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.     

A Bioethics Approach to Social Work Practice With Transgender Clients

Increased advocacy for the informed consent model of transgender health care specifies that patients should be in control of access to receiving medical interventions such as hormone therapy or surgery. However, in practice, mental health clinicians, including clinical social workers, are increasingly called upon by medical providers to serve as gatekeepers for these processes. It is frequently the role of social workers to assess transgender clients’ baseline mental health and their understanding of the consequences of treatment, and to forward recommendations to medical providers regarding the readiness of patients to transition. Therefore, social workers assisting transgender clients must be aware of the ethical standards that are particularly pertinent to their work with this marginalized and oppressed population. They must also be prepared to address unique ethical dilemmas that may be especially challenging to resolve. In this article we apply the most commonly utilized bioethical framework known as Principlism to describe the ethical standards and values that are particularly important to consider when working with transgender clients, namely autonomy; beneficence; nonmaleficence; and social justice. Because clinical social workers are frequently in the position of balancing client self-determination with their role as gatekeepers, a framework for resolving resulting ethical dilemmas is described (I CARE) and applied to three case examples.     

Transgender and Gender Diverse Children: Considerations for Affirmative Social Work Practice

Given growing public awareness about transgender and gender diverse identities, it is expected that greater numbers of children and families will seek mental health and social services, including transition-related services, from social workers and other mental health professionals. Transgender and gender diverse children have a range of transition-related needs which require the support of informed practitioners with transgender and gender diverse-specific knowledge and skills. Moreover, the needs and experiences of families and caregivers of transgender and gender diverse children will vary greatly. To date, research suggests a paucity of transgender and gender diverse-specific expertise among social workers and other mental health providers; this seems particularly evident with respect to the needs of transgender and gender diverse children. An affirmative practice framework to guide therapeutic work with transgender and gender diverse children and families is presented. In addition, key clinical practice considerations associated with engagement, assessment, psychoeducation, support and referral are provided. Finally, clinical examples illustrating use of the affirmative practice approach with transgender and gender diverse children are provided.     

Culturally Competent Practice with Bisexual Individuals

Working with lesbian, gay, and bisexual individuals requires clinical social workers to demonstrate cultural competency with these populations. Although there are many common issues across these identities, bisexual individuals experience unique challenges that differ from lesbian and gay individuals. Bisexuality is sometimes misunderstood by heterosexual as well as lesbian and gay individuals, leading to experiences of marginalization from multiple sources. Moreover, clinical social workers may incorrectly assume that the treatment needs of bisexual individuals are the same as lesbian and gay individuals. This paper utilizes qualitative interviews with 45 bisexual-identified people to illuminate five prominent issues in clinical practice with bisexual people. They are: (a) biphobia, (b) practitioner attitudes about bisexuality, (c) identity development, (d) social relationships, and (e) sexual health. Findings illuminate clinical practice strategies that will facilitate culturally competent social work practice with this population.     

Clinical Practice with Older LGBT Clients: Overcoming Lifelong Stigma Through Strength and Resilience

This article provides an overview of the unique challenges and strengths of the older lesbian, gay, bisexual, and transgender (LGBT) population and the theories and evidence-based interventions that can be used to work with them in a clinical setting. Two case studies will be used to highlight potential issues in clinical social work and provide guidance for intervention with LGBT older adults. The article concludes with a summary and implications for clinical social work practice.     

Perceptions of transition-related health and mental health services among transgender adults

The opportunity to live authentically is critical for the well-being of transgender individuals. For many this requires accessing transition-related services. Current knowledge of transition-related care is limited. This study aims to elucidate experiences and needs of transgender individuals (N = 65) related to (a) therapeutic support, (b) medical care, and (c) aspects of living authentically in order to inform the development and delivery of trans-affirmative services. Findings reveal challenges accessing health care providers with trans-specific competency; gaps between critical aspects of transition-related care and receipt of services; and heterogeneity of experiences and needs. Recommendations for improving transgender-affirmative services are provided.     

