The “Other” Effects of Psychotropic Medication: Social Workers’ Perspectives on the Psychosocial Effects of Medication Treatment on Adolescent Clients

This study explores social workers’ perspectives on the psychosocial effects of psychotropic drug treatment of their adolescent clients. Using a mail survey, we asked a national sample of experienced clinical social workers to answer questions about their perceptions of the effects of such treatment on the sense of self and social well-being of an adolescent client. The survey questions also explored associations between perceived psychosocial medication effects and characteristics of the client and the treatment. The findings suggested that social workers viewed medication treatment as having greater beneficial than harmful psychosocial effects on their adolescent clients, but that both effects existed simultaneously. The most important factors associated with the perceived effects of medication that emerged from social workers’ reports included the etiology of the disorder, the type of drug treatment and its effectiveness in addressing symptoms, the client’s “competence,” and the quality of the relationship between the client and the treating social worker. This study provides direction for future research on a neglected but important question. It would be helpful to broaden the scope of professional discourse on the advantages and disadvantages of psychopharmacologic treatment for youth beyond the effectiveness or safety of the treatment to include questions concerning clinicians’ perceptions of the effects of drug treatment on youths’ sense of self and social well-being.     

Narcissism and the Social Work Response

Abstract

This paper reflects on and discusses the relationship between social work knowledge and practice in the context of work with narcissistically-oriented clients. Two subtypes of narcissism postulated in the literature are discussed in relation to the pattern of narcissistic internal claims about self and associated relational expectations. Key messages for social workers are that greater knowledge of the dynamics of narcissism may lead to: accepting and adapting practice based on the idea that narcissistic dynamics have a certain intentionality; applying empowerment models more carefully with this group; better understanding of how to effectively engage clients without reinforcing strong narcissistic tendencies or “results”; and protection of social workers' wellbeing by being able to identify and understand how narcissistic dynamics impact in practice situations. Social workers are urged to critically reflect on and to develop deeper, social work-specific, understandings of personality psychology in the interests of greater practice effectiveness.     

War and Peace: Social Work and the State of Chemical Dependency Treatment in the United States

SUMMARY

In recent decades, treatment for alcohol and drug problems in the United States has been influenced by a number of factors. This article discusses several of these factors, including the “War on Drugs,” with its emphasis on law enforcement and interdiction, and managed health care, which has compromised access to treatment. In spite of these factors, the U.S. invests a goodly amount in alcohol and drug prevention and treatment services and research. Efforts are being made to ensure that research findings are being translated into improved clinical practice. Among the controversial issues in the treatment arena are recent efforts by the Bush administration to promote public funding of faith- or religious-based groups in delivering chemical dependency services. Social workers commonly see people with alcohol and drug problems in their practices, but only a small number of social workers are well prepared to treat this group of clients.     

Youth workers' use of Facebook for mediated pastoralism with juvenile delinquents and youths-at-risk

Youth work seeks to rehabilitate juvenile delinquents for re-entry into mainstream society and to prevent youths-at-risk from falling into delinquency, thus necessitating that youth workers assiduously monitor their clients. With the avid use of social media by youths, youth workers must also adopt these communication platforms to reach out to their young clients. Drawing from interviews with youth workers, this study analyses how they use Facebook to communicate with their clients and monitor their activities. Surveillance forms a key thrust of youth workers' professional use of Facebook, enhancing their ability to oversee these youths' personal development for the purposes of mentoring and rehabilitation. Contrary to dystopian, power-centric conceptions of surveillance, the study finds that the youth workers' surveillance of their clients is undergirded by care and beneficence, better understood using Foucault's concept of pastoralism. Through mediated pastoralism via Facebook, these youth workers can derive a more extensive picture of their clients, including their emotional state and peer interactions. With this knowledge, the youth workers can then calibrate their interventions more strategically and only step in when their clients engage in behaviour that poses significant risks or danger. In so doing, the youth workers foster sustainable social capital with their clients that they can still leverage over time. Facebook communications also help the youth workers to bridge communication gaps with these youths. The study also examines how the youths resist the youth workers' oversight in various ways.     

