Infertility is an experience that strikes at the very core of one’s life. Reproduction is considered the most basic of human needs, propelled by powerful biological and psychological drives. When the ability to reproduce is thwarted, a crisis ensues and impacts relationships with others, life goals, social roles, and sense of self. A host of emotions emerge in a somewhat predictable and repetitive process as one moves through medical diagnosis and treatment. Feelings of disbelief, anger, sadness, guilt, blame, anxiety and depression can be overwhelming and finding appropriate avenues to express these emotions is important.

For most people, in vitro fertilization (IVF) is not the first course of treatment for their infertility—it is the last, best option for having a child. It occurs after long months and sometimes years of treatment failure, often at tremendous emotional, physical and financial cost. Couples beginning IVF usually do so with the burden of grief and disappointment from infertility, and may feel depressed, angry, tired, and anxious. Although emotionally depleted, couples are attracted to a technology that offers hope where none may have existed. They find themselves drawn into new emotional turbulence of contrasting feelings of hope and despair, which seems to be generated in part by the experience of the technology itself.

The opportunities that IVF creates brings with it significant challenges. IVF is considered by patients to be the most stressful of all infertility treatments. Patients have rated the stress of undergoing IVF as more stressful than or almost as stressful as any other major life event, such as a death of a family member and separation and divorce. While general assumptions may be made about stress levels during IVF, the experience for infertility patients will be personal and unique—each patient will experience the stress differently based upon his or her own personality and life experiences.

The aspects of IVF that are perceived stressful to patients are multifaceted and affect all parts of their life: marital, social, physical, emotional, financial, and religious. Time is stressful, both in the time commitment to an intense treatment which leads to disruption in family, work, and social activities, and for some, in long waiting periods for treatment services. IVF stress impacts the marital relationship with an emotionally laden experience and, by removing the conjugal act of procreation, sexual intimacy is lost. Couples, also, are stretched financially paying for the high cost of IVF treatment with a relatively low probability of success. Dealing with the medical staff and with the side effects or potential complications of medical treatment has its own stress: hot flashes, headaches, mood fluctuations, shots, sonograms, future health concerns, and decision making about embryos and multiple pregnancies. Religious, social, and moral issues may also make IVF stressful, especially for those dealing with third party reproduction, when these values are in conflict with the choice of treatment.

The first treatment cycle has been found to be the most stressful for patients, with high levels of confusion, bewilderment, and anxiety. This may be due to inexperience with the process or possibly inadequate preparation of the patient by staff in terms of information and discussion of care. While experience seems to help the stress level in the next cycle, if it is unsuccessful the stress level rises again with the third cycle as the “stakes” have been raised. For many couples, IVF can feel like gambling where the stakes are high and the chance of success unknown. Like gamblers, some IVF patients may have unrealistically high expectations of success or feel compelled to try “just one more time” finding it difficult to end treatment after having already invested so much physically, emotionally, and financially to have a child.

Within a treatment cycle, patients view IVF as a series of stages which must be successfully completed before moving onto the next phase of treatment: monitoring, oocyte retrieval, fertilization, embryo transfer, waiting period, and pregnancy test stages. The level of stress, anxiety, and anticipation raises with each stage, peaking during the waiting period. Research has shown that in order of perceived stress for patients, waiting to hear the outcome of the embryo transfer is the most stressful, followed by waiting to hear whether fertilization had occurred, and then the egg retrieval stage. Patients are aware of the importance of these key phases in the IVF process and the uncertainty of the outcome is highly distressing.

Despite the stressful consequences of infertility and IVF, it is important to note that research has shown that the vast majority of patients are well adjusted. Further, there seems to be no long-term impact on the marital relationship and individual functioning. In fact, some research has shown that the crisis of infertility may actually improve marital communication and emotional intimacy. Couples may learn coping skills and communication patterns that provide life-long benefit.

IVF has the potential to be an emotionally, physically, and financially exhausting experience due to the “high stakes” and “end of the line” nature of this treatment. Thus, patients need to consider thoughtful preparation before beginning the process. If you are a patient about to begin a cycle, here are some tips to help get ready for IVF. (more…)

Excerpt from the U.S. Department of Eldercare Locator
Reviewed by NASW Office of Social Work Specialty Practice Staff

Today, family caregivers have options to choose from when they need assistance or respite. And, highly trained and experienced social workers are available to help caregivers sort through the range of available options.  Below is a brief description of some of the caregiving services commonly available. 

