Integrated Theoretical Perspective in Social Work Practice - Essay Example

Running Head: Integrated Theoretical Perspectives in Social Work Practice in Mental Health Integrated Theoretical Perspectives In Social Work Practice in Mental Health Loredana Pampinella Winthrop University In partial fulfillment of the requirements for SCWK 532 Deana F. Morrow December 03, 2008 Abstract Boundary spanning has been a recent development in social work practice. It aims to integrate various theories, assessment tools and interventionist approaches to social work through ecological reinterpretation. This social work framework not merely takes into account the individual from but also the environment. Psychodynamic perspective, ecological framework and general systems theory are particularly helpful in understanding and designing appropriate intervention measures in the mental health services sector. Likewise, it can also assist social work to conform to ethical standards and take into consideration diversity issues, specifically manifested in cross-cultural social work practice. I. Introduction A boundary line such as a line, a plane or a point, implies or secures a limit, a periphery, a range, or a barrier. To span “is to form an arch over, to extend over across” (Kerson, 2002, 1); thus, a boundary-exceeding framework to health-related social work broadens over already penciled in barriers so as to provide social workers a greater range of perceptiveness, greater autonomy in interventions, and greater access to organizations and structures. This paper then will discuss the importance of boundary-exceeding in all areas of social work so that social workers can learn to assist their patients, clients and consumers to achieve their aspirations (ibid). Throughout its years of experience, social work practice in mental health has revised itself by or has been described by several boundaries. Occasionally, the borders have been created for the participants; some times, the restrictions have been designed by the participants themselves. Such limitations have occasionally got in the way of social workers’ capability to comprehend or resolve in the most practical means. Throughout time, even if social workers have drawn the parameters themselves, they have discovered the boundaries too limiting (Meyer, 1988). In response, social workers have had to locate ways to batter down the hindrances, to do the practice tantamount to finding tougher or wider scopes, opening entryways, breaking down walls, or insisting for greater autonomy. This ecological reinterpretation caters to and redefines various existing parameters or boundaries, and this reinterpretation claims that parameters have to be spanned in manners that are less preventing (ibid). The first parameter that should be spanned is the thing that detaches health care from mental health care. Fresh knowledge on the symptomatology, etiology and handling of an array of illnesses implies that the separation between physical health and mental health is inaccurate. While technological and medical knowledge do not sustain this separation, social responses, integrating administrative systems and subsidizing streams, carry on as though physical health and mental health were two very different entities (Kerson, 2002). The second parameter region that must be revised in the context of health-related social work, which actually started out in public health venture, which is then relocated basically within the confines of university-related educating hospitals, was the limitation to work merely with native patients. As psychiatry and psychoanalysis improved, social work set up new boundaries associated to the extent of consciousness on which social workers could operate. While psychiatrists could function on all stages, social workers could function merely on the mindful and preconscious stages, on no account the insensible stage; during that time, several social workers went face-to-face with their clients, hence recurrently establishing restrictive parameters for their work (Levinson, 1992). A third parameter region is present between stages of practice or practice traditions. For several years, parameters were drawn between traditions, with social workers referring to themselves as group workers, case workers, or community planners. There were curriculums in colleges of social work called “Group Work for Caseworkers” and “Community Organizing for Group Workers,” (Kerson, 2002, 2) yet even with such curriculums, the boundaries were obvious. The boundaries could occasionally be interfered, but the basic description of the work was the strongly drawn traditions. In the contemporary period parameters are established between those who are direct practitioners, those who accomplish program development, and those who operate in the policy sector. Those are mutually preventive hindrances that must be spanned (ibid). Boundary spanning believes that to fulfill the objective of social work, social workers should have a breadth and range of wisdom that allows them to function using an ecological perspective. To operate in this manner indicates that social workers should recognize the forces that have influenced the profession and the constitutions and ethical concerns that are significant to the profession. Also, social workers must maintain the capability to understand structures and organizations, a profound appreciation of themselves, a