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The search for identity when clinicians become clients
- Author:
- PROBST Barbara
- Journal article citation:
- Clinical Social Work Journal, 4(4), 2015, pp.337-347.
- Publisher:
- Springer
- Place of publication:
- New York
It is widely accepted that those who provide psychotherapy for others benefit from experience in the client role; most clinicians do, in fact, seek their own therapy, as a sizable body of research indicates. Yet these studies address only one side of the phenomenon: the impact of personal therapy, usually early in their careers, on clinicians’ subsequent practice. Little is known about what happens when seasoned clinicians move in the other direction - from the “therapist chair” into, or back into, the “client chair.” These are a special group of clients, reacting to therapy in ways that other groups do not. As this qualitative study of 30 clinical social workers who have returned to the “patient chair” indicates, there is a unique struggle for identity and control. The paper explores the impact of that struggle on the therapeutic dyad and therapeutic frame, and concludes with implications and suggestions for further research. (Publisher abstract)
Queen of the owls: metaphor and identity in psychiatric diagnosis
- Author:
- PROBST Barbara
- Journal article citation:
- Social Work in Mental Health, 13(3), 2015, pp.235-251.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Clinical social workers’ commitment to social justice makes them acutely concerned about discrimination and dis-empowerment, and thus they are sensitive to the impact of stigma on persons diagnosed with a mental disorder. At the same time, it is important to explore whether clinicians’ assumptions about psychiatric diagnoses as stigmatizing mesh with the views and experiences of those who actually receive and live with these diagnoses. To address this question, in-depth interviews were conducted with 30 individuals carrying a range of psychiatric diagnoses. Narrative and thematic analysis yielded several distinct narratives about living with a mental health label. For many participants, diagnosis brought validation; to be "named" was to be welcomed into one’s tribe. For others, diagnosis meant reduction and mistranslation. Findings raise questions about the assumption that diagnostic labels necessarily bring shame and/or loss of self-efficacy. Without minimizing the impact of stigma, clinicians need to remain open to discovering how each client finds meaning in the diagnostic experience. Based on participants’ use of deeply personal images, metaphor is proposed as a creative means for re-claiming identity. Implications for practice and further research are suggested. (Edited publisher abstract)
In the hyphen: perceptions, benefits, and challenges of social workers’ dual identity as clinician-client
- Author:
- PROBST Barbara
- Journal article citation:
- Families in Society, 95(1), 2014, pp.25-33.
- Publisher:
- The Alliance for Children and Families
This study is the first to directly inquire into the experience of clinical social workers who live “in the hyphen,” having received psychiatric diagnoses and/or been in therapy themselves. Rather than inhabiting these roles sequentially as previous studies suggest, many inhabit them simultaneously. Social workers who took part in this qualitative thematic analysis describe the benefits of living in the hyphen, such as greater understanding of client resistance and opportunity to serve as a model of realistic hope, as well as its challenges, including countertransference, retraumatization, and fear of being “outed.” Overall, the experience of “sitting in the other chair” was more important to participants than having a skillful therapist as a role model or sharing a specific diagnostic history with a client, which they cautioned did not offer a shortcut to authentic understanding or formation of a therapeutic alliance (Publisher abstract)
Living with and living within: visions of ‘environment’ in contemporary social work
- Author:
- PROBST Barbara
- Journal article citation:
- Qualitative Social Work, 12(5), 2013, pp.689-704.
- Publisher:
- Sage
Social work’s commitment to an environmental perspective has been its hallmark, the feature that has distinguished it from other helping professions. Yet the definition and utility of person-in-environment have been inconsistent and poorly conceptualized, varying by practitioner as well as by cohort and era. As this thematic analysis of interviews with 30 clinical social workers reveals, ‘environment’ has both broad and specific meanings in contemporary practice, with horizontal (current) and vertical (historical) dimensions ranging from situational triggers to cumulative adversity. Social work clients bring to the clinical encounter a personal and socio-cultural history that they live ‘with,’ as well as a multi-faceted present context that they live ‘within.’ While participants in this study agreed that inclusion of context was essential for understanding a client’s story and struggle, they did not find environment to have significant clinical ‘power’ for treatment decisions or as a guide to practice. These findings raise important questions about what constitutes a uniquely ‘social work’ intervention, particularly in an era when treatment is increasingly shaped around de-contextualized psychiatric diagnosis. (Publisher abstract)
Diagnosing, diagnoses, and the DSM in clinical social work
- Author:
- PROBST Barbara
- Journal article citation:
- Families in Society, 93(4), October 2012, pp.255-263.
