Journal of Diverse Social Work ~~~ Hunter College School of Social Work ~~~

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1 Journal of Diverse Social Work ~~~ Hunter College School of Social Work ~~~ Inaugural Edition 2010

2 Journal Mission This journal is a forum for Hunter social work students to present and engage scholarship which reflects the academic rigor and sober idealism which are the cornerstones of the Hunter College School of Social Work. Just as Hunter s students regularly display professionally impassioned work in the field, many also create professional quality work in the classroom, deserving recognition for its merit and appreciation for its practical implications. We hope that this journal will serve not only as a forum for the work of current students from year to year, but as a motivation for future cohorts of social work students to conceive of themselves as scholars as well as practitioners in the making. 2

3 Table of Contents Editorial Board, Advisory Board, Administrative Staff... Page 4 Editorial Letter...Page 5 Disparities in the Health Care Experience of Lesbian Patients by Sharon Kaye O Connor Page 6 Improving Mental Health Care for Veterans: Lessons for Social Workers by David Shernoff......Page 10 Conflict Theory and Education: A Case Study at the University of Denver Graduate School of Social Work by Cameron Brown.... Page 15 Karen Horney s Contribution to the Strengths Perspective in Clinical Social Work by Tiffany Hung.....Page 21 The Politics of Physician Assisted Suicide: A Synthesis of Reverence for Life and Individual Autonomy by Dana Kragh...Page 26 Documentary Theatre and Eating Disorders: An Art Based Intervention for Education, Empowerment, and Advocacy by Mikki Jordan......Page 29 Editors & Contributors.. Page 32 3

4 Journal of Diverse Social Work Editorial Board & Managing Editors David Katzenstein ~ Hal Pollack Faculty Advisory Board Dr. George Getzel ~ Dr. Carmen Morano Joanne Messina ~ Dr. Steven Parker Administrative Staff Janet Tyson, Executive Administrator Hazel Chapman ~ Lauren Mazer ~ Yael Shwartz We wish to thank our professors and peers who guided and contributed to this project from its inception to its completion, with special gratitude to Dean Andrea Savage, Dr. Yolanda Mayo, and Dr. Irwin Epstein, for their unwavering commitment to the journal s success. With collective support the notion of a HCSSW student journal has gone from an abstract idea to a compelling reality. We are proud to announce that Cameron Brown and Dana Kragh, members of the HCSSW class of 2011, will be the managing editors for the next edition of the Journal of Diverse Social Work, and wish them the very best of luck in this endeavor. 4

5 Editorial Letter We welcome you to the inaugural edition of the Journal of Diverse Social Work. In this volume, we offer the reader articles on a range of topics which reflect the diversity of contemporary social work practice. In Disparities in the Health Care Experience of Lesbian Patients, Sharon Kaye O Connor illuminates the systemic micro aggressions to which the current health care paradigm actively and passively subjects its lesbian patients. In Improving Mental Health Care for Veterans: Lessons for Social Workers, David Shernoff discusses the unique mental health needs with which veterans returning from combat in Iraq and Afghanistan present, and explores two particular therapeutic programs which are successfully striving to provide this population with necessary and deserved support. In Conflict Theory and Education: A Case Study at the University of Denver Graduate School of Social Work, Cameron Brown argues for the importance of Spanish language social work programs in effectively addressing the needs of the fastest rising ethnic group in the United States, and presents a case study of a pilot program aimed at improving the cultural and linguistic competence of social work students. In Karen Horney s Contribution to the Strengths Perspective in Clinical Social Work, Tiffany Hung discusses the underappreciated and potential impact of Karen Horney on the field of clinical social work, and demonstrates that aspects of Horney s psychoanalytic theory speak to the core elements of social work s strengths perspective. In The Politics of Physician Assisted Suicide: A Synthesis of Reverence for Life and Individual Autonomy, Dana Kragh explores opposing sides of the ideologically fueled debate over physician assisted suicide, and attempts to draw out the central aspects of each position. In Documentary Theatre and Eating Disorders: An Art Based Intervention for Education, Empowerment, and Advocacy, Mikki Jordan proposes a unique treatment modality for eating disorders, enumerating the benefits that documentary theatre can have for a population which is often misunderstood and therefore under treated. David Katzenstein & Hal Pollack, Editors 5

6 Disparities in the Health Care Experience of Lesbian Patients Sharon Kaye O Connor, MSW 2010 Abstract This article explores the challenges experienced by lesbian patients in the health care setting. As the arena of womenʹs health care, particularly the field of obstetrics and gynecology, is focused primarily on the health needs of heterosexual women, lesbian and bisexual women are less likely to obtain the care they need, and are more likely to encounter stigma and negative responses from practitioners when they do seek care. Negative practitioner attitudes as well as a culture of heteronormativity act as deterrents to non heterosexual women obtaining quality and comprehensive care specific to their needs. Along with these challenges encountered in the health care environment, barriers created by policy, such as the inability of lesbian women to obtain health insurance through their partners, and the resulting inability to afford quality health care, also factor in to the overall lacking health care experience for the lesbian patient. W ithin the realm of the health care field, the experience of the patient is an extremely important factor in the perceived overall quality of the care received. Because the patientʹs experience is such a large element of care in general, in a health care situation in which the experience is unpleasant or lacking, it can also be perceived that the care itself is inadequate. Very often in the field of womenʹs health, practitioners operate with the ongoing presumption that their patients are heterosexual, and structure their treatments and interactions with patients accordingly. In other cases, practitioners may harbor strong biases against nonheterosexual patients. As a result of these assumptions and biases, and their resulting practices, the general health care experience queer women encounter as lacking often leads to inadequate or incomplete care, or the avoidance of health care situations entirely (Fields & Scout, 2001). The health care experience from the patientʹs perspective is frequently influenced by several factors, many of which are addressed by the Agency for Healthcare and Research Quality (2008) in its National Healthcare Disparities Report. The factors contributing to the overall patient experience, as discussed in the AHRQ report, are largely based upon communication between patients and their health care providers. The quality of communication between patient and provider can be assessed by the patientʹs perception of the degree to which the provider listens to her, whether or not the provider spends an adequate amount of time with her, respects her questions and concerns, or explains information in a manner that is understandable (AHRQ, 2008). The quality of patient provider communication also depends on the level of comfort the patient feels with disclosing personal information to her provider. In order for successful patient provider communication to exist, it is necessary for the patient to feel able to be open and honest with the provider regarding major issues. For the patient to feel such comfort, it requires the practitioner to exude an attitude of unconditional positive regard. The level of comfort necessary for such disclosure and discussion very often does not exist for the female patient who identifies as gay, lesbian or bisexual (Klitzman & Greenberg, 2002). 6

7 For the purpose of this discussion, the words gay, lesbian and queer will be used interchangeably to refer to woman whose sexual partners include, or have included women, regardless of whether or not their sexual interactions presently include, or have ever included, men. A 2002 study by Klitzman and Greenberg analyzed the potential factors that might have a detrimental effect on communication between lesbian patients and their health care providers. This study addressed the issue that gay women may be less inclined to openly disclose their sexual orientations to their health care providers due to the fear that they will face stigma and the quality of their care will be compromised (Klitzman & Greenberg, 2002). Fields and Scout (2001) recount the story of a young woman who, after telling her gynecologist she was bisexual, was abandoned in the examination room by the doctor, and the exam was then completed by the physicianʹs assistant. Klitzman and Greenberg (2002) found that these women are afraid of facing stigma not only from their healthcare providers but from their employers as well, due to the increased skepticism patients feel regarding their health insurance companiesʹ confidentiality practices. This fear of stigma, and ultimately of discrimination, from those in a patient s life who have access to her personal information, could understandably prevent a patient from disclosing said information to her healthcare provider (Klitzman & Greenberg, 2002). The Klitzman and Greenberg (2002) study also found that among the LGBTQ population, lesbians were less likely than their gay male counterparts to feel comfortable discussing their sexual orientations with their healthcare providers. The study hypothesized that this disparity existed because women were more likely than men to have physicians of the opposite gender of their own, which could lead to a decrease in trust and increase in presumed inability of the physician to understand the patientʹs position (Klitzman & Greenberg, 2002). Although it might be assumed that lesbians would be much more likely to disclose their sexual orientations to providers who were gay themselves, Klitzman and Greenberg (2002) found that this was not necessarily the case. In general, the gay women in their study were less likely than gay men to feel comfortable discussing their sexual orientations, or sex in general, with their physicians. Gay women were also less likely to believe they even had the option of finding a physician who was a lesbian, either due to limitations within their insurance networks or sheer lack of availability of LGBTQidentified physicians (Klitzman & Greenberg, 2002). Because it is often difficult to find physicians who are gay or gay friendly, it could be argued that gay women are so acculturated to the environment of heterosexual physicians (and very often, heterosexual male physicians) that on the rare occasion they do encounter a gay or gayfriendly healthcare provider, they may still feel quite uncomfortable discussing their sexual orientations as they are largely unaccustomed to health care situations in which they are able to do so. Considering the heterocentrist medical culture to which so many queer women are accustomed, it may be greatly beneficial to the lesbian population for insurance companies to allow clients to search specifically for LGBTQidentified or LGBTQ friendly providers in effort to establish a culture in which lesbians are encouraged to feel comfortable discussing their sexuality and sexual orientations (Klitzman & Greenberg, 2002). Another significant element of the disparity existing in the healthcare experience for the lesbian patient is the fact that the non heterosexual patient falls outside of the norm ; the lesbian patient might be quite correct in assuming that medical knowledge and practice has not been designed with her in mind. Rosser (1993) described how the modern medical model was designed primarily with the heterosexual male in mind, giving the example of heart disease and how it is so often mistaken for a male disease by public perception (although this misconception is beginning to change). Heart disease clearly affects both men and women, despite the fact that the majority of funding for heart disease research has gone towards research of heart dis 7

