CSWJ Forum: Is Clinical Social Work a Profession? Preliminary Considerations

Clinical social work, as it currently exists, is rooted in the formation of a professional association which represents the interests of professionals primarily concerned with direct practice. A diverse group of practitioners now describe themselves as clinical social workers, and clinical social work is increasingly being described as a profession. This article reviews the history of professions, and employs commonly accepted sociological criteria to begin to evaluate clinical social work's current standing as a profession.     

Teaching Note—Integrating Prevention Content Into Clinical Social Work Practice Courses

Rapid changes in health care services and delivery suggest an upcoming paradigm shift in the field of mental health. Recent national reports, health care policy changes, and growing evidence support a shift toward prevention-focused mental health care. The social work profession is uniquely positioned to act as leaders in this shift as the profession’s values, goals, and hallmark practice approach are consistent with preventive care. Most social work students, however, do not receive training in prevention practice. The author’s development, implementation, and evaluation of a prevention-focused master of social work elective in the area of mental health is presented as an example of integrating prevention content into clinical social work practice courses. Implications for social work education are discussed.     

Beyond Repair: Interpretation,Reparation, and Melanie Klein’s Clinical Play-Technique

This article puts clinical child psychoanalysis into conversation with recent debates about critical method in order to question the turn toward so-called “reparative reading” in feminist and queer theory. While Eve Kosofsky Sedgwick’s original call for a new kind of reparative method culled its key terms (“reparative” and “paranoid”) from child psychoanalyst Melanie Klein, the scholars who have adopted reparativity in critical theory pay little attention to Klein’s work. In this article, I take up Klein’s theory of the depressive position and reparativity as she elaborated them in her clinical work with children, particularly her wartime analysis of “Richard” in 1941. Klein interpreted Richard’s play—his clinical “war games”—through her idiomatic vocabulary of “attack” and “repair.” By situating this case and Klein’s larger theory of psychic reparations in the political climate of wartime Europe, I argue that Klein’s writings point to the ethico-political dangers inherent in reparative endeavors, which name the object and narrate its injury and repair according only to the perimeters of one’s own self. From this reading, I propose that there might be a benefit to foregoing the injury/repair framework implicit in reparative agendas—both critical and clinical alike. By returning reparativity to Klein, I therefore aim not to offer a corrective to Sedgwick or to the scholars following her, but rather to interrogate the ethical stakes of all reparative endeavors, be they political, intellectual, or clinical. At the most basic level, then, this article argues that the space of the clinic is an important (and often undervalued) object for the consideration of critical method.     

Assessing MSW Students’ Integrated Behavioral Health Skills Using an Objective Structured Clinical Examination

Within the last decade, there has been a significant shift in the field of social work toward competency-based education. This article details the use of the Objective Structured Clinical Examination (OSCE) Adapted for Social Work Performance Rating Scale. We used the measure to evaluate specific practice competencies among students (n=33) participating in a professional workforce development program, funded by the Health Resources Services Administration Behavioral Health Workforce Education and Training for Professionals. We report on students’ performance and their views of the OSCE as an assessment measure and learning experience, and on the interrater reliability and consistency of the OSCE. Results can be used by other social work programs to inform the use of OSCEs to facilitate competency-based assessment.     

The Clinical Relevance of Divergence in Adolescent–Parent Reports of Adolescent Depression and Anxiety

