bit of information about this groundbreaking movie with you; it’s being released this month and is a must-watch. The S Word director Lisa Klein is a survivor of her brother's and father's suicides. She knows on a deeply personal level the silent suffering that accompanies suicide and just how necessary conversations about suicide are. She uses The S Word to reduce silence and give a voice to the stories millions are stifling on a daily basis. The film invites you to join suicide attempt survivor Dese’Rae Stage’s journey as she seeks out fellow attempt survivors, and documents and shares each of their rich and complex stories. Dese’Rae skillfully captures the courage, pain, humor, and hope of her fellow survivors as she hears and shares their stories.

Throughout The S Word, we are reminded that suicide is not a them issue; it's an all of us issue. Despite the silence that so often surrounds this topic, every one of us is touched by suicide in some way. For some of us, it is in our work with clients. For others, it is within our family or close friend circles. And for some of us, it is an issue we battle ourselves (yes-even mental health professionals can struggle with suicidal ideation!). Suicide doesn’t discriminate: it affects people of all backgrounds, all socioeconomic statuses, all races and ethnicities, all faiths, all ages, and all sexual orientations and gender presentations.

The S Word is an open invitation to engage in honest and brave communication about suicide. It is a reminder that none of us are alone. The S Word has a myriad of goals: raising awareness about suicide prevention and resources, opening up conversations about suicide to include all people, creating spaces to speak about suicide openly and without shame or judgment, thinking about suicide in a different way, and ultimately changing the world. We here at TDC think it’s on its way to doing just that.

A TDC staff members shared, “the overarching theme for me is making space: how do we make space for the dialogue to occur safely? How do we help or support the family members left behind create and keep space for the person they lost (if that’s what they want)? How do we make space for different perspectives and ideas about suicide? How do we support couples and families in making space for a person’s pain and feelings? How do we support them in being vulnerable enough to let go of their own narrative to support the person who is suffering? How can we help support people in creating the groups and spaces that would be most healing for them? And how do we make space for the very rational fear that goes along with suicide without being consumed by it?

While the film and this topic can be difficult to engage in, we believe it is an incredibly important one to watch. This month there are screenings for The S Word in Michigan, Toronto, Washington, Iowa, Utah, Colorado, and Texas with additional screenings scheduled for October in Georgia, Kansas, California, and Massachusetts. To learn more click here.

Don’t see your state on this list? You can host a screening in your community! Learn more about hosting a screening of The S Word here.

We encourage you to check out their extensive list of resources available here. If you or someone you know is struggling with suicide, don’t stay silent. Help is out there.

Join us on our Facebook page to engage in conversation. Let's talk about the fears you have with this work, experiences, thoughts on how to increase awareness, and what you can do to further the conversation.

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Topics: Suicide Prevention