Module 9 – Implications for Clinical Social Work Practice

The Council on Social Work Education (CSWE) provides guidelines for educating social worker students to assure there are professional social workers competent in providing services to people suffering from mental health issues such as grief and loss, depression, anxiety, interpersonal violence, and trauma. Based on CSWE Competencies 6 thru 9 in their 2015 Educational Policy and Accreditation Standards (EPAS), social workers learn to engage, assess, intervene and evaluate the practice with individuals, families, groups, organizations, and communities (pp.8-9). [See CSWE 2015 EPAS] 

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Competency 8: Intervene with Individuals, Families, Groups, Organizations, and Communities

Competency 8 states that the social work profession “values the importance of human relationship and understands that engagement is an ongoing component of the dynamic and interactive process of social work practice with, and on behalf of, diverse individuals, families, groups, organizations, and communities” (pp. 8-9). Clinical social workers need to implement engagement and assessment skills along with clinical interventions. 

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A Human Rights Perspective​

From a human rights perspective, there is a need for services to address human rights violations and the stress of losses, violence, discrimination and trauma. The UN High Commissioner for Refugees (UNHCR) at a Geneva Convention reminds us that the “fear of being persecuted for reasons of race, religion, nationality” is a primary reason for persons to flee their countries (UNHCR, 2010, p.3). Offering interventions that care for people—both refugees and host community members—who feel afraid or threatened helps create safer, more inclusive neighborhoods and works to preserve human rights for dignity and equality as indicated in the UN Declaration of Human Rights [Review Module Two; See UNHCR (2010) Geneva Convention document and Universal Declaration of Human Rights document.]

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Mental health services are needed to address depressive disorders resulting from the losses accompanying disconnections from family, culture, and relationships. There are also those who may suffer from traumatic experiences and need trauma responsive care. Refugee Asem spoke of the traumatic experiences he had while trying to reach Germany. Borgwarth from the Refugee Council described the deplorable living conditions in many of the refugee camps in Romania, Poland and other countries. She further described a Syrian refugee who had experienced repeated traumas and missed his family so much that he was suicidal. She reported visiting a refugee camp where the women would come to her and cry. Freytag with the vocational training program shared how many refugees come to school with painful memories and needed additional mental health care and support to process intense feelings and thoughts. [See video]  [See Transcript]

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Relational-Cultural Theory

Relational-Cultural theory is an evidence-informed theory that has been shown to be effective in working with diverse clients. Modern advances in neuroscience indicate the brain is hard wired/designed for connection and they support RCT’s focus on relationships in clinical social work. For refugees who have been separated from most if not all of their personal and societal connections, fostering new connections can be a key part of their healthy integration into their new communities. Social workers can play an important part in this reconnection process by fostering working alliances with their refugee clients while providing needed services and opportunities for them to build new supportive relationships in the community. Empathy is an important factor in building relationships needed to help heal this pain and trauma. Jordan (2018) describes empathy as “a complex cognitive affective skill that allows us to ‘know’ (resonate, feel, sense, cognitively grasp) another person’s experience” (p. 110).

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Jordan (2018) writes that empathy is central to our responsiveness to others and for change to take place each person must experience mutual empathy or mutual responsiveness. She proposes that anticipatory empathy—anticipating what the other person is feeling based on their experiences—is important to developing growth fostering relationships such as in clinical social work. She points to the importance of self-empathy as a source of change in clinical practice. She notes empathic self-awareness of past experiences as important in promoting such personal growth for clients. Regularly caring for one’s own personal needs is also important. Self-empathy in social workers can lead to much needed self-care and the interventions suggested below may provide useful ideas for doing that self-care. 

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When volunteers organized places for refugees and community members to meet and interact with each other in the Welcome Cafes that Oellerking described, they demonstrated fostering anticipatory empathy. Bringing people together as he indicated they did on Labor Day in Schwerin with 10 to 12 musicians from different cultures “offering what they had brought with them of their culture” promoted the development of mutual empathy. Fostering empathy and connection is certainly crucial for healthy functioning of both clients and service providers.

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Linking brain science with relationships, Banks (2010) designed the C. A. R. E program to provide practical ways to assess and potentially foster healthy relationships. The C. A. R. E. program focuses on supportive, safe, calm, fun, and relational interactions that can stimulate a sense of Calm (smart vagus), Acceptedness (dorsal anterior cingulate gyrus), Resonance (mirror neurons) and Energy (dopamine).

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The C. A. R. E. program and related examples of supportive interventions include:

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C - Calm (smart vagus): Primary relationships help us manage stress in our lives. Good vagal tone allows us to be come upset, anxious or angry at a loved one without withdrawing or becoming physically aggressive. 

Example of an intervention: During the day, make eye contact, smile and greet others in passing.

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A - Acceptedness (dorsal anterior cingulate gyrus): Helps to feel that we belong and are accepted and not judged. Most of our relationships feel safe. Example of an intervention:Practice a loving kindness meditation: May you be happy. May you be safe. May you be well. May you be peaceful and at ease.

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R - Resonance (mirror neurons): Helps us to be able to read another person’s actions, intentions and feelings and resonate with them. Relationships feel relatively “easy” and we can read another person accurately. 

Example of an intervention: Watch a movie with a friend. Choose a character to “read”. Pick a scene and talk about how each of you think the character feels.

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E - Energy (dopamine): Healthy relationships help us feel motivated and energized. Example of an intervention: Do something to help another person in need. Allow someone to help you when you are in need. [See link: Dr. Amy Banks]

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The refugees and service providers in Schwerin reported instances of ‘helping another person in need’ as Banks suggests above to foster “Energy”, but some reported other self/relational-care activities also. The women at the Refugee Council shared how important it was for them to practice self-nurturing because of the stressful environment they dealt with on a daily basis. Borgwarth cited the importance of being with friends, playing her guitar and Irish drum as well as traveling. Oellerking suggested traveling, talking, smiling, dancing.

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[See article: Banks, A. (2010). Developing the Capacity to Connect. [See video]  [See Transcript]

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References

Jordan, J. (2018). Relational-Cultural therapy. Washington, D.C.: American Psychological Association.