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.     

Spiritual Well-Being and Suicidal Ideation Among College Students

Objective: This study explored whether specific dimensions of spiritual well-being (religious well-being and existential well-being) relate to reduced suicidal ideation, and whether associations persisted after controlling for religiosity and psychosocial variables associated with suicide. Participants: Participants were 457 college students who completed measures that assessed spiritual well-being, religiosity, hopelessness, depression, social support, and suicidal ideation. Methods: The authors used linear regression modeling to assess religious and spiritual correlates of suicidal ideation. Results: After controlling for demographic variables and psychosocial factors, neither involvement in organized religion nor religious well-being significantly contributed to suicidal ideation. However, even after controlling for significant correlates, existential well-being remained a significant predictor of suicidal ideation. Conclusions: This investigation highlighted existential well-being as an important factor associated with lower levels of suicidal ideation among college students. Findings from this study focusing on the association between spiritual well-being and suicidality may prove especially beneficial to suicide prevention efforts.     

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.     

An Integral Model of Well-Being and Development and Its Implications for Helping Professions

Abstract

This article describes a dieoretical construct that serves as a framework for anti-oppression social transformation work in Latino communities. The authors present an integral model that considers the structures and processes of individual well-being within the context of and in relationship to collective development. With this model as a baseline for a critical analysis of current realities, the authors also examine the forces that hinder individual and collective well-being, particularly, institutional oppression: racism, colonialism, classism, and other “isms.” Based on the belief that institutional oppression robs both oppressor and the oppressed of their humanity, the authors provide an overview of a transformative process model. Implications of the model for the development of professional selves among social workers, counselors, and other helping professionals in relationship to the communities they serve are discussed. Broader applications of the model to other practices of the helping professions are also presented.     

Agency Practices Affecting Social Workers Who Treat Substance-Abusing Clients

Abstract

This study interviewed 115 MSWs with substance abuse training working in general social service agencies to determine if they viewed their settings as facilitating or hindering their work with substance-abusing clients. This study builds on the work of Lightfoot and Orford (1986) who found that social workers were more hindered than helped by their agencies' practices regarding substance-abusing clients.

Results: A majority of workers viewed their agencies as facilitating substance abuse-related work through support from supervisors and administrators, availability of substance abuse training, workers' freedom to choose clients, and opportunities to supervise others on substance abuse-related issues. Supervisor data corroborated these findings. This is a hopeful sign for the profession contrasting with considerable social work literature documenting the profession's historic ambivalence toward substance-abusing clients.     

Rehearsing Gender and Sexuality in Modern Thailand

Abstract

In this paper I draw on a series of interviews with gay-identified Thai men, and with male bar workers and their clients in order to chart the traditions, discourses, and institutional contexts contributing to the construction of gender and sexual identity in Thailand. I argue against the uncritical application of Western paradigms to the study of Thai sexuality and present a view of gender and sexuality that is “fluid and pragmatic.” I consider difficulties associated with sexual choice and levels of acceptance and toleration, and look at examples of how sex work has been socially constructed. Finally, I discuss the attachment of Thai male bar workers to the “gay” community.     

Wo'Lakol Kiciyapi

ABSTRACT

This pilot study hypothesized that the ancient traditions of help and healing among traditional Lakota people represent an alternative or complementary model for understanding a distinctive approach to American social work theory and practice which includes “shamanic” or spirit healing as a constituent part of the help and healing process. Thirty-two individuals, Including traditional Lakota elders, educators, leaders, and mental health providers, were interviewed about their views on traditional ideas of help and healing and about social work and social service practices. The findings show that there were distinctive approaches to ensure social health and well-being among pre-reservation Lakota peoples, and that the traditions of help and healing are intimately linked to the “natural law” and to the ceremonial life of the tribe. The findings show a resurgence of traditional healing practices among the Lakota with important implications for Social Work theory and practice.     

The Role of Religion and Spirituality in Clinical Social Work

Abstract

Social work has a history of treating the whole person in his/her environment, however, the effort to be scientific in our approach to clinical practice often has obscured our examination of the religious and spiritual beliefs and practices of our clients and in our own lives. Consequently, there has been very little guidance to date on how curriculum can help integrate the professional identities of MSW/MDiv students. An elective practice course, “The Role of Religion and Spirituality in Clinical Social Work” in our accredited graduate social work program provides a transitional space for this integration to occur through a guiding framework of psychodynamic, systems, and postmodern theories.     

