By Stephanie Brill and Caitlin Ryan, PhD, ACSW

What Is Transgender?

Everyone has a gender identity. Gender identity is our internal sense of being male or female. For most people, our basic awareness that we are male or female matches our physical body. When we’re born, people decide if we’re male or female based on our genitals. But for children and adults who are transgender, their basic sense of being male or female – their gender identity – does not match their body. So a transgender person may have a male body, but feel inside that they are female. Or a transgender person may have a female body, but feel inside that they are truly male.

Can a Child Be Transgender?

Children and adolescents can be transgender, just like adults. In fact, a small percentage of all children are transgender. Children understand gender differences from a very early age. And transgender children strongly identify with the other gender, often from age two or three. Because we don’t talk about transgender people with children, adolescents or even adults, children who are transgender lack basic information about who they are, and struggle with feeling like they were born in the wrong body. And adults typically react as if there were something wrong with these children, as well.

In truth, there is nothing wrong with these children. But since very few people understand that it is natural for a small percentage of the population to be transgender, people don’t know that you can have male genitals and still be female or have female genitals and be male.

Transgender children who express their “real” gender identity can become extremely unhappy and depressed when adults try to prevent them being their true selves. Being transgender is not the cause of their distress. Instead, not being understood and feeling like there is something wrong with them causes them to suffer. And pressure to change their core sense of who they are causes emotional suffering, as well.

What Makes a Child Transgender?

Many parents are concerned that something they did made their child become transgender. This is not true. Nothing that a parent or anyone else does can change a child’s gender identity. Being transgender is not caused by divorce, neglect, wishing you had given birth to the other sex, using fertility drugs to conceive, encouraging your child to play sports too often or not enough, or other parental thoughts, behaviors or experiences. We don’t know exactly why some people are transgender. But science is showing that transgender children are most likely born that way, right from the start. Even before children can verbalize their sense of gender, they start to tell us who they are through their play and choices for clothing, hair styles, and toys. Once they are old enough to talk, transgender children strongly insist that they are “really” a boy, or “really” a girl. (more…)

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.
[Click here for the full article]

Reviewed by NASW Office of Social Work Specialty Practice Staff

Introduction

Families plan and prepare for major life events: attending college, getting married, having a baby, and retiring at the end of a career. However, few plan for events such as how we would want our health care delivered if we become very ill.

Or some people may be adamant about not going into a nursing home but they fail to plan for securing long-term care insurance, home modifications, or having someone to advocate for them if they cannot communicate. Rarely do we think that far head.

These are decisions that we all should be thinking about. They should be documented so that our family members, health care providers, etc. will know our wishes for our care.

In generations past, people who were terminally ill remained at home, dying quickly from infectious diseases or accidents. Today, with the deluge of new medicines and technologies, we have become a “death denying” society, in which death is an enemy that must be beaten at all costs. We focus on fighting death rather than preparing for its inevitability.

Who Needs Advance Care Planning?

Every adult can benefit from Advance Care Planning.  Planning is particularly important for those who are terminally ill. Research shows that people suffering from chronic illness also benefit from advance care planning. Even healthy people should consider their wishes for end-of-life care and discuss their decisions with family members or professionals, before a health care crisis occurs.

Because an accident or serious illness can happen suddenly, and at any time, thinking about this topic when you are capable of making decisions is important. Sharing these decisions with your family helps to ease their burden and reduce their uncertainty if they ever have to make health care decisions on your behalf.

What Are the Benefits of Advance Care Planning?

Studies funded by the Agency for Healthcare Research and Quality (AHRQ) have shown that people who talked with their family, physician, or others about their preferences for end-of-life care had less fear and anxiety, felt more in control of their own medical care, and believed their doctor had a better understanding of their wishes. Other potential benefits of advance care planning according to the National Institutes of Health include:

• Decreased personal worry
• Decreased feelings of helplessness and guilt for the family
• Decreased implementation of costly, specialized medical interventions
• Decreased overall health care costs

[Click here for the full article]

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…)

Click here to read a Q&A interview about divorce and domestic violence with NASW member Katherine van Wormer, PhD, the author of a number of books including Women and the Criminal Justice System (2007, co-authored with C. Bartollas) and books on addiction and human behavior. Dr. van Wormer teaches Social Work at the University of Northern Iowa.

Dr. van Wormer has published seven articles on www.HelpStartsHere.org http://www.helpstartshere.org/Default.aspx?PageID=1217

Introduction

Have you ever said to a friend “I’m looking for my perfect job” or “I want to find the perfect man (or woman)?”

If so, you are not alone. Far from it.

Unfortunately, we don’t do ourselves any favors by seeking perfection. Expecting
perfection — in ourselves, in others, in our careers — is not only unrealistic, it is self defeating.

We simply set ourselves up for failure by demanding perfection. That’s because there’s nowhere to go but down, even when all objective measures say you are successful. For example, when a child expects to get a score of 100% on every test in school, she will be disappointed when she gets a 93 – an otherwise fantastic score.

The same is true with adults.

We may be in a good relationship or we may have a rewarding job. But when our reality doesn’t match our idealized notions of what a job or a mate is supposed to be, not only are we disappointed, we often become depressed, angry and resentful. We feel as if we have failed in some deep and meaningful way.

Perfectionistic Thinking

Perfectionistic thinking comes in different forms: We may think we have to lose five pounds to get that great body, or we think we must have a Norman Rockwell sort of holiday get-together.

This sort of thinking often comes from our families. Many of us were taught either implicitly or explicitly that we were loveable to our parents only if we performed at a high level in school, on the athletic field or on stage. We grew up thinking that if we’re not perfect we won’t be loved. Love was conditional; it wasn’t about who we were but what we did.

It’s important to change that belief to something more rational and self-affirming. Here are a few examples: “I’m going to do the best I can on this project” or “I’d like to meet someone who shares similar interests as me.” Remove the word “perfect” from your vocabulary. You will find you’ll be just as successful as before – and a whole lot happier.