Social Work Today E-Zine

By Sam Maron, LSW, MSW

As an Orthodox Jewish social worker on the staff of a small Jewish family and children’s agency, I had been hired to provide services to Orthodox Jewish families in the area. But I had also developed a yen to serve other ethnicities as well—not only my own.

So at a staffing meeting when this case—that will always be tucked in a special pocket of my heart—was presented as a newly received case crying out for my services—I nearly handed it back to my colleagues.

“But Sam,” said one of my female colleagues, astonished that I would turn back such a client, “he needs you! This is an Orthodox Jewish boy who is suicidal. This boy needs your help.” Little did she know how her zealousness made the difference. Had she not been insistent that I accept this client, I probably would have refused. I was just at a point in my career at which I resented being stereotyped as the agency’s “Orthodox social worker.”

A 16-year-old studying at a yeshiva (a Jewish educational institution of higher learning) in the agency’s service area, “this boy,” as my colleague had put it, was indeed suicidal as I had found out in my initial session with him.

His Rebbe (rabbi, teacher)—a tall, slender man dressed in black whose height belied his gentleness and warmth—brought the boy for his first session and waited patiently in our small waiting room as I worked with him. The boy—who I’ll call Josh—opened up as we played a game of Connect Four.

All he wanted, he told me, was to be close to his father, who had died an untimely death, the result of a major heart attack. He just wanted his father to take him to a baseball game. He had been sent to the yeshiva since it specialized in working with boys from exceptional backgrounds and getting them back to mainstream yeshivas.

But his father had pushed him away. His father—a brilliant scholar and prolific author—felt so pressured to produce more and more books that he became distant from his wife and children.

Like her son, his mom was also depressed and suicidal. She had overdosed and was running out in front of traffic trying to kill herself. Her three-year-old daughter—emulating mom’s behavior—was following suit. Small wonder as I worked with Josh, 50 miles away they were also in therapy.

As Josh opened up, he shared his plans to kill himself

Back in his dorm, he conceded, he had a rope and knife and was contemplating either suicide by hanging or slashing his wrists. I thanked G-d that this case came my way. My colleague was right. It would have been difficult for another professional to help him.

That night—the night of our first session—where he made this disclosure—his Rebbe and I accompanied him back to his dorm room. He showed us the rope and knife and we were able to persuade him to give it to us for disposal. More importantly, he agreed to contract for safety and to continue to see me regularly.

Josh and I got to know each other well. He shared with me, as we played Connect Four, how his father once pushed him down the steps of their home after he tried in vain to ask his dad to take him to a Sunday afternoon baseball game. For Josh that would become the proximal event of his life—the experience of being slapped away, cast away by the man who he looked up to and loved more than anyone else in the world.

But as our relationship developed, I hoped I succeeded in showing him that it was okay to forgive himself for his mixed up feelings—the simultaneous anger toward his dad for his rejection and love for his role as father; the guilt he carried for hating him while still wishing they could have had a relationship; and that gap, that chasm, between his dad’s public image of a successful, well-adjusted scholar and Josh’s image of him as a driven maniac. Just as importantly, we agreed, it was okay for Josh to forgive his father, and, if one day—he could do so—to focus on what good times they had as well.

At our last session, he thanked me for my efforts and shared with me that he enjoyed our time together. His Rebbe—to my surprise—also thanked me and said he had really come to understand the important role played by social service professionals. To my amazement, the Rebbe said he had witnessed a remarkable emotional maturation in Josh as our sessions ensued.

I left the area and agency to take an administrative position elsewhere. Six years later, I had come back to a neighboring county to serve as its first part-time Jewish Family & Children’s Service social worker.

As I left to drive home on a Friday afternoon for our Sabbath, I stopped in a local kosher delicatessen to pick up some deli meats for my family. In line behind me, a tall, handsome young man called out, ‘Mr. Maron, is that you? It’s me, Josh.”

Startled and in utter disbelief, I stepped out of line to greet Josh, looking at him in amazement as we hugged each other.

“I’m a chussan, Mr. Maron,” he told me (meaning he had become betrothed and would be married soon). I owe you so much.”

“No,” I told him, as tears flowed down my face. “I owe you so much.”

In that wonderful moment, which I will forever cherish, I realized you could work in our field for an eternity and never get such a chance to help someone and see the results of your efforts.