Spirituality and social work practice at historically Black colleges and universities

ABSTRACT

In 2011 the Council on Social Work Education Religion and Spirituality Work Group was organized “to promote social workers’ knowledge, values, and skills for ethical and effective practice that takes into account the diverse expressions of religion and spirituality among clients and their communities.” In this article we discuss how the mission, charters, and goals of historically Black colleges and universities (HBCUs) addressed the domains of religion and spirituality from their inception. More specifically, the focus of this discussion is the epistemology of spirituality and religion at HBCUs from historical and contemporary perspectives. Content on the exploration of the related themes, religion and spirituality, as manifested in the curriculum, cultural milieu, and social environment of HBCUs will be described. Additionally, we document the role and influence of the African American community, church, and political insurgency. These forces, coupled with the inability or unwillingness of established social service agencies and other social institutions to address issues of inequality and marginalization of African Americans, influenced the essence of the content offered in HBCU schools of social work. Spirituality, advocacy for material aid, and critical race theory are themes that were prevalent in HBCUs curriculum. Finally we show that this “unique HBCU curriculum” was brought about primarily by environmental factors such as racism, segregation, and financial uncertainty, leading to what Du Bois referred to as a double-consciousness.     

Complementary Practices and Herbal Healing

Abstract

As a means of achieving increased levels of health and Wellness, complementary methods such as alternative approaches and medicinal preparations are being utilized to supplement or replace what has been viewed as traditional health care practice. To promote effective, efficient, and comprehensive helping relationships, social workers need to be cognizant that clients are using these methods and products, and how this use can affect the health care services they receive. This article identifies and discusses some of the basic types of alternative practices, herbal preparations, essential oils, and flower essences; as well as, the problems that can result from inadequate knowledge of the use or misuse of these products. In conclusion, emphasis is placed on increasing social work awareness and education in this area.     

Beyond “Dry Drunkenness”: Facilitating Second Stage Recovery Using Wilber's “Spectrum of Consciousness” Developmental Model

ABSTRACT

The usefulness of Wilber's “Spectrum of Consciousness” developmental model in the treatment of substance abuse is demonstrated by a case study that illustrates how underlying emotional pain and intimacy issues can be worked through in the counselling process with a client during the second stage of recovery from addiction. Wilber's model allows for narcissistic, critical self, social, identity, intimacy, existential, and psycho-spiritual issues to be integrated into the counselling process for long-term recovery. This model provides social workers and addictions counselors with a useful map in embracing client recovery.     

Amassing rural power in the fight against fracking in Maryland: A report from the field

ABSTRACT

Social workers can mobilize vulnerable populations to shape policy decisions about industrial practices that could have adverse impacts on their wellbeing. One such practice is hydraulic fracturing or “fracking” to extract oil and natural gas from shale rock deposits. There is scant social work literature on mobilizing opposition to fracking despite a proliferation of literature from other disciplines. This article documents the campaign in Maryland that led to the adoption of the first legislative ban on fracking in a U.S. state with shale gas reserves, using social movement theory to identify factors that led to this successful outcome.     

E-technology and Community Participation: Exploring the Ethical Implications for Community-based Social Workers

ABSTRACT

To date, much of the work on social work, ethics and technology has been focused on clinical social work and micromorality—the ethical practices of the worker and their clients in one-on-one or therapeutic group interactions. In contrast, this article foregrounds social workers engaged in community work and the ethical implications at a macromoral level. Central to community-based social work, also known as social development work, is the principle of participation. In observing the ways e-technology is affecting community participation, the focus is upon communicative and social technologies, rather than assistive technologies, or technology enabled assessment. The article explores the intersection of these three themes of community participation, technology, and ethics to examine the implications for social workers located in the complex context of community work.     

Recognising Strategy and Tactics in Constructing and Working with Involuntary Social Work Clients

ABSTRACT

This paper reports on the author’s academic work on working with involuntary clients, which began with a knowledge exchange project in Scotland. I reflect back on this work and use it as a way to explore subsequent reflections on the field. These move beyond consideration of the skills required to undertake such work through locating the category of involuntary clients within wider, yet contradictory, governmental discourses on client engagement. These are identified as the strategy that sets the context for such work. But the strategy is enacted through the day-to-day tactics of social workers on the ground; such tactics, enacted in everyday encounters, are constitutive of effective but also ineffective engagement with clients. The discussion goes on to problematise the distinction between voluntary and involuntary clients and to suggest that effective social work practice, whatever the nature of that involvement, requires that clients are recognised at an ethical and relational level.

IMPLICATIONS

• The term involuntary client(s) cannot be taken for granted but is constructed and needs to be understood in particular and often contradictory policy and professional contexts.

• Effective but also ineffective ways of working with involuntary clients go beyond the acquisition or demonstration of particular skills but are embodied in the everyday relational practices of social workers.

• Ethical engagement with involuntary clients proceeds from a sense of mutual recognition.

