William Brosh, LCSW - Counseling and Psychotherapy
Bill's Blog

An Ineffective and Dangerous Form of Punishment

'Benjamin Button Haircut' for Children No Laughing Matter
by Pauline Anderson, February 11, 2015

The worst kind of punishment that you can give to a child is to humiliate them in front of their peers; and teens are particularly vulnerable to being shamed.  Humiliating experiences often provoke a backlash of even more destructive behaviors and, worse, have a high potential to result in lifelong problems. When punishment is necessary, it must be utilized in a way in which the child will still feel that their parents will keep them safe and can still be trusted.  Read the article for a very fine assessment. 

http://www.medscape.com/viewarticle/839619?src=rss



Teaching again at Hunter College MSW Program

This fall semester, 2014, I will again be teaching at the Silberstein School of Social Work at Hunter College, City University of New York.  The class will be concerned with "Adult Psychopathology" which is part of Human Behavior in the Social Environment coursework.

I will be helping students to understand the etiologies of various mental illnesses, how to recognize symptoms in the context of one's social environment, and how to plan effective treatment.

In doing so, students will learn how to use the new Diagnostic and Statistics Manual (DSM-5), in order to assess accurate differential diagnoses.

Our goal will be to prepare future practitioners (in any mental health or substance treatment setting) to apply a psychiatric point of view to their bio-psychosocial assessment skills.

I am very much looking forward to meeting my future students.

Teaching at Hunter College MSW Program

This summer semester, 2014, I will again be teaching at the Silberstein School of Social Work at Hunter College, City University of New York. The class will be "Adult Psychopathology" which is part of Human Behavior in the Social Environment coursework.  Our purpose will be to gain a deeper understanding of psychopathology in adults and symptomatic behaviors in the environmental context. 

I will be helping students to understand how to recognize mental health disorders and assess differential diagnoses in order to identify appropriate treatment strategies.  In doing so, we will be comparing the clinical changes made in the recently published DSM-5 (Diagnositic and Statistics Manual) to the previous DSM-IV-TR.

Our goal will be to prepare future practitioners (in any mental health or substance treatment setting) to be able to apply a psychiatric point of view to their familiarity with biopsychosocial assessments.

I am very much looking forward to meeting my future students.

Workshop: Co-Parenting: Improving Communication

Career Gear [a suit - a second chance]  - is a wonderful organization, whose Professional Developmental Series provides skills that focus on the professional and emotional state of participants who are engaging in life changing experiences.  Last night I led a workshop "Co-Parenting:  Improving Communication" which was designed to help the men in attendance to better manage the dynamics that arise between themselves and their co-parents - who, together, are responsible for the well-being of their children.
Career Gear
120 Broadway
NYC 10271

Teaching at Hunter College

This fall semester, I will be teaching a class at the Silberstein School of Social Work at Hunter College, City University of New York.
 
The class will be "Adult Psychopathology" which is part of Human Behavior in the Social Environment coursework.  I am very much looking forward to meeting my future students.

Couples Counseling

 How does it work?

I believe that most people come to couples counseling with the presumption that they and the therapist will quickly begin to work towards restoring and/or improving the relationship.  I can’t speak for other therapists, but that is certainly not how I work.  How can we fix anything… whether it’s a car or a relationship, before we know exactly what the problem is and whether it is even repairable?

Some couples may come readily prepared to work hard on themselves, individually and with each other, for the sake of the relationship.  But, in my experience, most couples are not so clear about their goals.  One [or both] may be too confused to know exactly how he/she feels or what he/she wants.  Others actually come in order to achieve an amicable separation, though they may not always be aware of it.  Most often, though, couples come with a mixed agenda… where one may be desperate to work on the relationship while the other is desperate to walk out the door.