8 ease in males rather than females (Rosser, 1993). Lesbian patients are on the outside of the medical paradigm to begin with due to their gender, and are now at risk of further disenfranchisement, due to their sexual orientation. Rosser (1993) also points out that the field of womenʹs reproductive health care, particularly obstetrics and gynecology, was built upon the framework of heterosexual sexual activity as the norm. The elements of this norm include procreation and womenʹs sexual relations with men. While funding for research surrounding femalespecific issues such as menstrual and postmenopausal difficulties has been extremely limited, the technologies relating to womenʹs health that directly involve procreation (particularly invitro fertilization and amniocentesis, as well as other technologies to assist reproduction) are much more apt to receive adequate attention and funding. This disparity suggests that womenʹs health care issues are generally perceived as more valid or worthy of research when the resulting data and treatment ensure womenʹs ability to procreate and thus be useful to men (Rosser, 1993). Because the health care needs of lesbian women do not necessarily (although they may) revolve around procreation, research in areas of lesbian specific health issues has been lacking. Although lesbians are typically at a much lesser risk for certain diseases that are generally transmitted to women by means of heterosexual sex (such as chlamydia, human papilloma virus, and HIV), gay women are at an increased risk for other diseases less likely to strike their heterosexual counterparts. Campbell (1992), in her work, 1 in 3 Lesbians May Get Breast Cancer, Expert Theorizes, quotes Dr. Suzanne Hayes of the National Cancer Institute, who estimates that one in three lesbians may develop breast cancer in their lifetimes because they are more likely than other women to fall into high risk categories for the disease (as cited in Rosser, 1993, p. 187). It is thought that the risk for breast cancer is higher for lesbians for several reasons. One reason is that gay women are less likely than heterosexual women to have children, and it is thought that women who have not had children are at an increased risk for breast cancer by 80% (Rosser, 1993, p.187). It is also thought that lesbians are at a greater risk of developing breast cancer due to a higher incidence of obesity. Finally, lesbians statistically visit their gynecologists for exams less than half as often as heterosexual women (Rosser, 1993). Aside from the potential discomfort with gynecological visits due to the heteronormative mentality among much of the medical community, this difference in frequency of obtaining care can also be accounted for by the increased regularity with which heterosexual women visit their gynecologists. These visits are often for the ostensible purpose of birth control prescriptions as well as pap smears and screenings for various conditions typically transmitted or caused by engaging in heterosexual sex. During these routine gynecological visits, breast exams and/or mammograms are performed. The frequent employment of these screening tools provide heterosexual women with a greater chance of finding breast cancer (or another potentially serious condition) in its earlier and more treatable stages (Rosser, 1993). Perhaps the largest and most pressing issue facing lesbian health care is the lack of access to health care due to lack of access to health insurance. Because lesbian and gay couples are perpetually denied marriage rights in most geographic areas, many gay women are left uninsured when they are refused coverage under their partnersʹ policies. As quoted by the 2007 AHRQ Report (2008), Health insurance facilitates entry into the health care system. The uninsured are more likely to die early and have poor health status...are diagnosed at later disease stages...are sicker when hospitalized and more likely to die during their stay (p. 114). Even if the culture of health care existed without its current biases and heterosexist practices, a major disparity would remain present as many lesbians would still lack access to health care in the first place. The disparities which are present in the lesbian patientʹs experience of health care are both pervasive and persistent. From the inherent heterocentrist practices quietly passed off as 8

9 standard or normal in the medical arena, to the biases which are held in secret or expressed blatantly by practitioners, to the inability to gain insurance coverage through their partners due to the bigotry that insists their unions are invalid, the lesbian patientʹs experience of health care is vastly different from that of her heterosexual counterpart. Moving forward, it would require nothing short of a shift in cultural consciousness to eliminate these disparities, but there is hope that with effective leadership, education and visibility, the playing field that is the health care experience may be leveled for patients at all points on the sexual orientation spectrum. References Agency for Healthcare Research and Quality, AHRQ (2008) National healthcare disparities report. (AHRQ Publication No ). Rockville, MD: United States Department of Health and Human Services. Retrieved February 26, 2009, from Campbell, K. (1992, October 2). 1 in 3 Lesbians may get breast cancer, expert theorizes. Washington Blade. 1,23. Fields, C., & Scout, S. (2001, September). Addressing the needs of lesbian patients. Journal of Sex Education & Therapy, 26(3), 182. Retrieved February 26, 2009, from Academic Search Premier database. Klitzman, R., & Greenberg, J. (2002, February). Patterns of communication between gay and lesbian patients and their health care providers. Journal of Homosexuality, 42(4), 65. Retrieved February 26, 2009, from Academic Search Premier database. Rosser, S. (1993). Ignored, overlooked or subsumed: research on lesbian health and health care. NWSA Journal, 5(2), Retrieved February 26, 2009, from America: History & Life database. 9

10 Improving Mental Health Care for Veterans: Lessons for Social Workers David Shernoff, MSW 2010 Abstract During the years and decades ahead, it will be imperative for the United States to provide for the wide array of complex and intensive mental health care needs of the nationʹs returning military veterans. This article will attempt a brief summary of the scope and variety of mental health issues presently impacting combat veterans of the United States military, An effort will be made to assess the psychological and psychosocial challenges confronting our veterans after they return from combat theaters. After a brief discussion of the programs most commonly providing mental health care and therapeutic services to veterans and their families, two promising, recently established advocacy organizations working to improve mental health services for veterans will be examined. Attention will be paid to the roles that social workers as clinicians, organizers and advocates can play in addressing the urgent and often unmet needs of the nationʹs veterans.... let us strive on to finish the work we are in, to bind up the Nationʹs wounds, to care for him who shall have borne the battle and for his widow and his orphan.... Abraham Lincoln, Second Inaugural Address, Saturday, March 4, A man who is good enough to shed his blood for his country is good enough to be given a square deal afterwards. More than that no man is entitled to, and less than that no man shall have. Teddy Roosevelt, 1903 A t the time of this writing, approximately 120,000 and 45,000 active duty soldiers are deployed to the theaters of war in Iraq and Afghanistan, respectively. Despite affirmations made by President Obama during his presidential campaign, there is no valid basis for believing that all combat troops will be redeployed from Iraq in the near future. The President has already begun delivering on his campaign promise to increase troop levels in Afghanistan, and the Department of Defense has committed 20,000 additional troops to that conflict in coming months in an attempt at an Afghan surge. The number of veterans who have already completed their tours of duty in both conflicts is large and rising: Since 2002, more than 1.7 million members of the U.S. armed forces have served in an active duty capacity in the Iraq and Afghanistan wars. It will be imperative during the years and decades ahead for the United States to maintain a public mental health infrastructure sufficiently and capably equipped to deal with the ongoing, multiple, complex and intensive mental health care services our veterans will certainly require. This paper will attempt a brief summary of the scope and variety of mental health issues presently impacting combat veterans of the United States military, with a particular focus on Post Traumatic Stress Disorder (PTSD). An effort will be made to assess the psychological and psychosocial challenges confronting our veterans both as they depart for, and after they return from, combat theaters. A limited analysis will then be ventured of the efficacy, and potential areas of improvement, of the programs most commonly providing mental health care and therapeutic services to veterans and their fami 10

11 lies. Finally, the work of two promising, recently established advocacy organizations striving to improve mental health services for veterans will be examined in some detail. As war is inherently horrifying and shocking, soldiers involved in war inevitably experience trauma of some variety. While human beings especially men appear to be designed for combat and possibly possess an innate taste for extreme violence and killing, the actual experience of warfare is profoundly psychologically damaging to the many who have been exposed to, or who have engaged in, it. A small minority of soldiers and combat veterans may deeply enjoy mortal combat on the battlefield, and be gratified by the infliction of harm or even death on other human beings. Those veterans are not the focus of this paper, and it would likely prove difficult to empirically support such a speculative, provocative claim. The battlefield offers endless opportunities for soldiers to sustain psychological and emotional shocks and wounds. Yet perhaps the most damaging element of warfare is its capacity to undermine a person s general sense of security and safety at any given moment. This overall, everyday sense of safety and security that it is safe to walk down the street to a subway station, or that a fellow subway passenger does not, in fact, have a bomb vest hidden beneath his sweater, or that the destination the subway is transporting you to is not laden with mines and explosives and/or populated by fanatical adversaries willing to commit suicide in order to end your life as well, etc. is a kind of prerequisite for normal and adaptive psychological functioning and participation in the social order. In the absence of this overall sense of security, an individual can live in a nightmarish state of acute, constant fear of looming physical danger and threats, a state in which an apprehension of imminent risk or even death never relents and can never be alleviated. This shifting of the normal, daily experience of an individual from a secure to an insecure, vulnerable state is the most widely observable consequence of participation in warfare by soldiers and veterans. PTSD is rooted in this loss of a fundamental sense of security and safety, and in the consequent shifting of daily experience from a secure to an insecure state. As William Tecumseh Sherman memorably phrased it, war is hell. The Roman poet Virgil captured the impenetrability of that private hell to those who have personally and directly endured the horrors of warfare an impenetrability of which caregivers aspiring to treat the invisibly wounded would be well advised to be cognizant and respectful when he said that each of us bears his own hell. According to a major recent study conducted by the RAND Institute, some 20% of combat veterans who have returned from Iraq and Afghanistan are already bearing their own hell, as evidenced by their suspected suffering from PTSD, depression, and general anxiety disorder (Tanelian & Jaycox, 2008, p. 96). Based on the above cited 1.7 million total number of soldiers who have rotated through Iraq and Afghanistan since 2002, roughly 340,000 cases of PTSD and related conditions have either been diagnosed already among, or are presumed to be warranted for, returning combat veterans. Even more disturbing is the RAND report s conclusion that half of those troops and veterans affected are not receiving proper mental health care. Furthermore, physiological conditions such as concussions and Traumatic Brain Injury, conditions that are highly comorbid with PTSD and depression, are likewise not being properly diagnosed and treated. The present reality is that tens of thousands of new veterans returning home every year are suffering from mutually reinforcing psychological and brain injuries, which are diagnosed and treated only half of the time. In addition to PTSD, a high number of returning veterans are suffering from undiagnosed and untreated major depression, anxiety disorders, increased substance abuse, a heightened vulnerability to physical ailments, and are generally unable to reintegrate into the social order. This is a moral outrage and constitutes a social policy failure of great magnitude. There are a number of reasons for this massive failure of public mental health care systems. First and most obvious, longstanding, 11