Adult Day Care

Adult Day Care Centers are designed to provide care and companionship for seniors who need assistance or supervision during the day. The program offers relief to family members or caregivers and allows them the freedom to go to work, handle personal business or just relax while knowing their relative is well cared for and safe.

The goals of these programs are to delay or prevent institutionalization by providing alternative care, to enhance self-esteem and to encourage socialization. There are two types of adult day care: Adult social day care provides social activities, meals, recreation, and some health-related services. Adult day health care offers more intensive health, therapeutic and social services for individuals with severe medical problems and those at risk of requiring nursing home care.

How Do Adult Day Care Centers Operate?

These centers are usually open during working hours and may stand alone or be located in senior centers, nursing facilities, churches or synagogues, hospitals, or schools. The staff may monitor medications, serve hot meals and snacks, perform physical or occupational therapy, and arrange social activities. They also may help to arrange transportation to and from the center itself.

Assisted Living

Assisted living facilities offer a residential alternative for older adults who may need help with dressing, bathing, eating, and toileting, but do not require the intensive medical and nursing care provided in nursing homes.

Assisted living facilities may be part of a retirement community, nursing home, senior housing complex, or may stand-alone. Licensing requirements for assisted living facilities vary by state and can be known by as many as 26 different names including: residential care, board and care, congregate care, and personal care.

Assistive Technology

Assistive technology is any service or tool that helps the elderly or disabled do the activities they have always done but must now do differently. These tools are also sometimes called “adaptive devices.”

Such technology may be something as simple as a walker to make moving around easier or an amplification device to make sounds easier to hear (for talking on the telephone or watching television, for instance). It could also include a magnifying glass that helps someone who has poor vision read the newspaper or a small motor scooter that makes it possible to travel over distances that are too far to walk. In short, anything that helps the elderly continue to participate in daily activities is considered assistive technology.
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Note: All names have been changed to protect confidentiality.

By L.B. (LeslieBeth) Wish, Ed.D, MSS

Introduction

Sally had been a soldier’s wife for all twelve years of their marriage. She endured separations while her husband, Tom, was called to duty, and she toughed out raising twin boys alone. Sally said Tom loved her because, in his words, she was a “team player.” But ever since Sally learned that Tom was killed in a roadside bomb in Iraq, Sally doubts whether she can be a team of one. “I’m really not that strong,” Sally said. “It’s just a good act.”

When Rolanda was shot out of her helicopter, her husband Ray said he had no choice but to “pull himself together.” He had to focus on his job and raising his stepdaughter. “I only cry at night, and then only for a second or two. We were practically newlyweds. I don’t even know what I’ll be missing.”

“At least the kids are grown.” It was the first thing that came to Linda’s mind when she heard that her husband was killed in an ambush. But the relief was short—depression set in, and Linda felt “ashamed” for falling apart.

These stories provide a glimpse into the plight of many of the American families of downed warriors in Iraq. Each family’s grief is unique, but most share issues that are familiar to mental health professionals–adjustment, loss, grief, and anger.

Some families rely on friends, the Armed Forces community, and supportive family for help. But one of the issues that many (certainly not all) of these families also share is their reluctance to use the mental health services available to them.

Why? What makes providing counseling to these families so different from non-military families in mourning? And how can mental health professionals serve these families’ needs?

Let’s start with learning a little more about some of these families. Bear in mind, that there are many reactions to the loss of a family member and that not all families of downed warriors react the same. Yet, a constellation of beliefs, fears and adjustment issues does exist amongst many of these families, and it is important to become familiar with them.

Current Issues of Some American Military Families

At first, it seems that the most common issues of military families do not differ from the problems of families not in the military. People are people, as some say. After all, humans share common problems. Yet, military families often add elements to these issues that are unique to them.

Fear of Being “Found Out”

Many families worry about being seen in counselors’ halls and waiting rooms and about being judged and “found out.” They also worry about confidentiality. They believe that no matter what the organization, if it’s affiliated with the armed forces, it will keep records that could easily be shared with other branches and departments.

