International Reflections on Approaches to Mental Health Social Work

Malcolm Golightley, Gloria Kirwan

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781315472478
• Edition: 1
• Topic: Medicine
• Subtopic: Health Care Delivery

Growing out of an interest in exploring the contemporary contexts and practices related to mental health social work across the world, this book provides a range of insights into the social factors which contribute, sometimes quite significantly, to the emergence of mental health problems for individuals and even whole communities. The range and scope of mental health social work is highlighted through the different accounts of therapeutic work, advocacy, support and rehabilitation. But this collection goes further and also provides the reader with critical analyses of social work practice and social policies in certain contexts, thus inviting the reader to a more reflective consideration of the value of mental health perspectives in social work in general.

Taken as a whole, the collection suggests that social work engages with the field of mental health in diverse, creative, and very reflective ways, yet is always focused on the needs and rights of those for whom problems with mental health can be personally challenging and often disempowering. This book was originally published as a special issue of the Journal of Social Work Practice.

Robyn Lynn and Jo Mensinga

SOCIAL WORKERS' NARRATIVES OF INTEGRATING MINDFULNESS INTO PRACTICE

Mindfulness is increasingly important as a professional intervention in social work; however, little is known about how practitioners integrate a practice of eastern origins into a western context. To explore the integration of mindfulness in social work, we collected written stories from social workers who participated in two workshops in regional Australia. The participants developed their own individual written narratives about their understanding of and experience in using mindfulness, and contributed these to a larger group discussion. We identified four scenarios/plotlines within the collected stories and ‘restoried’ four examples of the participants' written narratives. The stories reveal that participants experience little dissonance when integrating mindfulness into their personal lives, but the process of incorporating it into their practice requires a complex negotiation between the participant's story of themselves as a practitioner of mindfulness, their ‘professional story’, stories of themselves as social workers and the story of social work in their professional knowledge landscape.

Introduction

Mindfulness is increasingly being researched and adopted in psychology, medicine and education, and has recently become more prominent in the social work literature. It is commonly defined as ‘moment-to-moment awareness’ or ‘paying attention to the moment without judgement’ and encourages attention to every movement, breath, feeling and thought – a ‘consciousness alive to the present reality’ (Hanh, 1976, p. 11).

In social work, the primary means of cultivating mindfulness is through formal and informal meditation practices and mindfulness-based applications. Although often associated with spiritual traditions, mindfulness can be learnt in a secular context without the support of a religion, as a means of facilitating awareness of the present moment (Hick, 2009, p. 2). This present moment orientation has been shown to be of benefit at the individual, group and community levels in social work, particularly in the development of increased attention, heightened self- awareness, cultivation of empathy and compassion, inner calm and peace, more insight and transformative ways of living and being (Coholic, 2005; Berceli & Napoli, 2006; Minor & Carlson, 2006; Hick, 2009).

As academics, we have included aspects of mindfulness and embodied awareness into our teaching in the university sector (Mensinga, 2010, 2011). However, following student questions and challenges about the value base underpinning these techniques, we developed an interest in exploring what, if any, ethical issues and/or dilemmas could arise when introducing mindfulness into social work practice settings. In another paper, we investigated the question ‘is mindfulness value free?’ and the implications (if any) for practitioners in the sector (Lynn, Mensinga, Tinning, & Lundman, 2015). During this inquiry, we found that issues and tensions that arose were largely due to a perceived conflict of interest between the orientation and approach to practice, advocated by the social work profession and the workers' own experiences, training and understanding of mindfulness (Lynn et al., 2015). We concluded that while mindfulness has been shown to be a natural process that can be cultivated, its translation and evolution as an eastern practice into a western context requires the worker to merge different cultural and world views while also integrating their own personal experience into what they perceive as the espoused orientation and approach of the social work profession.

Healy contends that social workers' ‘knowledge, purpose and skills bases - are substantially constructed in, and through, the environments in which [they] work’ (2005, p. 4). Although this professional knowledge context is a ‘dominant story’ that is itself a part and parcel of the larger discourse that determines ‘what is a profession’, we began to wonder if the eastern origins of mindfulness actually mattered to social workers' as they came to know about and chose to use mindfulness in practice. Drawing on Fenstermacher's work (1994), whose interest was in the epistemological drivers underpinning knowledge creation in education, we identified four questions, we thought would help us address our concerns and help us better understand the process by which social workers integrated mindfulness into their practice:

•How do social workers come to know about mindfulness?