12 deeply ingrained stigmas associated with seeking mental health care and being treated for mental health conditions persist, especially in the culture of the military. The RAND study found that many of the interviewed service members actively and intentionally avoided subjecting themselves to clinical assessments and care that they believed would have resulted in a mental health disorder diagnosis. A substantial body of research bears out the commonsense claim that stigma impedes people from seeking and fully participating in mental health care services. In particular, the threat of social disapproval and diminished self esteem that accompanies the label accounts for underused services (Corrigan, 2004). There is every reason to suspect that military cultural factors render soldiers and veterans even more susceptible than members of the general public to the adverse and inhibiting effects of stigma. A major study was published in the New England Journal of Medicine in 2004 which, to date, represents the most comprehensive examination of the barriers to proper mental health care faced by both active duty and returning combat veterans. Study participants who met screening criteria for a major mental health disorder were asked what they believed to be the most significant barriers to their receiving mental healthcare. The fear of being perceived as weak and a fear of losing the trust and confidence of their colleagues were the leading reported barriers (Hoge et. al, 2004, p.17). Nearly as commonly, respondents felt that integrating a mental healthcare treatment regimen into their lives and schedules would be a significant challenge. A majority of respondents believed that accessing appropriate treatment would hinder their ability to execute their duties and responsibilities, and there is no good reason to believe that their concerns were groundless. This implies that the military s own systems of mental health care are not adequately integrated into their total provision of healthcare for service members. The military is simply not well prepared for the virtually certain contingency that a large share of combat soldiers will sustain mental health injuries. The healthcare service delivery mechanisms maintained both by the service branches and by the Veterans Administration simply have not integrated mental healthcare preparedness as well as they ought to. Whether this is a greater barrier to care than an excess of caution in receiving potential treatment born of careerist caution remains to be seen. A remarkable advocacy organization called Iraq and Afghanistan Veterans of America (IAVA) was founded in 2004 by Paul Reickhoff, an Iraq War veteran. Its mission is stated simply: to improve the lives of Iraq and Afghanistan veterans and their families. While IAVA is only five years old, it has had significant success in impacting policy discussions and heightening awareness among policymakers and in the media of the multiple challenges facing new veterans as they return from the battlefield. IAVA places a particular emphasis on the need to publicize and destigmatize the discussion of mental health and Traumatic Brain Injury and the urgent need to increase mental health screening and support services among active duty soldiers as well as veterans. IAVA maintains an extensive website which provides clear, easy to access information regarding how to attain mental and physical healthcare services and how to navigate the VA most effectively. The website also allows interested parties to easily contact local, state and federal political representatives on behalf of veterans, and the IAVA is building a rapidly growing lobbying presence in Washington D.C. The most ambitious element of IAVA s legislative agenda is a new GI Bill which would substantially increase educational benefits for service members, sufficient and reliable funding of veterans health care, and mandatory, confidential mental health counseling for all troops returning from combat duty (IAVA 2008 Annual Report, p.6). This last element of the proposed new GI Bill reveals IAVA s explicit goal of placing mental health care for veterans at the heart of its mission and reflects its view that mental health care is inseparable from the overall welfare of returning veterans and their families, and needs to be consistently addressed in a public, open 12

13 manner. In recent years, suicide rates have increased markedly among active duty soldiers and veterans returning from Iraq and Afghanistan. IAVA has brought much needed media and legislative attention to this highly sensitive issue. In 2007, the organization succeeded in advancing the Joshua Omvig Suicide Prevention Act, which passed both houses of Congress unanimously. The Act was named after Joshua Omvig, an Army private who took his own life shortly after returning from Iraq in Although he was suffering from PTSD, his family s attempts to get him the mental health care he desperately needed were fatally stymied by difficulties with navigating the VA bureaucracy. The legislation mandates increased suicide preventions training for VA employees as well as a 24 hour suicide prevention hotline for troops. IAVA also recently called attention to the alarming spike in suicides at the Fort Campbell Army base in Kentucky, where troops had been taking their own lives at more than three times the rate at which they were dying in combat. While the Army itself claims to have proposed a stand down at Fort Campbell prior to the popularization of the story in the news media, there is good reason to believe that IAVA s relentless raising of the story hastened the Army s attempt at corrective action. IAVA appears to be a model of civic activism and community organization in the age of the internet and the hypermodern news media. By advocating for issues of unquestionable moral relevance in a highly public and publicized manner, IAVA has been extremely effective in moving political and governmental figures to action. IAVA has leveraged the by now clichéd political commitment to support the troops into concrete action and meaningful reform on behalf of veterans, reform which has normally failed to follow the public pronouncements of bureaucrats and politicians. Particularly striking is the group s willingness to address in such a public, relentless manner issues of veterans mental health and the crucial need to eliminate the barriers of stigma and shame that so often block the recognition and appropriate treatment of mental health conditions among veterans. Give an Hour is another advocacy organization that has been founded to provide mental health support services to returning veterans. Its mission is to provide free mental health services to U.S. military personnel and their families affected by the current conflicts in Iraq and Afghanistan. Give an Hour operates under the assumption that current mental health care efforts undertaken by the service branches and the VA are quite extensive and are actually improving in response to increasing need. Its intention is to supplement existing services and fill in gaps where necessary, not to radically reform or restructure the provision of mental health care to veterans. Give an Hour is not a quasi political advocacy group with an active lobbying agenda or a stated interest in effecting macro level policy change. Rather, its purpose is to match the voluntarily provided services (usually the hour of therapy suggested by the organization s name) of mental healthcare providers such as social workers, psychiatrists, and psychologists with veterans in need and their families. Give an Hour s aim is to facilitate the provision of clinical, psychotherapeutic services to those who otherwise have been unable to secure them or who are in need of additional assistance. It is achieving this aim by developing national networks of volunteers capable of responding to both acute and chronic conditions and its volunteer providers are able to treat conditions such as anxiety, depression, substance abuse, post traumatic stress disorder, traumatic brain injuries, sexual health and intimacy concerns, and loss and grieving. Give an Hour is similar to IAVA in that it operates primarily through its website. The Give an Hour website is the first point of contact for providers intending to volunteer their services, for potential recipients of care, and for donors and other interested parties wishing to assist the group in the carrying out its mission. Potential recipients can search for providers based on location or area of specialization, or both. Give an Hour also links to existing VA, service branch 13

14 and public health sources of mental health care, and, like IAVA, it attempts to help veterans understand just what benefits they are entitled to, as well as how to access them. Give an Hour is quite distinct from IAVA, however, in that it does not appear to aspire to grow as an advocacy group lobbying for social change, and its agenda is clinical, not political, in nature. Its goal is to serve as a kind of meeting point for volunteer providers and veterans in need of care; its mission is realized when caregiver and patient are connected and are no longer interacting in a way directly facilitated by the organization. While IAVA and Give an Hour have very different goals and organizational approaches and ambitions, they have both arisen in response to growing mental healthcare needs of our nation s veterans and their families, needs which are not always being served or even addressed by the institutions designed to do so. Both advocacy groups effectively harness the power of the internet, and both originated outside of the realms of policymaking and official power. These facts give hope and even optimism to those who would aspire, in an increasingly internet driven world, to intervene meaningfully on behalf of veterans and their families. Veterans will continue to require outside assistance in order to attain the square deal they are entitled to. In a more justly ordered society, perhaps they would not have to remind the rest of us either of their hard earned entitlements or of our own obligations, as President Obama said on Memorial Day 2009, to serve our nation s veterans as well as they have served us. Hoge C. W., Castro C. A., Messer S. C., McGurk, D. Cotting, D. I. & Koffman, R. L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 351, Tanielian, T. & Jaycoxx, L.H. (2008) Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica, CA: RAND Institute Iraq and Afghanistan Veterans of America. (2009) IAVA 2008 annual report. Retrieved November 21, 2009, from Give an Hour.(2010). Give help. Give hope. Retrieved November 20, 2009 from References Benedek, D. M., & Ursano, R. J. (2009). Posttraumatic stress disorder: From phenomenology to clinical practice. Focus : Benedek D. M. & Ursano, R. J. (2008). Exposure to war as a risk factor for mental disorders. Public Library of Science and Medicine 5(4): e82. doi: /journal.pmed Corrigan, P. (2004, October). How stigma interferes with mental health care. American Psychologist, 59(7),