This study examines associations between adolescent problem behaviors and adolescent–parent disagreement in ratings of adolescent depression and anxiety symptoms. Adolescent–parent dyads (N?=?463; mean age?=?12.68 years; 48.5% female; 78.2% White and 21.8% non-White) reported on adolescent depression and anxiety using parallel scales from the Youth Self Report (Achenbach et al., J Emot Behav Disord 10:194–203, 2002) and the Child Behavior Checklist (Achenbach and Rescorla, The manual for the ASEBA school-age forms & profiles, University of Vermont, Research Center for Children, Youth, and Families, Burlington, 2001) across four waves. Generalized estimating equations were used to examine the relationship between discrepancy scores and adolescent behavioral outcomes: incidence of adolescent past-year substance use (alcohol use, binge drinking, marijuana use, and nonmedical use of controlled medications), delinquency, self-harm behavior, and aggression. Findings showed that larger adolescent–parent divergence scores of depression were associated with higher odds of marijuana use, non-medical use of controlled medications, alcohol use, binge drinking, in-school delinquency, illegal behavior, self-harm behavior, and clinically significant levels of aggressive behavior. Results further revealed that larger divergence scores on anxiety were associated with higher odds of in-school delinquency, illegal behavior, self-harm behavior, and clinically significant levels of aggressive behavior. Adolescent–parent reporting discrepancy on adolescent’s depression and anxiety symptoms may be indicative of adolescent’s social, emotional, and behavioral problems, and the disagreement may signal further need for assessment of the adolescent.     

Clinical supervision: Its role in “Containing” countertransference responses to a filicidal patient

This paper illustrates the role of supervision in processing countertransference responses with might have disrupted the therapist's empathy with a patient who had killed her child. The clinical material demonstrates how the therapist's responses of initial denial and subsequent disgust and fear were dealt with in supervision. As a result, the treatment process led to genuine, albeit limited, therapeutic change in a patient with severe character pathology.This paper is developed from a presentation of the case of Mrs. Jay at Department of Psychiatry Grand Rounds, University of Cincinnati College of Medicine, on May 2, 1989.     

What’s Wrong With These People? Clinicians’ Views of Clinical Couples

Marriage and family therapy (MFT) faculty and graduate students rated the "typical" or predictable behaviors of husbands or wives coming for therapy using the Georgia Marriage Q-sort. Scores were compared with previously published scores for both "ideal" couples (i.e., showing positive behaviors, attitudes, and problem-solving skills) and a sample of 136 nonclinical, community couples. A review of correlations between MFT raters' scores for clients and the scores for "ideal" or actual community husbands or wives indicated that clinicians have negative views of both clinical husbands and wives. Such negative views of clinical husbands and wives are particularly marked in scores by MFT faculty. MFT students had a similarly negative view of clinical husbands, but such views were not evident for clinical wives. Recommendations for MFT training and implications for future research are discussed.     

Teaching Note—MSW Student Perceptions of Learning Advanced Clinical Practice Skills Through the Flipped Classroom

The flipped classroom, with its focus on student-centered learning and active student engagement, is a growing trend in social work education. This article presents an innovative way of delivering practice content through the flipped classroom model, which can be adapted for any level of social work education. It walks readers through the steps of developing the course and the successes and challenges of the flip, particularly with an incorporated skills lab component. Additionally, this article shares student reflections on the development and execution of the course, with specific feedback on the experiential learning environment, discussions surrounding instructor workload and preparation, and implications for future iterations of the course from students who had very little prior technologically centered learning experiences.     

Towards Body–Mind–Spirit Integration: East Meets West in Clinical Social Work Practice

Contemporary trends in clinical practice are moving more toward an integrative approach that views the mind, the body and the spirit as inter-connected entities. There is an increasing interest in approaches that utilize physical, cognitive, emotional and spiritual components in assessment and treatment. This paper presents an integrative body–mind–spirit approach in clinical social work practice which is informed by the Eastern philosophical traditions of Daoism, Buddhism, and Traditional Chinese Medicine. Our work with a bereaved elderly woman is presented to illustrate how the three key intervention principles: (1) promoting a dynamic balance within the individual through multi-modal intervention; (2) fostering strengths; and (3) facilitating meaning-making can be effective in helping people in a clinical setting.     

