Reflections on the Work of Professor Selma Fraiberg

This paper reviews the work of Professor Selma Fraiberg who became a leading figure in the field of infant mental health. Born in 1918 she first received an MSW in Social Work and then undertook her Analytic Training in Detroit Michigan. While she maintained her identity as a social worker throughout her life, she integrated insights from the fields of social work, psychoanalysis and developmental and ego psychology in her research and practice. This paper traces her development as a clinician, researcher, and educator. Three cases describe her ability to integrate social work methodologies with analytic insights. The cases describe the treatment of a latency age child at a time of social change, a clinical research study of the developmental risk of children blind from birth, and a groundbreaking study in the field of infant mental health. Her study of infants at developmental risk focused on the parent /infant relationship and parents were included in the treatment process so that they could become more attuned to their young child. Her work highlighted the intergenerational issues that shaped the parental capacity for empathic nurturance between parent and child. The article Ghosts in the Nursery incorporated the major theoretical concepts of the new theoretical approach to treatment and is still much read in graduate programs today. Although extensive new research has added to the field of infant mental health, her contributions are still relevant to research and practice today.     

Interview with Susie Orbach,Ph.D., C.S.W.

An interview with Susie Orbach highlights the trajectory of her career and current thinking on body image issues and eating disorders. Dr. Orbach’s work in this area as a clinical social worker, psychoanalyst, best-selling author and social activist has spanned three decades. In this interview she reflects on her earlier books, Fat is a Feminist Issue and Hunger Strike: An Anorectic’s Struggle as a Metaphor for Our Age, and discusses her current work and perspectives within the context of contemporary culture.     

Body Dysmorphic Disorder and Its Significance to Social Work

Body dysmorphic disorder (BDD) is a relatively common and often severe psychiatric disorder in which an individual has an excessive preoccupation with an imagined or slight defect in his or her appearance (American Psychiatric Association in Diagnostic and statistical manual of mental disorders. American Psychiatric Association, Washington, 2000). Despite its prevalence in the United States and worldwide, many health care and mental health professionals, including social workers, are unfamiliar with BDD. In fact, BDD is virtually absent from the social work literature and no authors or researchers have considered BDD from a social work perspective. The purpose of this article is to inform social workers about the seriousness, prevalence and treatment challenges of BDD, and to highlight its significance to social work practice and research. A clinical case presentation illustrates an example of how BDD may present in practice and the value of addressing it from a biopsychosocial perspective.     

Bargaining With Time: An Interview With Helen Pavlin

Helen Pavlin is an accredited mental health social worker and family therapist and accredited family dispute resolution practitioner in private practice in Darwin. She has been involved in social work and family therapy since the early 1970s in Australia and internationally. In 1996 she received the 50th Anniversary Commemorative Medal from the Australian Association of Social Workers. She is one of the assessors and associate editors for the Australian and New Zealand Journal of Family Therapy. In 2007 Helen received the Journal Award for her outstanding contribution to the family therapy field in Australia. She is an accomplished writer and a member of the Australian Society of Authors. Her poems and book reviews have been published frequently in ANZJFT.     

Schizophrenia,Community Integration,and Recovery

Abstract

Rooted in deinstitutionalization policy, the community inclusion required by the Olmstead case, and the grass roots recovery movement, community integration for those who have diagnoses of serious mental illnesses has become an increasingly important policy goal. The purpose of this project was to examine empirical evidence describing experiences with social or community integration for people with psychiatric disabilities, with a particular interest in the schizophrenias. Studies chosen for review all involved direct survey or interview data from people with psychiatric disabilities and examined subjective experiences with social relationships or linked social participation with clinical, functional, or quality of life outcomes. Experiences involving the dynamics of social stigma, the achievement of personal agency, and innovative pathways to satisfying social inclusion are core themes found that are highly relevant for practitioners. Social work, with its ecological perspective, is well suited to address the complexities of conflicting interests and objectives that have arisen in mental health care in the pursuit of community integration. Suggestions for fruitful responses are presented.     