Ethical Dilemmas of Practicing Social Workers Around Psychiatric Medication

Abstract

It is acknowledged that social workers in mental health and other settings routinely experience client-related ethical dilemmas. Further, there is wide recognition of the potential impact of ethical dilemmas on social work practice with clients who use psychotropic medication. Little is know empirically, however, about the experiences of practitioners with these dilemmas. This article describes the results of a national survey of practicing social workers regarding the nature of ethical dilemmas they face related to their work with clients on medication issues. The results make it clear that social workers regularly confront a variety of ethical dilemmas in this type of practice. Many of these dilemmas are related to ambiguities around the knowledge base of practice, appropriate roles of providers, and basic personal and professional values. The authors present implications of these findings for social work practice and further research.     

Nonmetropolitan sexual and gender minority youths' friendships: Perceptions of social support among SGM and non-SGM peers

ABSTRACT

Sexual and gender minority (SGM) youth are at risk of victimization which can lead to poor outcomes. Social support can mitigate the effects of minority stressors, yet little is known about social support among nonmetropolitan SGM youth. This study utilized minority stress theory (Meyer, 2003) and Weeks' (1996) theory of how sexual minority communities are constructed to understand how nonmetropolitan SGM youth perceive the support they receive from SGM and non-SGM friends. Qualitative interviews were conducted with nonmetropolitan SGM youth. Youth received general emotional support, relationship advice, and protection from SGM and non-SGM friends. From their SGM friends, participants reported receiving greater closeness and emotional intimacy and assistance with SGM identity development. Participants indicated that receiving acceptance for their SGM identity was important from their non-SGM friends. Participants also discussed the limits to support their non-SGM friends could offer. Implications for practice and research are discussed.     

How do you solve a problem like Maria? Family complexity and institutional complications in UK social work

ABSTRACT

This paper draws on UK data from an international, comparative project involving eight countries. The study examined how social workers’ conceptions and definitions of family impact on the way they engage with complex families, and how social policies that frame social work context impact on the way social workers engage with families. Focus groups were held in which social workers from four service areas (child welfare, addictions, mental health and migration) were asked to discuss a case vignette. Several factors were embedded in the vignette to represent a realistic situation a social worker may come across in their day-to-day work. Social workers clearly identified the complexity of the family’s situation in terms of the range of issues identified and candidate ‘causes’. However, typical first responses were institutional, looking for triggers that would signify certainty about their, or other agencies’ involvement. This resulted in a complicated story, through which the family was disaggregated into individual problem-service categories. This paper argues that understanding these processes and their consequences is critical for exploring the ways in which we might develop alternative, supportive professional responses with families with complex needs. It also demonstrates how organisational systems manifest themselves in everyday reasoning.     

Secondary traumatic stress and self-care inextricably linked

ABSTRACT

Increasingly trauma scholars are exploring the susceptibility of mental health providers to secondary trauma reactions. The current study explores the relationship between clinical social work practice with trauma-exposed clients and secondary traumatic stress among social workers. The intent of this study is to identify the role various factors play in the development of secondary trauma (also known as compassion fatigue). A simple random sample of National Association of Social Workers members were asked to participate. Participants completed an online survey that explored their exposure and responses to secondary traumatic stress. The online survey consisted of standardized measures including the Secondary Traumatic Stress Scale and The Coping Strategies Inventory which assesses secondary trauma and self-care strategies, respectively (Bober, Regehr, & Zhou, 2006; Bride, Robinson, Yegidis, & Figley, 2003). The magnitude of work (the extent and intensity of time working with trauma-exposed clients) is assessed by a non-standardized measure which consists of clinical caseloads composition questions. Job satisfaction is measured by items taken from the National Association of Social Workers’ workplace questionnaire (Whitaker & Arrington, 2008). 161 social workers completed the online survey. It required approximately 35 minutes to complete. This project empirically demonstrated that high-magnitude social work practice (providing therapeutic intervention to trauma survivors, i.e. military service members and veterans) is associated with higher levels of secondary trauma. There is also empirical evidence that self-care strategies can mitigate the impact of the secondary trauma. Educational and workforce implications for study findings are discussed.     