Non-military families may have similar feelings, but military families carry with them an extra dose of shame of being “found flawed.” They also say they “have had it” with the power of military and government rules. They long for privacy, and they have far higher doubts that their insurance can protect them.
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If you find that your child does, indeed have ADHD, it’s important to educate yourself as much as possible. There are numerous books on the subject. Consulting with a mental health professional to help you with the many challenges ADHD can present, is invaluable. Finding support by attending local groups such as CHADD (Children and Adults with Attention Deficit Disorder) also are immensely helpful in not only learning more about ADHD, but also to connect with other families who are struggling.

Since the treatment of ADHD often includes parenting strategies, it is imperative that you work with a professional to help you learn new techniques to not only help manage your child’s behavior, but to also help him learn organizing strategies, homework management, social skills and more.

Treatment also often includes medication to help quiet the hyperactivity and impulsivity and/or improve attention. Many parents are reluctant to give their child medications, but stimulants (the most common and beneficial medication for ADHD) are safe when given as directed. Still, all parents have concerns. Here are some questions to ask your doctor to help you in making the decision as to whether medication is right for your child:

• What are the risks vs benefits?
• What side effects might I observe?
• Which medications will work best for my child?
• What options do I have if I don’t want to use medications for my child?
• How will I know if the medications are working?

For more information visit www.helpstartshere.org.

By Alyson Mischel, LCSW

Introduction

Historically, social workers are trained to work with the populations most in need of assistance. They practice in prisons, with drug users, the severely mentally ill, batterers and domestic violence victims, and with HIV positive clients. But, increasingly, social workers have private practices and treat people who can afford to pay for traditional 50 minute psychotherapy sessions. Regardless of the brand of social work practiced, or the population served, social workers can rely on concepts of media psychology to serve their clients.

Most everyone watches television, listens to the radio, or reads some form of printed press on a daily basis. Media is the 21st century’s glue – it’s what connects us and makes a Wall Street banker able to relate to a struggling waiter in Los Angeles. As a consumer who may communicate with a therapist online, or have a therapist use television and film as case studies, it’s important to understand the following basic concepts of media psychology and how they relate to psychotherapy.

Telemedicine

Telemedicine is the delivery of medical and/or psychological services at a distance with the use of technology like telephones or web-based systems. Treatment via telemedicine could involve two medical professionals talking over the telephone in real time about a case and also the use of satellite equipment allowing a doctor in California to evaluate, diagnose, and treat, a patient in Brazil.

The focus of telemedicine is largely consultative, which is why there is a growing trend toward online, synchronous psychotherapy. Some psychotherapists offer online and telephone counseling services for marriage, depression, parenting, family, and grief issues. The International Society for Mental Health Online,  the National Association of Social Workers and the American Psychological Association have issued statements about telephone counseling. Understanding how telemedicine works is essential for consumers since psychotherapists increasing use e-mail and the Internet to provide services.

Cinematherapy

Cinematherapy is the use of film as a metaphor to bring about positive growth in psychotherapy clients. Watching television and films may be a catalyst for healing and change. Movies can be “windows” to the unconscious in the same way that dreams and fantasies are. Watching films allows clients to become consciously aware, resulting in gained insight and emotional release. Cinematherapy works best in the tradition of Systems Theory and Cognitive Behavioral Therapy, which are the treatment modalities used by most social workers. Films may help clients become aware of their irrational beliefs and poor coping mechanisms. Cinematherapy is another tool like stories, myths, and fables, that psychotherapists use to treat their clients.

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To read more from Alyson Mischel visit www.alysonmischel.com

A positive, compassionate, and enthusiastic personality, Alyson Mischel brings a special brand of empathy to her psychotherapy and life coaching work. Alyson combines her education and clinical training with her own experiences, and has developed a common sense approach for addressing life’s challenges. Alyson is a lecturer at the USC School of Social Work, and serves as a consultant for UCLA’s Educational Leadership Program, a doctoral program of education. She was formerly a clinical supervisor for the Los Angeles County Department of Mental Health. Alyson has counseled hundreds of people in the areas of career, relationships, health, and finances. A graduate of Stanford University, the University of Southern California, and a licensed clinical social worker, Alyson has been studying and practicing since 1998.