When couples come to me for help, I will first listen to what the couple presents as the difficulties. There will be no decision to move toward repairing the relationship at this time.  By the end of our first session, I will usually offer the terms that I find works best.  It typically goes like this… I will ask to meet with each of the individuals separately, one or more times, in order to be sure that I “hear” each of the partners’ concerns.  And, of course, we will also meet jointly.

 Only when it is clear to me and to both partners as well, [it often takes four or five sessions] do we decide which path we intend to take – whether to work diligently on the relationship [which always includes much individual change], or to work towards a healthy and amicable alternative to restoration and improvement


 
 – “If we do choose to work on the relationship, how long will it take?”

 
One of the most difficult problems that the couple and the therapist encounter is the pressure of time.  Intellectually, people know that when damage has been occurring for a long time… months or even years… the repairs may take a significant amount of time.  But we don’t always operate in an “intellectual” or even a rational manner.


Imagine this scenario:  An individual walks into a Medical Doctor’s office.  After a few questions, the doctor asks, “So when exactly did the pain start and what did you do about it?”  The patient responds:


            Well, I don’t recall exactly when the pain started… it has been a long time though… too long.  At first, I tried to ignore it.  But that didn’t really work.

            When I couldn’t ignore the pain anymore I tried to convince myself that whatever was causing the pain was just something minor – that it was temporary and sooner or later it would resolve itself.  But, it just kept getting worse.

            To be honest, I did think about going to a doctor; but, no offense, I don’t like going to doctors.  Maybe I’m afraid of them?  Or maybe I was worried that a doctor wouldn’t be able to figure out what’s wrong.

            Anyway, I then tried to believe I could just live with the pain… that I could find a way to accommodate it or integrate it into my life.  But, slowly [and I didn’t notice at first] the pain began to increase; and later, it was like, exponentially worse.

            By that time, I had already started to drive everyone in my family crazy.  The pain affected everything… my mood, my functioning.  Finally, I couldn’t deny that I needed help.  My life became a mess.

            So here I am!  Now, I’m glad I’m here.  So, doctor, what do you think?  You’ll be able to fix me up by the time I leave today, right?


Similarly goes the usual scenario of entering couples counseling.  By the time the couple walks into the therapist’s office, more often than not, you-know-what has hit the fan.  There has been Suffering.  Anger.  Resentment.  Sadness.  Frustration.  Hopelessness.  PAIN!  And so it feels to the couple that the “fix” needs to happen right now!  [In fact, yesterday would be even better!]

Obviously, this is not a realistic expectation. However, miracles are not required.  With commitment and faith, changes can happen.  Like any other important skill, it takes time to acquire the insight and to establish new behaviors that are needed to restore and even to improve the relationship.  We may not know how long it will take, but once a good outcome is achieved, it may last a lifetime.
 
             

“never wanna c u again!” Or, Text Messaging - a bad tool for an important job

Recently, I was counseling Mr. D and Ms. E; a couple that had separated, but were trying to get back together.  Predictably, (like nearly every couple) poor communication was at the heart of their difficulties.  

Early in the treatment, they described how they frequently had their arguments via text messages.  For, example, Ms. E would cancel a date scheduled for that evening with a text like “changed mind not coming”  Or Mr. D would become agitated and furious when - in the middle of a “conversation” - Ms. E would stop returning his texts altogether.  More often than not, when the dialogue resumed (hours or sometimes days later), it would begin again through text messages.  

I have learned that many people today prefer text messaging to phone calls.  And I understand (or think I do!) the usefulness of texts as a form of communication.  But I am also sure that having a dispute or expressing conflict about something as important as one’s relationship through text messages can be both emotionally limited and potentially more damaging than effective.  

So… I remember saying to them, “You know, I realize that I am older than you are and it’s perhaps even likely that you might think that people of my generation just don’t “get” texting.  And I can appreciate that sentiment.  

“But it’s important for me to say that, in a relationship, honest and effective communication is an incredibly difficult skill to maintain consistently, in the best of times and circumstances.  Even talking… looking into each others’ eyes with the best of intentions… often can’t capture exactly what we are feeling and what we need our partner to understand.  