competence to intervene as supporters, making use of case supervision, group and short-range work talents; and the ability to assess their work and their clients’ improvement (ibid). II. Psychodynamic Perspective in Social Work Psychodynamic social work covers a broad range of hypothetical and clinical subject matters: the interaction between social work and psychoanalytic assumption, the origin of psychoanalytic theory, the three stages of psychodynamic application, child psychotherapy and research on practice (Culver, 1995). Contemporary psychoanalytic thinking, explores, as it usually does, the characteristic and evolution of nature and personality rests the concern of mental agony. Psychoanalysts have been investigating the means in which, whether in the individual level or the society at large, development may be cultivated or held in conformity to the degree that agony is diversely adjusted, altered or avoided (ibid). The incapability to create boundaries, to claim limits, though normally more trouble-free as the line of minimum opposition, may frequently spawn a predicament in tolerating any agony or depression, and hence actually hamper development. This psychodynamic perspective, obviously, requests significant concerns, and emphasizes to the line of gap in the application of the parenting framework to social work practice. The framework, apparently, is designed suggestively, fairly rather than tangibly. Social workers do have a task to support and prop up their clients. Clients struggle successfully for every bit of reassurance they can and this, definitely, is a justifiable form of enterprise (Meyer, 1988). Apparently, sometimes, the client’s demanding attitude will be concealment mechanism for another form of poverty. But, employed frankly, to propose that this dislocation is the prevalent form of the social worker-client framework can strengthen dominant, chauvinistic, social work principles, in which the client is uncomfortable. The agony is grand: to lessen it to deficient parenting would be an unacceptable generalization, no superior than the reductionism of insufficient financial resources. Neither framework does impartiality to life at poverty. Some means has to be discovered of thinking about these dilemmas so that the physical, material and the sentimental or emotional can be reconciled into a more delicate relation (ibid). It is this very process of thinking that should be explored, for it embodies a determining aspect in the capability to develop a productive, completely dimensional inner domain and to take advantage on the resources of that inner domain to be as daringly oneself as probable, and hence, as successful as possible. It is perhaps true that lots of those who discover their way to social services are within in addition to externally removed, or impoverished. This is implied best, probably, through a depiction of the dilemmas appeared as ones in which thinking inclines to be conformity, and action and response dominate. This style of being evident typifies institutional and group dynamics in particular, and thereby relevant to the broader social structures. Thinking and feeling constitute difficult, emotional social work; vigorous processes, at the center of the psychodynamic theory of parenting resembles the responsibilities of the social worker. Social work is like parenting since it resembles the taking in of the child’s agonizing experience, the containing of it, the consoling of the most suffering aspects, and the giving it back in a more endurable form (Meyer, 1988). III. An Ecological Perspective The ecological framework suggests that clients, programs, agendas, communities, and all the relevant attributes of environment are sections of an interacting entirety. In order to gain knowledge on why, when, and what the process is to intervene, social workers must appreciate context, the interconnected circumstances in which the client, programs, agenda, or community subsist. The term concept of framework expresses breadth and space, as it does in art, providing supplementary dimensions to understanding. The notion of ecological was derived from ecology, the separation of biology that examines the relationships among living things and all the components of their environment that influence them and that they shape in any means. Ecology perceives individuals and their environments as mutually dependent. Individual units and features are divided for analysis in order to formulate strategies for modifying the relationships, but all divisions, aspects, and dimensions must be perceived together to be genuinely appreciated (Kerson, 2002). Hence, an ecological framework assumes a particular paradigm and perception of the individual from which all ways of evaluation, strategy designing, and instruments for intervention are created. This framework is neither a representation nor an assumption but a perspective that is a valuable means of contemplating about (Meyer, 1988). A framework is a system formulated to include or sustain a written work or organization of insights; whereas a representation is an explanation or embodiment of a structure that demonstrates the proportions and organizations of its constituent units, and an assumption or a theory is “a scheme or system of ideas or statements held as an explanation or account for a group of facts or phenomena, a hypothesis that has been firmed or established by observation