Army National Guard Specialist Chuck Ross

The Veteran’s Administration employs more than 4,400 MSWs to assist veterans and their families with individual and family counseling, patient education, end of life planning, substance abuse treatment, crisis intervention, and other services.

Please click here to read the article Leaving the War Half a World Away which is the story of Army National Guard Specialist Chuch Ross pictured above. When Mr. Ross returned home from the Iraq war experiencing symptoms of post traumatic stress disorder, he turned to social worker Dr. Rick Selig for help.

Below are links to additional articles about veterans affairs and social work.

• - About Post Traumatic Stress Disorder (PTSD) and Brain Injury in Iraq’s War Veterans
• - Help for Spouses of Combat Vets With Post Traumatic Stress Disorder From People Who Know
• - When the Soldier Doesn’t Return: The Needs of American Families of Down Warriors in Iraq
• - What It’s Like to Help Disabled Veterans as a Veterans Health Administration Social Worker
• - Love, Honor, & Obey: Working With Military Men and Their Families
• - How Social Workers Help Veterans and Their Families
• - Help for World War II POWs: The Former POW Living History Project
• - Retired Army Colonel and Dean of the University of Maryland, Baltimore School of Social Work, Jesse J. Harris, PhD, Honored by the Maryland Legislature

By LeslieBeth Wish, Ed.D, MSS

Introduction

Few of us are immune to holiday stress. It doesn’t help that Thanksgiving and Christmas are so close together. For many people, it’s like getting a second wham of anxiety and disappointment before you recover from the first one at Thanksgiving.

Because our American culture still promotes the image of the happy family with the white picket fence, we often assume the ideal family exists–even if we know that these families, too, have holiday difficulties. Holiday movies increase our disappointment. Oh, they might start out with family feuds, misunderstood children and unacceptable mates, but all these issues get resolved by the end of the film.

In reality, most families have a few issues that are unresolved. What may be stressful to one family may not be to another, yet despite the differences, the top holiday stresses are familiar to most of us. What can you do to make the holidays a happier time? Everyone’s situation is unique, but here are the top problems and solutions. (All names and identities cited below have been changed.)

Unrealistic Expectations of Happiness, Joy and Acceptance

The holidays are supposed to be a joyous time. If you have unresolved issues, hopes run high that the festivities will propel family members to act with greater kindness and emotional responsibility. Unfortunately, holiday time is not necessarily the best time to try to settle grievances or have one of those long, heart to heart talks with a family member. In fact, you might end up with nothing more than a lot of words and raised hopes—with little followup after the holidays are over.

The first thing to do is to lay the groundwork for a renewed relationship long before the holidays. Start by sending e-mails or birthday and anniversary cards. You want to send the message that you care about them and that you have changed.

It’s usually not a good idea to play a game of history where you review your past complaints. A long family meeting where you air your past anger won’t necessarily result in changing other family members’ behavior or attitudes about you. More effective change usually comes from your acting differently—and surprising them with the new you. Acting unpredictable in a positive way is a potent strategy for shaking up family members’ old views and treatment of you.

For example, if you’ve been regarded as the wayward child, you can demonstrate your maturity by telling the family about your life changes and speaking to each relative about things that are important to each of them. Even though it can take months for attitudes and behavior to change, when you act in a different and positive way, the family is more likely to notice you’ve changed.

Of course, if there is a timely hot topic that has to be addressed, then speak to other family members about ways to coordinate a strategy. For example, a common issue is how to care for a close relative who has dementia or Alzheimer’s disease. Some families divide up the tasks of researching doctors, nursing homes and other care facilities in the area. Family members then use e-mails to remain in touch.

Rigid Rituals

Rituals sustain the family emotional glue. They provide an easy format to recall and chart family growth, connection and cooperative decision-making. In addition, the holidays give families an opportunity to celebrate “who we are and why we matter.”

Later, as you mature, these family events provide a forum for testing your maturity, feelings and assumptions about yourself and others. You can assess family members with your own eyes and come to different or refined conclusions about how your family operates. You can forge your own identity and role as well as establish resources in the family through selected people.

