Articles & Trainings

As we approach the third anniversary of the COVID-19 pandemic and are hopefully transitioning to an endemic phase, we’re pausing to honor the 6.6 million lives lost, reflect on the profound experience this disease has had on us as survivors, and look for meaningful paths forward. In this article, part one of a two-part series on moving from a state of survival to conditions for thriving, we look at how American lives have collectively changed over the course of an ongoing public health crisis.

COVID-19: Surviving Survival Mode

In the beginning of the COVID pandemic, Americans went into survival mode. Many sheltered in place if they could; many experienced personal tragedies, from the deaths and prolonged illnesses of friends and family. We changed our behavior with social distancing; some of us shifted to unemployment or remote work; we developed coping strategies for the extreme stress, anxiety, and depression we were experiencing.

The trauma of COVID-19 caused such stress that our brains functioned in a different manner. Our prefrontal cortex, where executive functioning skills come from, turned the reins over to our survival brain. For adults, being in survival mode might look like:

  • A lack of focus.
  • Changes in memory. Your days may blend together, or you might not remember what happened earlier.
  • Low energy and fatigue. This includes your body and your mind.
  • Insomnia.
  • Emotionally reactive and/or withdrawn.
  • Forgetting basic needs.
  • More impulsive. Many Americans ate and drank more, for example.

For those who were able to develop healthy responses to the ongoing stress, they started to exercise and physically move, such as getting out of the house for a daily walk; to reach out and connect with others, perhaps through Zoom; and to practice self-care, including getting quality sleep, developing a new pandemic routine, making time for a new hobby like baking bread, or seeking out moments of joy and laughter. In other words, they developed a resilience toolkit. These Americans were able to slowly exit survival mode, or at least manage the chronic stress well. For many, though, stress management was not quite that simple—and chronic stress was not necessarily a new experience.

COVID-19: Stuck in Survival Mode

When you’re stuck in survival mode and experiencing chronic stress—because, say, you’re a frontline worker in constant danger of contracting COVID-19 who can’t work remotely or afford to look for another job or take time off—it affects your productivity, relationships, and health. You’re more likely to have serious diseases, such as heart disease, obesity, and Type II diabetes; have an addiction, such as with alcohol, nicotine, and/or prescription drugs, as well as the internet, food, or gambling; and have mood and anxiety disorders. Whether it’s from the pandemic or it’s more related to poverty, discrimination, or a combination, overexposure to cortisol—the “stress hormone”—disrupts almost all of the human body’s processes.

COVID upended everyone’s lives. But it most significantly impacted BIPOC communities. Blacks, Latinos, and other people of color have suffered higher rates of COVID-19 infection and morbidity. They are more likely to be essential workers, and they were more likely to be unemployed as a result of the pandemic—especially Black and Latinx women.

Furthermore, and important to our work in mental health, Black, Indigenous, and people of color are less likely to have access to and seek out mental health services, and they are less likely to receive needed care. When they do receive mental health services, they are more likely to receive low-quality care and end care prematurely. The vast majority of mental health treatment providers in the United States are white, and some research shows that provider bias and stereotyping are factors affecting health disparities. It is imperative that in our field especially we increase cultural competency trainings, diversify workforces, and reduce stigma of mental illness.

All told, COVID-19 helped expose huge disparities in health, wealth, and healthcare access for Americans of color as compared to white Americans. With such a wide discrepancy between how some Americans were affected by COVID-19 compared to others, Americans were confronted with the stark differences in their lives due to privilege. This led to public outrage and was partly why—in addition to police brutality, growing economic and political divides, and building momentum toward racial consciousness, among other factors—Black Lives Matter protests drew record-breaking crowds. An estimated 26 million people took to the streets in the United States in the summer of 2020 to draw attention to and decry systemic injustice.

COVID-19: Moving toward Reflection

With a more-widespread understanding and management of chronic stress, proclamations in support of racial justice, and a gradual acclimation to life during the COVID-19 pandemic, more people began to move from survival mode toward a mode of reflection. We considered essential questions about our lives aroused by the pandemic. Presented with so many deaths in a short time span, we asked ourselves: How do we live a life of meaning? We’ll look at this question in depth in part two of “Coming Out of the Pandemic: From Surviving to Thriving.”

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For independently licensed mental health professionals who own their practices, time management is an essential skill. You are juggling your caseload, your schedule, attentive care to your clients, and running your own business. Not to mention personal and family responsibilities – your plate is full.

To avoid overwhelm and the feeling that you just can’t get everything done, consider trying a few things to help with overall time management. Remember back in December when we talked about the issues with multi-tasking? Well, we’re revisiting the topic in order to help you strengthen your own time management talents.

Focusing on a single task at a time is a more effective time management skill because multitasking is distracting, slows you down, impairs executive function, and makes you make more mistakes. Some studies estimate that when you attempt to multitask, you actually end up taking 40 percent longer to finish the project than you would have taken if you’d given it your complete attention.

What to manage your time more effectively? Try to avoid:

  • Bouncing from one device to another; it’s just as distracting as bouncing from one task to another. Avoid spending time on multiple devices at once (aka media multitasking).
  • Constantly checking your phone or email.
  • Interrupting others who are in focused activities.

Instead, try this:

  • Self-regulate to purposefully avoid multitasking.
  • Time blocking – a powerful way to maintain control over your schedule by blocking off time on your calendar each day for specific tasks
  • Turn off electronic devices.
  • When interrupted, finish what you started first, if you can.
  • Silence online notifications. These are mini distractions!
  • Engage in single-tasking as much as possible.
  • Say no sometimes – it’s okay; we all take on too much at times.
  • Give others your full attention.
  • Model the behavior you wish to see.
  • Encourage and make time for mindfulness and mental wellness.
  • “Chunk” (single-task) your time, setting aside 25 minutes to two hours for each activity.