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.     

Names in the News

Introducing Lisa K. Bernhardt , who now heads her LKB Strategies, which lobbies for public health organizations. For many, she needs no introduction: She has a long history on Capitol Hill and in the Department of Health and Human Services (HHS). Nobody on the Hill knows more about the Substance Abuse Prevention and Treatment block grant (SAPT BG). From 2010 until last fall, she was the top staffer at the Senate Appropriations Committee, Subcommittee on Labor, HHS, Education & Related Agencies. Prior to that, she was a budget analyst at HHS for eight years and interned there for two years previously. She knows how things work. When she left Capitol Hill last October, she did so because she felt she could do more good as an advocate helping public health navigate the appropriations process. We have known her for years as a source. Now she is out there helping people work through the systems she knows inside and out. When she worked for the great Sen. Tom Harkin (D‐Iowa), with whom she was in lockstep on policy, legislative language was clear and to the point. The Substance Abuse and Mental Health Services Administration, which had been hankering to get SAPT BG money into mental health, was put in its place more than once. There was no tinkering with the law. Thank you for your years of service, Lisa, and welcome to the exciting world of the private sector. To reach her, email Lisa.Bernhardt@LKBStrategies.com .     

Re-Examining Evelyn Hooker: Setting the Record Straight with Comments on Schumm's (2012) Reanalysis

Evelyn Hooker's research comparing the mental health of 30 male homosexuals to 30 male heterosexuals may be the most influential study in the history of social science. The American Psychological Association (APA) claims her work was the major reason it began advocating for acceptance of homosexuality. It led the American Psychiatric Association in 1973 to eliminate homosexuality from the Diagnostic and Statistical Manual of Mental Disorders. And it impacted the U.S. Supreme Court's 2003 legalization of sodomy in Lawrence v Texas.

Hooker reportedly believed experts would be unable to distinguish homosexuals from heterosexuals on psychological tests. Re-examination of her work indicates that Hooker's study was neither rigorous nor reliable. Among other problems, homosexual subjects were easily identified on test protocols; her reports of how she obtained her samples were incomplete and contradictory; and her study generated results supportive of obsession/compulsivity in homosexuals.

Thus Hooker's study was seriously flawed. Moreover, because it was marketed by the APA as central in transforming homosexual activity from an illness/crime into acceptable behavior—yet Hooker did not correct those who mischaracterized her work—APA misrepresentations of Hooker over the past 40 years appear to be more in line with ideology than science.     

Mabel Agnes Elliott,We Hardly Knew You

Sociologist Mabel Agnes Elliott was elected the fourth president of the Society for the Study of Social Problems in 1956–1957 and was the first woman to hold this position. She was an anti-war activist, a feminist and a creative and diligent writer. Yet she experienced many challenges. The Federal Bureau of Investigation kept an active file on Elliott for approximately 30 years, she was the victim of discrimination by her male colleagues at the University of Kansas where she spent much of her career and Professor Robert E. L. Faris used many of the ideas from her Social Disorganization textbook without attribution. In spite of her research productivity her salary was frozen for 18 years. Once she began teaching women at Chatham College she found an institution that appreciated her many talents and rewarded her appropriately. Even so, in a male-dominated discipline, her contributions to criminology and social disorganization have been nearly forgotten.     

Looking Outside the (Voice)Box

Laura S. Brown, PhD, is a clinical and forensic psychologist in independent practice in Seattle, Washington. The bulk of her scholarly work has been in the fields of feminist therapy theory, trauma treatment, lesbian and gay issues, assessment and diagnosis, ethics and standards of care in psychotherapy, and cultural competence. She has authored or edited ten professional books, including the award-winning Subversive Dialogues: Theory in Feminist Therapy, as well as more than 140 other professional publications. She has also recently published her first book for general audiences, Your turn for care: Surviving the aging and death of the adults who harmed you. Laura has been featured in five psychotherapy training videos produced by the American Psychological Association. She was President of American Psychological Association Divisions 35 (Society for the Psychology of Women), 44 (Society for the Psychological Study of Lesbian, Gay and Bisexual Issues), and 56 (Trauma Psychology). Laura was also President of the Washington State Psychological Association. She is the founder and Director of the Fremont Community Therapy Project, a low-fee psychotherapy training clinic in Seattle. In the fall of 2000, she was the on-site psychologist for the reality show Survivor: The Australian Outback. In 1987, Laura lost her voice and was diagnosed with spasmodic dysphonia. In 1988, she found her voice again.     