“Walking the Tightrope:” Clinical Social Workers’ Use of Diagnostic and Environmental Perspectives

The purpose of this study was to understand how clinical social workers think about and utilize two distinct worldviews: the psychiatric perspective of DSM diagnosis (Diagnostic and Statistical Manual of Mental Disorders) and the contextual person-in environment perspective. The former is a requirement for service and reimbursement in nearly every clinical setting, while the latter has always been the hallmark of a distinctively “social work” approach. Although there have been quantitative surveys of social workers’ use of the DSM, this is the first qualitative study to examine how social workers actually navigate these two worldviews. Thirty clinical social workers took part in individual interviews, and their responses were analyzed thematically using HyperRESEARCH, a qualitative data management program. Findings reveal an array of ethical and practical issues, including the central “tightrope” of balancing the need to “ramp up” problem formulation in order to access service with the desire to “damp down” in order to minimize stigma and avoid pathologizing problems in living. Implications are addressed for social work practice, policy, and education.     

50?Years and the Future of Agency-Based Clinical Social Work Practice: Introduction to the Special Issue

This special issue is a celebration of the Silver School of Social Work??s 50th Anniversary in 2010?C2011. The articles in this issue celebrate the School??s distinct reputation for excellence in clinical social work. They also celebrate the school??s current mission, which includes knowledge development for social work practice, with an emphasis on urban problems, poverty and social justice, and agency-based practice. The majority of the submissions focus on contemporary and future social work practice. This paper concludes with a discussion of several issues that confront the future of clinical social work practice including workforce trends, technology, and the scientific basis for practice, wealth disparity and race as contemporary American issues that affect clinical social work, the globalization of social work and mental health services, and education for tomorrow??s clinical practice.     

Children’s Psychosocial Rehabilitation: Clinical Outcomes for Youth with Serious Emotional Disturbance Living in Foster Care

Children living in foster care are an especially vulnerable population who often come to the attention of Medicaid mental health providers. These children experience a high incidence of emotional and behavioral disorders and may have specialized treatment needs related to their living arrangement status. This study assessed whether Children’s Psychosocial Rehabilitation could effectively treat youth with severe emotional and behavioral disorders who live in foster care. Analysis of data from an open trial of 218 clinically-impaired youth, aged 3–18 years, revealed no reliable differences in treatment outcome between foster versus non-foster children, with a trend toward more favorable outcomes for foster youth. Findings justify further study of the effectiveness of this Medicaid-funded service for the treatment of youth in care.     

What Are the Correlates of Infertility-Related Clinical Anxiety? A Literature Review and the Presentation of a Conceptual Model

Infertility is a major stressor for many couples. Although several reviews addressing psychological distress and depression within infertile couples exist, less emphasis has been placed on infertility-related anxiety. Yet it is important to know whether clinical anxiety is a prevalent problem among infertile couples and what are the characteristics of those suffering from clinical anxiety. The present article summarizes the literature on infertility-related anxiety published between 1997 and 2008 and presents a model of infertility-related clinical anxiety that identifies variables that may distinguish individuals who present with clinical anxiety from those who successfully cope with infertility. This model is intended to inform both research and clinical practice with partners of infertile couples. Methodological shortcomings of infertility research and recommendations for future studies are also discussed.     

How Sturdy is that Digital Couch? Legal Considerations for Mental Health Professionals Who Deliver Clinical Services via the Internet

ABSTRACT

This article reviews legal issues related to providing mental health services via the Internet. It provides a general overview of the field and discusses jurisdiction, licensure, legal duties (competence, consent, confidentiality), and other legal concerns related to the business of online counseling. It surveys potential criminal and civil liability issues, noting procedural and substantive aspects of the relevant law. The author concludes that, although providers face a variety of challenges, their efforts in providing a service needed and desired by an important segment of the help-seeking population are worthwhile.     

Compulsivity and Impulsivity in Pathological Gambling: Does a Dimensional–Transdiagnostic Approach Add Clinical Utility to DSM-5 Classification?

