Joan Berzoff

Developing a renal supportive care team from the voices of patients, families, and palliative care staff

OBJECTIVE Although half a million Americans suffer from end stage renal disease (ESRD), their quality of end-of-life care has been woefully inadequate. The Renal Supportive Care Team is a demonstration project that is designed to elicit and provide for the needs of dialysis patients and their families throughout the trajectory of their illnesses. METHOD Six focus groups, including medical health professionals, dialysis patients, family members, and bereaved family members, discussed how to promote improved palliative care and encourage hospice referral for patients with ESRD. RESULTS Respondents agreed that there needed to be greater education of both patients and families regarding all aspects of the disease process, open communication, on-going support between patients, families, and the staff, continuity of care, pain control, and assistance with advance care planning. SIGNIFICANCE OF RESULTS Palliative and supportive care issues in ESRD need greater attention.

Nonsuicidal Self-Injury Among Nonclinical College Women: Lessons From Foucault

This article presents a qualitative study that explored nonsuicidal self-injury among relatively psychologically healthy college women. It examines the phenomenon of self-injury through a social theoretical perspective using Foucaults concepts. Key arguments are that self-injury in women may be a reaction to an insidious form of social control and a reflection of the social pressures for productivity that are enacted on the body. Self-injury may regulate socially unacceptable affects and modify states of the ego so that women can regain their capacity to produce within a competitive and capitalist society. Implications for social work practice are discussed.

From Separation to Connection: Shifts in Understanding Women's Development

This article considers the theories of adult development that have led to shifts in understanding the psychology of women. A male-defined life cycle of adult development has been succeeded by a self-in-relation psychology of women. The implications of this shift in paradigm for social policy and practice with women are discussed in relation to a number of issues. Group therapy for women is recommended as the treatment of choice, given the role of connectedness in womens development.

Why We Need a Biopsychosocial Perspective with Vulnerable, Oppressed, and At-Risk Clients

This article considers why we need to take a biopsychosocial perspective in assessment and treatment of individuals. Using psychological concepts drawn from drive theory, ego psychology, object relations, attachment theory, self psychology and relational theory, the author makes explicit the need to connect these ideas with social and biological contexts. Arguing that psychodynamic theories contain the social as well as the psychological, the author traces Freuds social commitments, the role of critical race theory, the importance of social contexts in shaping development while also considering the effects of neglect, trauma and abuse on the developing brain. Holding in mind all of these positions, is what makes clinical social work truly the impossible profession.

Innovations in Doctoral Education: Distance Education Methodology Applied

This study evaluated the impact of a distance education program to meet the practice learning needs of first‐year doctoral students. The program, a six‐session case‐based telephonic seminar, was taught to 19 first‐year doctoral students. Evaluation of the program included self‐report quantitative and qualitative data gathered pre‐ and postseminar, as well as qualitative data gathered three months postseminar. Quantitative and qualitative analysis revealed increased reports of practice competencies by the conclusion of the seminar. Analysis also illustrated the importance of continued evaluation given the small sample size and pilot nature of this unique distance education program.

Narratives of grief and their potential for transformation.

This article examines narratives of grief and loss and how, under the best of circumstances, they may lead to transformation and growth, even contributing to the greater social good. Using psychodynamic and narrative theories, and examples drawn from mourners who have used their grief in powerful and political ways, I make the case that even grief that has been highly appropriated and contested, as in the case of Terri Schiavo, may ultimately serve important functions. Grief may mobilize mourners by helping them to turn passivity into activity. Grief may mobilize higher-level defenses such as altruism. Grief and loss may lead to a mourners desire to do for others what was not done for him or her. A necessary part of turning grief into social action is the creation of a coherent grief narrative-first personal and then political. This coherent narrative can be developed using clinical interventions as well. Hence I discuss the clinical implications of helping those who are grieving to create coherent narratives out of shattered assumptions in a process of personal and social change.

Preparing PhD-Level Clinical Social Work Practitioners for the 21st Century

Social work doctoral programs are not adequately preparing students to educate future clinical practitioners. Social work is predominantly a practice profession. Social work’s PhD programs must continue the education of excellent researchers while also educating for excellence in practice, teaching, field liaison, and the supervision of practice. Nevertheless, The Group for the Advancement of Doctoral Education in Social Work (GADE) and the social work profession have heavily emphasized the education of researchers over the past 20 years but have neglected the practice needs of the profession at a time when client diversity has increased and available social supports have decreased. This article examines shifts in academic priorities, in funding, in hiring practices, and in accreditation standards that have reduced the quality and support for clinical practice education in social work. We also explore the much-reduced research expectations of social work’s emerging DSW programs. We recommend continued recognition and strong support for PhD education in social work, with a clear and extensive clinical practice component, as well as explicit attention to the education of PhD-level practitioner/researchers as leaders in social work education and in practice research. Affirmation by GADE and by the social work profession and its professional organizations is needed for educating leaders in clinical social work.

The role of attachments in female adolescent development

Traditional theories of normal adolescent development have incorrectly underscored the importance of the individuation as the psychological goal. This paper will discuss how adolescent girls use their relationships to clarify their identity and differentiate themselves from their families of origin. Girls use friends, as journals, to achieve self differentiation in the context of their relationships. The clinical implications of this newer model, with its emphasis on attachments rather than on separation, will be considered, and group therapy recommended as the treatment of choice for adolescent girls.

Group Therapy With Homeless Women

Womens groups are a treatment of choice for homeless women who have been abused, used substances, have mental health concerns, and have suffered traumatic events that have ruptured their attachments. Women in dialogue can learn to see themselves reflected, find each others strengths, and make advances in empathy, which can alter relational abilities. Their experiences of sharing similar traumatic events in a safe and containing environment can increase a sense of belonging. Psychoeducation and advocacy can further foster knowledge and self-empowerment. Leadership issues are important as the leader must create safety and serve as a model, but may also be used as a object of displacement for disavowed negative feelings among group members.

Teaching clinical social work under occupation: listening to the voices of Palestinian social work students

ABSTRACT The authors were invited to teach clinical social work in the Palestinian West Bank. In order to teach, we designed a study exploring how 65 Palestinian social work students described the psychological and social effects of working under occupation. Students described social stressors of poverty, unemployment, lack of infrastructure, violence, imprisonment, separation of families, and severe constraints on travel. They identified depression, suicide, anxiety, and war-related trauma as emerging from these conditions. Many experienced the same psychosocial problems as their clients in coping with harassment and delays at checkpoints. Implications for teaching social work theory and practice are discussed.