Toward Transgender Affirmative Social Work Education

Social work has professional and academic standards consistent with transgender affirmative education and practice. Nevertheless, a growing body of research suggests that transgender issues are largely absent from social work education, resulting in practitioners who are uninformed or biased against transgender issues. The present study expands the literature through a mixed methods study exploring perceptions of transgender issues in social work education from the perspectives of transgender social work students (n = 97). Quantitative and qualitative analyses reveal barriers to transgender affirmative social work education including (1) transphobic microaggressions within classroom and field settings, (2) the absence of transgender specific education and expertise, and (3) the general lack of visibility of transgender issues. Recommendations for transgender affirmative social work education are provided.     

Reshaping Clinical Practice for the New Millennium

In the new millennium, oppression will continue to affect social workers’ clients. This article discusses training clinical practitioners to address oppression. Drawing on poststructural, postmodern, feminist, and social constructivist theories, the article argues that to challenge oppression, clinical practice must address the dialectical relationship between private troubles and public issues while transforming professional relationships that disempower clients. The article describes a second-year MSW clinical practice sequence taught from feminist, poststructuralist, postmodern, and social constructionist perspectives, where students learn to assess the impacts of oppression, discover clients’ strengths, and respond in personal, social, and political contexts.     

Integrated Behavioral Health and Counseling Gender and Sexual Minority Populations

abstract

Counselors are increasingly expected to operate within an integrated behavioral health framework across systems of care. This critical literature review provides an overview of the integrated behavioral health paradigm, including the practice of interprofessional collaboration, with specific application to lesbian, gay, bisexual, transgender, queer (LGBTQ), and other gender and sexual minority issues. Implications for practice and research are discussed, along with a focus on concrete recommendations for application practicing interprofessionally with and on behalf of LGBTQ clients.     

The Psychology of the Psychopharmacology Triangle

Abstract

The psychopharmacological triangle generated by recent changes in mental health practices requires social workers to deepen their understanding of the psychological meanings of such treatment. Many clients receive concurrent psychotherapeutic and psychopharmacological interventions from different providers, creating a triangular treatment relationship. To facilitate a successful outcome, social workers will need to understand how meaning, transference and countertransference are stimulated by this arrangement. The literature on these issues as well as clinical experience will highlight specific issues requiring attention. By attending to these dynamics, the social worker can maximize the chances for a successful treatment outcome.     

Single Session Social Work in Hospitals

This paper reports on three complementary research studies that set out to examine the incidence and nature of single sessions in hospital social work practice. The first study was a data‐mining exercise that used statistics recorded by practitioners in nine public hospitals over a 12‐month period to establish the extent of single session work, the clinical areas in which it occurred, and the types of issues it covered. This quantitative information was enhanced with the qualitative findings of the two subsequent studies: the first with hospital social workers; and the second with singlesession clients. We concluded that single session work has not been sufficiently acknowledged in social work education and literature, and that it needs to become a more legitimate part of social work practice and training. At best, it represents social work at its highest level of skill, requiring expertise in quickly building rapport, assessment, and knowledge about sources of practical aid and information.     

Beginning Practice with Preoperative Male-to-Female Transgender Clients

Abstract

Preoperative male-to-female transgender clients often present with specific and unique psychological and social issues distinct from gay male and lesbian clients. Therapists must be ready to assess and help diagnose these in preparation for work with gender queer clients. Therapists must also be prepared to face and resolve the various counter-transference dynamics inherent in therapeutic relationships with transgendered individuals. This Practice Note focuses on the author's beginning clinical and social case management experience working with two preoperative male-to-female transgender individuals.     