The case I didn’t even want had blossomed into manhood.

— Sam Maron, LSW, MSW, is a senior mental health emergency services coordinator in the acute services unit in the department of behavioral health and mental retardation services in Philadelphia, PA.

By Grace Sotirakis, LMSW

He had walked into the ER at 4 a.m., crying uncontrollably. A deaf mute, unable to verbalize, the staff presumed that he was in pain. They soon discovered that he had the ability to read lips to some degree. He shook his head vigorously when asked if he was in pain. Another shake and more sobs when asked if he had ID. Yes, he could write his name—"JOHN" he wrote in large block letters. No, he could not write his address or phone number.

John was a big guy—about 6 feet tall, 250 pounds. He appeared slightly disheveled, in need of a shower and shave. Seated patiently on a gurney, his thick legs dangling over the side, he watched the ER nurse discuss his situation with me.

I walked over to him and introduced myself, taking care to form the words, "social worker." John promptly stood, towering over my 5', 120 pound frame. He pulled a key ring from his pants pocket and shook two keys frantically in my face while emitting a series of grunts and screeches.

"Are those your house keys?" I asked lamely. John, shook his head, continuing to rattle the keys at me. "Can you write down your address?" I asked, handing him my notebook. In his frustration, John flung the keys on the floor and sat down heavily on the gurney.

He began to sob once more, pushing my notebook back at me and shaking his head. "Okay, it's okay, John," I was feeling quite helpless by now. I turned to the nurse who had been standing by quietly. "Did anyone check his pockets?" I asked. "No, I don't think so, we waited for you," she replied, looking sheepish.

I asked John to empty his pockets, in hopes of finding a "clue".

Empty. Except for the key ring, nothing.

Until, under his faded blue sweatshirt, in the breast pocket of his flannel shirt was what appeared to be a business card!

It turned out to be a "Meal Ticket" bearing the name of a City Shelter! It was stamped with the current date. "Is this where you are staying?" I asked excitedly. John nodded vigorously, pointing to the card in my hand.

The shelter staff informed me that John had disappeared from the shelter three days ago. He had been with them for approximately four months. They had no prior history on John—he had appeared on their doorstep unable to tell them anything about himself. They too wondered about the key ring.

We learned that John as on medication for a seizure disorder and had not had his medication since his disappearance. John was also mentally challenged. We surmised that John had wondered off from the shelter and gotten himself lost. Somehow, he had known to come to a hospital for help. John grinned happily when informed that the shelter van would be picking him up.

We were left to ponder, where did John come from? Where did he belong? What door do those keys open in another time, another life? No one knows John's story, he is unable to tell it.

— Grace Sotirakis, LMSW, graduated from New York University with a masters in social work. She is a medical social worker who provides crisis intervention in a trauma level I emergency department in Brooklyn, NY, and is a social work consultant for a dialysis center. Her expertise in mental health includes providing therapy to children who have been victimized by abuse or neglect.

By Aileen McCabe-Maucher, RN, MSW, LCSW

Mrs. B lived on the 12th floor of a high-rise housing complex for low-income senior citizens. I hastily read the consult sheet on my elevator ride up to her apartment. “Social worker needs to evaluate for home safety and ability to live alone” the doctor had scribbled in authoritative handwriting. I took a deep breath, wishing that I had more time to investigate the case beforehand.

I stepped off the elevator and navigated the narrow dimly lit hallways, wondering how someone in a walker or wheelchair could possibly pass through this corridor. Miraculously, I located Mrs. B’s apartment despite the fact two of the numbers were missing from her door. Ten years of fieldwork have transformed me into a bloodhound. My ability to locate houses that are off the map astounds my friends and family who know that I get lost in the local mall. Most times I swear I am led to a patient’s home by sheer force of divine intervention.

I knocked loudly on the rickety door which was cracked and sounded as if would splint underneath the force of my fist. I waited patiently before instituting another series of thunderous knocks. Most of my clients are elderly and it is not unusual to wait 10 minutes for someone to answer the door.

“Come in, child.” A soft voice beckoned me from inside as I turned the unlocked doorknob and gradually opened the door.