or experiment and is propounded or accepted as accounting for the known facts; a statement of what are held to be the laws, principles or causes of something known or observed” (Oxford English Dictionary, 1971, 278). IV. General Systems Theory in Social Work Practice in Mental Health Work on an ecological framework for social work practice was apparently influenced by recognition of general system theory (Bertalanffy, 1974). The general system framework offered social work with a culture and a means of mobilizing social workers’ views of interconnectedness and dynamic practices (Ell & Northen, 1990). Furthermore, general system theory has been defined as a path or project in the modern viewpoint of science, an overarching paradigm, a theoretical meta-assumption, or a representation of relationships between purposes rather than simply an assumption (ibid). In biological disciplines, ecology addresses the relations between living things and their environment. In sociological terms, ecology is the branch focused on the spatial realities of populations and institutions and the consequential interdependency. Ecologists examine adjustment to changes in the surroundings or in the environment. Hence, studies of the relationship of organizational, material, physical and social strains to illness, life incident study, and researches of social support and health are all component on an ecological recognition of the relationship of the person to the environment. An eco-systemic perspective enhances the fraction of attention to involve the individual, social foundations, ways of life, and the contacts and transactions among structures and within particular systems (Ell & Northen, 1990, 63). The capability to function within and handle social service systems in highly efficient, goal-oriented means is essential for social work. Such information has been relevant for social work tradition, but the modern setting in mental health care makes crucial social workers’ facility to recognize organizations as structures, to convey the language and to manipulate in manners that assist clients to achieve their aspirations (Levinson, 1992). IV. Assessment and Intervention Person-in-Environment One modern approach to simplified assessment is the person-in-environment categorizations system that concentrates on social functioning. The system suit well with an ecological framework and offers a practical system for social work practice in multiple circumstances. The majority of social workers working in mental health contexts must make use of more specialized assessment instruments, but the significant contribution of this and other identical approaches is the emphasis on social functioning. A great number of funding sources and organization assignments associate social work practice to exploiting social functioning of patients and communities (Kerson, 2002). This type of assessment instrument facilitates social workers to preserve that focus. The PIE approach also stresses the client system’s strong points and coping capabilities, establishes the solutions to dilemmas within the environment rather than concentrating on the inadequacies of the individual, and does not demand a specific intervention for a particular problem description. PIE and its emphasis on social functioning assists to center and sustain the social worker. The PIE framework permits the social worker to illustrate, categorize, and code elderly clients’ dilemmas in social functioning (ibid). Strengths Model A fundamental course for social work education is the strengths model, an extremely optimistic framework to social work practice that implies identifying the strengths in the person, in the organization, and in the vicinity (Saleeby, 1997). Strengths-founded paradigms are essential in several health-associated disciplines of practice, involving mental health. The Biopsychosocial Model To be effectively helpful in circumstances addressing particular illnesses, social workers should have a comprehensive understanding of the illness (Kerson & Kerson, 1985). Understanding must involve the natural history of the illness or disease, the degree and the restrictions and the technologies employed to treat them. Without this kind of understanding, it is not probable to establish conclusions about people’s capabilities to perform roles and duties. For instance, if a social worker were to evaluate the capability of a mother with severe arthritis to nurture and care for her infant while the mother was enduring a terminal stage of her disease; then, the social worker did not recognize that several symptoms of the disease can be prevented through adjusted medication, the social worker might arrive to the conclusion that the mother is unable to physically carry out her responsibilities. This could moreover be a fact for a mother in an acute depression whose physical capacities to perform the duties of mothering might be unbroken but whose vigor and relationship skills might seem inadequate. In both circumstances, the social worker must have recognition of the natural history of the disease, the irregular nature of the path of the disease, and the possible impacts of medical intervention (ibid). IV. Relevance to Social Work Values and Ethics Among the ethical issues that social workers must acknowledge in mental health care are informed consent and competence. Informed consent implies that one must completely understand