Sunday, February 28, 2016

Diagnosing the Oscars

The 2016 Academy Awards are tonight and it got me thinking – let's look at the Best Picture nominees through a clinical/DSM lens to make studying more entertaining!

Image credit Kate McHugh Akbar

There will be no spoilers in this post because I have not actually seen any of the movies. I'll pull the “I have little kids and I don’t get out much” card here. 

To be truly transparent, this post should probably be titled Diagnosing the Oscar Best Picture Nominee Trailers, because that reflects what I have seen.  Regardless, let’s dig in.

These movies feature a few different mental health issues.  To start, Spotlight covers the story of journalists investigating the priest pedophilia (now called pedophilic disorder in DSM-5) scandal in Boston.  Brooklyn’s main character seems to encounter normal bereavement—not a DSM diagnosis on its own but should be assessed carefully, keeping consideration of possible major depressive disorder.  The Big Short makes me wonder if there’s some narcissistic personality disorder going on, what with the themes of success, power, and arrogance, but it’s hard to say based solely from the trailer.

However, the award goes to… (see what I did there?)

Six of the eight Best Picture Nominees showcase some seriously traumatic stress.

Posttraumatic stress disorder is diagnosed when someone has “exposure to actual or threatened death, serious injury, or sexual violence” (DSM-5). 

The experience results in 1) intrusive symptoms (e.g., flashbacks and dreams), 2) an avoidance of reminders of the trauma, 3) negative alterations in one’s cognition and mood, and 4) changes in arousal (e.g., outbursts, reckless behavior, and hypervigilance).  PTSD used to be included as an anxiety disorder in DSM-IV, but in 2013’s DSM-5 it has been moved to a new chapter entitled “Trauma- and Stressor-Related Disorders.”

Here are the Best Picture nominees whose characters could reasonably be suffering from posttraumatic stress disorder:

  •  Multitude of survivors of childhood sexual abuse, victimized by priests
Bridge of Spies
  •  Main character forced to go to East Berlin during the Cold War and lead a hostage trade negotiation; also witnesses killings
  • Additionally, his family suffers attacks on their home from angry neighbors
Mad Max: Fury Road
  • Judging by the trailer, this whole movie looks like an unending barrage of chase scenes, killings, and near death experiences
  • Also hints at captivity and sexual abuse for female characters
The Revenant
  • Main character mauled by a grizzly bear, left for dead, engages in intense physical battles
The Martian
  • Near death experiences for astronaut main character who survives a storm but is accidentally abandoned on Mars with limited resources
  •  Possible trauma for astronaut crew that embarks on rescue mission
  • Main character Ma, abducted by a predator and held captive for several years in a room, victim of recurrent sexual abuse
  • Her son Jack (the product of Ma’s rape) who has spent his whole life in the room, leads their escape, and adjusts to life outside


Two clinical notes to consider: 1) PTSD can be diagnosed when the disturbances last for a month or longer.  Acute stress disorder can be diagnosed when similar symptoms occur less than one month after the traumatic event.  2) Five-year-old Jack’s character in Room would specifically be diagnosed with the child’s subtype of PTSD for children 6 years and younger.

There's an awful lot of stress in these movies.  Is outrageous stress the key ingredient to deem a movie Oscar-worthy?

Honestly, I saw one or two movies this past year, and given the choice I did not select a stressful movie experience.  Some trauma workers, including social workers, encounter enough vicarious trauma through the job and don’t desire to witness more as entertainment.  Another topic for another time.

Who has seen these movies and can offer further commentary? What did I miss?  Bonus points for whoever correctly predicts Best Picture winner!

Thursday, February 25, 2016

Domestic Violence and Safety

One thing to remember about the ASWB test questions (and real-life social work practice, too) is that there is a priority placed on client’s safety and well-being.  That’s why there undoubtedly will be questions related to a social worker’s legal duty to report suspicions of abuse/neglect of children, elders, and dependent adults. 