I was greeted by a smiling 88-year-old African American woman who sat perched on the edge of a ripped couch. Her eyes are warm and inviting “Praise the Lord! I have been waiting for you child. I am so hungry! You can just set the fixin’s on the table here. I can open the milk and take that lid off for myself. I know you need to get going to deliver some more lunches”

Once again, I was mistaken for the meals on wheels volunteer. “Hi, Mrs. B, My name is Aileen and I am the visiting social worker. Your doctor sent me here to see how you are doing since you were released from the hospital.”

“I see. Well, have a seat, honey. You wanna take my blood pressure?” Ms. B boomed as generously offered me her left arm anticipating that I would slap a blood pressure cuff on it.

I gently touched her thin, withered arm and leaned in closer to her ear. “Mrs. B, the nurse will check your blood pressure when she visits later this afternoon. I am the social worker and I am here to chat with you and see how you are managing living alone, seeing as you just got out the hospital. I want to know if there is anything you need help with, maybe in the way of meals, keeping house, taking care of yourself. You mentioned you were hungry. Are you signed up for meals on wheels and waiting on the your lunch delivery?”

“Yessum. I have been waiting since Friday! I am so hungry I could darn near eat the cushion on this couch. But I am blessed to be here with a roof over my head,” Mrs. B said wearily as she patted her stomach.

It’s two o’clock on Monday afternoon, and, like many elderly recipients of the city’s meals on wheels program, Mrs. B had not eaten since midday Friday. Because the meal delivery program does not operate on Saturdays and Sundays, the city’s most vulnerable residents are left to fend for themselves on the weekend. For individuals without friends or family this means going without food for two days.

“Would you like an apple cereal bar?” I offered her a misshapen but intact snack I fished out of the bottom of my purse. Typically I kept my purse well stocked for occasions such as this. However, it was Monday and the third time I dug in my purse for food. I was dismayed to learn this was last item. I made a mental note to stop by the convenience store to pick up a box of soft granola bars prior to my next home visit.

Mrs. B graciously outstretched her and accepted the cereal bar, which had lint and ink spots of the wrapper, remnants from my disheveled pocketbook “Oh thank you honey. I am truly blessed to receive this! I will save it for next weekend. I just know that meal lady is going to be coming soon and I need to keep food handy for when it gets really bad.”

My heart sank and my body buzzed with outrage. Why do people have to suffer like this? As I glanced around I noticed a blood glucose monitor haphazardly placed on the floor by Mrs. B’s feet. For a woman with diabetes, not eating a proper diet could mean the difference between having two, one or no legs. “Mrs. B, with your permission I can arrange for you to have plenty of food for this weekend, so if you’re hungry please feel free to eat the bar now.” I tried to make my tone sound even.

Our conversation was interrupted by a loud series of knocks before the door flew open. I looked up to find a scrawny elderly lady in a stained housecoat standing in the doorway. Her eyes were wild, although somewhat hidden beneath oversized glasses that were held together by duct tape. “Hey Mrs. B, did you get lunch yet?” The lady in the housecoat bellowed, holding on to the wall for support.

“No, Mary, I did not. The meal’s lady is late again, but don’t worry she’ll be here. I have company dear, come back later, hear. ” Mrs. B gestured in my direction.

“Are you a nurse dear?” Mary ignored Mrs. B. and lumbered toward me with an unsteady gait. “My arthritis hurts so bad today. I ran out of those pills and I need some new ones.”

Before I had a chance to respond, a well-dressed woman with a corporate ID badge sauntered in the room. Her arms were laden with hot food trays “Lunch is here!” she beamed, clearly enjoying her volunteer experience.

“Thank the Lord!” Ms. B clapped her hands together and looked upward. Mary exited the room as quickly as possible so she could be sure and be at her place when her meal was delivered.

I offered to help Mrs. B unwrap her lunch, but she was famished and began digging into her rubbery Salisbury steak without entirely removing the foil wrap. She gulped down her meal is a feral, unabashed manner.

“Mrs. B, would you mind if I turned a light on while you are eating.” Although it was a bright and sunny days outside, Mrs. B’s tiny efficiency apartment had one tiny window that cast bleak shadow on the musty room.

“That’s not a good idea child,” Mrs. B said in between bites.

I was concerned that Mrs. B’s electricity had been shut off and needed to investigate this matter further.