Although the phenomenology of Pathological Gambling (PG) is clearly characterized by impulsive features, some of the Diagnostic and Statistical Manual of Mental Disorder (DSM-5) criteria for PG are similar to those of Obsessive Compulsive Disorder (OCD). Therefore, the compulsive–impulsive spectrum model may be a better (or complementary) fit with PG phenomenology. The present exploratory research was designed to further investigate the compulsive and impulsive features characterizing PG, by comparing PG individuals, alcohol dependents (ADs), OCD patients, and healthy controls (HCs) on both self-report and cognitive measures of compulsivity and impulsivity. A better understanding of the shared psychological and cognitive mechanisms underlying differently categorized compulsive and impulsive disorders may significantly impact on both clinical assessment and treatment strategies for PG patients. With respect to self-report measures, PG individuals reported more compulsive and impulsive features than did HCs. As regards motor inhibition ability indices, PG individuals and HCs performed similarly on the Go/No-go task and better than AD individuals and OCD patients. Results from the Iowa Gambling Task highlighted that PG, AD, and OCD participants performed worse than did HCs. An in-depth analysis of each group’s learning profile revealed similar patterns of impairment between PG and AD individuals in decision-making processes. Current findings support the utility of adopting a dimensional–transdiagnostic approach to complement the DSM-5 classification when working with PG individuals in clinical practice. Indeed, clinicians are encouraged to assess both compulsivity and impulsivity to provide individualized case conceptualizations and treatment plans focusing on the specific phenomenological features characterizing each PG patient.     

“She was more than a friend”: Clinical intervention strategies for effectively addressing disenfranchised grief issues for same-sex couples

This article focuses on grief experienced by same-sex couples with attention to the distinct factors that influence same-sex grieving partners within all social work system levels. An actual case narrative—the first author's lived experience—guides the reader through a powerful, personal journey to gain a greater perspective and connection on the impact of grief and loss. The concept of disenfranchised grief is applied to same-sex couples focusing on the grieving process. The authors delineate effective strategies for practitioner intervention for those working with individuals experiencing grief due to the loss of their same-sex partner. Particular emphasis is placed on cultural competence and cultural humility for enhanced effectiveness while working with same-sex-partner grief issues.     

Can Clinical Skills Be Taught Online? Comparing Skill Development Between Online and F2F Students Using a Blinded Review

This study compared the development of clinical assessment and intervention skills between students enrolled in a face-to-face (F2F) or an asynchronous online clinical social work class. All students from three semesters of F2F (n = 74) and online (n = 78) sections of an MSW clinical class taught by the same instructor were included. Two assignments were used to compare students: an assessment and treatment plan of a fictional case and a digital role-play. A doctoral student who was blinded to the course delivery mechanism graded the role-play. After controlling for baseline differences in age, there were no differences between online and F2F students in skill demonstration. It appears clinical skills can be taught as effectively online as in F2F situations based on blinded review of role-plays.     

Effects of a Foster Parent Training Program on Young Children’s Attachment Behaviors: Preliminary Evidence from a Randomized Clinical Trial

Young children who enter foster care experience disruptions in care and maltreatment at a point when maintaining attachment relationships is a key, biologically based task. In previous research, we have found that young children experience challenges as they form attachments with new caregivers. They tend to push their new caregivers away, even though such children are especially in need of nurturing care. Further, many caregivers do not respond in nurturing ways when their children are distressed, which we have found is problematic for young children in foster care. We developed an intervention that is designed to help caregivers provide nurturance even when children do not elicit it, and even when it does not come naturally to them. This paper presents preliminary findings of the effectiveness of this intervention on children’s attachment behaviors. Forty-six children were randomly assigned to either the experimental intervention or to an educational intervention. For three consecutive days, attachment behaviors were reported across three distress-eliciting situations. Children whose parents had received the experimental intervention showed significantly less avoidance than children whose parents had received the educational intervention. These preliminary results suggest that the intervention is successful in helping children develop trusting relationships with new caregivers.