QUESTIONS AND HINDSIGHT: WORK WITH ZARA,AN ASYLUM SEEKING CARE LEAVER

Psychodynamic ideas are used to think about social work with an asylum‐seeking young woman with mental health problems. Questions are raised about her needs and our response to them in relation to her individual history, the organisation and the wider socio‐economic context. These lead to reflections on adolescence and the leaving care task, non‐dependence, loss of home and homelessness, fear of madness, attitudes to difference and asylum seekers and institutional racism. Failure and learning from it is also a theme.     

Mental health in vietnam and the move to incorporate social work: A mixed methods study of staff perceptions and expectations

In 2010, Vietnam established social work as a profession. As part of their strategic plan, the government aims to incorporate social work into existing hospitals and health care facilities in the country, including psychiatric hospitals and mental health care centers. This paper, based upon survey and focus group data from 194 people working in three major mental health facilities in Hanoi, explores direct care staffs’ perceptions of this historic incorporation of social work, with a particular eye to the benefits and challenges of the transition. Results show most staff members thought social workers would provide great support to the many unmet needs of their largely underserved and impoverished patients. They also viewed social workers as a potential resource to the treatment team by reducing work overload. Existing staff, however, were less attuned to the clinical functions of social workers in mental health settings, often equating social work with community development and social movements. Some were concerned about social workers taking on their tasks; others about new social workers being hindered by the professional hierarchy in which doctors were placed at the top. Successful integration of social workers will hinge on strong support from policy-makers and leaders of mental health systems.     

The Evolution of Mental Health Care Policy and the Implications for Social Work

Abstract

The focus of this article is on the evolution of mental health care policy in the United States from the eighteenth century to the present. To the extent that social work practice enacts policy, this article focuses particularly on the ways 20th century social workers have reflected, interpreted, and forged mental health care initiatives and reforms. The article includes a discussion of how the cycles of mental health reform (moral treatment, mental hygiene, and community mental health) have influenced not only the roles but also the actual practices of social workers. The article concludes with a consideration of the impact of managed care on mental health policy and the implications for social work.     

Challenging cultural constraints: a personal testimony

DISHA is one of the oldest Oxfam project partners in Uttar Pradesh, India. DISHA works with rural women and rope-makers; it encourages village-level women's organizations to fight against obstacles to women's empowerment and to institute income-producing activities; and it provides legal, educational, and health care services. In this article, a Muslim woman tells the story of her involvement with DISHA and how that involvement gave her the courage to reject the restrictions of purdah and of the wearing of the bourkha. This woman was married at age 13. She suffered ill treatment at the house of her in-laws and returned to her father's home with her 3 daughters. Her husband eventually joined her at her father's house. She was approached by a coordinator of DISHA and asked to apply for a job. She was offered the job, which she accepted. When she started going into the villages, she felt that the restrictive dress of the bourkha interfered with her ability to work. With the permission of her father and her husband, she set aside the bourkha. She had to endure criticism and censure for this action, but eventually people have been won over to her position as they have seen the positive results of her work on behalf of society. After having 5 daughters, she finally had a son. Now she is determined that her daughters will never wear the bourkha, even if they must remain single as a result of this resolve. She feels that DISHA has given her the power to overcome oppression in her own life, in the life of her family, and in society.     

