Clinical Practice

These modules focus upon integrating the foundational content with one’s current clinical practice. Foremost, through learning to write a quality and rigorous narrativized case study, the curriculum seeks student integration as its primary aim. Students learn to write close descriptions of their clinical work while placing it within multiple contexts, including their philosophical and theoretical commitments. Three umbrella content areas comprise the clinical curriculum: phenomenology of psychopathology, the overarching elements of clinical practice, and the narrativized case study.

Phenomenology of psychopathology breaks down the typical subject/object dualism of medical diagnostic categories and replaces it with an intersubjective, subject/object pair. A phenomenological case study aligns itself with twentieth-century philosophy, science, and social science (e.g., anthropology, psychology, and ecology), a body of work that rejects the separately acting, discrete agent, rationale-choice actor (i.e., the dualist view of subject/object or mind/body). Ecologists, for example, have argued that our existence is inevitably intertwined with our natural environments. Anthropologists and sociologists have shown how our seemingly essentialist identities, gender, sexuality, and ethnicity are constitutive of how we perform and engage with each other. In numerous ways, psychological theories have challenged the idea of free agency and its corollary assumption that we possess an absolute power to make choices–surely, to posit unconscious motivations is to directly challenge the idea of absolute autonomy. As a whole, however, a commonsense view dominants in social work: a client makes a choice to engage social workers and social workers, in turn, make intervention choices. In the dominant view, both practitioner and client are seen as mutually distinct subject/object entities. Phenomenological approaches critique this traditional view by recognizing the importance of experience and the role of interpretation.

Phenomenology posits that meaning making is intersubjective and therefore extremely dependent on the context. Our narrativized case studies include contextual factors that make the case unique. So what is meant by context? From fifteenth century Latin, we have contextus, “a joining together”, originally of contexere, “to weave together.” A further elaboration on the definition of context includes,

“The surroundings, circumstances, environment, background or settings that determine, specify, or clarify the meaning of an event or other occurrence.  For example, in what context did your attack on him happen? – We had a pretty tense relationship at the time, and when he insulted me I snapped. In linguistics, context includes the text in which a word or passage appears and which helps ascertain its meaning.  In archaeology, context includes the surroundings and environment in which an artifact is found and which may provide important clues about the artifact’s function and/or cultural meaning” (http://en.wiktionary.org/wiki/context).

Large survey studies and controlled behavioral science studies typically erase context to achieve the goal of generalization; to generalize means to find a law that applies to everyone in spite of a particular context. Social work realities assume that client and clinician “surroundings, circumstances, environment, background or settings” do matter and case studies, then, must demonstrate how and why the context should not be erased. In short, context is essential to our knowledge of clinical meaning making.  In social work generally, we do not work in or encounter closed context or systems. In short, the mind, the interpersonal world, the family, the neighborhood, the school, are all open systems. Closed systems exist only when we can and do take action to control the variables (e.g., controlling the effects of temperature or pressure or other potentially intervening causes in a laboratory experiment, for example). Social work researchers do, of course, design random controlled trials and the results may be rigorous, but usually they lack relevancy, that is, their findings do not account for how contexts set the backdrop for meaning making between client and social worker.

The third major content area includes topics related to the common elements of social work practice. These topics are integrally related to phenomenological perspectives, most specifically to meaning making and interpretation. Culture is more than being culturally competent, it’s understanding that a client’s cultural context matters a great deal in how the social work encounter creates, in-vivo, meaning. Assuming an intersubjective perspective also means that social workers must theorize, practice, and reflect upon the nature of a therapeutic relationship or alliance. We can no longer take up traditional conceptualizations of gender and sexuality; instead we must carefully listen and observe the unique ways these are expressed and performed. Humans attach and separate, and are forever engaged in such processes throughout life; thus, understanding grief and loss across the lifespan is essential to properly contextualize client suffering. The domestic household, however constituted, includes contextual dynamics and includes the role of parenting. As ways to experience and re-experience the body, increasingly, clients turn to yoga, dance, acupuncture, massage, and one could argue body piercing and tattooing. Thus, how is the body conceptualized in social work practice?  There is perhaps nothing more common in many social work contexts–or in mental health vernacular co-morbidity–than having an addiction along with other disturbances. Moreover, humans often deny, project, rationalize, and routinize experience; therefore theories of psychological defenses are relevant to understanding experience. We are always confronting our desires, impulses, emotions and feelings. And finally, clinical work assumes practitioner and client reflexivity, but what is it and how is it achieved?