“Mrs. B what will happen if I try to turn on the light?” I gestured toward the switch.

“Go ahead, see for yourself.” Mrs. B shrugged, placing her fork in the starchy mashed potatoes.

As I flipped the switch I was happy to see the room fill with light. However, I was appalled to see the numerous roaches that literally came out of the woodwork when I turned the lamp on. I looked down at my foot. Moments earlier I had become aware of a sensation below my ankle that I had mistakenly attributed to sitting in one place for so long. I watched in horror as two huge roaches scampered across the top of my foot looking for refuge. I vowed to get Mrs. B into a better living situation. I also vowed never to wear sandals on a home visit again. This was far from the first time I had seen cockroaches but this was one of the worst infestations I had seen in a while. I tried not to look repulsed but despite her near blindness Mrs. B was one perceptive lady. “They are God’s creatures just like us child. Great and small. They have to eat, too.” Mrs. B placed a piece of her meat on the floor ostensibly for the cockroaches.

Mrs. B and I spent the next hour talking. Mrs. B told me about the 60 years she spend working as a seamstress and housekeeper. As tears filled my eyes, she told me of her three children and beloved husband that died in a house fire 50 years ago. With conviction, she described how she survived the heartache by opening up her new home to foster children and extended family. Mrs. B is the sole survivor of a family rocked by tragedy. One by one her few remaining relatives died. Mrs. B was literally alone in the world; housebound with no identifiable next of kin “I know it will be my turn soon. I am so blessed to get to be on this Earth for so long, I can’t complain. It has been a gift. But I can’t wait to go home again to the Lord, child. To my babies.” Her eyes glistened with anticipation.

As I listed to Mrs. B’s life story in awe I gently steered the topic of the conservation to the present and Mrs. B’s plans for the future. Ultimately, Mrs. B chose to go spend her remaining years in a nursing home. I heard from a friend of mine that works at the nursing home in which she resides, Mrs. B always saves a portion of her meal and gives it the therapy dogs that visits the nursing home on a weekly basis.

— Aileen McCabe-Maucher, RN, MSW, LCSW, works for Children and Families First in Wilmington, DE, and is also an adjunct faculty member at Delaware Technical and Community College. In addition, she maintains a small private practice.

DISCOVERY

To dance in the discovery
To marvel in the mystery
To connect in the conversation
To love in the listening
To sing in the service
To swim in the spirit
To create in the collaboration
Integrating the art with the science
Social Work is living life in compassionate
Action with the aim of social justice.
I Care, Therefore, I Am.

GRATITUDE

Giving Thanks
Thanks for the Giving
Upon us it is.

The Spirit of reverance for life, may
We honor and open our hearts.

The ecology of the mind, may we
Purify and protect.

Mindfulness in every breath
Peace in every step

Abundance within, may we cultivate and offer
It without

Compassion
And
Community
The deeper tenets of our Human Family

Sojourners we are on borrowed time and
Borrowed territory of Mother Earth
May the light of
Respect
Honor and
Humility
guide our way in this world
and be the tools we use to take our stand
in this land
serving our brothers and sisters, mothers and fathers,
sons and daughters...
wielding our warrior strength
through
wise discernment

knowing
that the Ultimate
of all
Powers
in Life
Is
Love.

TEAMING

I often sit
in
Silence
and see
surrounding the
self of me
many people who are clearly
gifts to the Spirit.
In the honoring of such gifts,
I do weep.

A Dream
A Vision
Of what can Be

What do we need in order to See?
Strength of Heart
Sensitivity in Spirit
Clarity of Compassion

Respect
Honor
And Humility

A holding together among all members on the Team
of the same Dream
of the same Vision
driven by a Unified Mission-
A Mission undergirded by an intimacy with the work
and a commitment to move toward
Integrity.

TEMPERED STEEL

Transformation
Born
Out of
The
Tempest
Within.

A soaring
Spirituality
Rising to new heights
Born out of
The
Daily
Discipline

A training of the mind
Meaning in the pain and suffering, both within and without,
My current search to find.

Today, I am able to See
I have many Teachers
Through written word, print
And,
In physical form, present

My Process:
One of tempering steel
My Aim: To become stronger, more compassionate and
Clear.

