Reflections on Social Work Theory in Practice

• Carolyn Gibson Smith, MSW Candidate, University of Windsor
• Communication Skills in Social Work Practice, February 4, 2017

As I pull together an eclectic professional history and look toward a future as a counsellor specializing in end-of-life care, this course represented my first deep dive into the theories, practice, microskills and practicalities of social work counselling. Because I can’t yet connect it to a lived practice, I had a bit of extra work to do to scope out what my future practice might look like, and how it will be informed by the current material. To that end, I have imagined my future practice by drawing on journal articles and, primarily, Colleen McBride’s 2015 MSW Thesis describing her placement in hospice palliative care.

To begin, I continue to find the path of social work an incredibly meaningful one. As a lifelong feminist, I am encouraged every time we are reminded to consider our clients as not only individuals with their unique challenges, but also as part of families, communities and society. This was the piece that was missing for me during my B.Sc. undergrad in psychology, where we studied the history of psychology, neuroscience and the DSM-III R in great detail, yet could not have helped a real person dealing with actual suffering.

I had multiple “a-ha” moments in the readings and the class as Professor Gibson rolled out a series of tools like the bio-psycho-social assessment, strengths approach, Motivational Interviewing, Narrative Therapy, Cognitive Behavioural Therapy and more. But the biggest “a-ha” of all is that a degree in social work is just a foundation for a practice of lifelong learning. While I know we go into more depth in later courses, it’s clear to me that it’s my individual responsibility to identify which modalities work best for my client groups and seek additional, in-depth learning, through readings and workshops.

As far as general skills development, our class time and standardized client interview work gave me my first opportunities to try out new skills. Because of my lack of formal training in this area, I was pleased to discover the phases of a counselling relationship (beginning, action and ending), and logistical elements such as how to structure and begin an interview, develop relationship, sessional and anticipatory contracts, and the other fairly logistical aspects of this work. I took advantage of each opportunity to try out these skills. I was pleased, in all these first interviews, to receive feedback that I have some good active listening skills courtesy of my journalism background and peer counselling work. I can also sit with or companion difficult emotions. One skill I need to work on is confrontation. I am comfortable confronting people, but I did like the delineation of feedback vs incongruity confrontation. I believe that using confrontation in combination with statements of strengths could make my confrontations more effective in eliciting positive change.

In thinking ahead to my future practice in hospice, I recall McBride’s review of her days in her palliative care unit. Palliative social workers assess patients’ past experiences and awareness of their current illness, including goals, expectations, hopes, fears and concerns.” For each client they conduct a life-review, assess “...cultural beliefs and practices relevant to care, community supports, strengths, coping and decision-making styles, along with self-care practices.” Clearly this work will require the skills of active listening, the use of silence, and above all, empathy and self-care. We touched briefly on the subject of spirituality and religion in our readings, and that being open to such discussions in a palliative setting will open the doors to understanding how people consider the big issues of the purpose of life and what happens when we die. In fact, I headed out to Palcare Network in Newmarket a few weeks ago to attend an enlightening evening session on cross-cultural beliefs about death. For example, in some Eastern religions, death marks the transition to a new life, and if one has lived life well, it will be a better life the next time around. That’s a very different angle than the Western Christian conceptions of death with which I am culturally familiar, and using all forms of questioning will get me closer to understanding -- but in particular, indirect questions may be the most effective, as in, “I am curious about…” I have also read the section of Ivey, Ivey & Zalaquett (2010) on family genograms to assist in understanding people's networks of support and ultimately remembrance.

Conceptually and theoretically I was most drawn to Narrative Therapy (NT), and that was before reading McBride’s account, in which she states, “...palliative social work companions with patients and families in an effort to reconnect to one as a human being rather than to a person’s disease” (McBride, 2015). If that’s not NT, I don’t know what is. I have a stack of readings to go through before our next course starts, including works about the use of family genomes and NT in palliative care, all inspired by this course.

In conclusion, this was the first course to demonstrate the promise and the challenges of social work in a concrete and meaningful way for me. It represented a challenge in terms of incorporating new theories and skills into my work, but gave me definite direction in my learning. It’s not often I come out of a course not wanting it to end, and piling up additional material to keep the experience going. 
 

References

Ivey, A. E., Ivey, M. B., & Zalaquett, C. P. (2014). Intentional interviewing and counseling: Facilitating client development in a multicultural society. Toronto: ON:Brooks/Cole (Pearson).

McBride, C. (2015). The role of social work in hospice palliative care (Doctoral dissertation, Faculty of Social Work, University of Regina).

Additional Readings

Caldwell, R. L. (2005). At the confluence of memory and meaning—Life review with older adults and families: Using narrative therapy and the expressive arts to re-member and re-author stories of resilience. The Family Journal, 13(2), 172-175.

Hedtke, L. (2014). Creating stories of hope: A narrative approach to illness, death and grief. Australian and New Zealand Journal of Family Therapy, 35(1), 4-19.

Kruizinga, R., Hartog, I. D., Jacobs, M., Daams, J. G., Scherer‐Rath, M., Schilderman, J. B., ... & Van Laarhoven, H. W. (2016). The effect of spiritual interventions addressing existential themes using a narrative approach on quality of life of cancer patients: a systematic review and meta‐analysis. Psycho‐Oncology, 25(3), 253-265.

Moxley-Haegert, L. (2015). Leaving a legacy and letting the legacy live: Using narrative practices while working with children and their families in a child palliative care program. The International Journal of Narrative Therapy and Community Work, (2), 58.

Noble, A., & Jones, C. (2005). Benefits of narrative therapy: holistic interventions at the end of life. British Journal of Nursing, 14(6).

Romanoff, B. D., & Thompson, B. E. (2006). Meaning construction in palliative care: the use of narrative, ritual, and the expressive arts. American Journal of Hospice and Palliative Medicine®, 23(4), 309-316.

Shebib, B. (2017). Choices: Interviewing and counselling for Canadians (6th ed.). Toronto: ON: Pearson.

White, M., & Epston, D. (1990). Narrative means to therapeutic ends. WW Norton & Company.

White, M. (2007). Maps of narrative practice. New York: W.W. Norton & Co.