Conceptualization: definitions, approaches, and applications

Social work is an important profession that assists in stabilizing society. Social workers are individuals who are extremely dedicated to their work and understand the important and sensitive nature of the jobs that they hold. Within the context of social work Conceptualization in social work purposes within social work practice venues. The purpose of this discussion is to examine view on social work and social work practices.

Conceptualization of Clinical Social Work

A clinical social worker is defined as "A person with specialized post-graduate training in social work aspects of psychiatry who uses techniques pertinent to both fields. These individuals are concerned with helping people find ways of dealing with mental health problems (glossary)." According to the National association for Clinical Social Workers must be accessible to clients during nonemergency and emergency situations. As a result of the responsibilities associated with social work, certain conceptualizations have developed.

One of the first and most important concepts is that of assessment. Within the context of clinical social work one of the first acts that has to take place in the assessment of the situation and the patient(s) that are being treated. Assessments are important because they establish exploring the concerns presented by the client, examining circumstances that might demand legally mandated intervention or safety and health concerns, and exploring the strength of the resources that will be available to the social worker and the client (Hepworth et al., 2009). It is through this type of assessment that the clinical social worker can determine how best to assist the client (Hepworth et al., 2009). These assessments also allow the social worker to communicate with the client in a manner that is clear and addresses the issues that are present.

Once an assessment is complete the social worker can determine the tactics that will be used to improve the situation. For instance the circumstances may require that the client receives legally mandated counseling or other services. In addition the clinical social worker can also refer clients to other mental health counselors if there are issues that need to be addressed that cannot be handled by the social worker. If there are mental health issues, in many cases the issues must be addressed first with the assistance of counseling and perhaps medication. Once those issues are handled the clinical social worker can work with the client(s), to resolve other problems that are within the field of expertise for the clinical social worker. With these things understood, assessment is a critical concept with the sphere of clinical social work. Such assessment serves as a building upon which the rest of the clients treatment is based.

Another critical concept within the context of Clinical social work is communication. Communication is needed and necessary for both the client and the social worker. One of the major problems that arise in practice is that of a discrepancy between the expectations of the client and the expectations of the social worker. In many cases this problem arises because clients do not have a clear understanding of the helping process. Such misunderstanding often results in discontinuation of therapy.

"Patient-initiated premature termination refers to a patient's decision to end therapy, contrary to both the therapist's current recommendation and the initial agreement between patient and therapist. Such terminations are also referred to in the literature as unilateral termination, discontinuing, or dropping out. The specific components that define premature termination (patient's decision, initial agreement, therapist's current recommendation) vary depending on the treatment context. Therapies (e.g., crisis intervention, short-term therapy, psychoanalysis, open-ended group therapy) differ on important factors such as treatment objectives, expectations concerning the length of the patient's stay in therapy, and criteria for success, all of which contribute to defining premature termination. Patient initiated premature termination typically, but not always, occurs early in therapy before the patient has experienced significant improvement (Ogrodniczuk et al., 2005)."

In most cases of premature termination of counseling there is no justifiable reason why clients leave therapy. The premature termination of counseling is extremely harmful as it relates to the ability of the client to receive the proper mental health services. I addition early termination can also be harmful for therapists. In fact Ogrodniczuk et al., 2005 explains that premature termination can be demoralizing for therapists; this is particularly true of therapists who are just beginning their careers. The demoralizing emotions come as a result of therapists believing that they have failed the patient or rejected by the client. According to the authors these beliefs have negative impacts on the confidence and effectiveness of therapists. Additionally the therapist may feel as if their time and was wasted as a result of a premature termination. The authors also explain that some therapists suffer from narcissistic injury when clients terminate treatment. Narcissistic injury occurs when a therapist's self-esteem is connected to their capacity to assist people with their problems. If such a therapist loses a patient as a result of premature termination the self-worth of the social worker can become threatened. In addition, "Painful reactions to losing a patient through premature termination, such as hurt, rejection, or anger, may interfere with other aspects of the therapist's professional or personal life (e.g., interfering with the therapy of another patient who may be similar to the one who prematurely terminated) (Ogrodniczuk et al., 2005)."

The above scenarios involving the early termination of therapy is detrimental to everyone involved. As such, researchers and practitioners alike have adopted pre-counseling strategies to reduce the probability that a client will terminate counseling. One such strategy is known as the role induction interview. This strategy is designed to inform the client of the type of assistance that they will receive and the manner in which the treatment will benefit them. There is a great deal of research which suggests that such interviews increase the probability that clients will remain in therapy. There are several aspects of the strategy that have to be present in order for it to be carried out successfully.