“It’s hard for me to imagine that text messages can be relied on for a nuanced and effective communication of emotions.  Even the disembodied voice of a phone call can express subtle information that texting misses. I really believe that the bottom line is, if you're not making your absolute best effort to communicate effectively, you are being disrespectful to the relationship.”  

I asked Mr. D and Ms. E to commit to each other that all future communication that they felt was important to the relationship, be done by phone - or even better, saved for when they would see each other in person.

Resolving Conflicts and Making Choices: Wish vs. Expectation

"I have a dilemma, Bill, and I don't know what to do!"
 
Daily life requires that we must constantly make choices.  Black or brown shoes?  Have another beer or go home?  Go to the baseball game or to a cousin’s funeral?  Fortunately, most decisions are relatively easy to make and don’t require the expending of much psychic energy.
 
Then, there are the BIG decisions.  Most people don’t ask their therapists what car to buy or where to go on vacation.  But our clients do ask us to help them to make choices that can resolve dilemmas where their emotional and rational selves appear in conflict.
 
In addition to our education and our trainings, most of us therapists also develop our own creative and often original techniques, to effectively help our clients.  Here is a self-examining exercise, which, from my experience, I find clients respond well to.  I call it Wish vs. Expectation
 
Example:
 
In our session, (we’ll call her) Janet, presents a dilemma.  She confides that she has lately been preoccupied, thinking about an ex-boyfriend.  Although she has not spoken to him in more than two years, and both now have new partners, Janet feels that she is on the verge of phoning him.
 
The relationship did not end terribly… but not particularly well either.  Janet states that she never truly felt that she had experienced closure and there is still much that she would like to say (and hear!).  She admits that her "emotional" side also wants to know whether he still has feelings for her.
 
Yet, at the same time, Janet recognizes that reaching out to her ex might be a risky proposition.  She fears that there could easily be an unrewarding outcome. 
 
Now she now feels stuck, vacillating between "to call or not to call," because her mind is very good at presenting compelling arguments for both the emotional and rational aspects of the issue.
 
Responding to her conflict, I say to her, “Okay Janet, your mind is playing ping-pong between two different types of logic.  Let’s see if we can break through.  Start by imagining [you can close your eyes, if you think it will help] …you call up your ex-boyfriend “out of the blue” as you described it.  He answers the phone and you have a conversation.  Now… imagining that you had your dialogue and now the call is over…  What is the outcome that you would most hope for?  Feel free to fully indulge your fantasies.  Describe, in detail, what it is that you wish to experience.”
 
Usually, our wish is to have an experience that will feel great, make us happy – and will have a lasting effect.  We recognize that this is fine because we are all entitled to indulge our fantasies of perfect outcomes.  But what is most important in this exercise is in the exploration of the conscious and unconscious meanings of the wish.  We want to learn about the origin of the wish, how it was subsequently refined and what is the emotional gain that is hoped for.
 
Once we have a working understanding of the wish, and both its real and metaphoric meaning, my next request is, “Now Janet, let’s go back again to imagining the moment you finish the phone call with your ex-boyfriend. This time, instead of exploring what you wish for, let’s tune into what you actually expect would result?  In other words, use your most rational, logical mind to try to predict the most likely consequences of what will occur after you call him.”
 
I find that clients nearly always recognize, rather quickly, an interesting disparity, or gap, between what their emotional selves yearn for and what their rational selves predict.  Further exploration and self-examination of this gap usually gives the client
some insight as to whether her wish for total emotional gratification is likely or even possible.  A wider perspective begins to take shape, which is less conflicted and more reality based.
 
Often, depending on the nature of the issue, the order of the questions can be reversed.  I may ask the client to begin by exploring her expectations first and then to entertain the wish fantasy after.  Either way, the goal is for the client to become curious about her inner processes and ultimately to be able to use a new analytical skill to help resolve psychological impasses.