— Jean E. Balestrery LICSW, MAC, ACSW has 16 years experience working in the mental health and substance abuse fields of practice. Her time living and working in the bush of Alaska inspired this writing. She is currently enrolled in the dual discipline
doctoral program in social work and anthropology at the University of Michigan.

By Bruce Miller, BSW

I have experienced quite a bit in my career, so far, for only having just graduated with my BSW. I have worked with kids, substance abusers, and, now, veterans. My most memorable experience was when I was stationed in Mosul, Iraq, for one year with an Army Reserve unit out of Colorado Springs. I was on a Combat Stress Control Team which consisted of me and a forensic psychologist for the whole base.

In the military, my job was a mental health specialist and due to the training the military gives, I was able to carry my own caseload of soldiers. On my caseload, I had a soldier who was diagnosed with obsessive-compulsive disorder. It was unclear why the soldier was still enlisted in the Army since the Army doesn't do much to deal with Axis I diagnoses except discharge them to the civilian world. This soldier was not able to mentally function in his job, explosive ordnance disposal (they explode or disassemble enemy bombs), so his commanders had him doing office-type work. I had been working with this soldier for a couple of months on various subjects. Since I am a big believer in socialization, I had convinced the soldier to spend time with other soldiers from his unit during his down time. He started doing very well and not isolating himself. He was even going to the chow hall and eating with the other soldiers in his unit.

In December of 2004, I was in my office-trailer eating some lunch when I felt this deep rumble that shook my organs. I looked out my door to see that no more then 200 yards away the chow hall tent had blown up. Apparently, an Iraqi soldier had been a suicide bomber and blew himself up in the middle of the chow hall while it was packed with American and Iraqi soldiers. The soldier I was treating was in there. He didn't die, but was seriously wounded and sent to Germany to receive better medical care.

I had convinced the soldier that it would be okay if he socialized with his fellow soldiers and not to isolate himself in his room. If it hadn't been for my intervention the soldier wouldn't have been near to the chow hall. It took several weeks for me to stop blaming myself for the soldier being there when it blew up. What really gave me a sense of relief was when the soldier's friend from his unit came by my office and said, "[name taken out] wanted me to tell you that he is in Germany, and doing well. He wanted me to thank you for everything that you did for him." That was the last time I heard from or about him. I finished out my year and came home having learned an extremely important lesson.

Even though we (social workers) try to help and have the best intentions, things may not turn out the way we wanted them to. As long as our intention was not to harm or be negative in any way then it is not our fault. Life is too unexpected to know what is going to happen next and if you accept every bad thing that happens to your clients as your fault then you will burn out quickly. It reminds me of a phrase I have used with a couple of my clients, "You can't control everything that goes on in your life, but you can control your reaction to it."

— Bruce Miller, BSW, lives in Eagle Mountain, Utah. He has been in the military for almost ten years and is a mental health specialist. He also works for Veterans Affairs as a case manager for lower functioning veterans.

By Regina D. Cassidy, LMSW, MS

“Hello, and how are you today?” I’m happy to see Edith, who greets me with a big smile. Well-groomed, her wispy hair carefully covered by a blonde wig, she laughs and says, “Fine and dandy, never been better!” She has on a pretty silk blouse and beige slacks, with matching clip earrings and a beaded necklace.

Every day, our conversation is much the same as we walk to the adult day healthcare center. We chat about the weather, her family, and often share a joke. Edith has a diagnosis of advanced Alzheimer’s, and so, she has little memory of anything that occurred longer than a few moments before. However, she is physically fit, and still able to care for herself. She knows how to perform the regular tasks of daily living, as long as she receives gentle reminders from our nursing staff.

As Edith joins her tablemates for breakfast, I head to my office. My busy day has begun and I find myself slipping into my regular schedule, half aware of what is going on around me. The other half is planning what I have yet to do here, as well as at my other job and at home with my family. Often, I write lists so that I can keep track of everything, or leave messages on my answering machine as a more persistent reminder.

I look out from my glass-enclosed office at Edith as I review my daily calendar. She is chatting with her best friend at her center, Rita. I’m not certain what they talk about, but they chuckle now and then, often holding hands. As I write routine but never-ending progress notes, Edith sips her coffee, eats her daily breakfast of two small corn muffins, and jokes with the staff.