But consider a question about domestic violence.  Domestic violence—also known as intimate partner violence—can include physical, sexual, mental, emotional, and/or economic abuse of one partner to the other.  It is usually rooted in the abusing partner’s desire to exert power and control over the victim.

A key thing to remember about DV questions on the exam is that domestic violence is NOT reportable to the local law enforcement or any other entity.  If a child is physically assaulted during a physical attack (accidentally or on purpose), that would be a mandated report to child protective services, but a social worker is not required to report physical violence between two adult partners.  Remember the distinction when you’re taking the exam.

Image credit Pixabay

A few other things to know about domestic violence:

A major goal when working with a victim of domestic violence is to help ensure her/his safety, along with that of any children in the home.  Helping the client come up with a safety plan is of utmost importance.

If the client is out of physical danger and has a safety plan in place, then a social worker might focus on psycho-educational topics.  One initial topic that is important for both the clinician and the survivor to understand is the cycle of abuse.  In short, the cycle looks like 1) tension building, 2) explosion/abuse, 3) apologies and honeymoon phase, and repeat.

Clinically speaking, family therapy and couples counseling are NOT recommended interventions for a domestic violence situation.  There is no way to ensure a victim’s safety in counseling, and often as a result of speaking freely in counseling, the victim is punished more by the abuser later.  Individual therapy for the survivor, and a separate counseling program for the abuser, are preferable treatment plans.

Thanks for reading and study well!

Monday, February 22, 2016

Taking the California Law & Ethics Exam

It’s the start of 2016 and you are trying to get licensed in California.  If you’re just now beginning the exam process, you will take the CA Law & Ethics exam.

Did you know that since the exam is new, the BBS is taking time to statistically analyze the questions before deciding how to score them?  That means you have to wait to get your score report… and wait to know if you passed.

The BBS website says:

Exam candidates who take the LMFT and LCSW Law and Ethics Examination and the LMFT Clinical Examination after January 1, 2016 could experience up to an eight (8) week delay in obtaining their exam score report.  Each new Board examination requires an analysis of candidate responses to examination items in order to identify any problematic items that may need to be excluded from scoring. Once the analysis is complete and the passing score is validated, score reports will be mailed to candidates. 

So instead of that tense, few-second pause at the computer before your score pops up, now you have to wait a relatively long time to know the outcome of all your hard studying.  

When I completed the exam in February 2015, I received a certification letter at the test center stating that results will be mailed out in approximately 6 weeks.

Photo Credit Pixabay
What do you do while you wait?

First of all, you can give yourself permission to take a break from the process.  You just took (and hopefully passed) a big exam!

But before you take too long of a break, take some time to sit down and process your exam experience.

During the exam, did you run out of steam before finishing?  Did you forget to bring anything that could have helped you (printed directions to the test center, a snack to eat before or after, etc?)  Did you utilize “marking” a question to go back to review or not?  Did you finish earlier than you thought or did it take you longer than expected?

Content wise—were there specific topics that you recall being difficult for you?  Jot them down and make a plan to review those content areas.  Good news here: ethics makes up a big portion of the ASWB clinical exam, too (18% of those questions).

You know what kind of timeline under which you are operating – you can either wait to receive your results or just go ahead starting to prep for the ASWB exam.  Find affordable test prep and practice exams here.  Either way, good job on completing this first important step!

Sunday, February 21, 2016

Kate's LCSW Journey (Part 2)

Read Part 1 here

I became eligible to take the exams during the transition time from California’s Standard Written exam followed by Clinical Vignette exam (2015 and prior) to the current Law & Ethics exam followed by ASWB Clinical exam (2016 and onward).  I decided to hold off on taking the exams until 2016.  It’s likely that my family will relocate states again, so I thought the nationally-used ASWB Clinical exam would be advantageous to potentially transferring my future license to another state. 

But honestly, it also felt good (in that lazy way, you know what I’m talking about) to procrastinate on studying some more.  I was now pregnant again and found it hard to devote time to studying, plus working, plus parenting.  