15 Conflict Theory and Education: A Case Study at the University of Denver Graduate School of Social Work Cameron Brown, MSW Candidate 2011 Abstract This article presents the need for graduate schools of social work to provide new pedagogical models that will help to address the growing disparity between the small number of Spanish speaking social workers and the growing number of Spanish speaking clients in the United States. From the standpoint of conflict theory, social workers are called upon to resist the social reproduction of an elite class of social workers who cannot communicate effectively with the Spanish speaking population of this country. Recruiting bilingual individuals into social work programs has not proved sufficient in meeting this great need for bilingual workers. Graduate schools of social work must apply conflict theory in innovative ways in order to produce social workers who can resist the systemic oppression and subordination of Spanish speaking Latinos into perpetual lowerstatus in society. A case study of a certificate program at the University of Denver Graduate School of Social Work which includes Spanish language and cultural competency training for social work students is analyzed and put forth as a positive development in the resistance of social work educators to the perpetuation of social hierarchies by social workers themselves. T he educational system in the United States is a complex bureaucracy that is more successfully navigated by some than others, and various theories on education have been developed in an effort to further analyze and understand the purpose, outcomes, and stratification which exist in education today. For social workers who are committed to achieving social justice for disadvantaged populations, conflict theory proves the most applicable theory for understanding the implications of education in contemporary American society. An understanding of conflict theory is essential to best serving oppressed communities whose opportunities in the educational system have been limited due to the discriminatory practices of the dominant culture. An analysis of conflict theory and its application to the current issue of immigration and language in American education and society reveals the need for social work advocacy in the educational system at large as well as in graduate schools of social work. A case study at the University of Denver Graduate School of Social Work provides a model of reform that schools of social work may utilize in order to train new social workers to work competently with disadvantaged immigrant populations, particularly Spanish speaking immigrants from Central and South America. Conflict theorists in education argue that schools create and sustain inequity in society by creating a false consciousness that causes students to internalize their lower status and buy into the myth that they have failed through a lack of merit rather than a lack of opportunity (Ballantine & Spade, 2008). Conflict theorists argue that teaching this false consciousness, a concept which stems from the literature and insights of Karl Marx, is the primary aim of the institution of school. By inserting a false consciousness into their student bodies, schools guide each student to an understanding of his or 15

16 her place or status culture in society, which in turn becomes a self fulfilling prophecy. Although Marx s idea of status culture was originally based on the socioeconomic oppression of the poor, Max Weber later adapted this idea beyond the conflict of economic status to apply more generally to the power statuses of and conflicting interests between different groups in society (Ballantine & Spade, 2008). Collins (1971) argues that there is more support for conflict theory in education than functional theory because, beyond the provisions of mass literacy shifts in the proportions of more skilled and less skilled jobs do not account for the observed increase in the education of the American labor force (p. 1007). In other words, the skills needed for employment have not grown consistently with the increased amount of education acquired by the American public over time, and thus the relationship between education and employment is not one of functional necessity, but is a strategic relationship set up by the dominant culture in order for its members to maintain their elite status in society. Although conflict theory is criticized for its macro level focus and lack of attention to individual interactions that create this inequity, its breadth takes into account large scale problems that would be missed if one were only to examine the daily social interactions of individuals, as micro level interaction theorists do (Ballantine & Spade, 2008). After Marx and Weber s earlier work established the basic criterion for conflict theory in society and education, conflict theory branched out into several other areas of theory, including the concepts of social reproduction and social and cultural capital, as well as theories of resistance and credentialism. Credentialism is consistent with Collins aforementioned argument that higher education is a tool for the elite class to maintain their higher status, and social reproduction is the way the school system socializes lower status groups to learn their position as part of the working class, thus upholding the hierarchical, capitalist system that the elites depend upon (Collins, 1971). Central to social reproduction theory are Bourdieu s concepts of social and cultural capital, referring to the social resources students bring to their education and future engagement in school or community and the cultural practices, including language patterns and experiences... that provide knowledge of middle and upper class culture (Ballantine & Spade, 2008, p. 15). Through social and cultural capital, middle and upper class students are able to maintain and reproduce their elite status for the next generation, and lower class groups are continuously subordinated to the position of working class. As social and cultural capital is transmitted, lower status groups have little opportunity to change the stratification of the educational system. However, resistance theorists argue that teachers and students are not passive participants in the school process, and... they do not always follow the expectations that result in social reproduction (Ballantine & Spade, 2008, p. 16). Resistance theory implies more hope for changing the educational system, suggesting that students can resist their socialization into lower status groups and that teachers and other school staff can empower students to do so. A theoretical framework focusing on resistance theory with a foundation in conflict and social reproduction theories provides the most salient basis for explaining the functions of the educational system today and the prospects of changing it so that lower status groups have equal opportunity for mobility. One particular problem in the mobility of lower status groups in education today is that of language. This applies to both immigrant English Learners as well as to native speakers of English who do not conform to the pattern or dialect of the dominant culture. Because status groups generally have a common culture in terms of styles of language, lower status groups use of language is deemed inferior and therefore is incongruent with social mobility (Collins, 1971, p. 1009). Specifically, the use of language as an indicator of a group s status is particularly harmful to the increasing number of English Language Learner students and monolingual Spanish speaking immigrant families who come to the United States in search of upward mobility. In this 16

17 country, other languages are positioned in relation to English, and therefore a lack of English proficiency is commonly viewed as a barrier... [and] as a personal deficit (Harrison, 2007, p. 6). This Anglo centric view promotes the maintenance of a dominant, monolingual, English speaking culture and minimizes the social and cultural capital that Spanish speaking students carry with them into the school setting, thus situating them up to be socioeconomically oppressed. English language dominance imposes numerous difficulties upon minority and immigrant cultures and ultimately results in a lesser accumulation of social and cultural capital for students and families in these lower status groups. According to Dornbusch and Stanton Salazar s (1995) study of social and cultural capital for Mexican origin high school students, because of language and cultural barriers, many immigrants are denied opportunities to acquire valued institutional support even when their consciousness and their efforts may reflect and pay tribute to American ideals of hard work and material success (p. 131). In American society today, this devaluation of the other is a discriminatory practice that cannot be ignored, especially as the number of Spanish speaking residents in the United States continues to grow. In 2002, the U.S. Census Bureau estimated 38.8 million or 13.4 percent of the population to be Hispanic, and within that population, about 4.4 million households or 11.9 individuals were considered linguistically isolated, which refers to families that have no members over the age of fourteen that are English proficient (Kilty & Vidal de Haymes, 2007). A large proportion of these families live in poverty due to racial oppression and discriminatory immigration laws that negatively affect their opportunities for upward mobility. Additionally, their lack of weak ties or networking capacity with middle and upper class resources denotes minimal social and cultural capital and limits their progress in relation to the dominant group (Dornbusch & Stanton Salazar, 1995). With a Latino population this large, it is negligent for the educational system and its teachers, administrators, and social workers to ignore the fact that many families do not receive equitable services due to their linguistic isolation. This difficult circumstance is exacerbated in school situations where students need special services, such as special education evaluations and placements. When special education professionals encounter monolingual Spanishspeaking families, the stress of an alreadydifficult situation is exacerbated and there is a greater likelihood that the outcome of such meetings will be inadequate or incomplete (Nystrom et. al., 1991). The implication is that social workers need to understand the inherent conflict that exists between educational institutions and monolingual Spanish speaking families... [to] make these initial interactions more efficacious (Nystrom et. al., 1991, p. 1). An understanding of conflict theory and social reproduction theory will enable a social worker to resist participation in this pattern of inequality in schools and to help families resist the race based discrimination and social reproduction that immobilizes them and their children. For social workers to work from a stance of resistance theory while aiding in the interactions of monolingual Spanish speaking families and educational institutions, two main criteria must be achieved: First, social workers must be culturally competent and sensitive towards their Spanish speaking clients, and second, they must be able to communicate with them. Although some might argue that translators can accomplish this second task, it is also important to consider how authentically one can relate to a client through an interpreter (Alter & Sisneros, 2009). It is also imperative that a child not be asked to serve as interpreter, as this may upset the family balance or established familial roles. This suggests that for a social worker, fluency in Spanish enhances the development of a stronger connection between the social worker and the family... [and] is a form of empowerment and institutional reciprocity (Nystrom et. al., 1991, p. 4). A main function of social work is to connect clients to resources, and as gatekeepers to social and educational services, social workers with the ability to communicate in Spanish will help resist the oppression of lower 17