•What do social workers know about the effective use of mindfulness in social work?

•What knowledge do social workers consider essential for using mindfulness?

•Who do social workers trust to produce knowledge about mindfulness in social work?

With these questions in mind, we designed and delivered two workshops in two different regional cities along the East coast of Australia. The workshops provided a space for two separate groups of social workers to develop their own individual written narratives about mindfulness and to reflect on them in a larger group discussion. Following the workshop, we engaged in a process of focused reading of the written stories and reviewed notes and transcripts of the discussions. We familiarised ourselves with all the data by initially noting our own influence on the production of the narratives before identifying existing themes. This was followed by a further analysis of the collected stories, in which we used Clandinin and Connelly's (2000) three-dimensional space approach to better understand the influences on the participating social workers' knowledge of and uptake of mindfulness in their practice.

In line with Clandinin and Connelly's (2000) narrative inquiry approach, we chose to restory and present four examples of the participants' written narratives to illustrate the dimensions/influence of place, time and social interaction made explicit during the workshops. In doing so, we revealed that the contextual nature of the profession as described by Healy (2005) and what we named the ‘professional story’ does indeed impact the process by which social workers story the acquisition of and use of mindfulness in practice. Similarly, in the process of exploring the four questions we raised in relationship with Fenstermacher's (1994) epistemological drivers, we conclude that the integration of mindfulness into social work practice is both a contextual and relational process that draws on the practitioner's personal experience/knowledge of mindfulness (rather than on its religious underpinnings or theoretical understandings) and is influenced by their assessment of clients' needs within the agency context.

Mindfulness in social work

Interest in mindfulness in social work is a relatively recent phenomenon that is not fully integrated into the purpose, professional knowledge base and framework for practice. From the mid 2000s onwards, there have been a number of articles that indicate social work is engaging with mindfulness in individual, group and community interventions (Hick, 2009). They often use research undertaken in psychology, sociology or medicine to define and inform their knowledge of mindfulness and to provide the primary source of evidence of the effectiveness of mindfulness-based applications. These practices are used as a form of intervention, for cultivating a positive relationship with clients and as a mode of self-care for social workers and their clients (Hick & Furlotte, 2009).

Mindfulness-based applications have their roots in the Buddhist traditions that describe it as a process or spiritual practice that involves distinct phases of development (Bodhi, 2011; Milton, 2011). In western psychology, there are a range of definitions and ways of operationalising mindfulness. The emphasis in these definitions has been on what it is and how to measure and develop it (Grossman & Van Dam, 2011; Milton, 2011, p. 24). These more recent accounts that have evolved through the science of mindfulness differ considerably from the traditional way it was defined. The recognition of these differences has led to an increase in discussion about whether the separation of mindfulness from its holistic roots in this work is useful and/or appropriate (Grossman & Van Dam, 2011; Wallace, 2006, 2011).

Hick and Furlotte (2009) in their review of the definitions of mindfulness in social work identify Bishop et al.'s (2004) definition as the most commonly applied in social work. This definition has a health and wellness focus. Bishop et al. describe mindfulness as a two component model consisting of (a) ‘self-regulation of attention so that it is maintained on immediate experience, thereby allowing for increased recognition of mental events in the present moment’, and (b) ‘adopting a particular orientation toward one's experiences in the present moment…characterized by curiosity, openness, and acceptance’ (2004, p. 232). Drawing on this or similar definitions and knowledge from other sciences, the social work literature is beginning to develop its own theoretical, factual and practical knowledge (Trevithick, 2008) about the role and effectiveness of mindfulness for the social worker and the people with whom they work (Birnbaum & Birnbaum, 2008; Hick, 2008, 2009; Hick & Furlotte, 2009; Lee et al., 2009, Turner, 2009; Gause and Coholic, 2010; Segal et al., 2010) While it is important to generate this knowledge in the context of social work, we propose that this is only part of the story about social workers' knowledge and use of mindfulness and that an exploration of how they come to know about and integrate mindfulness practices is also necessary.