Sustaining an intimate and sexually fulfilled marriage or partnership in older adulthood with a disability: Perspectives of social workers

ABSTRACT

The American portrayal of sex is often left for only the young, attractive, and able-bodied. In contrast many studies have found that older adults with disabilities in marriages and intimate partnerships have sexual desire and sexually active lives. Social workers are often burdened with balancing the sexual intimacy desires of their older adult clients with disabilities, alongside the need to protect them from sexual abuse and exploitation, particularly among those who may lack the capacity to consent due to cognitive impairment. This phenomenological study aimed to understand the lived professional experience of social workers (N = 5) in supporting married and intimately partnered couples in which at least one person was an older adult with a disability to understand the clients’ needs and common social work practice methods used to address their needs. Inductive coding was used to identify themes and subthemes. Their role included helping their clients to learn about their ability to have sex, consenting to sex, negotiating accommodations for intimacy and sex with their spouses, and counseling those who took on caregiver roles for their spouses. Social workers reported that individual diagnosis, such as dementia, should not alone determine one’s ability to consent to sex.     

Medication for Children with Attention-Deficit Hyperactivity Disorder

When making assessments and planning interventions, social workers adopt a biopsychosocial perspective. One important area where biologically based treatments influence psychosocial functioning is the area of psychopharmacology. However, even though many clients take medications, social workers often feel poorly prepared to address a subject that could be very important to their clients; that subject is the meaning of the medication to the client. The meanings that clients ascribe to medication can have a significant impact on medication adherence. Using attention-deficit/hyperactivity disorder (ADHD) to illustrate, I provide an overview of ADHD and common forms of treatment, discuss the possible meanings and acceptability of stimulant treatment for ADHD, provide practice guidelines for helping families reduce ambivalence about medication, present two clinical vignettes, and suggest resources for social workers and families.     

Social Media and Social Work: The Challenges of a New Ethical Space

ABSTRACT

Social media and other online technologies have transformed communication between social workers and service users, with many practitioners engaging and working with clients through social networking sites. While there are numerous ethical issues associated with online practice related to con?dentiality, dual relationships, and boundary crossing, there is lack of clarity about how to deal with such issues. This article uses a case example to develop a nuanced understanding of ethical issues and ethical behaviour in online spaces. We argue that social workers need to link their knowledge of the complex interplay between discourses that underpin daily practice like those related to power, permanency, authorship, audience, embodiment, and professionalism to social media created spaces. In doing this, social workers must retain their commitment to ethical values and critical reflective practice. We conclude with recommendations for education, research, and practice.     

Acknowledging the Impact of Social Forces on Sexual Minority Clients: Introduction to the Special Issue on Clinical Practice with LGBTQ Populations

Over the last two to three decades, advances in clinical practice with lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals have been extensive. Many clinical social workers now incorporate LGBTQ-affirmative approaches into their practice, and a number of social workers have contributed to the literature on clinical practice with sexual minority clients. Despite these advances, we still require specialized knowledge to understand a number of LGBTQ-related mental health issues. The Clinical Social Work Journal’s first special issue on clinical practice with LGBTQ populations emphasizes psychotherapy techniques that acknowledge and also address social forces (e.g., transphobia, homophobia, and heterosexism) that affect the psychosocial functioning of LGBTQ clients. The special issue focuses on LGBTQ populations, such as transgender and bisexual individuals, sexual minority youth, and older adults, and psychotherapy modalities informed by a number of clinical and theoretical approaches. These in-depth articles offer guidance to clinical social workers who need to expand their knowledge of LGBTQ-related mental health issues and also provide those with existing knowledge an opportunity to refine their clinical skills and sharpen their thinking.     

Impossible Clients

Abstract

This paper is concerned with a group of clients, whom I have identified in terms of their capacity to evoke strong dislike amongst Social Workers. These clients approach us in a manner which suggests a lack of the most basic social skills. I shall try to describe some of their characteristic attitudes, and the ways these are demonstrated in their contact with the workers they meet, with particular reference to the hostility that typifies their dealings with us, and can paralyse us into an ineffective response. There follow some guidelines I have evolved from my own attempts to work with some of these clients.     

Voter Registration

Abstract

Historically, social workers have used voter registration to politically empower their clients. This paper describes the agency-based voter registration project of the University of Connecticut School of Social Work, Nancy A. Humphreys Institute for Political Social Work, including the project's implementation, and evaluation. Voter registration principles emerge from analyses of successful agency-based voter registration programs.     