18 status groups, especially monolingual Spanishspeaking clients. Clients are disempowered when they are linguistically marginalized, so they tend to have less trust in institutions, and this further limits their weak ties and ability to connect with networks and resources. Conversely, monolingual Spanish speaking clients can be empowered by social workers who can effectively communicate with them and encourage their trust and connection to institutions. A case study of the Social Work with Latinos Certificate program at the University of Denver Graduate School of Social Work (GSSW) provides an exemplary model for social workers seeking to work from a resistance theory perspective. In response to the need for social work programs to develop greater bilingual manpower, the University of Denver GSSW created a specialized 36 quarter hour certificate program that prepares social work students for work with Latino communities and can be completed within the traditional two year time frame for Masters of Social Work (MSW) students. According to Alter and Sisneros (2009), this is one of three bilingual social work programs available in the United States, yet similar programs in the country have historically recruited only students, who were already fully bilingual... [which] today does not provide sufficient numbers of bilingual social workers needed by our schools, medical and mental health facilities, and family service agencies (p. 12). The five central goals of the program are to teach students to develop historical and cultural understanding of Latinos, to advocate for Latinos at the policy level, to develop social welfare programs for Latinos, to provide direct service to Latino immigrants, and to be fluent in the Spanish language; fluency in Spanish is the most important aim of the program according to its designers. They accept students who have an intermediate or advanced level of Spanish to build upon during their two years in the program, and introductory level students outside of the certificate program also have the opportunity to take elementary level Spanish classes. The curriculum entails a basic Multicultural Social Work Practice course in the first year, followed by a summer of intensive language study and a month in Mexico to complete the Social Development in Mexico course. All summer study is subsidized by GSSW so students are not precluded from participating in the summer program due to issues of cost. In the second year, which is considered the concentration year, the certificate program students take their advanced practice courses in Spanish, participate in brown bag lunches with discussions in Spanish, and are placed in a field practicum with Spanish speaking clients that enable them to utilize and develop their Spanish skills at least fifty percent of the time (Alter & Sisneros, 2009). The program for the Social Work with Latinos Certificate seeks to defy social reproduction through the application of resistance theory on two levels. First, as an educational institution, the GSSW at the University of Denver attempts to produce a new group of social workers who are both culturally and linguistically competent in working with Latinos, rather than reproducing the status quo of social work students, which would uphold an Anglo centric, monolingual English speaking culture. As opposed to viewing Latino clients as linguistically deficient, this program labels the norms of social work education put forth by the CSWE as deficient, thus actively resisting social reproduction by refusing to produce an elite group of social workers that are inaccessible to Spanish speakers. On a second level, the creation of a new class of Spanish speaking social workers attempts to defy social reproduction of their Spanish speaking clients in lower status groups by creating greater institutional connections that translate into social and cultural capital for these clients. In public schools, this institutional reciprocity will enhance institutional resources and connections for Latino students and their families, thus transforming the educational system into one that resists social reproduction of lower status minority groups. The program creators at the GSSW purposefully operate in a critical theory framework in order to fight the prevalence of essentialism, or the attribution of a list of traits to all Latinos. They assert that, critical theory is based on the 18

19 premise that, since the Latino population is actually composed of many groups linked together by oppression, they cannot be characterized by a list of individual traits... [which] moves the discussion from one based on race and culture to one based on oppression (Alter & Sisneros, 2009, p. 5). In contrast to a positivist paradigm in which one would use rules and logic to assess the Latino population so that it could be objectively known, the critical theory framework implies that an objective assessment of Latinos would be based upon the inherent inequality and oppression built into their social relations with the dominant culture. In other words, a critical theorist paradigm would be more accurate in viewing the Latino population because it would view Latinos as, not only influenced by culture, but also by the interaction of culture with the oppressive societal structures of race, class, gender, sexual orientation, and disability (Alter & Sisneros, 2009, p. 6). Unfortunately, as resistance theory implies, the program at the University of Denver GSSW faces some adversity in its endeavor to challenge the status quo of social work education and educational institutions that interact with Spanishspeaking Latino families. One complication they faced was the need to add courses beyond the number of credits required for the MSW program, resulting in a higher cost and potentially lower number of students willing or able to participate. Also, finding field placements where the students could speak Spanish with both clients and supervisors who were fluent in Spanish were minimal, so the program directors had to be flexible and seek Spanish speaking supervision that could be implemented outside of the agency. Third, garnering support of the provost and the faculty partners in the Spanish Department took much groundwork, and the school had to forgo revenue for the program s summer courses and settle on a break even budget. According to Alter and Sisneros (2009), without the continued support of the provost and the personal dedication of Spanish Department faculty, our certificate program would not be possible (p. 19). By choosing to resist social reproduction at the GSSW, the school faces greater challenges than other MSW programs, but also achieves greater influence in the fight for social justice for Latinos in the United States through building up a large base of bilingual social workers. Sadly, the seemingly rigid CSWE accreditation process and its simplistic focus on only cultural competence rather than language acquisition does not necessarily inspire more universities to attempt such brave resistance in their curriculum design (Alter & Sisneros, 2009). The implications for social work education and practice are clear. For universities that truly espouse social justice and seek to defy social reproduction, programs like the Social Work with Latinos Certificate at the University of Denver GSSW provide an exemplary model of how to produce social workers that can authentically work with the large, growing Latino population and connect them to institutional resources. The University of Denver GSSW states that across all programs, their students serve a Latino population of about 31.8 percent (Alter & Sisneros, 2009); certainly Hunter College School of Social Work students work with at least this proportion of Latino clients, if not more this student author currently has 33 Hispanic clients out of a total of 42 clients, or 78.5 percent. New trends in Latino settlement patterns also show an increase in Latinos living in suburban communities rather than the urban areas that they have historically inhabited; this points to the need for a cross national effort to increase the number of bilingual social workers available to serve in many areas of the country (Kilty & Vidal de Haymes, 2007, p. 107). With this goal in mind, schools of social work must begin to resist the process of social reproduction that is currently reinforced within their curriculum. MSW students who graduate with the ability to work bilingually and be culturally competent will function as an additional link for Latino youth and families, rather than as a barrier that preclude them from accessing the services that they deserve. If social justice for disadvantaged populations is truly a primary goal of MSW programs, reform will be necessary across the nation. 19

20 References Ballantine, J. H., & Spade, J. Z. (2007). Getting started: Understanding education through sociological theory. In Ballantine, J. H., & Spade, J. Z. (Eds.). Schools and society: A sociological approach to education, third edition. California: SAGE Publications. Adapted from Social science theories on teachers, teaching, and educational systems. The new international handbook of teachers and teaching. New York: Springer. Collins, R. (1971). Functional and conflict theories of educational stratification. American Sociological Review, 36(6), De Haymes, M. V., & Kilty, K. M. (2007). Latino population growth, characteristics, and settlement trends: Implications for social work education in a dynamic political climate. Journal of Social Work Education, 43(1), Harrison, G. (2007). Language as a problem, a right or a resource? A study of how bilingual practitioners see language policy being enacted in social work. Journal of Social Work, 7(1), Martinez Brawley, E., & Zorita, P. M. (2007). Language, identity and empowerment: The case of Spanish in the southwest. Journal of Ethnic & Cultural Diversity in Social Work: Innovation in Theory, Research & Practice, 15(1), Nystrom, J. F., Medina Gutierrez, B., & Acosta, V. (1991). Spanish speaking families and the special education system: Analysis and guidelines for practitioners. Social Work in Education, 13(5), Sisneros, J., & Alter, C. F. (2009). Educating social work students to practice in the Latino immigrant community. Journal of Ethnic & Cultural Diversity in Social Work, 18(1),1 23. Stanton Salazar, R., & Dornbusch, S. M. (1995). Social capital and the reproduction of inequality: Information networks among Mexican origin high school students. Sociology of Education, 68(2),

21 Karen Horney s Contribution to the Strengths Perspective in Clinical Social Work Tiffany Hung, MSW 2010 Abstract This paper seeks to recognize Karen Horney s contribution to clinical social work by demonstrating the relevance of her psychoanalytic theory to the application of the strengths perspective in social work practice with mental health clients. Core concepts of Horney s constructive theory of neurosis, including the distinction between mental health and pathology, man s natural strivings toward self realization, and the constructive forces of the real self, are presented. Writings by Horney s colleagues are drawn upon to elaborate her ideas about mobilizing constructive forces in the therapeutic process. My own belief is that man has the capacity as well as the desire to develop his potentialities and become a decent human being, and that these deteriorate if his relationship to others and hence to himself is, and continues to be, disturbed. I believe that man can change and go on changing as long as he lives. And this belief has grown with deeper understanding. (Horney, 1945, p. 19) S ocial work students are likely not to have heard of Karen Horney or to study her work in the course of their graduate social work education. Upon studying her work, one discovers the great potential for her psychoanalytic theory to make a significant contribution to clinical social work practice. This essay is in part a tribute to the contribution she has made to the field of mental health and in part an effort to stimulate interest in her ideas in the social work community. Specifically, it attempts to demonstrate that her theory supports and lays a solid foundation for the application of the strengths perspective in clinical social work. The idea of using a strengths based approach to working with clients can be traced back to the very beginnings of the social work profession and was later more rigorously defined and conceptualized by Dennis Saleebey in his well known text, The Strengths Perspective in Social Work Practice. Saleebey (2002) writes that practicing from a strengths orientation means this everything you do as a social worker will be predicated, in some way, on helping to discover and embellish, explore and exploit clients strengths and resources in the service of assisting them to achieve their goals, realize their dreams, and shed the irons of their own inhibitions and misgivings, and society s domination ; it means, furthermore, that rather than focusing exclusively or dominantly on problems, your eye turns toward possibility. In the thicket of trauma, pain, and trouble, you can see blooms of hope and transformation (p. 1). Saleebey (2002) is very critical of the disorder based thinking of contemporary mental health professionals, whom he believes place overdue emphasis on psychopathology (p. 3). He implies that clinical social work has been seduced into adopting the pathology based practice philosophy which is popular among mental health professionals, in order to elevate the status of social work vis à vis other professions. Although the practice of clinical social work should be compatible with a strengthsbased approach, the infusion of psychodynamic thinking, the rise of private practice and vendorship, the mass appeal of DSM IV TR among other factors have driven social work toward a 21

