By Kaitlin Louie
About Anne Friedman, ASW: Anne Friedman works as an Associate Clinical Social Worker Fellow in Kaiser Permanente’s Psychiatry Department. As a Fellow at Kaiser, Ms. Friedman provides group-based therapy and mental health support to individuals suffering from mental health challenges and/or chemical dependency.
Ms. Friedman earned her MSW from UC Berkeley in 2014. Her first year internship was at Bay Area Community Services, a nonprofit based in Oakland, where she provided case management services and brief counseling to low-income adults, many of whom had comorbid physical and psychiatric illness. Her second year internship was in a local county mental health system, again doing case management. The agency served older adults with severe and persistent mental illness and was entirely field based, designed to provide services in clients’ homes, whether that was a shelter or a relative’s apartment. During this second year internship, Ms. Friedman worked on an interdisciplinary team with an LCSW, psychiatrist, and nurse.
Prior to graduate school, Ms. Friedman conducted public health policy research at Columbia University. Though she enjoyed research, her experiences also helped to clarify her desire to pursue a career with more face-to-face interaction and tangible outcomes.
[OnlineMSWPrograms.com] Can you give an overview of your core responsibilities as an Associate Clinical Social Worker in Kaiser Permanente’s Psychiatry Department? What types of clients do you work with, and what kinds of challenges do they face? How do you support them?
[Anne Friedman, ASW] I’m doing a post-master’s clinical training fellowship in Kaiser Psychiatry, so my schedule is a little different than a regular employee. Within the Psychiatry department I’m on two teams, Chemical Dependency (CD) and Adult Mental Health. CD is an entirely group-based program, and I help facilitate an early recovery group two days a week and a drop in support group for dually-diagnosed (substance use and mental illness) patients once a week. Within the adult team, I do intakes for new patients, see a caseload of individuals, and run groups. I also spend two mornings in the Intensive Outpatient Program, for patients who are at risk of psychiatric hospitalization or who have just been discharged from a higher level of care. My patients are ages 18-70+ and come in with a pretty wide range of presenting problems–from heroin addiction to bipolar disorder to postpartum depression.
Although I do refer people to community resources (like housing, domestic violence support, subsidized transportation), my role is really to provide mental health support through therapy. I would say I’m informed by psychodynamic and attachment theories, and the work I do tends to be fairly brief (~10 sessions) and focused on symptom alleviation, so I’m giving people tools drawn from Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), and Seeking Safety. Kaiser is mostly a group-based mental health program, so I also refer people to our many groups. Some of the groups I co-facilitate in mental health include CBT, DBT, and Social Skills, for patients on the autism spectrum.
Because it’s a training fellowship, I have two hours a week of individual supervision with an LCSW and two hours of group supervision, one of which is a didactic format (on a wide range of topics – working with sex offenders, anger management, boundaries, Seeking Safety trauma treatment with teenagers, etc). I also attend once a month afternoon trainings with all Kaiser psychology interns in Northern California.
[OnlineMSWPrograms.com] For students who are just learning about psychiatric social work, can you give an overview of your team and how psychiatric social workers work with other medical professionals to provide psychiatric care? For example, do you work with psychiatrists, psychiatric nurse practitioners, and clinical psychologists?
[Anne Friedman, ASW] I collaborate frequently with psychiatrists and primary care physicians to support patients who want medication. Many of my patients work with a Kaiser psychiatrist, and sometimes I’ll consult with them and vice versa if we feel like someone isn’t getting better or the diagnosis is unclear or complicated. Within Kaiser psychiatry, LCSWs, marriage and family therapists (MFTs), and clinical psychologists (PsyD and PhD) all do the same thing – we all run groups and see patients individually, working alongside each other. The one thing that is slightly different is some clinical psychologists also do neuropsych testing. Psychiatrists prescribe medication, do not provide therapy, and see patients with much less frequency than mental health clinicians at KP.
[OnlineMSWPrograms.com] Why did you decide to work in psychiatric social work? What have been some of the highlights of your experience at Kaiser Permanente?
[Anne Friedman, ASW] I wanted to pursue psychiatric social work because I’m really interested in mental health and, personally, love thinking about how social, political, economic, and historical (ie macro) factors affect people’s wellbeing, and vice versa. One of the things I’ve loved most, but has also been difficult, about this training year is the diversity of my patient population. When a Kaiser member calls for a mental health appointment, they speak with a licensed clinician (clinical psychologist or LCSW) in triage, who asks some brief questions about why the person is seeking services, assesses risk and safety, and books an intake appointment for the patient. Regular staff clinicians can tell triage if they have a special interest (anxiety, eating disorders) and when someone with that concern calls for an intake, triage makes an effort to assign cases accordingly. Also, staff members are either CD or mental health. Because I’m a trainee I have exposure to a bigger mix of patients than regular clinicians might. On one hand this is great, because I get to meet a lot of people and learn and apply interventions for a huge range of conditions. On the other hand, sometimes it feels like I can’t get a toehold because there’s always something new. This is probably part of being in such an early stage in my career, as well.
[OnlineMSWPrograms.com] On the other hand, what are the most challenging aspects of your job? How do you recommend students who wish to enter psychiatric social work prepare themselves to face these challenges?
[Anne Friedman, ASW] See above for one of the challenging aspects. I would say another challenge of this setting is the pace, which is extremely fast. Most days I’m seeing patients back to back and then rushing to complete clinical documentation and coordinate with other clinicians, and return patient calls and emails. I also think it’s important to be able to stay with – even relax – into the unknown. The process of change and insight is slow, and I view my role as helping to a) hold space for peoples’ narratives and stories to unfold and b) to empathize with and help the patient tolerate that which is psychically and emotionally intolerable for the patient to metabolize alone. At the beginning of the year one of my supervisors made the point that it’s somewhat unethical and voyeuristic to be providing therapy and not doing that kind of introspective work oneself. I agree, and think it’s important for therapists to be in therapy. If nothing else, it’s good self-care in a field with a really high burnout rate.
[OnlineMSWPrograms.com] For MSW students who are interested in becoming psychiatric social workers, what advice can you give them about optimally preparing for this field while pursuing their degree? Do you have any additional advice you would like to give current and prospective students who are interested in clinical social work and/or psychiatric social work?
[Anne Friedman, ASW] I recommend taking classes on therapeutic modalities you’re interested in (psychodynamic work, CBT, family systems, etc). One of the reasons I’m doing a post-master’s training year in mental health is that I felt like my internships weren’t especially clinical. I think it can be hard to enter psychiatric social work after grad school if your internships haven’t been in this field, so I would encourage MSW students to pursue internships in agencies or organizations doing mental health work if this is an area they’d like to go into. Different settings provide different experiences in terms of duration of treatment – psychiatric ER will be short-term and crisis-focused, versus an agency providing long-term therapy to trauma survivors, for example.
Thank you Ms. Friedman for your time and insights into psychiatric social work.