Systemic Barriers to the Employment of Social Workers in Alcohol and Other Drug Treatment Agencies

Abstract

Literature suggests a low number of social workers employed in the field of alcohol and other drug (AOD) treatment. This study shows that social workers with undergraduate degrees (BSWs) have higher rates of employment in AOD than bachelor's degree holders from other disciplines. Master's level social workers (MSWs), however, have a much lower involvement than their counterparts with counseling degrees. Six factors are inferred to partially explain MSWs' low involvement in the field: (1) low education requirements; (2) low pay; (3) absence of “social worker” positions; (4) competition among different disciplines; (5) lack of MSW interns; and (6) state certification requirement. Suggestions to increase the employment of social workers in the AOD field are offered.     

Untapped Sources for Recruiting Minority BSW Students

Abstract

Social agencies and social services units currently are experiencing a personnel crisis. Many agency employees who provide direct services to clients lack professional education. Decreasing commitment to traditional social work practice with the most vulnerable populations and increasing interest in psychotherapeutic services may account for the shortage of professionally trained social workers.     

What's in It for Me?

Abstract

Social service workers' values and religious beliefs often differ greatly from those of their clients. This paper will assist helping professionals to develop a deeper understanding of the motivations behind clients' religious behaviors by describing religious participation through the lens of rational choice theory. A working definition of rational choice is provided. A graphic construct explaining the interaction of demand and supply on religious participation is presented. This model shows how a feedback loop develops to increase religious involvement. A discussion follows regarding religious participation as viewed from a demand side and supply side perspective. The paper concludes with ideas of how the information applies to social service workers and researchers.     

The Strengths of Rural Social Workers: Perspectives on Managing Dual Relationships in Small Alaskan Communities

Social workers are advised to avoid dual relationships; however, this recommendation is not realistic for rural social workers. Using qualitative analysis, this study examines the perspectives of 10 rural social workers in Alaska who are long-term members of their community. From the data, four themes emerged: (1) Rural social workers cannot avoid dual relationships, (2) Healthy dual relationships can have benefits for clients, (3) Social work and other professional education helps rural social workers manage complex situations, and (4) Rural social workers use complex critical thinking and have developed advanced skills to negotiate dual relationships.     

Facilitating Transition Among Transgender Clients: Components of Effective Clinical Practice

Although transgender clients seek services in a number of settings in which social workers practice, there is a dearth of scholarly literature available to guide effective clinical practice with this population. When transgender issues are included in the practice literature, the trend has been to consolidate the needs of transgender clients with those of the larger lesbian, gay, and bisexual community or to simply focus on increasing the comfort level of clinicians working with this population. This is concerning because transgender individuals represent a vulnerable subgroup of clients with unique and specific treatment needs related to the transition experience. Social workers play a critical role; they may serve transgender clients and their families in many ways: as advocate, educator, diagnostician, and individual, couples or family therapist. The purpose of this article is to identify several key components of trans-specific clinical practice and the role of social workers in supporting and facilitating client transition. Specifically, the authors will discuss: (a) relevant definitions and terminology, (b) emerging issues related to depathologizing the needs and experiences of transgender individuals, (c) the critical elements of trans-specific clinical assessment, and (d) clinical advocacy associated with the medical legal and social aspects of the transition process. Specific recommendations for trans-affirmative social work practice will be offered.     

Psychosocial Treatment of Oppositional Defiant Disorder

Abstract

Objective:To review and describe empirical outcome studies on the psychosocial treatment of children and adolescents meeting the criteria for Oppositional Defiant Disorder (ODD).Method:To locate these treatment outcome studies, an extensive review of the literature using the PsycINFO database was conducted. Results:Psychosocial treatments designed solely for youth meeting the criteria for ODD are rare. Rather, it seems that most of the intervention studies have involved youth with Conduct Disorder as well as ODD, even though these two disorders have distinct differences. Selected psychosocial interventions, including anger control and stress inoculation training, assertiveness training, multisystemic therapy, and rational emotive therapy, have produced favorable outcomes in the studies conducted and published to date. Conclusions:Social workers serving ODD youth should seek training in these provisionally supported evidence-based practices. Given the scarcity of treatments designed solely for ODD with adolescents, there is a need for more outcome studies on this specific population, and for more studies of social work practice involving such youth.