I recall, a few years ago, when I first met Edith. Little children had come to visit as part of our intergenerational program. I watched Edith, fully engaged in the activities—playing ball, exercising, and singing songs with the youngsters—all the while talking with the young mothers. From my seat, I could see that everyone loved her—and she loved everyone.

After the children left, I walked out to see her and asked, “Edith, how did you enjoy the little ones today?” She looked at me and said, “Children? Were there children here today? Oh, dear me, I’m so forgetful!” With that, she laughed and went back to her lively conversation with Rita. I remember that I walked back to my office that day, shocked. She had such a good time—and she didn’t remember any of it?

Since that day, I’ve learned a lot from Edith. Many people at my center have some form of dementia, but Edith is different. She knows that her memory is not what it used to be, but she does not let it trouble her. Each morning, she’ll share her motto, “Live for today.” And this is something she does fully and completely. Games, parties, discussions—whatever the day brings, you can count on Edith to get involved completely and enthusiastically.

As I sit before my charts, my lists, and my phone messages, I realize something. I am guided by the principle, “Soon.” Soon, I will have time to walk in the park. Sometime, I will sit and read. I will talk and visit more with family and friends, I will pray, I will... You get the idea. Moreover, I will do all these things with both ears, both eyes, with full attention. Someday.

Tomorrow, Edith and I will repeat our morning ritual. We will have the same conversation and laugh at the same jokes. I don’t know if she’ll remember me; she has never called me by name. But one thing is certain. I will always remember Edith’s living example. “Slow down and enjoy the moment. Now is the only time we have—there is no yesterday or tomorrow, only this present moment. Enjoy it, make other people happy and be happy yourself.”

I thank God for Edith; I am blessed to know her.

— Regina D. Cassidy, LMSW, MS, is a social worker in Carmel Richmond Adult Day Healthcare Center on Staten Island, N.Y. She works as a parent education director with young families in Staten Island.

By Karen L. Dodson, MSW

I facilitate a grief and loss group in a Mental Health Day Program within the VA HealthCare System in Connecticut. Nick*, a veteran I have been working with extensively regarding his goal of maintaining sobriety, attended a group session in which the topic for the morning was “Taking Care of Yourself During Times of Grief.”

Nick specified to the group that he is still grieving the divorce from his wife five years ago. Nick stated, "It is hard knowing what I lost. She is still alive after all." Nick further expressed that he has been consuming alcohol in order to cope with his grief and to sleep some nights. During the session, Group members and I discussed healthier and more positive ways to cope with grief. I advised Nick that relying on alcohol is not an affective way to cope with grief and, in fact, may prolong the grieving process. I could see in Nick's face he had just experienced an "A-ha moment" that continued the remainder of the session. The group continued discussing appropriate ways of taking care of themselves after a significant loss, which led to the comfort drawer exercise.

Nick participated in the discussion about "outfitting a comfort drawer," which is a box filled with stress-relieving items to be used when feeling overwhelmed by grief. Nick stated, "I do not have a box like this, but it is getting me thinking that I should." I encouraged him to create a comfort drawer and, when he has an urge to consume alcohol, use items from his comfort drawer. The group then talked about items that belong in their comfort drawers. Some of the items which Nick identified were a favorite magazine, scrapbook of personal mementos, and some bubble bath. Nick further stated, "I enjoy a good bath," which provided a break of laughter in the group. I further encouraged Nick to possibly keep phone numbers of his support system in his comfort drawer.

Towards the end of the session, one group member expressed I provide too many handouts including the comfort drawer handout. When Nick heard this statement he stood to my defense by stating, "I keep all your handouts from group. They are all so helpful." After this session, I began to conceptualize that maybe I was Nick's comfort in times when he feels he can do nothing else than guzzle a bottle of Vodka when he is feeling overwhelmed. Perhaps Nick will put the handouts he has collected from group and place them in his comfort drawer. Who knows? Just knowing that maybe I have finally made a connection with Nick regarding his drinking, and his report of wanting to create a comfort drawer in order to begin coping positively and healthfully with his grief is a comfort.

*Name has been changed to protect confidentiality.

— Ms. Dodson obtained her MSW at Wichita State University in 2006. Currently she is conducting a Psychosocial Rehabilitation Fellowship at VA Connecticut Healthcare System in West Haven, CT.