22 model of practice that is more heavily aligned with psychological thinking and psychopathology theories (p. 18). Were it not for Karen Horney, one might agree with Saleebey s point that the adoption of psychoanalytic theories has diminished clinical social work s interest in applying the strengths perspective in work with mental health clients. In many ways, Horney s ideas reflect the spirit of the strengths perspective and have created the theoretical framework necessary for understanding clients from a strengths perspective. In fact, strengths based approaches to working with clients who struggle with mental health conditions arguably find their roots in Horney s theory. Karen Horney was born in Hamburg, Germany, in She studied medicine and psychiatry in Berlin and taught at the Berlin Psychoanalytic Institute from 1918 to Horney came to the United States in 1932 and served as Associate Director of the Psychoanalytic Institute in Chicago for two years. She then took a position at the New York Psychoanalytic Institute, where she remained until 1941, when she broke away from the institute and became one of the founders of the Association for the Advancement of Psychoanalysis and the American Institute for Psychoanalysis. Horney came to represent a radical shift from the framework of Freudian psychoanalysis in which she was trained. She is widely recognized as one of the first feminine psychologists as well as one of the first psychoanalytic thinkers who considered the role of culture in influencing individual psychodynamics (see The Neurotic Personality of Our Time, 1937). In New Ways in Psychoanalysis (1939), she challenged several concepts central to Freudian theory, such as libido theory, the primacy of infantile sexuality, and the repetition compulsion, while affirming what she believed was essential to psychoanalytic theory and practice (Rubin & Steinfeld, 1991, p. 3). Perhaps her most radical concept, according to Rubin and Steinfeld (1991), was the idea that what is psychologically healthy in human beings is qualitatively different from what is unhealthy. That is, what is unhealthy operates according to completely different dynamics from what is healthy. Most other theories, in contrast, are based on the premise that what is pathological is either an exaggeration or distortion of what is normal (p. 4). Horney s distinction between health and neurosis was one of the central tenets of her conflict theory of neurosis, which she set forth in Our Inner Conflicts (1945) and further developed in Neurosis and Human Growth (1950). In fact, Horney opened the latter work with the proposition that the neurotic process is not only different in quality from healthy human growth but, to a greater extent than we have realized, antithetical to it in many ways (p. 13). This standpoint opened up the possibility of thinking about patients strengths in ways which affirmed a person s inner capacities and motivations for change and were therefore more in line with what present day social workers would recognize as the strengths perspective. Horney (1950) theorized that inherent in man are evolutionary constructive forces, which urge him to realize his given potentialities (p. 15). This means that man, by his very nature and of his own accord, strives toward selfrealization, and that his set of values evolves from such striving. That is, under favorable conditions, individuals have a natural propensity to grow and realize their unique potentialities. Through this process one develops a healthy way of being which is unique to each individual what Horney called the real self, ones fundamental core of aliveness. The constructive forces of the real self are the sources of growth in each person. Neurosis is a result of disturbances in ones human relationships and environment which divert our constructive energies into unconstructive or destructive channels, leading to alienation from self and neurotic processes of development (p. 15). Horney did not view obstructive or destructive forces as innate to man, as did earlier Freudian theories of instinctual conflict and repression. She used the metaphor of the process by which an acorn grows into an oak tree to illustrate her ideas about development: Given the right conditions, an acorn will naturally grow into an oak 22

23 tree, but its development may be thwarted by a variety of adverse environmental influences. Ultimately, Horney (1945) called her theory of neurosis a constructive one. Her reasons were twofold: On the one hand, she was guarded against the unrealistic optimism that neuroses could be cured by simple means (p. 18). On the other hand, she called her theory constructive because it allowed for the possibility that neurotic conflict could eventually be resolved rather than simply endured, resulting in a real integration of personality (p. 19). Her stance was in large part a reaction against Freud s pessimism regarding man s ability to change and achieve happiness. The overall goal of therapy, according to Horney s formulation, was to create the conditions necessary within the individual to allow the constructive forces of the real self to have a chance to grow. Therefore, Horney proposed that the therapeutic process involved two complementary and concurrent objectives: One was to undermine the obstructive forces impeding a person s growth, and the other was to mobilize that person s constructive forces in the service of self realization (Horney, 1950). As one of her disciples, Harold Kelman (1953), put it, the objectives of therapy are to identify, undermine and dissipate obstructive and destructive patterns of existence while concomitantly identifying, supporting, extending and expanding constructive patterns of living (p. 4). The latter objective appears to reflect a strengths based approach to practice, as defined by Saleebey (2002). In fact, much of what Horney wrote on the subject of mobilizing constructive forces affirms the strengths perspective. She acknowledges that there are healing forces operating in the patient from the very beginning, although at the onset of analysis, they are usually deficient in vigor and must be mobilized before they can assist the patient toward his goals (Horney, 1950, p. 348). The patient s interest in getting help is itself a constructive force. Although the patient s reasons for seeking help at the outset may be questionable, the analyst is to make use of these motivations to engage the patient in analytic work (Horney, 1950, p. 349). When the patient begins to wonder how well he actually knows himself, the analyst will actively try to bring the patient s sense of selfalienation to the patient s awareness. The analyst will also not lose an opportunity to encourage explicitly any sign the patient gives of greater independence in his thinking or feeling, of assuming responsibility for himself, of being more interested in the truth about himself (Horney, 1950, p. 351). He will point out the ways in which any moves toward selfrealization have positive effects on the patient s relationships and functioning. Finally, as the real self emerges, the analyst will help the patient explore what makes it possible for him to be more spontaneous, to make a decision, or to be active in his own behalf (Horney, 1950, p. 352). Unfortunately, Horney did not develop her ideas on mobilizing constructive forces much further since she focused most of her intellectual career on identifying the basic neurotic trends and defense mechanisms and integrating her findings into a dynamic theory of neurosis. Using her lectures and writings as a foundation, her colleagues later elaborated on her ideas about constructive forces. Morton Cantor (1967) suggested that mobilizing constructive forces begins with eliciting them from the patient. Eliciting constructive forces starts as soon as the analyst and patient discuss the patient s reasons for seeking help and is especially relevant when reviewing a patient s history. He points out that traumatic experiences in a patient s history are not as important as how the patient responded to them. The analyst will often find that constructive forces were at work, as evidenced by the patient s resilience and ability to tolerate psychic pain and learn from his experiences. When this is the case, the analyst should elicit these constructive forces in the patient by questioning, underlining and clarifying what is being presented. At the same time, the analyst is welcoming constructive elements the patient may never before have paid much attention to and encouraging further moves in this direction (p. 192). 23

24 Cantor (1967) also recognized the general human help of the analyst, or what contemporary clinicians might refer to as the therapist s use of self in the therapeutic relationship, as a mobilizing force, by which he was referring to the analyst s humanness, his emotional attitude towards the patient, not just his interpreting, directing, correcting, etc. (p. 193). Similarly, Nathan Freeman (1953) wrote that the therapist s interest in the patient s growth and his belief in his ability to grow can be a productive, stimulating call to the blocked constructive forces (p. 13). Harold Kelman (1953) emphasized that the motive power behind all positive changes we see in patients are their constructive forces, which he also called assets (pp. 4 5). He went on to describe the specific assets one might find in patients, including past and present capacity to form positive interpersonal relationships, the ability to feel, will, think, and act, the development of wisdom, the ability to reason, a sense of humor, and the capacity for psychological thinking. Kelman (1953) believed that with such knowledge of constructive forces, the tendency to focus one sidedly on pathology and irrationality will shift to a proportionate emphasis on the assets and liabilities in the whole person, and toward the end of a more effective and productive therapy. He pointed out that therapists often do not see a patient s assets even when they are looking for them and that the tenacity for life and growth is often far greater than we may give our patients credit for (p. 8). Frederick Allen (1953) made an intriguing point that even in the patient s symptom, a constructive force is operating. The symptom indicates that the individual is in one way or another attempting to solve a dilemma (p. 9). It is also evidence of vitality within the patient which has not yet been released for creative living. Allen (1953) believed that even resistance to the therapist s interventions could be interpreted as a manifestation of the patient s constructive forces since it represented the patient s attempts to maintain the integrity of his ego and contain[ed] the nucleus of the patient s quality to use the therapist to effect change (p. 10). Karen Horney s theory of neurosis and human growth is compatible with the strengths perspective in social work and has even provided a conceptual framework for understanding clients from a strengths perspective. However, Horney s standpoint does not entirely align with social work values, and social workers are not encouraged to adopt it wholesale. For example, like most of the psychoanalysts of her time, she remained within the framework of a hierarchical doctor patient relationship and did not emphasize the exchange between person and environment as a locus of both strengths and liabilities. Horney s greatest achievement was her willingness to understand human beings first from the perspective of their health and natural strivings to develop their potentialities. Consequently, she began to rectify her profession s over emphasis on pathology and open its eyes to the blooms of hope and transformation, as Saleebey (2002) put it. Her outlook affirmed the inherent dignity and worth of individuals and their innate capacity to grow and achieve healthy relationships with themselves and others. In this regard, she represented a radical break from the past and laid the groundwork for applying the strengths perspective to clinical social work practice. For her contribution, Karen Horney deserves a place among the many psychoanalytic theorists studied by social work students. References Allen, F. (1953). Constructive forces operating in the individual. In K. Horney (Ed.), Constructive forces in the therapeutic process (pp. 8 10). American Journal of Psychoanalysis, 13, Cantor, M. (1967). Mobilizing constructive forces. American Journal of Psychoanalysis, 27, Freeman, N. (1953). How to mobilize constructive forces. In K. Horney (Ed.), Constructive forces in the therapeutic process (pp ). American Journal of Psychoanalysis, 13, Horney, K. (1945). Our inner conflicts: A constructive theory of neurosis. New York: W. W. Norton & Company, Inc. Horney, K. (1950). Neurosis and human growth: The struggle toward self realization. New York: W. W. Norton & Company, Inc. 24

25 Kelman, H. (1953). What are constructive forces? In K. Horney (Ed.), Constructive forces in the therapeutic process (pp. 4 8). American Journal of Psychoanalysis, 13, Rubin, J. & Steinfeld, S. (1991). Foreword. In K. Horney, Neurosis and human growth: The struggle toward selfrealization (pp. 1 9). New York: W. W. Norton & Company, Inc. Saleebey, D. (2002). Introduction: Power in the people. In D. Saleebey (Ed.). The strengths perspective in social work practice, third edition (pp. 1 22). Boston: Allyn and Bacon. 25