     

Managing Risk in Community Care of Older People: Perspectives from the Frontline

Abstract

Since the mid-1980s, Australian governments have focused on expanding community and home-based services for older people. This has led to increased levels of dependency, vulnerability, and complexity to be managed in the community. Consequently, aged care services have had to develop mechanisms for regulating and managing these increased risks, and risk management has become more central to the practices of professional workers in this field. This paper reports on some findings from a large-scale study that explores the way risk management policies have been translated into practice by community-based services in Victoria, Australia. Drawing on interviews with 18 frontline and management professionals employed in community aged care, we found that these workers were wrestling with a diverse and new range of institutional risks beyond those encountered in the actual delivery of frontline care. We found that these workers experienced “risk” in four different contexts, which often created demands for contradictory or conflicting responses. Here we examine these “contexts of risk practice”: professional workers' relationships with their clients, relationships with other service providers, the unregulated nature of the home as a work environment, and community expectations about the management of risk. Despite tensions that frequently arose, workers expressed strong professional commitments to their clients and were motivated to find positive resolutions amid competing interests. We conclude that tensions experienced by workers were embedded in the structural dimensions of institutional relationships and the systematic absence of shared understandings of “acceptable” risks in the community care of older people, rather than in the failure of professional agency.     

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.     

The Policy Transfer Model

ABSTRACT

“New” social welfare policies are often actually policies borrowed from other states or nations. This paper reviews the recent theoretical developments in understanding the processes of policy transfer and presents a “policy transfer” model that can be a useful heuristic tool for social workers engaged in policy making. It discusses how the field of social work can benefit from understanding the factors underlying successful and unsuccessful policy transfer, and argues for the inclusion of the study of policy transfer in social welfare policy courses.     

A scoping study of moral injury: Identifying directions for social work research

This paper presents a scoping study of moral injury that identified directions for social work research. “Moral injury” refers to lasting psychological, spiritual and social harm caused by one's own or others' actions in a high stakes situation that transgress deeply held moral beliefs and expectations. A “scoping study” is a type of systematic review and knowledge synthesis useful when considering complex, emerging areas of research. Results revealed an increasing interest in moral injury over the past five years primarily in psychology/psychiatry. The majority of published articles are conceptual. Empirical studies aim to better understand the experience of moral injury, qualitatively; and develop and evaluate instruments to assess moral injury, quantitatively. Most empirical studies of moral injury involve US war veterans with little attention to moral injury in other groups, sociocultural contexts, or at different times in development. Failure to address issues of moral injury in social work may leave vulnerable clients struggling with issues of guilt, shame, moral confusion, and an absence of meaning that may persist for years and create obstacles to positive change. In addition, social workers may experience moral injury as they witness morally injurious behavior of others and of systems. If unaddressed, such injuries may diminish effectiveness, or lead to burn out. Social workers need relevant research to understand the extent to which moral injury affects them and their clients, and how to identify and address it.     

When Bourgeois Utopias Meet Gentrification: Community and Diversity in a New Urbanist Neighborhood*

Abstract

Scholars have recently begun to explore how social and politically liberal gentrifiers make sense of the classed and racial inequalities linked to gentrification. In this article I ask how residents of one new urbanist “bourgeois utopia”—the Mueller Development in Austin, Texas—experience and give meaning to their neighborhood in a context of gentrification. Drawing on 31 in-depth interviews I explain how new urbanism has reimagined and marketed “diversity” and “community” to middle-class and wealthy consumers and provides these to affluent people as neighborhood amenities. I show how residents draw on diversity ideology and multicultural capital to neutralize what they see as their neighborhood’s role in gentrification. In doing so this article adds to our theoretical understanding of how contemporary urban development exploits pursuits for the social good as rhetorical tools to assuage privileged guilt while promoting profitable enterprises.     

Responsibilisation,social work and inclusive social security in Finland

ABSTRACT

In this article responsibilisation in social work is studied by analysing two Finnish state-level policy documents (called final report and research report) which concern a current activation initiative called inclusive social security (ISS). It is asked how social workers and clients are constructed as responsible subjects in these documents. Responsibilisation refers to the advanced liberal mode of governmentality, which aims to strengthen citizens’ abilities to self-governance through various techniques that include the intertwined elements of surveillance and empowerment. It is demonstrated that the policy documents construct the social workers’ and the clients’ responsibilities partly in different ways. The final report leads activation to be based on shared responsibility and social work to be more community-based, whereas the research report strengthens more individual-based responsibility of clients and social workers. For the clients, the interpretation of ISS based on shared responsibility would probably be less stigmatising and paternalistic than the one based on individual responsibilities, i.e. approaching long-term unemployed citizens as being personally ‘at risk’ and thus a justified target group of individualised techniques for activation. For social workers and clients, future activation appears to be a wide mix of different techniques, moral expectations and possible ways of being a responsible subject.