Susie Page, MSW, LCSW, ACM: Emotional First Aid in the Clinic
Wednesday, August 28, 2019
The mind-body connection is well established. We all know “real life” problems of our patients make them vulnerable to chronic disease and stress. As licensed clinicians, social workers are authorized to diagnose pathology per DSM-5 guidelines. The reality is that family medicine social workers live in the V codes of DSM-5 and Z codes of ICD-10: “Person in Situation.” These codes represent social determinants of care that have wide ranging psychological impact: from trauma to everyday challenges, such as food insecurity and caregiver burden. Social workers receive many referrals about real world problems, and as my colleague noted in a previous blog, there are always underlying issues and emotions attached to these presenting problems.
It seems the latest thing in popular psychology is “Emotional First Aid.” This model promotes self-awareness and skills to eliminate or prevent negative thought patterns that arise in response to failure, rejection and loneliness — experiences of many of our patients and labeled as “disabling thoughts” in Positive Psychology.
These issues often present to us as “Anxiety and Depression.” What is our role in building and fostering resilience for patients? We often meet with patients for one session in responding to a crisis. The referral is often for assistance in treatment planning via psychotherapy. Although this is appropriate, access can be difficult, directed by insurance networks, and often delayed. As “first responders” we have a variety of approaches beyond providing a supportive presence, guidance and advocacy. Several real-time interventions I have used in my practice include brief sessions of imagery to focus on bodily discomfort that symbolizes emotional pain; and guided meditations to foster self-esteem. I have found most patients to be receptive and to benefit from participating in these personalized sessions.
As noted, the mind-body connection is significant. I would like to highlight “tapping,” a type of somatic therapy that invites attention to various acupressure points on the head, torso and hand. I recently worked with a patient experiencing an acute stress reaction following a rollover MVA. Her husband joined the session. She was first asked to rate a “SUD” (subjective level of her distress). By tapping we were able to immediately decrease her SUD by several points. Her husband was able to express guilt he felt about the accident. We tapped on his distress, which provided emotional release. In addition to cognitive restructuring in this session, the couple will continue practicing tapping at home. Tapping reduces and ruminating thoughts and in this way is “Emotional First Aid.”
Susie Page, MSW, LCSW, ACM, is a clinical social worker for Duke Family Medicine Center. Email firstname.lastname@example.org with questions.
Editor’s note: Providers in the Duke Family Medicine Center occasionally guest blog. Blogs represent the opinion of the author, not the Duke Family Medicine Center or Duke University Health System.