26 The Politics of Physician Assisted Suicide: A Synthesis of Reverence for Life and Individual Autonomy Dana Kragh, MSW Candidate 2011 Abstract This paper aims to deconstruct and synthesize two opposing perspectives on the issue of physician assisted suicide. Ira Byock, a physician and leader in the hospice and palliative care movement, believes that a good death is, by definition, one that occurs naturally. Consistent with hospice movement ideology, he rejects physician assisted suicide as antithetical to the affirmation of life. By contrast, philosophy professor David McKenzie supports an individual s right to elect physician assisted suicide as a means of ending suffering and therefore ensuring a good death. Both Byock and McKenzie draw upon myriad sources of knowledge, often overlapping in their reasoning and occasionally in their perspectives. A cross lines of race, religion, and culture, the eventuality of death is an unwavering certainty. Perspectives on what constitutes a good or favorable death are myriad and often disparate. One of the most hotly contested topics related to death and dying in recent years is physician assisted suicide, a process by which one who is suffering on the path of dying is granted help from a medical professional in hastening death. Divergent viewpoints on this practice abound. For Ira Byock, M.D., physicianassisted suicide is an unacceptable practice that negates the fundamental significance of life (Byock, 2007). Conversely, philosophy professor David McKenzie supports the legalization of physician assisted suicide as a means to dying well (McKenzie, 2004). Both of their perspectives draw upon several sources of knowledge that lead to their divergent conclusions. Dr. Ira Byock has been active in the hospice movement for many years. Hospice and palliative care ideologies firmly reject physicianassisted suicide. Byock has actively participated in protesting the legalization of physicianassisted suicide. In To Life! Reflections on Spirituality, Palliative Practice, and Politics, he mentions that some of his activism has been in conjunction with efforts of faith based organizations, including fundamentalist Christian groups (p. 438). Byock comes from a Jewish background, and although not particularly observant of religious rituals, he posits that, regardless of religious affiliation, a reverence for life is inherent in human spirituality (p. 437). It is through this broadly spiritual lens that Byock builds his central argument. His views may seem enmeshed in religious ideology and have thus been met with suspicion from secular opponents, and Byock himself acknowledges the controversial nature of his beliefs and the mission of hospice An ironic shift arises when Byock describes an aspect of the good death debate on which religious and political agendas diverge. In 2004, a bill, initiated in New Hampshire, sought to loosen restrictions on updating advance death directives. This was an effort that Byock supported, a position consistent with his adherence to the hospice and palliative care mission to allow individuals to die naturally when death is imminent, without undesired artificial nutrition or resuscitation. Byock explains how the bill was hijacked by the far Right in the wake of Terri Schiavo s death; bureaucrats inserted language 26

27 requiring those without an advance directive to undergo medically administered nutrition, hydration, and cardiopulmonary resuscitation before allowing them to die (p. 437). In Byock s conception, these requirements were intended to be symbolically meaningful, yet made no biological sense. Thus, it would seem that the far Right is suggesting that death is somehow optional. While Byock acknowledges the inevitability of death, he endorses a life affirming view throughout the article, quoting the late Cardinal Bernadin of Chicago, who stated that even a person who decides to forgo treatment does not necessarily choose death. Rather, he chooses life without the burden of disproportionate medical intervention. This statement encompasses both a reverence for life and acceptance of death. Byock weaves together his perspective from scientific, spiritual, intuitive, and experiential knowledge. However his stance on allowing life to continue as paramount over ending extreme suffering might be inadequately supported. While his experience and varied sources of knowledge lend much clout to his position, his case against physician assisted suicide seems to be highly personal, thus discounting situations in which allowing life to continue may feel less affirmative and more punitive to the terminally ill person in question. And while the hospice and palliative care movement offers holistic support for dying patients, it is still possible that a good death to some patients cannot be achieved through the individual control exemplified by physician assisted suicide. In stark opposition to Byock, in Church, State, and Physician Assisted Suicide, David McKenzie analyzes the position of Justice Stephen Reinhardt of the 9 th Circuit Court of Appeals underlying the decision in ʹCompassion in Dyingʹ v. ʹWashingtonʹ (1996), which upheld a patientʹs constitutional right to physicianassisted suicide. McKenzie strives to reinforce the validity in Reinhardt s reasoning, as it was called into question when the Supreme Court overturned this decision. Through careful examination of Reinhardt s arguments, McKenzie seeks to credit the judge, thus presenting an indepth critique of the Supreme Court decision to overthrow this case. Reinhardt cites constitutional rights to liberty in determining the time and manner of one s own death as the foundation of his argument (p. 791). To bolster this point, he references existing laws which allows for cessation of life support for terminally ill patients, thereby demonstrating a hands off provision that effectively parallels physician assisted suicide. McKenzie concurs with Reinhardt s position, subsequently questioning why the time and manner of one s own death in the face of profound personal hardship should be limited by government, and arguing that this is essentially an issue of separation of church and state. McKenzie also mentions that current social attitudes toward physician assisted suicide show widespread acceptance of the practice. McKenzie s philosophically based argument is consistent with his occupation and apparent perspective; he staunchly rejects religion as a basis for making decisions appropriate to governing human life. While his argument in favor of physician assisted suicide seems both viable and well rendered, his personal bias toward religion discounts his categorical dismissal of the validity of religious perspectives in determining individual rights and decisions. Nonetheless, he has a strong basis for arguing that the law should not be based upon religious decree. Although he does not explicitly address political affiliation in this article, his support for the liberal Reinhardt in opposition to a conservative values based decision suggests that he disagrees with the agenda of the political right wing. McKenzie s perspective is an interesting parallel to Ira Byock s. While McKenzie suggests that religious ideology is enmeshed in the conservative perspective to the extent that it undermines their argument, Byock would argue that its influence is only on the far Right. In the widely contested debate over physician assisted suicide, the argument seems to hinge upon whether religious or other ideological influences are inseparable from political stances. Ira Byock essentially argues that the political agenda of the far right is counteractive 27

28 to key aspects of the hospice and palliative care mission. He alludes to the view of the far Right which equates the hospice movement s honoring of do not resuscitate orders by allowing a person to die without a feeding tube with murder. That being said, Byock himself draws the core of his viewpoint from spirituality in addition to experience, intuition, and science. David McKenzie is similarly opposed to judicial action that reflects a conservative agenda with regard to death and dying, arguing that the political decisions of the right, exemplified by Justice Rehnquist, are entangled in a religious agenda and thereby violate legitimate liberty interests of United States citizens. References Byock, I.R. (2007). To life! Reflections on spirituality, palliative practice, and politics. American Journal of Palliative Medicine, 23(6), McKenzie, D (2004). Church, state, and physician assisted suicide. Journal of Church and State, 46(4),

29 Documentary Theatre and Eating Disorders: An Art Based Intervention for Education, Empowerment, and Advocacy Mikki Jordan, MSW Candidate 2011 Abstract This paper argues that documentary theatre, a grassroots, community based dramatic process, has the potential to be a unique and empowering prevention and treatment modality for eating disorders through its potential for advocacy, education and catharsis. The rate of eating disorders is rapidly increasing in men and women of all racial, economic, and cultural backgrounds while educational and preventive efforts are doing little to adequately address the reality of what so many are struggling against. By combining oral history and advocacy with dramatic techniques, documentary theatre can create an open space where a community s voices might be heard and an honest, realistic examination of eating disorders might be explored. S tudies have reported that 50% of females age would rather be run over by a truck than be fat and 2/3 would rather be mean or stupid (Wolfe, 1991). Other studies have shown that 42% of 1st 3rd graders wanted to be thinner and 81% of ten year olds are afraid of being fat (NEDA, 2009). Documentary theatre which combines advocacy, journalism, and oral history with dramatic elements (Wilmeth, 2007) has enormous potential to be a uniquely effective educational tool and a practical means of combating eating disorders. It can be used to raise social awareness, mobilize community advocacy, and empower and support those who are struggling with an eating related illness, as well those in recovery. By creating a performance by, for, and of the people, documentary theatre represents a forum for a community s voices to be heard and for a realistic and relevant story of eating and body image to be told. Documentary theatre has the capacity to incite change and action on a broad scale. The prevalence of eating disorders has been on the rise for decades and little action on an institutional level has been taken. Only seventeen states included eating disorders in the mental health parity laws passed in Furthermore, about 80% of the girls and women who have accessed care for their eating disorders do not get the intensity of treatment they need they are often sent home weeks earlier than the recommended stay, and 96% of eating disorder professionals believe their anorexic patients are put in life threatening situations because health insurance policies mandate early discharge (Renfrew, 2003). The prevalence of eating disorders is rapidly increasing in men and women of all racial, economic, and cultural backgrounds; they are even being seen in children as young as young as seven and in seniors as old as eighty. It is estimated that 27 million Americans and 70 million people worldwide are struggling with an eating disorder. If one were to factor in those who engage in disordered eating behaviors such as dieting, food obsession, weight obsession, and over exercising, these numbers would be substantially higher (Renfrew, 2003). As Naomi Wolfe (1991) describes, If anorexia is defined as a compulsive fear and fixation upon food, perhaps most western women (and many men) can be called mental anorexics. Eating disorders are considered a treatable medical illness with complex biological and

