Joseph Walsh

Ethical Dilemmas of Practicing Social Workers Around Psychiatric Medication: Results of a National Study

Abstract It is acknowledged that social workers in mental health and other settings routinely experience client-related ethical dilemmas. Further, there is wide recognition of the potential impact of ethical dilemmas on social work practice with clients who use psychotropic medication. Little is know empirically, however, about the experiences of practitioners with these dilemmas. This article describes the results of a national survey of practicing social workers regarding the nature of ethical dilemmas they face related to their work with clients on medication issues. The results make it clear that social workers regularly confront a variety of ethical dilemmas in this type of practice. Many of these dilemmas are related to ambiguities around the knowledge base of practice, appropriate roles of providers, and basic personal and professional values. The authors present implications of these findings for social work practice and further research.

Clinical relatedness with persons having schizophrenia: A symbolic interactionist perspective

The practive of psychotherapy with persons having schizophrenia has been increasingly abandoned by clinical social workers, even as an adjunct to broad psychosocial interventions, due to the rise in prominence of case management and biological interventions. The author opposes this trend and presents a rationale for including long-term relationship-based clinical treatment with the client population as a major portion of a comprehensive treatment milieu. This article focuses on the difficult process of developing the treatment relationship and is based on a conceptual framework of symbolic interactionism. The process, including seven practive guidelines, is illustrated with a case example.

Supervising the Countertransference Reactions of Case Managers

Abstract Most of the literature on countertransference in clinical social work practice is based on assumptions that the relationship between the client and practitioner is structured and formal. These assumptions do not apply in community-based case management practice, where the social worker and client interact in a variety of settings and circumstances. Additionally, the complex problems of clients who have serious mental illnesses may evoke a range of conscious and unconscious reactions from social workers that must be acknowledged for appropriate intervention to occur. In this paper key principles for the supervisors recognition and management of countertransference are presented and discussed. Case illustrations are included.

The Termination Stage in Bowen's Family Systems Theory

The termination stage has always been recognized as an important aspect of the clinical intervention process. Careful attention to that stage is even more critical in the current practice environment of short-term intervention and demands for measurable outcomes. Bowens family systems theory, while well established in the field of clinical practice, does not incorporate clear directives for the practitioner about the ending stage of intervention. Still, its major concepts for assessment and intervention suggest a range of termination activities that can affirm and summarize a familys gains. In this article the authors offer a variety of ending strategies for use within family systems theory.

Anti-anxiety medications: a review for social workers.

ABSTRACT Social workers in mental health settings frequently participate in the treatment of clients with incapacitating anxiety. Medication is often included among the interventions for these clients. Social workers, who specialize in psychosocial interventions, also have key roles in the assessment and monitoring of medication effects. The purpose of this article is to provide social workers with an overview of the pharmacological treatment of anxiety so that they can carry out their range of interventions more effectively. Included is information about types of medication and their dosages, positive and adverse effects, interactions of medication with other interventions, and special concerns with children and adolescents.

Services for Persons With Mental Illness in Jail: Implications for Family Involvement

After committing relatively minor offenses many persons with serious mental illness are arrested and then detained because they lack adequate housing or other support resources. Deinstitutionalization of these individuals has led to an increase in such arrests and imprisonment, with negative consequences. In jail, the special needs of persons with mental illness are likely to go unserved with the consequent risk of symptom relapse and physical harm. The authors identify critical areas in which family members and professionals can advocate for change in treatment and community linkage of persons with mental illness in jail.

The lived experience of schizophrenia: A systematic review and meta-synthesis

ABSTRACT Schizophrenia is a serious mental illness characterized by abnormal patterns of thought and perception. What has been studied less often is the personal experience of having schizophrenia. Qualitative studies have been illuminating in this regard, and the purpose of this meta-synthesis is to determine the themes that can be identified across those studies. The inclusion criteria required that the studies employed qualitative methods, that participants had been diagnosed with schizophrenia, and the studies focused on their “lived experience.” After applying search criteria to databases, 27 studies were included in the meta-synthesis. Five major themes were identified in the results, including: (1) the experience of symptoms; (2) the process of acceptance; (3) personal relationships; (4) treatment experiences; and (5) spiritual practices and faith. Implications of these results are explored.

The Therapeutic Use of Humor With Clients Who Have Schizophrenia

A positive worker/client relationship contributes greatly to a mental health client’s achievement of intervention goals. Practitioners who work with clients who have schizophrenia sometimes face challenges in developing positive relationships with them when the cognitive impairments characteristic of that disorder make verbal communication difficult. The purpose of this article is to review the indications for using humor with clients in general and then consider the potential for practitioners to use humor as one means of developing constructive working relationships with clients who have schizophrenia. This article does not address the use of specific humor techniques, but considers whether practitioners with a natural sense of humor can use it to their advantage in working with members of this population. Seven principles for the use of humor, and seven client examples, are included.

Treatment of the bipolar client: Clinical social work contributions

The medicalization of bipolar disorder during the past two decades has tended to obscure the fact that it remains a disorder of uncertain etiology. Research has continued to support hypotheses that there are psychological and social, as well as biological, components of the onset and course of the disorder. Comprehensive treatment of the bipolar clinet thus requires intervention at all three of these levels. Social workers, with theiry psychosocial perspective, are well qualified to coordinate an overall treatment plan. The social workers role includes six general intervention strategies.

The appropriateness of physical contact with clients who have schizophrenia

ABSTRACT The potential benefits and dangers of physical contact between social workers and their clients have been debated for decades. Some authors and researchers assert that non-erotic touch, when done with discretion and client consent, may be therapeutic, while others caution that such contact, regardless of intent, risks being harmful to clients. The issue of physical contact between social workers and clients with schizophrenia may deserve special attention, given the boundary, interpersonal, and sensory deficits experienced by many of those persons. The purposes of this article are to review the literature on client/practitioner physical contact, consider the issue in the context of working with clients who have schizophrenia, and provide a list of practice recommendations for social workers.