Is all Multitasking Bad for You?

While the research is pretty clear that multitasking isn’t healthy for you, there is some nuance in the study results. Not all tasks require our complete concentration and focus. We can, for example, fairly effectively sing and take a shower at the same time.

The human mind is “evolutionarily scripted for monotasking,” writes psychologist Jeff Comer, Psy.D. As tasks increase in complexity (and thus need more of our cognitive skills available), our ability to be efficient decreases when we multitask. So next time you are inclined to “get more done” and, say, text and write a paper, or finish up that email while you’re listening to a Zoom call? Think again. There is a real cost to your productivity and performance.

A Healthier Approach to Time Management

To complete a task, we must set a goal, identify the information we need to achieve it, and disregard irrelevant distractions. When we invite irrelevant distractions by attempting to focus on more than one task at once, we take away from our ability to complete the tasks. Over time, this behavior leads to more distraction. Research is ongoing to determine the long-term effects of multitasking on our brain function. For now, we know that studies show there are short-term negative consequences. To combat the erosion of concentration and focus that multitasking can produce, we can develop stronger mindfulness habits and engage in single-tasking.

Perhaps it’s worth pulling back and considering why we invest in time management techniques in the first place. As Anne Helen Petersen recently asked in her article, “The Diminishing Returns of Calendar Culture,” what would happen if we decouple time management and optimization from our ideas of “success” altogether?

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As Americans, we like to think of ourselves as rugged individualists, self-sufficient and driven to succeed. So, it’s no surprise that when it comes to our New Year’s resolutions or other big goals, we rely on our willpower and sheer determination to change our habits. After all, we can do it! But nearly 80% of New Year’s resolutions fail within a month. It may be wise to consider how humans can effectively implement personal change and use an alternative approach to make your goals—and ultimately your life—successful.

Who to Blame When Goals Fail

We tend to blame our lack of willpower for failed New Year’s resolutions, and equate this with a countrywide decline in self-control. Science does not back up our propensity to insist that we and our peers follow the age-old, all-American advice to “pull yourself up by your bootstraps,” though. In fact, it’s nearly the opposite.

It’s true that there is some work you can do by yourself to make change impactful and lasting. A deep understanding of how and why you operate the way you do is beneficial in many areas of life, not least of which for behaviors you’d like to change. When you truly grasp your mindset and core values, as well as what’s holding you back and limiting you, you will be more effective at changing your habits. An action you want to achieve that speaks to your core values, life purpose, and sense of meaning is an action you are more likely to take. And when you make it a SMART goal, you are more likely to succeed with that action.

That said, big personal change and goal achievement doesn’t happen in a vacuum. You need to make a sustained effort to change your habits over the long term, and one of the more effective ways to get there is by shaping your external environment—not focusing on your internal “lack” of self-control or otherwise blaming yourself for missteps or failures.

How to Make Goals Successful: Our Environment

We need to face facts. We will always have temptations thwarting our best intentions: the free candy when you’re trying to reduce added sugars in your diet, the compelling clickbait article when you’re trying to lower how much time you spend in front of a screen. There will always be obstacles in our way to a better life; we can’t control these. We can, however, exert some influence on our social and physical surroundings. Research shows that rather than rely solely on willpower to achieve our resolutions, we need to shape our environment to make self-control and accountability simple, easy, and convenient. Think of it as preparing the groundwork to then be lazy!

You have likely heard of the term “accountability partner” in reference to goal setting—and with good reason. When you shape your environment to achieve lasting change, put help via outside accountability high on your to-do list. This may come in the form of a formal or informal support group, online or in-person, who are making similar changes themselves, or it could be an individual accountability partner: a coach, a mental health practitioner, or someone else who is committed to helping you make the change you wish to see. Whichever it is, check in regularly.

That may sound like more work, and it is, but it substantially increases your chances of being successful with your stretch goals. We are, after all, social animals. Keep in mind that by adopting a support network, it may mean more internal work, too, in that you may need to not only hear constructive criticism, but embrace it. By welcoming external feedback, you can discover what went wrong and find ways to fix it, thereby improving yourself and moving ever closer to your big goals.

In addition to finding others to support us, another method to creating a fertile field for change is to design our physical environment. When we optimize our environment, we make self-control easier. If your goal is, for example, to spend less time with your smartphone, you could change your physical surroundings by putting your cell phone in a hard-to-reach place or disabling apps that might be tempting. The farther away and the more effort you have to make to indulge a temptation, the better. Make the good choice the easy choice by default.

Willpower is a limited resource, just like attention. Don’t make it do all the work to change—shape your support network and design your surroundings so you are set up for success.

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With the winter holidays upon us, we may feel the additional pressure to go, go, go: making holiday cookies, selecting gifts, getting twinkly lights up, seeing family and friends—all on top of our everyday lives, a mile-long to-do list, and what may feel like perpetual busyness. While your natural inclination may be to multitask and make it all happen, a smile plastered on your face all the way to the finish line, let’s pause for a moment and consider: is multitasking a healthy way to live?

What Is Multitasking?

Before we look at whether multitasking is a healthy habit, we need to define what multitasking is. Multitasking is, essentially, the performance of more than one task simultaneously. We all know what that looks like: wrapping up an email while we talk on the phone, responding to an instant message while we’re on a Zoom conference call.

A 2017 study published in Applied Ergonomics delves further in and differentiates between three types of multitasking:

Concurrent multitasking is when you conduct two or more tasks at the same time.

Interleaved multitasking, or task switching, is when you switch between two or more tasks as they develop.