Review of “No One Wants to Work With Me: Working with Difficult Populations” Workshop

Below is the review of our workshop.  To read more, go to the following link to the Criminal Justice Caucus blog:
 
Criminal, dangerous, scary, stay away, scared, murder, watch out, offensive, terrible, aggressive…these are some of the phrases chosen to describe “violent offenders” in a free association exercise.
 
On April 11, Nicole Rochat, LMSW, Director of Social Work/Reentry Program at Office of the Appellate Defender (OAD) and Bill Brosh, LCSW, Forensic Social Worker at Legal Aid Society challenged attendees to re-frame these labels to avoid “othering” in a workshop entitled “No One Wants to Work With Me:” Working with ‘Difficult’ Populations, hosted by the Criminal Justice Caucus in partnership with the Men’s Caucus.
 
Parent, student, classmate, relative, teacher, friend, boss…if we are going to label people, these words do a much better job of identifying the many roles people play outside of the criminal justice system.
 
Mr. Brosh drew an important distinction when we talk about “difficult” clients; some clients present as difficult for us to work with professionally because they are non-compliant, challenging, or defiant, while others are difficult for us to work with personally because they committed a heinous crime but we often find them to be very engaging and likeable.  “It’s very upsetting when your entire worldview gets challenged.  That’s why we need to separate the behavior from the human being,” he explained.
 
So, what is it about working with certain populations or individuals that makes us so uncomfortable?  The feelings identified related to anxiety, anger, frustration, powerlessness, fear, and being unsafe.  In response to a question about how to empathize with someone when you cannot understand how they could have committed a certain crime a participant stated, “I could never murder someone else.  I just couldn’t.”  Mr. Brosh responded, “It’s very hard to know what you would do when the pressure gets turned up and up and up…  Really, you could do almost anything.  You might just be capable of doing things you never thought you could do.”
Mr. Brosh added, “What is your view of humanity?  How does the world really work?  If you come into the room with some kind of mindfulness and acceptance around the reality of how humanity works, it makes it much easier to work through some really challenging stuff.  I’m not saying you should accept heinous crimes as okay from a judgmental place; just that this is the reality and to be accepting of everything is often so challenging.”
 
Ms. Rochat ended the workshop by showing a clip from MTV’s True Life: Sex Offender followed by a brief discussion about our misconceptions and judgments of people labeled registered sex offenders.  She encouraged the room to consider whether or not the registry requirements actually promotes public safety or just serves to publicly shame individuals who have already served them time.  The title of this workshop came from a client at OAD on the sex offender registry who has been told so many times that he is unworthy and undeserving that he really started believing it and questioned why anyone would want to work with or help someone like him.
 
The light at the end of the tunnel: “some people want to work with me.”  While they are certainly not the majority, there are quite a few providers who genuinely want to work with those who are routinely marginalized and oppressed, pushed to the outer limits of society and deemed undeserving by most others.  Ms. Rochat acknowledged that it is perfectly acceptable to questions why we would want to help anyone who has harmed someone else, but she forced us all to remember, “Everybody is a human being with a story.”
 

WORKSHOP: "No One Wants To Work With Me"

No One Wants To Work With Me
Working with ‘difficult’ populations
 
I will be co-facilitating this workshop.  It will be a great training for any social work student, intern or professional.
 
Here are the details:
 
WHERE: Columbia University School of Social Work
1255 Amsterdam Ave, Room 404
 
WHEN: April 11 @ 12:15PM

 

A discussion and skills-based workshop facilitated by Nicole Rochat, LMSW, Director of the Social Work/Reentry Program at Office of the Appellate Defender and Bill Brosh, LCSW, Forensic Social Worker at Legal Aid Society.
 
 
 
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An Ineffective and Dangerous Form of Punishment
Teaching again at Hunter College MSW Program
Teaching at Hunter College MSW Program
Workshop: Co-Parenting: Improving Communication
Teaching at Hunter College

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