By Kaitlin Louie
About Jana Morgan, LCSW: Jana Morgan has over 15 years of experience in clinical social work. In addition to working as a therapist in private practice, serving clients in Los Gatos, Los Altos, and Scotts Valley, California, she is a part-time group therapy skills consultant, staff trainer, and group therapist for several organizations. Prior to her current work in private practice and therapeutic groups, Ms. Morgan was a Psychiatric Social Worker in the Forensic Unit at the University of California, San Francisco (UCSF) Medical Center and a Mental Health Case Manager for the Family Service Agency of San Francisco. Ms. Morgan earned her MSW from McGill University in Montreal, and her BSW from York University.
[OnlineMSWPrograms.com] Could you please elaborate on your role and the types of clients you have counseled and assisted in a clinical social work capacity?
[Jana Morgan, LCSW] I have been in the field of clinical social work for a total of 17 years. I began working with children and by connection and necessity with parents, which lead to work with adults and mental health, which interfaced with addiction issues. Social work is, by nature, interdisciplinary, and clinical social workers can work in a variety of settings along a continuum of care, from inpatient social work to day treatment and outpatient services. I have done street outreach to youth, and case management with chronically mentally ill individuals who were being discharged from state hospitals and brought back to communities of origin to be placed in board and care homes (i.e. residential treatment facilities).
Issues that my clients faced included social isolation, anomie and sometimes over-medication and self-medication with a variety of substances. Other presenting problems were what people would describe as emotional difficulties, a stressful life, and practical difficulties that were leading to exhaustion and subsequent emotional and familial problems. People come looking for solutions to problems they are encountering–quite often with some blind spots about how best to go about it. It appeared to me at the time that when people could not cope with their lives they suffered psychologically. People are overwhelmed, exhausted, and at times the issue they identify is not really the problem or is just part of the problem. The manifestations of their suffering were depression, high anxiety, and so much pressure that confusion, distortion and thought disorders ensued–often coupled with attempts to self-soothe via substance abuse and dependency.
Today, it seems, many professionals seem to sum the above challenges into a diagnosis of “your brain is not working, so you must take these pills and do a self-thinking reframe via mindfulness techniques to get back into mental health.” In my experience, if people could do this reframing through mindfulness independently, they would not show up in clinics and helpers’ offices. CBT/DBT [Cognitive Behavioral Therapy / Dialectical Behavioral Therapy] is useful once the client is able to take some responsibility for maladaptive habits and behaviors.
As a young professional I began to work in settings, such as inpatient mental health wards, where people show up in an acute state or as a result of crisis situations. My training was in childhood and adolescent mental health, which really formed a developmental basis for understanding human behavior. My studies into psychoanalytic literature about early childhood development, which was part of my training, fueled my interest in how these concepts are reflected in people over the course of their lives.
During my time in inpatient medical and psychiatric social work, I worked as part of a larger team, generally consisting of nursing staff, psychiatrists, occupational therapists, social workers, and nursing assistants. I have been part of the creation of diversion programs from psychiatric inpatient (hospital diversion to less expensive acute residential treatment) to jail diversion (from jail and jail psychiatric services to community/non criminal system supports). Diversion programs are basically ways to channel certain types of clients into services that are meant to be less pathologizing, less intrusive, less expensive potentially and more progressive. Diversion programs direct clients from one service to another, such as from the criminal justice system into the mental health system. Generally the diversions occur between public service systems and are a reflection of changes in public policy on how to treat certain groups of clients. When working at UCSF, I compiled extensive corroborative assessments/mitigation reports for the office of the Public Defender to help the attorneys get inmates with psychiatric symptoms referred to community mental health clinics.
Along the way, I realized the power of group and group therapy. I began post-graduate study of group therapy and personally identify as a group therapist. Post graduate study really allowed me to focus my training on my specific interests. I was drawn to relational work. I began to facilitate groups where “relational challenges” are amplified and get addressed more directly. I have observed and experienced the efficacy of relational work. People’s difficulties have a social context. Relational work allows people to see in the moment how they search for help, interact with others, and come to trust or distrust. Groups can guide people to a better understanding of themselves and their relationships. To this self-awareness the therapist can add the teachings of CBT and mindfulness tools. Furthermore, the relationships formed in groups are an instrumental developmental piece for clients, and can prompt participants to mature at a more rapid pace than they would be capable of through solo work. My post-graduate training felt professionally empowering as well as personally therapeutic. The training was seminal to my synthesizing my education and experiences as well as creating a professional peer group for further sharing and ongoing support.
