What is Clinical Social Work in the 21st Century?  Practitioner’s Views

Overview: Clinical social workers define their specialty as applying social work values and purposes. The engagement, assessment and intervention processes were affirmed – though evaluation was minimally emphasized. Theories and treatment models were conflated. Mental health needs were emphasized; taking a systemic approach and advocacy was key to their work.Proposal text: Background/Rationale: Ewalt’s (1980) early definition clinical social work (CSW) states a consensual definition is necessary to convey to the public and professions what we do, and to orient professional education. There are many definitions of CSW (i.e., NASW, ABE, state licensure regulations) that vary in emphasis and content. Most are abstract and use technical jargon. Later, Goldstein (1996, 2007) outlined several areas of knowledge, values, and skills for clinical practice and education, but there has been little contemporary study. We sought to learn how contemporary clinical social work practitioners define their specialty in their own words. We sought to learn if areas of emphasis have evolved in the last 25 years, and if new areas of interest have arisen. We also explored how CSWE’s competencies fit with how CSW’s viewed their specialty.

Methods: We completed a thematic analysis (Boyatzis, 1998; Braun & Clarke, 2006, 2019) of a national sample of 40 clinical social workers, using maximum variation sampling since we sought varied points of view. The interviewing team also varied by race, ethnicity and geographic region. After IRB approval, hour-long, semi-structured in person, phone and Zoom-based interviews were completed. The interviews were coded individually, generating over 200 codes. These were reviewed by the full team to define final themes.

Results: Level of experience and work setting shaped participant’s views – more experienced participants emphasized professional use of self as important/foundational in addition to theories/models of treatment. Focus on engagement, assessment and treatment/intervention was widely supported, with a mental health emphasis, while evaluation was minimally discussed. Most participants endorsed CSW as holistic in approach, viewing persons-in-environments, recognizing psychosocial problems situated in sociocultural contexts, and focusing on community work which differentiated CSW from other professions. Descriptive theories were frequently conflated with practice models (DBT, MI). The core focus on services to individuals, families and groups was widely endorsed, though couples were often omitted.
The importance of the therapeutic relationship was also widely endorsed. Empathy, professional self-awareness, a non-judgmental stance, and vulnerability/authenticity in the work were seen as vital components of CSW. Many respondents also noted that advocacy was part of their clinical work, as was resource finding, prevention, and education. CSW could be seen as deficit focused – on client concerns – but this was balanced with attention to client strengths. Careful attention to human diversity was viewed as essential to successful intervention. Social justice, equity, and human rights were widely affirmed as key parts of clinical practice.
Conclusion/Implications: CSW is defined differently by professional groups and state regulations. These highlight some aspects of CSW’s knowledge and skill base but omit others. CSWE’s emphasis on engagement was endorsed by many participants but is not found in many organizational definitions of CSW. Engagement, assessment and intervention were seen as vital parts of CSW, though evaluation was much less emphasized. Distinguishing descriptive theories from applied practice models needs greater attention in social work education. Additional theory, social work skills and professional use of self all need to be part of the specialization CSW curriculum.