Evidence-Based Practice in Social Work: Challenges and Opportunities for Clinicians and Organizations

Evidence-based practice (EBP) is increasingly emphasized in social work, yet effective approaches for translating research evidence into social work practice remain elusive. Despite a growing body of evidence describing effective interventions with a variety of populations, social workers continue to encounter substantial challenges with incorporating knowledge gained from these intervention studies into their routine practice with clients. This paper presents the current research outlining the known barriers and promoters to using EBP in social work clinical practice. Because social workers practice within the context of organizations, we consider the barriers that exist at both the individual and organizational levels that affect clinical social work practice. In addition to addressing the various challenges to incorporating research evidence into practice, we will also discuss a variety of emergent opportunities accompanying the move toward EBP that can be leveraged by clinicians in their social work practice with clients.     

What is clinical social work? looking back to move ahead

This paper traces the evolution of the concept of clinical social work and looks at where we are and where we are headed as clinical social workers. It reaffirms the view that clinical social workers intervene with clients presenting the full range of problems in a variety of facilities and in private practice and must draw on a broad knowledge base within a person-situation perspective and address the special needs of culturally diverse and oppressed populations. The paper also considers the move toward legal regulation, the role of private practice, the need for clinical doctoral education, the importance of new models for clinical research, and the significance of advocacy for a broad range of services to clients.     

Clinical Treatment of Substance Abusers: Past, Present and Future

With an estimated 9?% of the population in the United States having a substance use disorder, it is a rare social worker that has not encountered a substance abuser or a family member of one in his or her clinical practice. This article provides a brief history of social workers?? role in the treatment of substance abusing clients, an overview of the current, evidence-based treatment approaches and some of the issues that will be impacting this field in the future. A case study is used to illustrate some of the dynamics of substance abusing individuals, the impact on the family and effective treatment approaches.     

Translove

Abstract

For the academician, clinician or other person interested in transgender issues, this article defines populations and identity issues. Then, it solicits the reader's empathy by linking transgender survival experiences which are similar to critical GLB lives. In the face of hostility a transgender person's success hinges on receiving critical care, family and social support. Discussion includes those outcomes when these support systems fail, and how having even ‘one’ supportive family member can garner a successful transition and social adjustment. Challenging questions provoke the reader to think through the human experience of transgender men and women. Discussion also focuses on the changing face of transgender politics and social constructs, and how these effect both adults and children of transgender parents. The article summarizes basic coming out and relationship issues for transgender persons, including parents with minor children.     

Infusing Content on Older People with Developmental Disabilities into the Curriculum

Although older people with developmental disabilities (OPDD) are living longer than before and appearing more often as clients of social workers, this population has not been included in the growing effort to prepare social work students for practice with older clients. This article explores the issues unique to OPDD and their families. Using a model based on an ecological perspective, it indicates appropriate content on OPDD for infusion into social work curricula at the micro-, meso-, exo-, and macrosystem levels. It also suggests relevant content for four foundation sequences.     

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.     

Women in corrections: A call to social work

As governments continue to spend more money on law enforcement and prison construction, social workers will be increasingly faced with clients who have connections with the criminal justice and correctional systems. Despite the increasing numbers of women entering the criminal justice system, they continue to be one of the most marginalised groups in Australian society. This article reviews the social work literature concerning this population and proceeds to argue that social work has a significant role to play with women in corrections. Using a conceptual model based on an ecological systems framework, the author examines the mutuality of various social work practice principles at different levels of intervention and the roles that social workers may engage in to enhance the lives of women in corrections.     

Work‐to‐School Transitions in the Age of the Displaced Worker: A Psychology of Working Perspective

Frank Parsons (1909) founded the vocational guidance movement more than 100 years ago within the context of a shift from an agricultural to an industrial workplace. Today, globalization, workforce diversity, and the financial instability related to the Great Recession present numerous challenges to workers across the economic spectrum. In addition to highlighting Parsons's continued influence on career counseling practice, the authors draw on David Blustein's (2006) psychology of working to enhance the understanding of the needs of dislocated workers. Using case examples, the authors demonstrate how to incorporate insights from the psychology of working to address social justice, financial, relational, and self‐determination concerns among this vulnerable population. Counseling strategies for clients in transition, especially those considering educational options, are provided.