Combined multitasking is a combination of the two types above; it is when you execute two or more tasks concurrently while switching between tasks as they develop.

In general, when folks refer to multitasking, they are referring to combined multitasking.

Is Multitasking Bad for You?

With job descriptions routinely advertising for employees who can juggle multiple tasks and lives that seem to get busier and busier, multitasking can seem like a knee-jerk response to getting more done in a day. It’s worthwhile, however, to pause and look at the research done on time management techniques and consider whether multitasking is a healthy or unhealthy practice to partake in.

People who multitask are less efficient than those who focus on one project at a time, according to a study in the Journal of Experimental Psychology. In fact, Stanford University studies show that productivity can be reduced by as much as 40% when we multitask. With substandard results in our performance, why do we persist in our attempts to multitask, and continue to believe it’s an efficient, productive way to work when, in fact, it’s not?

When you multitask, it seems like you’re accomplishing many things at the same time. But rather than getting more done, what you are really doing is quickly shifting your attention and focus from one thing to the next. It’s this switching, or interleaved multitasking, that slows you down and stresses you out.

How Does Task Switching Affect Me?

Multitasking is managed by your brain’s executive functions, which determine how, when, and in what order tasks are done. There are two stages to the executive control process: goal shifting (deciding to do one thing instead of another) and rule activation (changing from one task’s rules to the rules for a new task). When you multitask, you incur what psychologists call “task switch costs,” or the negative effects resulting from switching among tasks.

Research has shown that when we grow accustomed to frequent interruptions, we develop a short attention span and even begin to self-interrupt, which leads to a longer-term problem, as it extends the amount of time needed to finish tasks.

What Happens When I Multitask?

People tend to overestimate their ability to multitask, and those who multitask the most demonstrate more impulsivity, less executive control, are more easily distracted, and tend to downplay the negative effects of their behavior.

Intense multitasking can induce a stress response, according to Dr. David Meyer, a psychology professor and codirector of the Brain, Cognition, and Action Laboratory at the University of Michigan. This further degrades cognitive processing, says Dr. Jeff Comer.

Multitasking results in:

  • Diminished ability to concentrate
  • Decreased ability to pay attention to details
  • Lower competency in organization skills
  • Being perceived as disrespectful
  • Delayed task-completion
  • Increase in stress
  • Increased impulsiveness
  • Lower recall
  • More frequent memory lapses
  • More frequent accidents and errors
  • May worsen work and/or school performance
  • Burnout

The Importance of Breaks

Guess what? Multitasking makes us very tired. By quickly switching between activities, even minor ones, we use up our precious supplies of oxygenated glucose in our brains—the very same fuel we need to focus on a task! To compensate, many folks reach for more coffee (caffeine), more food—in other words, more energy. Instead, Dr. Daniel Levitin, professor of behavioral neuroscience at McGill University, speaks to the benefit of regular breaks. When we take 15-minute breaks every couple of hours and allow our minds to truly wander, we’re more productive. Your brain is, after all, a muscle, and it needs time to rest and recover after it’s worked out.

One way to think about multitasking is purposefully giving ourselves distractions in the form of other tasks. But switching tasks is stressful, and on average it takes us twenty-three minutes to return to our work when we’re interrupted, according to Dr. Gloria Mark at the University of California, Irvine. To avoid that switch-induced delay caused by multitasking, she advises “chunking” your time. Also known as time blocking, monotasking, or single-tasking, this method of scheduling your day can give you a sense of control over your time and make you more productive.

What Is Single-Tasking?

Single-tasking is the opposite of multitasking. With single-tasking, you balance competing tasks. When you become a single-tasker, you are filtering tasks, determining priorities, setting goals, and completing the many items on your to-do list. You maximize your productivity by setting aside specific times for completing your most important work. You can do this by focusing on creating a prioritized to-do list and then time blocking.

Single-tasking (aka time blocking) is a time management technique that is as simple as it sounds: block off a period of time to complete a particular task. By setting aside specific times to respond to emails, return calls, and focus on important projects throughout your day, you can improve your focus and deter any tendency you might have to procrastinate. Best yet, at the end of the day, you’ll feel like you accomplished something—because you likely did!

As we move through the hectic holiday season, consider taking a break from multitasking and purposefully engage in a time management technique that will reduce stress, improve your focus, and help you happily, healthfully conquer your never-ending to-dos.

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We know that self-care is important for everyone. But how do you practice self-compassion and personal wellness when you have been through trauma or are trying to help someone through a traumatic life event? In the first part of a two-part series on trauma-specific self-care, we looked at how your body responds to stress and trauma and what individuals can do to begin healing. Now, in part two, we’ll explore how mental health professionals can take care of themselves while they take care of their clients.

How Does Treating Clients with Traumatic Experiences Affect Me?

The reality is that treating clients who have experienced trauma can have impact. This “inevitable secondary stress,” as Trauma expert and Simmons College Graduate School of Social Work professor Julia Colpitts, MSW, calls it, is natural. We evolved to connect with our pack to survive. When we see or hear other people’s trauma, the areas in our brain that are activated are the same ones that would be activated if it was primary trauma—our own trauma. Mirror neurons are engaged in the trauma’s retelling, and our bodies respond to the story and mimic the survivor’s physiological response. Trauma is, in a sense, contagious. So, what can we do about it?

What Is Secondary Stress?

“Vicarious or secondary stress is empathy in action,” Colpitts states, and it is unavoidable. We are social animals, and we respond naturally to others. The impact ranges from mild to clinically symptomatic, but all responses on the continuum can have a long-term effect. We can get stuck in arousal mode from the continuous retelling of traumatic life events if we don’t actively manage our secondary stress and its impact on us as therapists and mental health providers. It doesn’t have to lead to professional burnout; viewed and managed differently, it can even become an invitation to grow personally and professionally.