The ‘professional story’ of social work

Like other professions, social work lays claim to a particular way of knowing reality that forms part of a ‘sacred story’ on a professional knowledge landscape (Clandinin & Connolly, 1996). In the case of social work, this story attempts to gloss over its religious-linked beginnings and adopt a materialist-positivist world view that both fosters a preferred humanist-modernist professional paradigm and helps to lay claim to knowledge and skills considered unique to social work (Payne, 1996; Fook et al., 2000; Fook, 2002; Lynn, 2010). However, what constitutes social work knowledge still remains inconclusive. While some authors choose to emphasise scientific, rational and legitimate knowledge, others focus on action and experience (Trevithick, 2008). Healy (2005), on the other hand, draws attention to a constructed knowledge space where the knowledge social workers assume to inform their purpose and practice is constantly negotiated between the different components that make up this space.

For our purposes then, we adopted Healy's (2005) model as a preferred way of understanding social work knowledge. We believed that Healy's (2005) concept of a constructed knowledge space better captured the challenges that practitioners would encounter when trying to integrate mindfulness into practice. The model itself identifies the practitioner's need to consider the institutional context (including public policies, laws, organisational policies as well as accepted practices); the formal professional base (service discourses from the human sciences, formal theories of practice, Judeo-Christian beliefs and formally accepted skills) and the worker's own individual framework (practice wisdom, developed theories of professional practice and skills and acquired knowledge) when actioning a particular practice approach. In our reckoning, then when choosing to adopt mindfulness, the social worker would not only need to reconcile their own experience of mindfulness within a western cultural context, but they would also need to navigate the dominant discourses that are strongly related to the materialist/positivist, humanist and modernist principles of objectivity, rationality and individualism which influence what is considered to be the appropriate knowledge for practice and practice decisions (Healy, 2005; Bell, 2012).

Clandinin and Connelly (1995) describe a similar process as that outlined by Healy (2005) when exploring how teachers made sense of presenting demands to negotiate their purpose and practice of teaching. However, in their work they propose that this process is best understood narratively and by way of metaphor. They suggest the image of a ‘professional knowledge landscape’ to depict the space in which teachers tell stories to account for their professional practice and understand the stories told in that space as the means by which teachers traverse the landscape. Drawing on both Clandinin and Connelly (1995) and Healy's (2005) work as ways to understand the integration of mindfulness into social workers' practice, we decided that collecting and exploring the stories social workers told about how they came to learn about and implemented mindfulness in their practice would provide answers to our questions as outlined in the beginning of this paper.

Preparing for and hosting ‘A conversation about mindfulness in social work’

Our project was conducted at a regional university in Australia as part of its field education professional development program. The project was designed with the dual purpose of providing a professional development opportunity for social workers interested in participating in ‘A conversation about mindfulness in social work’, while at the same time producing material for our research on the inclusion of mindfulness approaches into social work practice.

The Social Work Field Education Unit invited social workers on their database to two professional development workshops. Each workshop was aimed at social workers who were familiar with mindfulness and who had either adopted it or were interested in its application in practice. On receiving Ethics Approval, interested participants were sent an information sheet which invited them to take part in our research on mindfulness in social work as part of their attendance. This information also outlined the aims of the research, data collection and management processes, the voluntary nature of participation, confidentiality and how the findings would be disseminated.

The workshops, of three hours duration, were held in two regional centres in Australia. The stated aims for the workshops were (a) to facilitate and collect participants' individual written narratives about their use (or desired use) of mindfulness in social work; (b) to provide a safe space in which participants could critically reflect upon and discuss their narrative and its meaning for their practice; (c) to develop a shared understanding of the possible tensions and dilemmas that may arise when using mindfulness, particularly in light of the ethics and values espoused by the profession, and (d) to identify any emerging implications for practice.

Each workshop began with some yoga and meditation practice. Information about the research aspect of the workshop was then revisited and formal consent sought to reco...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright
• Contents
• Citation Information
• Notes on Contributors
• Introduction: mental health an issue for everyone?
• 1. Social workers’ narratives of integrating mindfulness into practice
• 2. Early onset schizophrenia and school social work
• 3. Analysis of social work practice: Foucault and female body image in therapy
• 4. Police encounters in child and youth mental health: could stigma informed crisis intervention training (CIT) for parents help?
• 5. Structural and cultural factors in suicide prevention: the contrast between mainstream and Inuit approaches to understanding and preventing suicide
• 6. ‘Only connect’ ‘nearest relative’s’ experiences of mental health act assessments
• 7. Impasses in the relationship between the psychiatric rehabilitation practitioner and the consumer: a psychodynamic perspective
• Index