However, rituals are often unresponsive to change. Family ruts are easy to get into. For example, mother always sits here, father there. It’s amazing to see the power of even these simple acts. Yet, not everything can stay the same. Family members are lost and added through death, marriage, birth and feuds. Life demands flexibility. Rather than complain about a ritual, recruit the key person in the solution. Be prepared to provide a reason and ideas.

For example, no one wants to hurt Cousin Dee’s expectations about hosting the Thanksgiving feast. However, now the family is too large to fit into her dining room. If you have a better idea, discuss it with other members, including the person whom Cousin Dee responds to with the least defensiveness. Then, have this person seek Dee’s advice about some related issue such as how to arrange the seating order or what chairs to use.

If you are that designated person, act perplexed about the best way to accommodate the growing family. You might mumble about moving chairs or using the kitchen. You might even say things such as: “Gee, it’s too bad Cousin Tina hasn’t offered to have the Thanksgiving meal at her house. Then we could have the next day brunch all day at your house, where it’s more fun and casual. Do you think Cousin Tina would want us messing up her new carpet?” Of course, you’ve already cleared it with Cousin Tina. The goals are to get creative and positive and to turn the key family members into key players in the solution.

Finally, take advantage of changes in the family to forge new traditions. Use events such as births, marriages, remarriages or college graduations as springboards for new gift giving, different homes for the celebration or more flexible seating arrangements around the dining table. These changes might prompt innovative ways of sharing the holiday. For example, you can divide up Christmas into Christmas Eve, Christmas morning and Christmas dinner. (more…)

College Student AnxietiesSocial workers in college counseling centers see increasing numbers of students each year for problems ranging from homesickness and test anxiety to eating disorders and suicidal thoughts.

While many people think of college as an ideal time of life when young adults are meeting academic challenges, experiencing personal growth and enjoying social activities like football games and parties; college can also be a time of depression and overwhelming anxiety, confusion about identity and dealing with losses and traumas such as parental divorce or date rape.

Life can feel complicated and lonely as students move into a new and shifting environment without the emotional skills or support to deal with many of the changes they are facing. For returning adult students there may be additional financial and caretaking issues with which to contend.

How Social Workers Help

An effective social work therapist in the college counseling center setting is able to evaluate, diagnose, and provide treatment for a range of life and emotional issues. Clinical social workers engage in assessment of student problems and emotional status, provide crisis intervention, individual and group counseling, make referrals for medical and psychiatric services and engage in consultation with friends, family and other caregivers on campus.

Working with young adults requires openness to changes in cultural trends and surface presentations of students while also connecting with them about timeless issues such as understanding life events, developing coping strategies and finding meaning in their struggles. In the case of suicidal or high risk behaviors, a social worker’s role may involve developing a safety plan to prevent harm.

In addition to counseling services, social workers also engage in education and prevention activities as well as activities designed to create a more caring and emotionally responsive environment. Social workers present workshops and classroom presentations for students on topics such as stress management, depression, and relationship communication. Faculty, staff, and peer helpers are also trained to identify and refer students experiencing emotional distress.

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The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.

Easton (Mass.) Journal, March 4, 2005

By Cathy Knipper, Correspondent

Doll Statue On Tour To Counter Unrealistic Body Image Expectations

She is the one who every girl hopes will be at her birthday party. Her clothes are stylish, she always looks so together, everyone wants to be like her. Her name is Barbie, but the image she promotes is not all that pretty, and it is one that the professionals and volunteers of the South Shore Eating Disorder Collaborative (SSEDC) hope to shatter with their “Get Real Barbie” tour.

The SSEDC is a group of clinicians providing care for those coping with eating disorders. It was founded by Kathleen Burns Kingsbury of Easton.

Kingsbury is a mental health counselor and co-authored the book, “Weight Wisdom: Affirmations to Free You From Food and Body Concerns,” with fellow Easton resident and SSEDC member Mary Ellen Williams.

To promote National Eating Disorder Awareness Week, (Feb. 27- March 5) the members of SSEDC have built and designed a paper mache statue of Barbie who will travel from Easton to Boston Children’s Hospital, and then on to schools and hospitals throughout the South Shore area.