Secondary traumatic stress often causes muted arousal responses, either hyper (flood of anxiety, fear, and anger) or hypo (distancing from emotion). Over time, cognitive distortions can develop, altering one’s focus, the content of their thoughts, and even their worldview. Unacknowledged vicarious stress also has a negativity bias, which can obscure our compassion satisfaction and real accomplishments. For therapists who hear traumatic stories that resonate with their own prior life trauma, the arousal response can deepen—and our professional dissociation and burnout, historical and/or cultural trauma, and traumatized organizations can serve to further deepen that response.

Some mental health professionals, like others in the population, cope with secondary stress and trauma by employing short-term relief strategies to manage their state of arousal, such as food and alcohol issues, inactivity or “mindless” (dissociative) activities, and overwork. These primitive defense mechanisms may appear to help for a few hours, but ultimately they all have long-term negative consequences.

Unhealthy coping behaviors such as substance use may have the same effect as ignoring the secondary stress altogether: illness, including serious chronic conditions such as heart disease. Women who are social workers, for instance, are 36% more likely to have heart problems than women in other professions (American Heart Association scientific session, November 2019). And “community and social services” is number one of the top ten professions correlated to cardiac arrest (gender-neutral) (CDC Morbidity and Mortality Weekly Report, 2016). It is therefore crucial that we develop positive coping methods for secondary traumatic stress.

A therapist’s self-care involves acknowledging the continuous stress you are under and allowing yourself a release. We need to proactively prepare for secondhand stress and its impact on us through daily doses of calm interspersed through our days.

Which Tools Should Therapists Use for Secondary Stress?

How do we turn off the arousal response? We activate the care system.

“Self-care is not just what we do after work. Self-care is how we do the work itself.” –Julia Colpitts, MSW


First of all, guard against the tendency to overcommit, to overwork in an effort to soothe. Like the proverbial oxygen mask on an airplane, you are ill equipped to help others if you’re not functioning well yourself.

Then, create a resilience menu. Choose from an array of simple, self-care actions to calm the body and calm the mind—a personal relaxation practice that can radically reframe how you go about your day. As though you are selecting a dish from a restaurant menu, choose the one(s) that sound best to you that day, at that time. And just as we are advised to “eat the rainbow” when it comes to dietary health, your resiliency menu or toolkit works best when you layer soothing actions across the spectrum, and use self-care well not just when there’s a personal crisis, but proactively and intentionally, every day. Some examples of what relaxing options might be on your resiliency menu [link “resiliency menu” to October blog] include:

  • Breathwork, such as box breathing
  • Being kind to yourself—kick out the inner critic
  • Muscle tension release using progressive relaxation techniques
  • Guided meditation, such as those offered by Kristen Neff
  • Sensory stimulation (e.g., aromatherapy, calming visuals, nature sounds, savory tastes, touch, water, sexual activity, massage, Reiki bodywork, and grounding strategies)
  • Acupressure and acupuncture
  • Yoga, tai chi, and other mind-body centering work
  • Conjuring up images of love and connection
  • Self-compassionate meditation and activities, such as bilateral stimulation like the butterfly hug, and affirmations
  • Interacting with animals, including equine-facilitated therapy
  • Mindfulness and related physical practices, such as walking meditation and forest bathing
  • Body scans
  • Expressing gratitude and love

Your resiliency tools not only help to heal the impact of secondary traumatic stress by releasing stored arousal responses and reestablishing a peaceful baseline, they also help strengthen your capacity for joy and presence and prepare you for future sources of stress.

How Can I Support Other Mental Health Professionals’ Well-being?

To journey to wellness together, we need to support positive attachments to ourselves, to others, and to community coregulation. As mental health providers, we can:

  • Talk openly about secondary trauma and its impact.
  • Add moments to meetings that emphasize compassion satisfaction.
  • Practice personal relaxation techniques openly, as appropriate, to model calm.
  • Notice and address when organizations are traumatized.
  • Support setting realistic workloads.

Thank you to Julia Colpitts, MSW, for sharing her keynote presentation and ideas on this subject.

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This webinar will provide participants with an overview and in-depth examination of compelling ethical challenges in behavioral health.

Thu, November 10, 2022
Wed, November 30, 2022
8:30 AM – 4:00 PM EST

Refund Policy

No Refunds

About this event

About the Training:

This webinar will provide participants with an overview and in-depth examination of compelling ethical challenges in behavioral health. Dr. Frederic Reamer will explore complex and challenging ethical issues and practical strategies designed to protect clients and practitioners. The webinar will include a series of challenging cases and discuss practical steps professionals can take to manage ethical issues skillfully. Key topics will include boundary issues, dual relationships, conflicts of interest, confidentiality, privileged communication, informed consent, clients’ rights, delivery of services remotely, termination of services, and impaired professionals, among others. Dr. Reamer will discuss relevant ethical standards; national practice standards; and statutes, regulations, and case law. The webinar will focus especially on complex documentation issues. The presenter will make extensive use of case material and provide ample opportunity for audience participation.

This training is worth six (6) contact hours.