the hazards and advantages of a prescribed treatment before one can be regarded accountable for decisions on the basis of that information and prior to one consents to proposed treatment. This is a legal mandate for treatment of any type. A client must be provided with essential information about what has been suggested and must concur with the recommendation before a physician can give service to the patient (Annas, 1989). The procedure of guaranteeing that the client grasps the rationales for, and nature of, an intervention improves the professional relationship and promotes the social work service. Informed consents are relevant in every social work rapport, but its relevance is reinforced in any reliant or involuntary condition. For instance, in systems offering mental health supports, social workers must recognize the civil rights of patients in the use of psychotropic medications, charitable and spontaneous commitment to psychiatric establishments, limitations, and negative reinforcement measures (ibid). On the other hand, competence refers to the capability to carry out a specific task. Mental competence implies possessing the capacity to appreciate the subject matter and the repercussions of providing or withholding consent. In circumstances associated to health care, competence is the capability to create independent health care judgments, particularly, to decide for oneself how one desires to continue. The issue of competence is specifically critical with regard to psychiatric treatment. Individuals who are gravely depressed, mentally unstable, or demented frequently do not comprehend that they need therapy or medication and may have a problem understanding the hazards and benefits of the therapy. Occasionally, the rejection of treatment is related to the signs of the illness itself, as in the illusion that medication may be toxic or poisonous. Yet, spontaneous treatment remains an intriguing solution. Several states will permit the forced treatment of an obliged hospitalized patient if and only if it obeys a judicial trial and court verdict which says that as a consequence of the mental illness, the patient is incapable to decline the medication (Weiner & Wettstein, 1993). Commitment is a legitimate process and is commonly civil rather than deviant. In this circumstance, an individual is resolved to demand hospitalization due to a mental disorder, but that individual does not consent to the hospital confinement. It creates serious ethical problems because it deprives individuals of their freedom of a particular period of time during which they are normally imprisoned in a psychiatric facility (Culver 1995). V. Diversity Considerations Scharfstein (1989) maintains that, “presumably, anyone living within an embracing context, such as that of a culture, is immersed in it so deeply that a clear notion of what it would be like to be out of it can hardly arise in one’s mind; but the stronger the sense of the foreign, which lies outside, the stronger the likelihood that the foreign already exist within—at least in the form of an unexpressed attraction outward. An explicit presentation of the contextual differences between different cultures is an implicit appeal to go beyond any an all of them” (53). Effective social work practice should be cross-generational or take into account diversity of culture and should be culturally competent. Being culturally aware will not be sufficient; social workers must be proficient in cross-cultural tasks. Cultural competence or proficiency in diversity, the ability to incorporate cultural awareness and knowledge and capabilities in the process of assisting, must be the objective of every social worker in mental health care services (Kerson, 2002). Like relationship abilities, cultural competences can by no means be absolutely achieved and remains an aspiration for an individual’s lifetime. VI. Summary This paper reviews and reinterprets the ecological framework for social work practice and explains the aspects that have influenced modern social work practice in mental health care. Also integrated here is a concise history of social work practice in mental health care, in addition to a description of the effect of particular federal regulations associated to mental health care. Furthermore, it reviews the purpose of law and ethics that influence social work’s clients and communities. It also reviews the location, meaning, and significance of professional codes of ethics, particularly informed consent and competence, on the National Association of Social Workers Code of Ethics. Instances of ethical decisions in which social workers might have experience involve allocating scarce health care resources and initiating or terminating aggressive medication. Lastly, it involves a discussion of establishing judgments about capabilities, needs, and objectives, direct and indirect practice regarding collection of information, decision making, and acting as a response. The relationship of assessment to the progress of objectives, aspirations, and consequence measures is also discussed, underlining the mounting relevance of outcome measures for assessment and carried on support of individual client structures and projects. Works Cited Annas, G. (1989). The Rights of Patients. Tutowa, NJ: Humana Press. Bertalanffy, L. (1974). General system theory and psychiatry. In S. 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