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.     

Social work and therapy: Reclaiming a generic therapeutic space in child and family work

This paper reflects upon some mixed messages found in recent consultation and framework documents that have been issued as part of the debate surrounding the Government's emphasis upon education and training within its 'modernisation' agenda. It identifies the long-standing arguments about 'testing' versus 'learning' or 'contextual' paradigms and suggests that, perhaps, there is still scope to influence the future direction of social work. The author has drawn upon his research with social workers and their team managers in current post-qualification award programmes to argue for a renewed emphasis upon the inter-personal and relationship aspects of educational processes within more broadly conceived socio-cultural contexts. A focus upon reflexively defined concepts of 'engagement' and 'assessment' is used to explore constructivist arguments that locate individuals within an interplay of potential and constraints. It is argued that constructive engagements within revised conceptions of assessment can form the basis of a framework of continuing professional development that starts from and develops the unique realities of social work practice. This requires the committed involvement of more people, in the negotiation of a professional practice agenda for knowledge creation through relationships, rather than the imposition of more measures.     

Longitudinal qualitative studies and the reflexive self

This paper reviews the utility of the framework offered by Giddens' 1991 work Modernity and Self Identity: Self and Society in a Late Modern Age , for the analysis of longitudinal qualitative studies. Working from two different longitudinal qualitative data sets, the authors explore the extent to which the notion of the 'reflexive project of self' and associated concepts might be operationalized to assist with the analysis and interpretation of empirical data. We first explore the notion of 'fateful moments' in a longitudinal qualitative interview-based study of young people's biographies. We then explore the importance of mechanisms of 'shame' as accompaniment to dramatic life transition, using data taken from a 3-year study of female sex workers in New Zealand. The paper concludes by arguing that although Giddens' work provides us with an interesting starting point and some useful operational tools, in practice the data outgrow the theory.     

Observing Different Faiths,Learning About Ourselves: Practice with Inter-married Muslims and Christians

Abstract

Advanced care planning and end-of-life decision making are part of contemporary debates about death and dying. A data-mining study reviewing medical records of patient deaths in hospital investigated these issues and the utilisation of social work services. Findings indicated that the majority of records included some form of documentation about end-of-life care, including cardio pulmonary resuscitation (CPR) orders and that family members and surrogate decision makers were more likely to be consulted than patients about these plans. The incidence of referrals to social workers was found to be highest “out-of-hours”. Key social work interventions were identified, including establishing the reliability of surrogates' decisions through social work assessment. This paper discusses elements that contribute to a supportive environment for patients and family members to facilitate the decision making process, including the need for a broader ethical discourse to accommodate the increasing complexity of end-of-life decision making in hospital settings.     

Individualization and Prevention

SUMMARY

In 1905, Massachusetts General Hospital initiated the first medical social work program in the United States. Based on the writings of its leaders, this paper presents the early history of medical social work in the United States. Inspired by developments in European health care that emphasized the community context of disease, medical social work pioneers saw a need to individualize the patient while also promoting public health measures in the community, improving the patient's environment to eliminate the causes of disease. In addition, since they served patients because of their diseases rather than their poverty, medical social workers were among the first to provide social work services to the non-poor. In spite of their emphasis on environmental change, many of early medical social work leaders had an anti-institutional bias; they were suspicious of large-scale solutions for what they saw as fundamentally individual problems. Consequently, methods for promoting individual adaptation developed more rapidly than methods for promoting environmental change. Ironically, the medicalization of social problems in contemporary times has resulted in a focus on individual pathology rather than social and lifestyle causation in health, even as the rising cost and complexity of the system challenges health care consumers in the United States. Reaffirming the environmental emphasis of medical social work pioneers provides a way for today's health care social workers to incorporate environmental modification into their practice and promote the health of all citizens.     

Social work and technology: Challenges for social workers in practice: A case study

Abstract

Social Work is just beginning to consider the full impact of technology on practice. In this paper the experience of social workers working in Centrelink, the Australian Government's service delivery organisation, is explored in the context of Centrelink's increased reliance on technology to deliver its services to six million Australians. The results of a survey that indicated nearly one half of Centrelink's social workers have received no formal training in how to use the technologies they rely so heavily on in their work are considered, as is the role of the social workers who are working as a part of Centrelink's call centre network. It is argued that social workers need to be careful not to confuse means and ends when it comes to utilising technology as a part of their practice.     

The same but different: Social work with centenarians

Abstract

Since the underlying theme of the 1999 International Year of Older Persons was 'Towards a society for all ages', analysis of client groups at the extremes of the age structure should not be neglected. The research reported here was undertaken as part of the International Year and presents a brief investigation of an under-researched group of very long-lived individuals who occasionally interact with social workers working in aged care. Following some introductory information on the socio-demographics of this group, findings on their health status are presented, as well as social workers' experiences of working with centenarians. The study finds that despite their unique age, the health and social support required is no different from that needed by much younger aged clients. This important finding of heterogeneity and inter-individual variability should assist social work advocates arguing against stereotyping this group based solely on their outstanding chronological characteristic.     