By the end of this workshop, participants will be able to:

  • Identify challenging ethical issues and dilemmas in behavioral health
  • Apply practical ethical decision-making frameworks and protocols
  • Identify ethical issues that pose malpractice and liability risks
  • Design strategies to protect clients and practitioners

Agenda for the Day:

  • Difficult ethics cases in behavioral health: The anatomy of ethical dilemmas (8:30-9:30 a.m.)
  • Compelling ethical challenges: boundary issues, dual relationships, conflicts of interest, confidentiality, privileged communication, informed consent, clients’ rights, delivery of remote services, termination of services, and impaired professionals (9:30-10:15 a.m.)
  • Break: 10:15-10:30 a.m.
  • Compelling ethical challenges in behavioral health (continued) (10:30 a.m. to noon)
  • Lunch (Noon to 1:00 p.m.)
  • Risk-management strategies to protect clients and prevent ethics complaints and litigation (1:00-2:30 p.m.)
  • Break: 2:30-2:45 p.m.
  • Ethical decision-making strategies (decision-making protocols; codes of ethics; ethics literature; ethics committees; practice standards; relevant regulations, statutes, and case law) (2:45-3:40 p.m.)
  • Questions/answers (3:40-4:00 p.m.)

***This training has been approved for LADCs and CADCs by the Maine Board of Drug and Alcohol Counselors.***

About the presenter:

Frederic G. Reamer is Professor in the graduate program of the School of Social Work, Rhode Island College, where he has been on the faculty since 1983. His research and teaching have addressed a wide range of human service issues, including mental health, health care, criminal justice, public welfare, and professional ethics. Dr. Reamer received his Ph.D. from the University of Chicago (1978) and has served as a social worker in correctional and mental health settings. He has also taught at the University of Chicago, School of Social Service Administration (1978-1981), and the University of Missouri-Columbia, School of Social Work (1981-1983).

Dr. Reamer has served as Director of the National Juvenile Justice Assessment Center of the U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention (1979-1981); as Senior Policy Advisor to the Governor of Rhode Island (1987-1990); and as a Commissioner of the Rhode Island Housing and Mortgage Finance Corporation, the state housing finance agency (1987-1995). Dr. Reamer served on the State of Rhode Island Parole Board from 1992 to 2016. He also served as Editor-in-Chief of the Journal of Social Work Education (1990-1994). He serves as Associate Editor of the National Association of Social Workers Encyclopedia of Social Work (Oxford University Press and National Association of Social Workers). Since 2012, Dr. Reamer has served as the ethics instructor in the Providence (RI) Police Department Training Academy.

Dr. Reamer has conducted extensive research on professional ethics. He has been involved in national research projects sponsored by The Hastings Center, the Carnegie Corporation, the Haas Foundation, and the Scattergood Program for the Applied Ethics of Behavioral Healthcare at the Center for Bioethics, University of Pennsylvania. He has published 24 books and 175 journal articles, book chapters, and encyclopedia articles. His books include:

  • Moral Distress and Injury in Human Services: Cases, Causes, and Strategies for Prevention (NASW Press)
  • On the Parole Board: Reflections on Crime, Punishment, Redemption, and Justice (Columbia University Press)
  • Ethics and Risk Management in Online and Distance Behavioral Health (Cognella Academic Publishing)
  • Ethics and Risk Management in Online and Distance Social Work (Cognella Academic Publishing)
  • Risk Management in Social Work: Preventing Professional Malpractice, Liability, and Disciplinary Action (Columbia University Press)
  • Boundary Issues and Dual Relationships in the Human Services (Columbia University Press)
  • Heinous Crime: Cases, Causes, and Consequences (Columbia University Press)
  • The Social Work Ethics Casebook: Cases and Commentary (NASW Press)
  • A Guide to Essential Human Services (NASW Press)
  • Criminal Lessons: Case Studies and Commentary on Crime and Justice (Columbia University Press)
  • Social Work Values and Ethics (Columbia University Press)
  • Tangled Relationships: Managing Boundary Issues in the Human Services (Columbia University Press)
  • Ethical Standards in Social Work: A Review of the NASW Code of Ethics (NASW Press)
  • The Social Work Ethics Audit: A Risk Management Tool (NASW Press)
  • Ethics Education in Social Work (Council on Social Work Education)
  • The Foundations of Social Work Knowledge (Columbia University Press; editor and contributor)
  • Social Work Malpractice and Liability (Columbia University Press)
  • Social Work Research and Evaluation Skills (Columbia University Press)
  • The Philosophical Foundations of Social Work (Columbia University Press)
  • AIDS and Ethics (Columbia University Press; editor and contributor)
  • Ethical Dilemmas in Social Service (Columbia University Press)
  • Rehabilitating Juvenile Justice (Columbia University Press; co-author, Charles H. Shireman)
  • The Teaching of Social Work Ethics (The Hastings Center; co-author, Marcia Abramson).
  • Finding Help for Struggling Teens: A Guide for Parents and the Professionals Who Work with Them (NASW Press; co-author, Deborah H. Siegel)
  • Teens in Crisis: How the Industry Serving Struggling Teens Helps and Hurts Our Kids (Columbia University Press; co-author, Deborah H. Siegel)

Dr. Reamer is also the author of chapters on professional ethics in the Encyclopedia of Social Work, Encyclopedia of Bioethics, Encyclopedia of Global Ethics, Encyclopedia of Applied Ethics, Encyclopedia of Lifespan Human Development, Encyclopedia of Higher Education, and Encyclopedia of Primary Prevention and Health Promotion. He has been an essayist on National Public Radio’s Morning Edition (“This I Believe” series), a commentator on National Public Radio’s All Things Considered, and a guest on various radio and television broadcasts. From 2007 to 2021 Dr. Reamer served as host and producer of the National Public Radio series This I Believe—New England, broadcast weekly. He is featured in the podcast series Trapped in Treatment produced by Paris Hilton, Warner Brothers, and iHeart Media; Yahoo News national series Unfiltered; and as a commentator in the video documentaries America’s Serial Killers: Portraits in Evil and Rampage: Killing without Reason. He is also a featured expert on the PBS (Public Broadcasting Service) series This Emotional Life.