- Publisher:
- The Alliance for Children and Families
Using data collected within a larger study, this article presents findings about how clinical social workers think about and use diagnoses deriving from the Diagnostic and Statistical Manual of Mental Disorders (DSM) and differential use of diagnostic categories. The US-based qualitative study gathered information from a sample of 30 clinical social workers in Westchester County who took part in face-to-face interviews. The article describes the methodology and the results of thematic analysis of the interviews. It discusses the findings, covering 7 specific themes: diagnosis can provide useful indications for treatment decisions, the importance of a diagnosis depends on the disorder, diagnoses can be affected by preference for a familiar or popular category, clinical social workers prefer to select the mildest diagnosis available, diagnosis is more problematic for children than for adults, experience changes attitudes towards and use of DSM categories, and DSM categories are not exact so choice can be a struggle. It reports that participants distinguished between thinking diagnostically and using the DSM, and considered symptoms a more useful analytic focus than psychiatric categories.
Not quite colleagues: issues of power and purview between social work and psychiatry
- Author:
- PROBST Barbara
- Journal article citation:
- Social Work in Mental Health, 10(5), 2012, pp.367-383.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Social workers are the largest group of mental health professionals in the United States, providing 60% of all therapeutic services. In providing mental health service, social workers typically engage with psychiatrists. Working with, and sometimes under, professionals from another discipline presents unique challenges, particularly when the other discipline is more highly regarded. The qualitative research, conducted within a larger study of clinical social work, offers new insights into the complex interweaving of power, setting, money, and clinical practice. A total of 30 clinical social workers took part in one-hour face-to-face interviews. The participants reflected on their attitudes toward the psychiatrists they had worked with, the impact of setting on their professional identity, and the relationship between payment and power. The findings reveal tensions about power and purview that create a complex, often troubled landscape for contemporary social work practice. Suggestions are offered for fostering meaningful, collaborative relationships, and for helping social workers cope with ethical dilemmas that arise when navigating psychiatric and traditional social work paradigms.
Implicit and explicit use of the strengths perspective in social work education
- Author:
- PROBST Barbara
- Journal article citation:
- Journal of Teaching in Social Work, 30(4), October 2010, pp.468-484.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
To date, there has been a lack of literature on strengths based perspective in social work education. Previous studies have tended to focus on content a practice based perspective, rather than data obtained directly from social work faculty. In order to address this gap, this paper presents findings form a study of faculty teaching Master of Social Work foundation courses, at Fordham University, New York. Six faculty members were included in the study. Three taught Human Behaviour in the Social Environment (HBSE), 2 taught Generalist Social Work Practice (GSWP), and 1 taught both. All participants had at least 5 years experience. Findings indicate that instructors vary in how implicitly or explicitly they use the strengths perspective, using a range of concepts and terms to capture the notion of strengths. Instructors who taught HBSE made use of strengths-based perspective differently from those that taught GSWP. In conclusion, a strengths based perspective was an effective mediator between theory and topic.
Contextual meanings of the strengths perspective for social work practice in mental health
- Author:
- PROBST Barbara
- Journal article citation:
- Families in Society, 90(2), April 2009, pp.162-166.
- Publisher:
- The Alliance for Children and Families
To explore how the strengths perspective functions in action and in context, this article examines a) the role of strengths in assessment, b) the relationship of strengths to change, and c) structures and supports for utilising a strengths-based approach.
Issues in portability of evidence-based treatment for adolescent depression
- Author:
- PROBST Barbara
- Journal article citation:
- Child and Adolescent Social Work Journal, 25(2), April 2008, pp.111-123.
- Publisher:
- Springer
Depression is one of the most commonly diagnosed psychiatric disorders among school-aged youth, with high prevalence and far-reaching consequences. However, even though there are two evidence-based practices for treating adolescent depression (Cognitive-Behavioural Therapy and Interpersonal Therapy), most adolescents referred for treatment are unlikely to receive either. In part, this is due to the difficulty of transporting an evidence-based practice from laboratory to real-world setting, and determining how to transport an empirically validated treatment has thus become a focus of concern for social work researchers and practitioners. This article is organised in four sections: 1) background on adolescent depression and its treatment; 2) discussion of factors that may affect treatment outcome and how each can be addressed to enhance portability; 3) review of suggestions that have been proposed to resolve the efficacy/effectiveness gap; and 4) conclusions.
Re-framing and de-pathologizing behavior in therapy for children diagnosed with psychosocial disorders
- Author:
- PROBST Barbara
- Journal article citation:
- Child and Adolescent Social Work Journal, 23(4), August 2006, pp.487-500.
- Publisher:
- Springer
The increasing number of children diagnosed with psychosocial disorders reflects a trend toward pathologizing behaviour that is unusual, challenging or extreme. Although these behaviours may match items on the symptom lists for various disorders, a therapist must first consider the origin and context of those behaviours for an individual child through a non-pathological lens. This paper proposes a framework for understanding the behaviour of difficult children based on core issues rather than diagnostic symptoms: arousal/excitability, range of focus, perfectionism, intensity, interpersonal sensitivity, sensory sensitivity, cognitive/perceptual style, perception of time, reaction style, and affiliation/integrity. Each trait is examined from two perspectives: how it can lead to or be interpreted as a problem, and how a therapist can re-frame the trait and build on it to identify effective interventions. This approach affirms children’s strengths and upholds social work values.