Firstly, the social worker must determine the expectations of the client. In most cases the expectations of the client include such things as magical solutions, lectures, changing family members and the giving of advice. Additionally in many cases special attention should be paid to ethnic minorities that are not accustomed to receiving mental health assistance. Social workers should be sensitive to the needs and expectations of minority group and handle pre-counseling role induction interview. According to Hepworth et al. there are occasions when clients will explain their expectations to the social worker without being prompted. When this occurs the social worker should take the opportunity to present the client with realistic expectations. Although some clients will offer unsolicited expectations, in most cases the social worker will have to prompt the client concerning their expectations. However, the social worker has to be careful to develop a relationship with the client first and not to press the client for this information too hard. Doing so may cause the client to become defensive and communication between the social worker and the client can break down. Instead the social worker should inject questions about client expectations into the session in way that is subtle and natural. However, this should only be done once the issues that need to be addressed in the treatment have been exposed and the social worker recognizes that the client is comfortable in the counseling setting.

In addition it is important for social workers to have a different type of induction interviews for people who are referred to the counseling service. It is important that a distinction be made between those that choose counseling and those that are mandated into counseling as it pertains to the role induction interview. This distinction is due to the fact that those that are mandated to attend counseling may be more skeptical of treatment and the social worker in general.

Secondly, as it pertains to the role induction interview the social worker must then explain the characteristics of counseling or the helping process. In addition the relationship between the social worker and the client must be clarified and established. Social workers should establish that the treatment will be a partnership between the client and the worker. They both have to work together to remedy the situation. It is important during this aspect of the interview that the social make clear to the client that there are no easy or quick remedies. Clients will be able to abandon unrealistic expectations if the social worker explains the ways in which they can assist the client in a systematic manner that is logical and possible. Social workers must also make a concerted effort to communicate to the client their intentions to assist them on the pathway to healing and wholeness. Failure to do this could leave the client feeling as the social worker is not there to assist them in any way.

Again such pre-counseling interviews are absolutely essential to establishing the relationship between the client and the social worker. In addition these interviews clarify expectations and decrease the possibility that the client will end treatment prematurity. The stopping of treatment is the primary reason for this early intervention. This tactic has been extremely successful for many years and should be

Once the induction interviews are complete, the client and the social worker can move on to treating the patient. Once the treatment has started it is vitally important that the social worker pay careful attention to eliminating communication patterns that are counterproductive. Social workers have to be careful not to get stuck in unproductive type of communication that serve no purpose and do nothing to assist the client.

In addition if a social worker must examine the family functioning and diverse family and cultural contexts. This simply means that the social worker is responsible for examining the home situation of the client and assisting the client based on this environment. There are several different family structures that may be present including single family homes, blended families and so on. Each family structure has different challenges. For instance, in a blended family the step parents may have difficulty getting along with their step children. In such an instance the social worker may need to assist the family in solidifying the relationship so that the family unit can be stronger and more secure.

Once the home situation is made clear there are a plethora of theories that can be applied to the situation. Indeed, it is also essential that social workers implement change oriented approaches. There are four primary approaches which include task centered systems, crisis intervention, cognitive theory, and solution focused (Hepworth et al., 2009). The task centered systems, crisis intervention, cognitive theory are similar in that they are all problem-solving oriented approaches (Hepworth et al., 2009). That is, these approaches tend to try to understand the problem and resolve the problem so that the client can be assisted (Hepworth et al., 2009). On the other hand, the solution focused approach tends to put a great emphasis on the remedy instead of the problem (Hepworth et al., 2009).

According to the authors all of these approaches have as a foundation the systematic interpersonal and structural characteristics of the helping process. The helping process is actually inclusive of four stages which include, engagement, assessment, intervention and termination and evaluation (Hepworth et al., 2009). Understanding the strategies to implement during each phase is critical for social workers. The inability to properly implement the most effective strategies at each phase can prove to be detrimental to clients and can increase the likelihood that the client may not complete treatment.

One of the most responsive and successful cognitive approaches is the social learning theory (Zastrow, 2009). The social learning theory asserts that

"human behavior is learned during interactions with other persons and with the social environment. This is not to deny the presence of biological or psychological processes that produce emotions and thoughts. However, little credence is given to the idea that some sort of internal personality governs behavior. Thus learning theorists are much more interested in observable behaviors and in the factors that produce and modify these behaviors. A shorthand way of thinking about the factors that produce or modify behavior -- that is, the contingencies of social learning -- is as cues, cognitions, consequences (Silver, 1980). In Silver's words, "To understand social action, social learning looks to cues that occur prior in time, mental processes (cognitions) that mediate them, and rewarding or punishing consequences that follow. There is also feedback from consequences to cuing and thinking for future behavior. All together, these are the social learning contingencies (Hardcastle 2004, 35)."

Additionally social learning theory acknowledges the significance of cognition in understanding and changing human behavior. The authors explain that perceptions, thoughts, memories of the past and anxiety about the future all have an impact upon behavior (Hardcastle 2004). In addition the Social cognitive theory proposes "a model of reciprocal causation in which behavior, cognition and other personal factors, and environmental influences all operate as interacting determinants that influence each other bidirectionally (Hardcastle 2004, 36)."

The aforementioned theories can be used in practice to assist people in changing their behaviors. This is done by changing the nature of the interactions that the client has with people in his environment. The client may not have control over the other person's behaviors but he does have control over his own behavior. By showing the client skills that can be used to better interact with their environment, gradual behavior changes will occur.