Client Care: Learning the Benefits of Clinical Social Work

Schools of Social Work

By Peter Craig

While getting his PhD in social work, Christopher G. Mitchell took a job at Kaiser Permanente in Washington, D.C., where he discovered that he “very much enjoyed doing clinical work and found it very rewarding.’’ He was then off to the Jane Addams College of Social Work at the University of Illinois-Chicago, where he ultimately became an associate professor and has taught clinical practice within the college’s mental health specialization for more than 25 years.

Clinical MSW students there take required courses in mental health practice, policy and research. They learn that assessing a client’s mental health involves not only determining any history of trauma, but also viewing that person through social work’s traditional person-in-environment and strengths perspectives, says Mitchell.

The Bigger Picture

In nailing down someone’s mental health issues, the clinical social work process is simply more comprehensive than psychiatry or psychology, according to social work educators. “What makes us distinct is that we always take the environment into account whenever we are trying to understand how someone may be struggling in their functioning,” says Dr. Linda Lausell Bryant, associate dean for academic affairs and clinical professor, New York University Silver School of Social Work, who points out that social workers are the largest provider of mental health care services in the U.S.

After covering assessment, clinical social work educators will move on to interventions. “It used to be that people were in psychoanalysis for years,” says Bryant. “But with the impact of managed care and insurance companies’ limits to reimbursements, the field has had to use more short-term, focused and evidence-based models.” Interventions include short-term psychodynamic therapy, attachment-based therapy, cognitive behavioral therapy (CBT), dialectical behavioral therapy, interpersonal therapy, motivational interviewing and others.

The University of Illinois-Chicago clinical social work program emphasizes CBT, says Mitchell, because of the particularly large “body of evidence that shows it can be effective for clients who have mental health conditions such as depression, anxiety, etc.”

In her clinical social work practice classes at San Diego State University, Dr. Nicole Dubus, LTSW, LITSW, associate professor of social work, reviews theories ranging from developmental (starting with Freud) to humanistic as part of her “toolbox” approach to interventions. “The goal is that students will be comfortable enough with this toolbox that they will be able reach their hand in it and grab the right tool for the job, but agile enough with it to be able to choose a different intervention if that first one didn’t work.”

Meanwhile, at the NYU Silver School, PhD candidate and adjunct instructor Aaron Rodwin, LCSW, is drawing from some innovative music-oriented interventions in writing his dissertation on how music can help promote improvement in young adults with severe mental health issues (see “Clinical Social Work Research: A Rundown,” page 52).

Field Goals

As in all other areas of social work education, field practicum is key. “It’s not the abstract,” says Mitchell about practicum assignments. “Students are working with clients—real people who have real challenges, special issues they’re trying to address.” His program’s practicum partners in Chicago have included places like the University of Illinois hospital; Haymarket Center, which offers services for people with substance use issues; and Metropolitan Family Services.

At the Rutgers University School of Social Work, the practicum experience “really helps to impart the knowledge, values and skills needed to be a clinical social worker,” says Dr. Edward Alessi, professor and MSW program director, who teaches “Clinical Social Work I.” “There are hospitals, community centers, mental health clinics and other sites.”

Learning about mental health care can also take place at seminars and conferences. At Fordham University, for instance, individual professors and others regularly organize events around different topics, says Dr. Tina Maschi, LCSW, ATSW, professor, Graduate School of Social Service, who herself—both in the classroom and beyond—has long emphasized music and the arts as interventions. One recent event was the interprofessional conference “Mental Health and Crime: A Path to Safety for All,” which was moderated by Graduate School of Social Service Dean Debra M. McPhee.

In fact, such interprofessional collaboration tends to be emphasized by social work programs in mental health and other areas. At the University of Illinois-Chicago’s Jane Addams College of Social Work, a clinical practice class recently featured a joint activity with occupational therapy students. The two disciplines learned about each other’s structure and strengths and, in a case study, together identified goals and did some treatment planning around them. “The mental health care system,” says Mitchell, “is most effective when multiple providers from multiple disciplines actually talk to each other and coordinate care for an individual to try to ensure the greatest outcome for the person’s health and wellness.”

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Clinical Social Work Research: A Rundown

There is interesting and unusual research going on in the field of clinical social work. For example, at Rutgers University School of Social Work, Dr. Edward Alessi, professor and MSW program director, has been doing some work on the intersection of gender, sexuality and migration. He says it’s about “understanding the health and mental health issues that are driven by the structural conditions that marginalize LGBTQ+ migrants,” who include refugees, immigrants and asylum seekers.

At the New York University Silver School of Social Work, PhD candidate and adjunct instructor Aaron Rodwin, LCSW, is working on his dissertation, which will focus on ways music can be used as a self-management strategy to help in the recovery of young adults living with serious mental illness.

One approach is a “reflective” intervention where a therapist, in either an individual or a group session, will have participants listen to and then discuss a song that has mental health-related lyrics, “using the content as a tool to help facilitate the therapeutic process,” says Rodwin. Other approaches involve more active participation. For example, in a Bronx high school hip-hop therapy program, complete with a music studio, “kids learn how to make music, they sing, they rap, they learn how to DJ,” Rodwin says. “So it’s a lot more somatic and sensory, and, from a mental health perspective, more helpful in things like regulating emotions and allowing self-expression.”

And although music may trigger painful memories or disturbing images for some people, says Rodwin, the resulting emotions can be valuable “for the therapist to explore with the client and use as a therapeutic tool.”

Following are some published research materials on clinical social work. All materials except “Mental Health and Social Work” can be found by searching NASW’s Research Library database at socialworkers.org/Practice/NASW-Research-Library.

• “Aging Behind Prison Walls: Studies in Trauma and Resilience” by Tina Maschi and Keith Morgen
• “Dealing with the Aftermath: A Qualitative Analysis of Mental Health Social Workers’ Reactions after a Client Suicide” by Laura Ting, Sara Sanders, Jodi M. Jacobson and James R. Power
• “Evidence for Public Policies to Prevent Suicide Death in the United States” by Jonathan Purtle, Amanda I. Mauri, Michael A. Lindsey and Katherine M. Keyes
• “Mental Health Recovery Paradigm: Implications for Social Work” by Jenneth Carpenter
• “Resiliency with Forced Migrants: A Qualitative Study of Providers and Forced Migrants through a Resilience Perspective” by Nicole Dubus
• “Mental Health and Social Work” by Mo Ray, Richard Pugh, with Diane Roberts and Bernard Beech