Dr. Reamer has lectured extensively nationally and internationally (including India, China, Singapore, South Korea, Japan, Taiwan, Sweden, Germany, Italy, Portugal, Djibouti, Bahrain, Indonesia, Diego Garcia, Spain, Romania, Poland, Greece, and Canada) on the subjects of professional ethics and professional malpractice and liability. He has served as an adjunct professor and visiting scholar at the University of Pennsylvania, Tulane University, Simmons University, Smith College, University of Oklahoma, and Augsburg University. Dr. Reamer chaired the national task force that wrote the National Association of Social Workers Code of Ethics and served on the code revision task force. He chaired the international commission sponsored by the Association of Social Work Boards to develop Model Regulatory Standards for Technology and Social Work Practice. Dr. Reamer also chaired the national task force sponsored jointly by the National Association of Social Workers, Association of Social Work Boards, Council on Social Work Education, and Clinical Social Work Association to develop Technology Standards in Social Work Practice. He has served as an expert witness and consultant in 130 court and licensing board cases addressing professional ethics.

Dr. Reamer received the “Distinguished Contributions to Social Work Education” award from the Council on Social Work Education (1995); Presidential Award from the National Association of Social Workers (1997); Richard Lodge Prize from Adelphi University for “outstanding contributions to the development of social work theory” (2005); Edith Abbott Award from the University of Chicago for “distinguished service to society and outstanding contributions at the local, national or international levels” (2005); Neil J. Houston, Jr. Memorial Award for “dedicated service and citizen contribution toward the criminal justice profession and the public interest” (2009); International Rhoda G. Sarnat Award from the National Association of Social Workers for significantly advancing “the public image of social work” (2012); Excellence in Ethics Award from the National Association of Social Workers (2015); and inaugural Contributor Award from the Association of Social Work Boards (2019). In 2016 Dr. Reamer was named a Social Work Pioneer by the National Association of Social Workers for his “commitment and dedication to the social work profession and to the improvement of social and human conditions at the local, state, national, and international levels.”

Register here for the Tuesday, November 10 session!
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Self-care is important for everyone. But how do you practice self-care and self-compassion when you have been through or are currently experiencing a traumatic life event? In this first of a two-part series on trauma-specific self-care, we look at how your body responds to stress and trauma and what individuals can do to begin healing.

What Determines my Level of Tolerance?

We all have different ranges of tolerance to life’s stressors. The ideal state of being in which you have the ability to deal with life’s ups and downs to a reasonable extent is what the National Institute for the Clinical Application of Behavioral Medicine refers to as your “window of tolerance.” Stress and trauma affect your window of tolerance, shrinking it and disturbing what stresses you’re able to handle. You may become hyperaroused—anxious, angry, overwhelmed—or hypoaroused—zoned out, numb, frozen. These reactions aren’t something you choose; it’s simply how your body reacts. Working with a mental health provider can help you by expanding your window of tolerance, so you have a wider range of situations and challenges you are able to cope with.

How Is my Body Affected by Stress?

Traumatic stress is experienced in the body. Upon noticing something novel, you become alert. You then move into threat identification, seeking social cues to evaluate the extent of the threat. Both the alert and the subsequent shift into threat identification are instinctual responses to your environment, and you may not even be conscious of them. If you perceive the novel event as a threat, whether real or imagined, your body is then aroused—your lower, reptilian brain takes over, and your threat-defense system is activated. This process sends adrenaline, cortisol, and oxytocin into your body. You then experience a defense response: fight, flight, freeze, or tend and befriend. If your defense response works, your body calms down and your upper or cortex brain begins processing the experience.

In a state of alert, your body becomes hypersensitive, with a particular heightened awareness of the real or perceived threat. You can experience hyperarousal when trauma associations are triggered, feeling a flood of emotions such as anxiety, fear, anger, and grief. Trauma expert and Simmons College Graduate School of Social Work professor Julia Colpitts, MSW, calls this state “stuck on.” Or, you can experience hypoarousal, where you distance yourself from emotions to quiet the state of hyperarousal, which can lead to numbness and a disconnection. Colpitts calls this state “stuck off.” Your arousal responses highjack your higher brain functions and create physical reactions.

When stress and trauma are complex or ongoing, your body does not return to its baseline, and this sort of constant hypervigilance and arousal flood your body with stress hormones, which can impact health. Physical reactions can range from simple tension to chronic illness. Often, those who experience trauma will develop behavioral patterns to manage traumatic arousal. These behaviors often involve food, alcohol, inactivity, or overwork, which can provide short-term relief but cause long-term negative consequences.

How Can I Heal from Stress and Trauma?

Calm the body, calm the mind. Self-compassion involves enacting a lesser-used cycle of emotional regulation, which Paul Gilbert calls the “soothing system” in his book The Compassionate Mind: A New Approach to Life’s Challenges. The soothing system, which manages functions to slow down, soothe, rest and digest, safeness, kindness, and care, can be underdeveloped in an individual. With practice, you can build upon it to better manage your emotions and expand your window of tolerance.

What is a Resiliency Toolkit?