(For those of you keeping track, yes!  This story has now gone on for so many years that it includes me giving birth to two [2] children and attaining zero [0] clinical licenses!)

I found my old study materials from the Illinois LMSW exam and laughed when I saw that I was using SWTP’s practice test questions back in 2010, and here I am using them again six years later.  For me, slogging through a massive tutorial trying to cover every possible topic on the LCSW exams sounds too daunting and likely to make my eyes glaze over.  I also know I have good knowledge on certain topics and want to focus on the ones I don’t know. 

Taking practice exams is a great way for me to jump in to the studying process – I took a practice exam without studying, just to gauge my readiness level.  It was a wincing moment when I saw the initial score, but I know that it was going to be improvement from there forward.  I also find the SWTP blog posts focusing on specific content, with a practice question and detailed rationale on the right and wrong answers, to be very memorable for my learning style.

I’m motivated now to take (and pass!) the LCSW exams for several reasons. 

  •       I want to ensure I have greater job opportunities in the future that an LCSW will open up for me—I don’t want to be held back by lacking those letters behind my name. 
  •       Ideally I want to be able to find a clinical job with a nonprofit that would be eligible for the Public Service Loan Forgiveness program. 
  •       I’m motivated because I don’t want this process to drag on for any longer – it’s already been the better part of a decade!
  •       I’m also motivated because I know that now that the process has started, I better not let my eligibility lapse.  It would be a major nightmare to reapply for exam eligibility with my out of state background.
  •       I’m eager to accomplish my LCSW because as good as procrastination feels, getting a long-overdue task handled and checked off your to-do list feels a million times better. 

Photo credit Pixabay

I know that there are many other readers who can relate to the last point.  What about you out there?  Why are you motivated to take and pass the LCSW exam?  Share via comment below.  Or— submit your own story to be featured to motivate others just like you!

Bonus PS – Read up about motivational interviewing and then practice motivationally-interviewing yourself to get started on your own LCSW test prep!

Saturday, February 20, 2016

Kate's LCSW Journey (Part 1)

Photo credit Christy Tyler Photography
My name is Kate and I’m an MSW en route to getting my LCSW.

I graduated from my MSW program in 2010.  While job searching I passed the LMSW in Illinois.  I subsequently acquired all of my clinical hours during my time working as an adoption counselor.  I became eligible to take the Illinois LCSW exam in 2012.

Right around the time that I received my eligibility from the Illinois board and I began to study, it became clear to my family that a move to a different state within the next six months was likely to occur.  Additionally, life happened – I became pregnant and the challenges of working fulltime, being pregnant, figuring out the logistics of a cross-country move, along with general life-living, all got in the way of preparing for the LCSW exam. 

Simply stated, I lost motivation to study and take the exam since I didn’t even know where we would be ending up – west coast or east.  (Who else out there has longed for some sort of a national-level LCSW certification, huh?)

We landed in California and I began the long, arduous process of trying to become exam-eligible in a new state.  Happily, my clinical hours in Illinois were deemed worthy by the California Board of Behavioral Sciences.  I had to take some extra courses to meet CA’s state requirements and ensure that the Illinois board submitted a bunch of documentation—even verifying my IL supervisors’ LCSW certifications.

The wait to hear back from CA BBS was long.  I submitted my packet to the BBS in February of 2014 and ultimately got approval in May of 2015.  15 months!  Although it’s typical for a lengthy wait (averaging 6-9 months at that time), the length of my wait time was anomalous. My approval was delayed because of issues getting some information correctly submitted from the Illinois board to California.

My loooong wait to get CA BBS approval to sit for the exams provided, in equal parts, some welcome procrastination from the process as well as some motivation to just get this done already.  Meanwhile, I was able to find a job that does not require LCSW certification.  Phew!

Come back for part 2 which discusses the rest of Kate’s exam-eligibility adventure and read about her motivation to finally prepare for the exams!