Get Real Barbie

The statue, dubbed “Get Real Barbie” encourages the public to “get real” information, “get real” expectations and “get real” help for eating disorders.

The first thing anyone looking at “Get Real Barbie” will notice is that she does not look like a “real” Barbie. The truth is, this life-size figure is actually as “real” as Barbie gets.

Inspired by a proportion lesson in her geometry class, Easton resident Kristine Alach, 14, decided to calculate Barbie’s life-sized proportions. (more…)

By John D. Weaver, LCSW, BCD, ACSW, CBHE

People are always changed by disasters and other traumatic
life events, but they need not be damaged by them.

Introduction

Tropical storms, tornadoes, fires, floods, earthquakes, transportation accidents, mass murders, hazardous material spills, building collapses, nuclear plant malfunctions, terrorist bombings, and many other disasters occur throughout our country each year. In the wake of these events lies a wide path of catastrophic physical and emotional destruction. Many seriously traumatized people can be found there, struggling to recover from their losses and rebuild their lives.

Once a disaster occurs, folks look at a lot of things in a different way than they did before. Prior to the event, people have an order to their lives and they feel like they are in command. In the days and weeks following the disaster, they often feel they no longer have control over anything - the event has caused unexpected losses and has taken away their normal routines. They will find themselves awash in a sea of paperwork and bureaucracy (relief agencies and services, insurance claims, etc.) that many refer to as the second disaster. They soon begin to realize it will be some time before they will regain their former sense of stability and control. Faced with so many changes, people begin to react with fear, anger, anxiety, and depression - all normal stress reactions under the circumstances. Victims will expect themselves to “get over it” and to feel better quickly. When they don’t, they suddenly begin to fear they’re weak or they’re going crazy.

Typical Reactions to Disasters

These are the common feelings and reactions that most victims will express and/or display: basic survival concerns; grief over loss of loved ones and/or prized possessions; separation anxiety and fears for safety of significant others; regressive behavior (e.g., thumb sucking in children); relocation and isolation anxieties; need to express thoughts/feelings about experiencing the disaster; need to feel one is part of the community and rebuilding efforts; altruism and the desire to help others cope and rebuild.

Disasters often cause behavioral changes and regression in children. Many react with fear and show clear signs of anxiety about recurrence of the disaster event(s). Sleep disturbances are very common among children (and adults) and can best be handled by quickly returning to (or establishing) a familiar bedtime routine. Inability to do this often proves to be a major problem following major earthquakes, as frequent aftershocks and displaced residences make it difficult for anyone to return to regular sleep routines. Many families end up sleeping together in the same bed long after the main quake.

Similarly, school avoidance may occur and it can lead to development of school phobias, if children are not quickly returned to their normal routine of school attendance. In some disasters, the schools may be flooded (or damaged in another way), making them inoperable. This, and the need to be bused to other, unfamiliar buildings, will further add to the stresses on the children, who may prefer staying home due to fears of leaving their parents’ sides for the length of a school day.

Adults often report mild symptoms of depression and anxiety. They can feel haunted by visual memories of the event. Pre-existing physical problems such as heart trouble, diabetes, and ulcers, may worsen in response to the increased level of stress. They may show anger, mood swings, suspicion, irritability, and/or apathy. Changes in appetite and sleep patterns are quite common. Adults, too, may have a period of poor performance at work or school and they may undergo some social withdrawal.

Middle-aged adults, in particular, may experience additional stress, if they lose the security of their planned (and possibly paid-off) retirement home (or their financial nest egg), and if they are forced to pay for extensive rebuilding costs. Older adults will greatly miss their daily routines and will suffer strong feelings of loss from missing friends and loved ones. They may also suffer feelings of significant loss from the absence of their home or apartment or its sentimental objects (especially items like paintings, antiques, family Bibles, photo albums, and films or videotapes), which tied them to their past.

Timing of onset of these changes varies with each person, as does duration. Some symptoms occur immediately, while others may not show until weeks later. Just about all of these things are considered normal reactions, as long as they do not last for more than several weeks (to a few months). Unfortunately, victims and relief workers who are unfamiliar with these normal feelings/emotions/reactions will often begin to fear they are losing it or going crazy from the disaster related stress.
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