I do individual treatment as well, where my understanding of mental health is very helpful. I work relationally, humanistically, and psychodynamically, using developmental frameworks and Jungian ideas to engage, explore and problem solve with my clients. I am finding Jungian concepts applied to psychotherapy useful as it allows me to draw on human beings’ attributes in a global way and incorporate myth and archetypes as tools for exploration of my clients’ experiences.
Group work is for clients who are interested in becoming more self aware with the longer goal of improving their relationships. Individual therapy is a more private dialogue about symptoms and symptom management with a broader hope that quality of life will improve. Both modalities are based on having a trusting relationship with the therapist. This takes time to develop, and the efficacy of the treatment is contingent on having time to explore and experiment with how therapy experiences affect and apply to life outside of the treatment room. I find I use a mixture of techniques depending on presenting issues. I think of individual clients graduating to group therapy as it takes a certain amount of courage and ego strength to “come out” and say to self and others, “I matter and I am interested in others too” which I see as a sign of health. All psychological change happens in the context of relationships hence my relational approach.
I have a particular interest in working with clients who experience extreme affective states and thought disorders–who may have a severe mental illness diagnosis, such as bipolar, schizoaffective and schizophrenia. At this time, I see it best in my private practice in individual therapy sessions, without the organizational context of an agency day-treatment center.
[OnlineMSWPrograms.com] What types of clinical interventions and therapeutic methods do you use with your clients?
[Jana Morgan, LCSW] I work relationally, focusing on in-the-moment communications with my clients. I use a developmental and psychodynamic, transference and countertransference awareness and processing while relating to my clients. I am humanistic and work within an existential framework. A humanistic approach incorporates an acceptance of the value of each human being–and works to preserve each client’s dignity and give them the respect they deserve. An understanding of developmental frameworks is important for me to gauge the degree to which an individual’s past experiences have affected their development and ability to function normally. Developmental frameworks assume that there are normative physical and psychological phases in human life, and they can be used to determine, for example, how/whether a client who suffered trauma at age 10 is managing, underperforming, or over-performing relative to his normative middle aged adult peers.
Psychodynamics refer to intra-psychic events, thoughts and feelings that play out in behaviors that are either working, partially working or destructive to how the person wants to feel or live his or her life. These dynamics get played out in-situ in the therapy hour. My role as a therapist is to work within these dynamics, re-parent, support, and gradually empower the client to become aware of the dynamics and subsequently utilize their own volition to responsibly make choices in a more attuned manner to his/her own self-determined goals.
Cognitive Behavior Therapy and Dialectical Behavior Therapy are mindfulness tools I use, with the understanding that a person has to be ready for these therapy forms by having a capacity for self-observation. The client would not be sitting in front of me asking me for help if he or she could do that spontaneously on his/her own. It takes time to get there and that process happens over the course of treatment. The client must develop responsibility for himself or herself when certain behaviors are activated.
Motivational Interviewing (MI) is a conglomeration and a re-packaging of previously developed skills and viewpoints by psychologists, psychiatrists and social scientists of the last 100 years. I learned several of the counseling skills used in MI in my various trainings and MSW program. They are now found under the rubric of MI. I find the stages of change–an MI concept–to be useful as clients are more or less receptive depending on what stage they are at in the process of positive change. The stages of change are pre-contemplative, contemplative, preparation, action, maintenance. A common mistake is to think that clients are in the preparation or action phase when as a therapist you meet with them. Actually, quite often they are not and work must first focus on how to get them to the point where change can occur.
Existential approach incorporates ideas that as a therapist I can open up a dialogue of wonder. There are laws in the universe that clients learn from their experiences, and I ask them to share these with me. Within these laws lie themes of love, death, redemption, suffering, journeys, etc.–which for me tie into Jungian themes. These are theories and ways of thinking which I personally find meaningful. I infuse my work with these ideas and explorations. I energize the client-therapist relationship with these elements. Rich conversations follow, which are part of the liaison that is necessary for therapeutic gains.
In the past 5 years, I have been interested in literature about attachment and substance use. I have found this to be a useful paradigm to understand clients who are struggling with addictions because clients–be they addicts or not–all have emotional needs, attachments, and struggles.
[OnlineMSWPrograms.com] What are some of the most rewarding aspects of your experiences in clinical social work? On the other hand, what are some of the most challenging aspects of clinical social work?
[Jana Morgan, LCSW] The most rewarding aspects of my work are to feel and see the emotional impact I can have with my clients as an ally as they manage their struggles. The work is so collaborative and becomes increasingly meaningful as my clients and I get at what brings them to treatment. Together we begin the challenge of self-discovery, acceptance, tolerating the heat and re-directing energy into self healing out of self loathing. These challenges are mine as well, as my life is not perfect. I try to balance a very high cost of living and my own personal life with staying clear and available for my clinical work.