To strengthen your soothing system, spend more time in self-compassionate practices that center physiological and mind-body relaxation. Focus on creating a personalized relaxation practice from a menu of soothing options, Colpitts advises. Some soothing strategies to add to your resiliency toolkit include:

  • Breathwork, such as box breathing
  • Muscle tension release using progressive relaxation techniques
  • Guided meditation, such as those offered by Kristen Neff
  • Sensory stimulation (e.g., aromatherapy, calming visuals, nature sounds, savory tastes, touch, water, sexual activity, massage, Reiki bodywork, and grounding strategies)
  • Acupressure and acupuncture
  • Yoga, tai chi, and other mind-body centering work
  • Self-compassionate meditation and activities, such as bilateral stimulation like the butterfly hug, and affirmations
  • Interacting with animals, including equine-facilitated therapy
  • Mindfulness and related physical practices, such as walking meditation and forest bathing
  • Body scans
  • Expressing gratitude and love

Try to maintain a regular practice of your chosen relaxation techniques. You can form healthy habits by starting small and attaching a technique to part of your regular routine, such as breathwork after brushing your teeth each day. Take note of the improvements you feel, which will help you continue and build upon your emotional resiliency menu of options. By regularly employing direct body and other relaxation strategies, your body will calm down and your mind will follow suit. This will create patterns of calm that serve to “release stored arousal and reestablish a peaceful baseline,” according to Colpitts. “The more strategies you use,” she states, “the more difference it will make.”

What Else Can I Do to Take Care of Myself after Trauma?

In addition to using tools in your resiliency toolkit, you can also “burn off” the stress in your body from traumatic experiences by engaging in physical activity. This can include energetic pursuits, such as dancing and working out, and/or more soothing activities like hiking and listening to music.

You may also need strategies to depower your threat defense system, which for those who have experienced or are experiencing trauma is overactive. You can do this by partnering with a mental health professional to learn new patterns and activate the care system. We also advise working with a practitioner on cognitive behavioral work and to engage with trauma success factors, including taking reparative action, interrupting the trauma flow, managing arousal, bringing attention to cognitive adaptive patterns, cultivating positive attachment and experiences, and attending to context.

“Being kind to ourselves releases energy to move forward,” Colpitts says. And it “soothes body, mind, and spirit.”

Thank you to Julia Colpitts, MSW, for sharing her keynote presentation and ideas on this subject.

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As summer comes to a close, parents and students across America start preparing to head back to school. Some students understandably have anxiety about returning to the classroom in light of the school shooting in Uvalde, Texas, and other recent incidents of school shootings. How can we help children who feel anxious about school violence? Let’s look at ways back-to-school anxiety is expressed and examine strategies for helping students with concerns about school violence.

What are Signs of Anxiety in Children?

Anxiety over school shootings has become common in America. Even when children aren’t directly involved in episodes of school violence, they are deeply affected by these traumatic experiences. Exposure to violence can cause learning and behavioral problems in students. Children may feel anxious or fearful, and they may not express the distress they are feeling in a way that adults can easily recognize.

If a child isn’t directly communicating their worries about returning to school, look for symptoms that may indicate anxiety is present. These signs can include:

  • Excessive worry
  • Seeks constant reassurance from teachers and caregivers
  • Avoids school or summer camp
  • Sadness/depression
  • Withdrawn
  • Difficulty enjoying activities that were previously pleasurable
  • Irritability/anger
  • Argumentative
  • Negative thinking patterns
  • Hypervigilance
  • Difficulty concentrating
  • Poor or declining school performance
  • Poor appetite
  • Headaches
  • Nightmares

How Can I Help Anxious Students?

The most important way you can help school-age children coping with anxiety around school violence is to talk to them. Do not avoid the scary topic—that makes it scarier. Ask them what they are thinking and feeling. Listen attentively, and use the information you gather as a basis for how much information they need and can handle, in addition to the child’s age and whether or not they have experienced trauma before.

Children’s concerns and questions tend to be different than adults’. Kids often want to know who is to blame, what could be done to prevent the tragedy, or whether it could happen at their school. Being truthful in your response—while keeping in mind developmental appropriateness—is crucial to building and maintaining trust and open communication with the child.

Validate the child’s feelings. Avoid downplaying their concerns or fears. And keep the conversation going—this is not a one and done talk, and it might be best to handle in smaller doses, especially for younger children. An open-door policy and a continued dialogue encourage children to share their concerns at any time.

Anxious kids also benefit from routines. Keep schedules predictable to the extent you are able. The consistency of their daily routine will help them feel secure and safe.

Limit their exposure to violence. While we want to keep an open, honest dialogue, seeing the same event televised or in the papers repeatedly is not helpful and may in fact be harmful. This can mean developing new household rules to limit screen time or access to newspapers and/or social media, especially after a school shooting or other traumatic event.

For parents, caregivers, and therapists of older kids, such as those in middle school or high school, we can help them convert anxious or angry feelings into plans for action. Older students may find that becoming an advocate for school safety helps them channel their anxiety into action, creating a helpful, healthy coping strategy for dealing with feelings around school violence. Also encourage them to report specific incidents that concern them, such as bullying or threats, and occasionally check in about how they are feeling or what they are experiencing at school.

Finally, as an adult, manage your own anxiety around school shootings. Kids are very adept at picking up on their parents’ fears, which can contribute to increasing the intensity of their own fears. To reassure a child, you need to be taking care of yourself, too. Ensure you have another adult to talk to about how you feel, de-stress, and engage in regular acts of self-care. When you model healthy ways to cope with stress and fear, children will learn from that behavior. Ultimately, we want to teach children skills for self-soothing and effective, lifelong coping mechanisms in dealing with stressful events to develop their resiliency for all they might encounter.

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Summertime… and the living isn’t easy for everyone. Depression in the summer is more common than you might guess. While many equate summer with school vacation, outdoor camps, water fun, and blooming gardens, others can and do feel depressed during the sunny season—and the social expectation that you’re supposed to have fun can make that depression feel even lonelier and more isolating.