30 psychological causes and often coexist with other psychiatric disorders. Eating disorders have the highest death rate of any mental illness as they often lead to other health complications including heart conditions and kidney failure (NIMH, 2009). In the course of the disordered relationship that contemporary culture has with food and body image, many people who count calories and diet compulsively, displaying symptoms of eating disorders, alternately go unnoticed or are even praised. While the U.S. Department of Health and Human Services Task Force on Eating Disorders had implemented educational curricula in schools, Renfrew (2003) determined that the attempt was a complete failure. The strategy of having eating disorder survivors come in to share their experience with students merely served to increase the prevalence of eating disorders, as young people who were desperate to feel better about their changing bodies were introduced to new ideas of how to lose weight. We must keep in mind that young people in particular might romanticize pop culture depictions of potentially self destructive behaviors. The reality and danger of the eating disorder culture is simply not understood nor is the status quo of food and body obsession being adequately challenged, which is why educational efforts are failing: They address only the superficial or manifest issues while neglecting the complex latent issues that are often the catalysts for developing full blown eating disorders. They consist of top down, one dimensional messages that fail to connect to reality. This is where documentary theatre could intervene as a creative and effective educational tool. Documentary theatre projects are typically created by a group of artists who go into a community to conduct a series of interviews, edit these interviews to shape the story they find most compelling, and then act out the stories in the format of a theatrical production. Documentary theatre has the potential to connect more openly and honestly with the psycho social and socio cultural pressures that many individuals struggle with, as it facilitates a broader exploration of these pressures, representing, as it does, the diversity of its artists backgrounds and experiences (Bottoms, 2006). One must be cautious in ones application of documentary theatre to the issue of eating disorders, however, because the same personal subjectivity that imbues documentary theatre with its strength to heal and empower might also lend itself to the exploitation of its subjects voices either inadvertently or with the best of intentions. The artist is always trying to balance a sense of loyalty to what is true with the need to make the performance dramatically effective. Ones appreciation of such work, which is presented onstage as truth, must be tempered by the knowledge that a group of outsiders has taken artistic license in determining and portraying what they consider to be the most compelling issues, events or characters within a given community (Claycomb, 2003). Indeed, there is no absolute truthful representation, but in combating eating disorders, potential practical benefits largely outweigh the concerns about factual inaccuracy. Ideally, those creating and performing the piece would connection to or experience with eating disorders. A troupe without connection to eating disorders risks collectively taking on the role of expert, distancing themselves from their intended audience, and misrepresenting the actual stories and individuals themselves. Documentary theatre could also function as a more therapeutic intervention by allowing for an exchange between those currently suffering and those who have recovered. It provides individuals who are currently battling an eating disorder many of whom might not believe that full recovery is possible, with an opportunity to hear the stories of those who have recovered or who are in recovery; they may begin to find new meaning in their experiences as they discover how their struggles and successes can now inspire others. Peggy Claude Pierre, a world renowned eating disorder therapist, has said that for incoming patients, spending time with fully recovered patients helps to create a bridge of hope that is crucial and that no doctor can give (Claude Pierre, 2000). Finally, documentary theatre has great po 30

31 tential to address media accountability in how the media utilizes images of beauty against women, fueling a culture of body and food obsession that, no doubt, feeds into this eating disordered culture. As Naomi Wolfe (1991) states, There is nothing wrong with women s (or men s) faces or bodies that social change won t cure. There is a dangerous economic investment in keeping women, and, increasingly, men, hating their bodies. The dieting industry grossed over $55 billion in the U.S. in 2005, while the cosmetic surgery grossed $31.7 billion globally in 2008 (Marketdata, 2005; BCC Research, 2009). In order to sell its products, it is imperative to convince the masses that they are inadequate and that they need cosmetic products and enhancement services to make them more valuable or attractive. It is a classic marketing scheme which is affecting more and more young children everywhere as they grow up with the belief that they are not beautiful enough unless they meet certain physical standards. Social workers have an opportunity to raise this discussion to the next level through the mechanism of documentary theatre. In utilizing this performance based method, we might treat and educate younger generations, raise awareness about the roots and risks of eating disorders, and open a dialogue within communities, mobilizing a demand for action from policy makers, medical professionals, and the media. Across social work methodology, documentary theatre has great promise as a unique and dynamic intervention tool in addressing our eating disordered culture. Claycomb, R. (2003). (Ch)oral history: Documentary theatre, the communal subject and progressive politics. Journal Of Dramatic Theory And Criticism, 0(2). Retrieved from /3474 The Renfrew Center Foundation for Eating Disorders (2003). Eating disorders 101 guide: A summary of issues, statistics and resources. Retrieved from Eating Disorder Information (2009). National Institute of Mental Health. Retrieved from Epskamp, K. (2006). Theatre for Development: An introduction to context, applications, and training. London, U.K.: Zed Books, Ltd. Fondakowski, L. (Interviewee) (2009). Interview with Leigh Fondakowski. Retrieved from /articleid/ Marketdata Enterprises, Inc. (2005). The US weight loss and diet control market (9 th ed). Marketdata Enterprises, Inc. Retrieved from National Eating Disorders Association [NEDA]. Retrieved from Recovery Productions (n.d.). Retrieved from Rahman S, Rahman SM, Ahmed R (2002). International Conference on AIDS. Community theatre approach to increase knowledge and change of of Medicine of the U.S. National Institute of Mental Health. Retrieved from: f= htmlbehavior for HIV/STDs prevention in Bangladesh [Abstract]. National Library Wilmeth, D. B. (2007). Cambridge Guide to American Theatre. New York, NY: Cambridge University Press. Wolfe, N. (2002). The beauty myth: How images of beauty are used against women (pp ). New York, NY: Harper Collins Publishers Inc. References. BCC Research. (2009). Cosmetic surgery markets: products and services. Retrieved from Surgery Markets Products and Services.html Bottoms, S. (2006). Putting the document into documentary. TDR: The Drama Review, 50(3), Retrieved from Academic Search Premier database. Claude Pierre, P. (2000). The secret language of eating disorders. New York, NY: Random House Publishing Inc. 31

32 Editors David Katzenstein is a graduate of Touro College, where he majored in Psychology, and a graduate of Yeshiva Chaim Berlin Rabbinical University, where he obtained a degree in Talmudic Law. He is the founder of a project in the Orthodox Jewish community of Brooklyn which assists newlyweds. For his first year placement, he worked with families involved in ACS court cases, providing crisis counseling and advocacy at the Brooklyn Family Defense Project. For his second year placement, he worked at St. Vincent s outpatient psychiatry clinic as well as the Walk in clinic, providing evaluations and diagnoses, and individual psychotherapy to children, adults, and couples. His major method at HCSSW is Clinical Practice with Individuals and Families. Mr. Katzenstein can be reached at [email protected] Hal Pollack is a graduate of Brandeis University, where he majored in English and Creative Writing. Prior to HCSSW he joined the New York City Teaching Fellows, working as special education teacher at Paul Robeson High School in Brooklyn and earning a Masters in Teaching at Pace University. For his first year placement he provided supportive counseling for homebound elderly clients in Brooklyn through the Mapleton Midwood Geriatric Service. For his second year placement he worked at the Comprehensive Adolescent Rehabilitation and Education Service (CARES) at St. Luke s Roosevelt Hospital, providing therapy and case management services for adolescents with psychiatric and substance related diagnoses. His major method at HCSSW is Clinical Practice with Individuals and Families. Mr. Pollack can be reached at [email protected] Contributors Sharon Kaye OʹConnor is a graduate of New Jersey City University, where she majored in Music and minored in Psychology. For her first year placement, she worked with homebound elderly clients in Brooklyn at Mapleton Midwood Geriatric Services. For her second year placement, she worked with adult community college students of varying ages and backgrounds in the ASAP Program at LaGuardia Community College. Her major method at HCSSW is Clinical Practice with Individuals and Families. Ms. Kaye O Connor can be reached at [email protected] David Shernoff is a graduate of Oberlin College, where he majored in English and Philosophy. During his first year at HCSSW he interned with a criminal justice nonprofit, advocating for alternatives to incarceration for nonviolent criminal offenders struggling with mental illness and substance abuse issues. During his second year field placement, he provided individual and family counseling to clients coping with terminal illnesses. His major method at HCSSW is Clinical Practice with Individuals and Families. Mr. Shernoff can be reached at [email protected] Cameron Brown is a graduate of NYU, where she majored in Journalism and Art History. She received a Masters in Teaching from Pace University. For her first year placement she worked at Big Brother/Big Sister facilitating after school peer mentoring for adolescents. For her secondyear placement she will participate in the Child Trauma Program. Her major method at HCSSW is Clinical Practice with Individuals and Families. Ms. Brown can be reached at [email protected] 32

33 Tiffany Hung is a graduate of Harvard University, where she majored in East Asian Studies. For her first year placement, she worked as a Housing Specialist at Catholic Guardian Society and Home Bureau, a homeless shelter for women and children ages 0 2 years, providing case management and supportive counseling for clients. For her second year field placement, she worked at the Karen Horney Clinic, providing outpatient psychotherapy for children and adolescents ages 4 to 18. Her major method at HCSSW is Clinical Practice with Individuals and Families. Ms. Hung can be reached at [email protected]. Dana Kragh is a graduate of Ithaca College, where she majored in psychology. For her first year placement she worked with seniors at the Rodney Kirk Center at Manhattan Plaza. Her major method at HCSSW is Clinical Practice with Individual and Families. Mr. Kragh can be reached at [email protected]. Mikki Jordan is a graduate of NYU, where she majored in Theater and Acting. For her first year placement she worked at Lenox Hill Neighborhood House Senior Center at Saint Peterʹs Church. She is also a NYS certified rape counselor. Her major methods at HCSSW are Group Work and Community Organizing. Ms. Jordan can be reached at [email protected]. 33