[OnlineMSWPrograms.com] You have also worked as a program development consultant, training staff in group therapy and assessment skills. Could you elaborate a bit on this role, including what your responsibilities are and how you train staff members?
[Jana Morgan, LCSW] In my training role I am aware the huge part paraprofessionals play these days in treatment program delivery. Coming into the psychiatric health facility, a residential psychiatric treatment center where patients/clients are on 72 hour holds, and are sometimes held for up to 14 days, I am very aware of how institutionalized it is.
I meet with individual “service coordinators,” who are really doing social work as far as psychosocial assessments and discharge planning. Treatment plans are developed out of a set of formularized options, not leaving much scope for individualized attention. I see my job as helping to humanize the patients to the direct care staff, who are hired for social work without social work training. I help them go through the computerized pages of information gathered about the patients by the admitting nursing staff who are also filling out 5 to 10 pages of questionnaires, checking off what brings the patient into care. We read the diagnosis provided by the psychiatrist together. It is often general and reductionistic for reasons such as the fact that no corroborative data is accessible and the emergency personnel are the only source.
I help guide the staff through the process of putting the intake data together to create as best they can a basis for assessment areas to explore with the patient. I encourage them to engage the patient, not just try to get more information. I ask them to pay attention to their observations about the interview and their own reactions to the person, so that this might be incorporated into their work with them.
The group training is an extension of this attitude toward the patient. The main goal of the groups is to help each person have a positive social experience–in other words, they have an experience in the therapy room where they felt seen, respected, and understood, so that they might develop some hope that things could be different for them. I often run the group and then the staff and I discuss it. I have also sat in and let staff lead group sessions and then we discuss how they felt it went, areas of strength and improvement, etc. As clinical supervision is so new to the service coordinators, they are often highly anxious and can sometimes perceive this process as evaluative of their job performance.
I eventually hope to run a training group with the staff, as I believe that one is dramatically more effective as a group therapy facilitator if one has participated in group work. While this job is challenging, it is a labor of love for me, and I’m glad that the facility at which I work is trying to develop their staff’s skills and improve their programs and services.
[OnlineMSWPrograms.com] Regardless of their specific field, how important is it for clinical social workers to understand substance abuse and addiction? While some social workers work specifically in substance abuse and addiction counseling, do clinical social workers in other fields frequently encounter this issue?
[Jana Morgan, LCSW] Substance abuse and its treatment are totally relevant and present in my community. It is so recognized that even county social services have been merged so that mental health and substance recovery services are now one department, having one director. The service delivery is still separate but integrative health clinics are now starting to provide treatment in a more whole person manner. In private practice, I always assess and monitor for co-occurring substance abuse and chemical dependency. Addiction is such a large part of our society that it permeates and reflects into almost all human behaviors and endeavors. I use a harm-reduction approach when working with clients struggling with substance abuse, and keep in mind that it is a coping behavior. I see other behaviors as potential expressions of addictive processes used to alleviate distress.
[OnlineMSWPrograms.com] What advice do you have for students considering a career in clinical social work? What challenges have you faced in this field, and how would you recommend students manage these challenges?
[Jana Morgan, LCSW] I think social work training has become hyper-focused on cross cultural awareness and rather politicized to the point that it is structured as a profession for mass social change. But the fact is, social workers usually work with individuals and families. The clinical skills needed for both micro and macro work build on each other. The MSW students I supervise sometimes feel they are not getting the tools for the work, and often ask me how I know what I know. They report to me that they want more and don’t know where to look. I set a tone of “wondering” with them and try to help their inquisitiveness grow by looking together at our working relationship as a parallel to their own individual journey. I recommend readings and encourage them to come back to me with their reactions. It is unfortunate that while in their graduate program their schedules and academic demands do not allow for much wandering away from the required readings by the school. To the best of my ability, I try to discuss life-time learning and encourage consistent efforts to read professional literature as a self-care and professional endurance strategy.
I also spend a fair amount of time emphasizing the importance of stress management and self-care–modeling an awareness of self and one’s potential well-being. I see self-care as integral to professional survival. I also try to teach by example in this area, while reminding my students that self-care is not an easy task, and requires conscious effort and time. For example, I try to dress well, am in shape and generally calm, warm and kind. It is who I am, and I do see that I bring this with me wherever I go. I remember in my own training how run down many of my female mentors were. I seriously was affected by this and recall a time where I promised myself I would not become like that. Even as I write this years after my training experiences, I recall some of my mentors and have a sense of concern. I see that, at that time, I was in an environment where very few people spoke to this phenomena. With the interns in my charge, I create openings to discuss such matters. It is a critical thinking approach.
Thank you Ms. Morgan for your time and insights into clinical social work.