How to Identify Summer Depression

While summer depression shares common symptoms with depression (feeling depressed most of the day, having low energy levels, losing interest in activities you used to enjoy, difficulty concentrating on tasks, and feeling hopeless or worthless), summer depression has specific symptoms that include:

  • agitation and restlessness
  • loss of appetite
  • trouble sleeping (insomnia)
  • weight loss
  • anxiety

If you feel depressed come June each year and it seems to improve around September, you may be experiencing summer depression. The National Institute of Mental Health indicates a patient may be diagnosed with summertime seasonal affective disorder if they have symptoms of major depression, have lived with depressive episodes in the summer months for two consecutive years, and have a tendency to have depressive periods more frequently in the summer than in than in other times of the year.

Symptoms of summertime blues, by contrast, are similar (low mood and a lack of energy) but less debilitating.

Where Does Summer Depression Come From?

Like all forms of depression, summertime depression can have biological, psychological, and/or environmental causes. Summer schedules are often disruptive to our usual schedules, and this sudden, big change can be hard to handle, especially for people who are vulnerable to depression.

Biologically, some studies suggest that, like other forms of major depressive disorder (MDD), summer depression may be linked to the brain chemical serotonin. The risk of developing summer depression is higher for women, those with relatives with a mental illness, or those who have major depressive disorder, bipolar disorder, or another mental illness.

More than 3 million American adults experience seasonal affective disorder, or SAD. Of those, about 10% of people who have a MDD with a seasonal pattern, such as SAD, have their depression symptoms begin at the onset of summer, not winter. It’s unclear why this happens to a subset of those with MDD or SAD. Some experts point to too much sunlight, heat, and humidity as possible culprits.

How to Help Your Clients Cope with Summertime Depression

A number of tools and strategies can be employed by mental health practitioners to help their clients cope with summer depression.

  • Change dosage. If you are licensed to prescribe medications, consider temporarily increasing the dosage of your client’s medication for depression. Or, if you are not, encourage your client to speak to their medication prescriber about gradually increasing their dosage in late spring and easing off slowly in the fall.
  • Respect the worry your client may be feeling. With summer depression in particular, people who are struggling with their mental health are apt to feel something is wrong with them: Why does it seem like everyone else is having fun and I’m not? What’s wrong with me? While this is a typical response, it is not helpful to compare how we’re feeling with how we think we’re supposed to feel. Instead, gently encourage your client to focus on the causes of their summertime depression and how it can be resolved.
  • Evaluate triggers. Consider what past experiences your client may be associating with summer, whether it’s the death of a loved one, an important anniversary, or another traumatic event. Working through triggers may lessen or release some of these associations.
  • Experiment with darkened rooms. Following some mental health professionals’ theory that too much sunlight could be causing summer-onset MDD, spending more time in darkened rooms—the opposite of light therapy—may be advisable. For similar reasons, wearing sunglasses may help.
  • Advocate for regular exercise. Numerous studies demonstrate that regular physical activity can help depression and mood disorders.
  • Recommend a good night’s sleep. Insufficient sleep can trigger depression. Rule out this cause by ensuring your client is getting enough ZZZs (generally 7 to 9 hours a night for adults).
  • Engage in mindfulness. Yes, there’s that oft-mentioned recommendation to develop a meditation and mindfulness practice again! Evidence shows mindfulness has a significant impact on mental wellbeing, combating fatigue and naturally bolstering one’s defenses against depression.

Get Help

If you or someone you know thinks they might be depressed, regardless of the time of year, please get help. Do not take summer depression lightly or downplay its symptoms. Talk to a mental health practitioner. We are here to help, and there are effective treatments available. You do not need to suffer in the summer.

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We explore the common co-occurrence of mental health and substance use conditions in this six-hour training for clinicians.

Fri, September 16, 2022
Fri, September 30, 2022
9:00 AM – 4:15 PM EDT

About this event

About the Training:

This highly interactive six-hour training will review best practices for working with clients who have addictions as well as comorbid psychiatric disorders. The presenter and participants will explore various treatments and treatment issues for clients with addictions and mental health disorders. In addition, participants will learn skills to manage their own reactions to clients who present challenging behavior patterns. Case examples, surveys and group discussion will be used to illustrate key points.

This training is worth six (6) contact hours.

By the end of this workshop, participants will be able to:

1. Identify major diagnoses and diagnostic categories of addictions.

2. Discuss treatment approaches to addiction and psychological disorders.

3. Categorize ethical issues that emerge in working with clients with co-morbid addiction and mental health issues.

4. Increase empathy and personal ability to manage countertransference in dealing with clients who present challenging interpersonal behaviors.


Agenda for the Day:





Neuroscience and addiction

Stages of Change

10:30-10:45: Break



Evidence-based treatment Medication-assisted treatment (MAT)

Case #1

12:15-1:00: Lunch on your own


Treatment dilemmas

Who is the client?




Scope of practice/expertise

Case #2

2:30-2:45: Break


Ethical issues


Case #3

4:00- 4:15: Discussion/Question/Wrap-up


About the presenter:

John M. O’Brien, Ph.D. ACC, NBC-HWC earned his doctorate in Counseling Psychology from Michigan State University in 1996. Since 1998, he has been in private practice in Portland, Maine, providing psychotherapy and consultation services with specialties in addition, trauma, grief and LGBTQ+ clients. He is an adjunct faculty member at the University of Maine at Augusta, teaching courses in psychology and addictions. He served as president of the Maine Psychological Association and is currently co-chair of Continuing Education for the APA Society of Consulting Psychologists.

John is an ICF ACC Certified Coach and NBHWC Certified Health and Wellness Coach. He coaches leaders in a variety of fields, including business, health care and the law.

In his spare time, John enjoys motorcycling, skiing, biking and furthering his ability in German.

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Register here for the Friday, September 30 session!

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