Feeling Northern: ‘heroic women’ in Sally Wainwright’s Happy Valley (BBC One, 2014—)

This article analyses a recent television drama written by Sally Wainwright in order to explore notions of Northernness, gender and class. I consider to what extent Wainwright is expanding and revising current perceptions of the North, and more specifically of Northern women, through an analysis of her recent television programme, Happy Valley. Wainwright’s work shares characteristics of the British social realist television drama from the late 50s, early 60s: they have themes of escape, they use location to say something about their characters and they take viewers on an emotional journey that is related to the social conditions they inhabit. And yet, she is also putting women, who were often on the periphery of social drama, in the centre. Wainwright takes her viewers on a journey that begins with the anger and injustice resonant with the male protagonists of social realism, but as women, this anger and injustice is worked through in terms of the family and eventually leads to a greater sense of commitment to community and the place she comes from, which, in Wainwright’s work, is the North. In so doing, she expands the genre and gives it a female voice. She offers us a sense of what ‘feeling’ Northern is to women, as well as men. Additionally, she is a screenwriter who is speaking from the position of the working-class North; she is intimate to these communities, not a ‘detached observer.’ And yet, despite these inroads, her work has only recently received praise from the British television Industry.     

A Disillusioned College Professor

In this article, the author discusses the double-bind situation of being an educator in a college setting, but reluctant to disclose that which could enlighten her social work students the most—at 14 years old she experienced a complete psychotic break (catatonic-type), but completely recovered within a few months and largely without medication. Here the author acknowledges the shameful nature of contemporary controversial issues in mental health some 37 years after her own experience and includes an excerpt from “An Absence of Concern,” a work in progress, to illustrate the dynamic inner processes that remain intact during a break, but largely denied by an ignorant society.     

The use of mental health care,psychotropic drugs and social services by divorced people: does informal support matter?

This study compares the mental health care, psychotropic drugs and social service use of divorced people (re-partnered or single) with that of married people. This paper questions whether the availability of informal support facilitates or substitutes for formal care seeking. Data from the Divorce in Flanders survey of 2009–2010 are used. Logistic regression analyses are performed separately for women (N = 3450) and men (N = 3020). Greater use of mental health care, psychotropic drugs and social services by single divorced men is explained by their higher need for care, while divorced women (especially single divorced) more frequently contact a general practitioner (GP), a psychiatrist, or a psychologist, regardless of their mental health, socio-economic background and informal support. Women who have support from non-family members are more inclined to use social services and to contact a GP, while support from family members is only positively related to GP consultations. With regard to men, informal support from non-family members positively influences each type of formal care seeking. Our results suggest that non-family members (and only among women, family members as well) can provide help and advice about seeking professional mental health care and social services, but they do not have an influence on psychotropic drug use.     

How Do Social Workers Respond to Potential Child Neglect?

Although neglect is a common form of child maltreatment, it can be difficult to detect within a clinical interview between a social work clinician and client for the purpose of assessment and intervention, leading to a failure to act and secure a child's safety. This Canadian study utilized the objective structured clinical exam (OSCE) to assess social work clinicians' ability to recognize and respond to a case of suspected child neglect. Twenty-three participants (social work students, recent graduates of a Masters in Social Work programme, and experienced social workers) conducted a 15-minute interview with a standardized client followed by a structured reflective dialogue focusing on case conceptualization and emotional awareness. Qualitative analysis of the reflective dialogues revealed participants' difficulty in detecting child neglect as opposed to focusing on a client's negative self-beliefs or mental health issues. Implications for social work education and practice are suggested.     

Mental Illness,Social Construction,and Managed Care

Abstract

Managed care is creating a social reality that affects the lives of millions. Mental health coverage under health care plans is a function of how mental illness and its proper treatment are defined. These definitions are shaped by social actors competitively seeking to satisfy their particular interests. This paper examines the influence of privatized managed behavioral health care on these evolving social definitions, as evidenced in published works, written reports, and legal actions. It is written from the perspective of social workers as providers of services and advocates for social justice. Options for social work responses to managed behavioral health care are explored.