Towards Customized Deliberations

ABSTRACT

The profession of social work has important contributions to make in the rapidly developing dialog about medical care decision making and to the evolution of hospitals as systems that engage with people as patients, for whom illnesses create increased vulnerability (Gruber, 1998). Professional ethics clearly states that the individual professional social worker has a responsibility to influence processes involving vulnerable populations. Articulating social work's responsibility and potential contributions in the area of medical care decision making begins with an application of social work's mission and values, and then continues with consideration of the profession's evolving role in hospitals. Pertinent aspects of the health care industry, including current models for continuum of care and for provider-patient relationships, are discussed in terms of opportunities to modify the models used to guide interactions with patients. Finally, the impact of a growing number of distinct treatment options is also considered. The objective of the article is to offer social workers in health care settings a conceptual framework for considering professional ethical obligations and for participating in the contemporary dialog regarding medical care decision-making.     

Reflective practice in a process for the re-approval of ASWs: An exploration of some inevitable resistance

In this article a mental health trainer and a group facilitator explore the background to developing a new protocol to manage the re-approval of mental health social workers in an inner London borough. The new procedure involved social workers attending a series of small group sessions in which they were invited to present and reflect on their work with clients. The dynamics of these sessions and particularly some of the transferential material between group members and facilitator are explored here. The significance for mental health social work, post-qualifying learning and the possibilities of reflective practice is considered.     

Having it all overseas: Aid workers and the international division of reproductive labour

This article examines the dynamics of power and privilege at work in international development through the prism of domestic service for expat aid workers in developing countries. Drawing on ethnographic fieldwork amid aid workers and their domestic staff in Dakar, Senegal, I argue that access to affordable care work greatly enhances the lives of women who work overseas in development. The postcolonial underdevelopment and poverty that aid work addresses is paradoxically critical to the aid workers' own access to affordable care, family balance and the means to do their jobs. I put this insight into the larger scholarly conversation about domestic work and global inequality, including on the Global Care Chain.     

Keeping up appearances: aesthetic labour in the fashion modelling industries of London and New York

This paper addresses itself to literature on ‘aesthetic labour’ in order to extend understanding of embodied labour practices. Through a case study of fashion modelling in New York and London we argue for an extension of the concept to address what we see as problematic absences and limitations. Thus, we seek to extend its range, both in terms of occupations it can be applied to, not just interactive service work and organizational workers, and its conceptual scope, beyond the current concern with superficial appearances at work and within organizations. First, we attend to the ways in which these freelancers have to adapt to fluctuating aesthetic trends and different clients and commodify themselves in the absence of a corporate aesthetic. The successful models are usually the ones who take on the responsibility of managing their bodies, becoming ‘enterprising’ with respect to all aspects of their embodied self. Secondly, unlike Dean (2005 ) who similarly extends aesthetic labour to female actors, we see conceptual problems with the term that need addressing. We argue that the main proponents of aesthetic labour have a poorly conceived notion of embodiment and that current conceptualizations produce a reductive account of the aesthetic labourer as a ‘cardboard cut‐out’, and aesthetic labour as superficial work on the body's surface. In contrast, drawing on phenomenology, we examine how aesthetic labour involves the entire embodied self, or ‘body/self’, and analyse how the effort to keep up appearances, while physical, has an emotional content to it. Besides the physical and emotional effort of body maintenance, the imperative to project ‘personality’ requires many of the skills in emotional labour described by Hochschild (1983 ). Thirdly, aesthetic labour entails on‐going production of the body/self, not merely a superficial performance at work. The enduring nature of this labour is evidenced by the degree of body maintenance required to conform to the fashion model aesthetic (dieting, for example) and is heightened by the emphasis placed on social networking in freelancing labour, which demands workers who are ‘always on’. In this way, unlike corporate workers, we suggest that the freelance aesthetic labourer cannot walk away from their product, which is their entire embodied self. Thus, in these ways we see aesthetic labour adding to, or extending, rather than supplanting emotional labour, as Witz et al. (2003 ) would have it.     

The Mark of Madness

Abstract

Stigma is a major barrier to recovery for individuals with mental illnesses. It interferes with community living and attainment of resources and goals and damages self-esteem and self-efficacy. Given that social workers provide much of the mental health care to individuals with mental illnesses, and that actions to reduce stigma support the social justice mission of social work, addressing stigma should be a focus of social work interventions. The goals of this paper are to explore stigma theory in general and for individuals with serious mental illnesses, discuss the implications of this stigma analysis for social work, and make recommendations for action in both practice and research.     

Experience of undertaking infant observation as part of the Post-Qualifying Award in Child Care

Enquiries into child deaths have pointed to the difficulty that social workers seem to have of 'holding the child in mind'. Undertaking 'child observation' can be a powerful way of understanding what these difficulties are about and how to work in a way that is child focused, whilst being attentive to adult considerations crucial to children's positive development. This is an account of an experience of undertaking a 10-week child observational study as part of the Post Qualifying Award in Child Care from a student's perspective. It suggests that developing observational skills and an understanding of psychotherapeutic ideas enhanced the practitioner's ability to work with uncertainty and make accurate assessments.     

Kinship Care and Public Child Welfare: Challenges and Opportunities for Social Work Education

Abstract

The growing practice of arranging and financing “foster placement” of abused and neglected children with relatives provides an opportunity to redefine relationships between extended families and the child welfare system. The dilemmas and possibilities presented by kinship care as a child welfare service challenge schools of social work to provide intellectual leadership and to prepare social workers for changing child welfare practice. The author's ideas concerning responses to this challenge focus on key mandates of the Council on Social Work Education's Curriculum Policy Statement and on five principal curriculum areas in social work education.     

Social work and resettlement

Summary

This paper describes counselling in a social work agency that provides hostel accommodation for single homeless women, and works to resettle them into permanent accommodation. Given that the Barclay Report described the practice of social work as made up of the two elements of counselling and social care planning, the paper explores the way counselling is influenced when carried on in an agency with a specific ‘social care’ function. This is contrasted with counselling in agencies that offer a counselling service alone. Examples will be given of people using an attachment to a hostel, and to a worker, as they cope with change and make psychological growth. The power of such workers can only be exercised if they are true to the agency function, and gear their interventions to the task of resettlement. If workers do this they may find that as well as resettling people into accommodation, they are resettling them into life.     

Challenges,Barriers, and Opportunities: Social Workers With Disabilities and Experiences in Field Education

ABSTRACT

The purpose of this study was to explore the experiences of social work students with disabilities in field education. This qualitative inquiry used semistructured interviews exploring inclusion and accommodations in field education. The 15 participants were graduates of accredited BSW or MSW programs and reported one to five disabilities each. Four themes emerged: different experiences with visible versus invisible disability, confusion about accommodation, field as a learning opportunity regarding disability, and a sense of isolation being a social worker with a disability. This study provides information valuable to social work educators and field instructors regarding strategies for improving opportunities for students with disabilities as future social workers, aligning with the mission and values of the social work profession.     

Beyond labour rights

The protection of workers worldwide is most often sought through reference to the International Labour Organization's ‘core’ labour standards. These rights are, in themselves, of great importance; that said, however, the blanket approach with respect to workers that results from the over-reliance on rights is gender-blind, and incapable of integrating the crucial normative dynamics of relational power, collective responsibility and mutual dependence into its analysis. By contrast, a normative framework based on a feminist political ethic of care allows for a clear picture of the actual, situated, interdependent lives of all people, and is particularly useful in highlighting existing gender imbalances with respect to responsibilities for care work. Globally, women bear by far the greatest responsibility for care work, and that burden has been multiplied exponentially under conditions of globalization. This article will argue that only a care-centred perspective can provide the necessary moral orientation and policy framework through which to begin to solve these problems of gender (as well as race and class) inequality related to both wage labour and paid and unpaid care work, as well as problems relating to the under-provision of care on a global scale.     

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.     

'He's not my carer—he's my husband': Personal and policy constructions of care in mental health

This paper is based on empirical research into the skill needs of care managers and examines the legacy of care management and the effect that 'new managerialist' approaches have had on care management work. The concept of emotional labour is used in context and applied to the work of care managers where the ultimate aim is quality outcomes for users of services. The paper argues that recognising the validity of the concept of emotional labour in context relates to the need for a greater acknowledgement of the skills required by care managers. 'Soft skills' that involve improving own learning and performance through reflection, problem solving and working with others are the key skills required for complex care management work. A rationale is made for reconsidering competency approaches to training in favour of continuing professional development. A preferred approach is one that emphasises both the personal and professional aspects of learning and the social world of the learner.     

Raising the Titanic: Rescuing Social Work Documentation from the Sea of Ethical Risk

Abstract

One of the most contentious issues in social work practice concerns what should be written about people who access social work services, how comprehensively, and in what format social work assessments, interventions, and outcomes should be documented. The present paper describes a structured approach linked to an action research project that was undertaken by hospital-based social workers to identify and minimise problems associated with documentation in the medical record. The Social Work Ethics Audit provided social work staff with a risk-management tool that highlighted documentation as a key area of ethical risk. Through a process of evaluating existing recording practices, social workers were able to meet the challenge of improving social work recording in medical records, returning it to its proper place as a vital component of clinical and ethical practice rather than an administrative task submerged beneath competing priorities. It was anticipated that the social work documentation proforma that resulted from the ethics audit process would have applicability in other health care settings.