Contextualizing Clinical Social Work Practice with Individuals, Families, and Groups in Northern British Columbia by Maria Tobias Mkango B.A. Honours., University of Dar Es Salaam, 2012 M.A., University of Northern British Columbia, 2015 PRACTICUM SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER IN SOCIAL WORK UNIVERSITY OF NORTHERN BRITISH COLUMBIA August 2021 © Maria Mkango, 2021 Table of Contents Abstract.......................................................................................................................................... v Acknowledgements ...................................................................................................................... vi Dedication ................................................................................................................................... viii Chapter One: Introduction .......................................................................................................... 1 Practicum Placement Agency.......................................................................................................................... 2 Employee and Family Assistance Programs ........................................................................... 3 Client Group and Services ....................................................................................................... 4 Funding .................................................................................................................................... 5 Chapter Summary ............................................................................................................................................... 6 Chapter Two: Theoretical Orientations ..................................................................................... 7 Anti-Oppressive Practice .................................................................................................................................. 7 Strengths-Based Practice ................................................................................................................................ 10 The Systemic Approach in Clinical Social Work.................................................................................... 10 The Practicability of Systemic Approach in Clinical Social Work Practice ......................... 12 Chapter Summary ............................................................................................................................................. 13 Chapter Three: Literature Review............................................................................................ 14 Identity and Clinical Social Work Practice ............................................................................................... 14 Allyship in Clinical Settings .......................................................................................................................... 15 Reflexivity in Clinical Social Work Practice ............................................................................................ 16 Fostering Clients’ Safety in the Clinical Social Work Context ........................................................... 17 ii Cultural Humility in Clinical Social Work Practice ............................................................................... 19 Contextualizing Clinical Social Work Practice with Indigenous Peoples ........................................ 21 Efficacy of Clinician’s Self-disclosure in the Clinical Social Work Setting ................................... 22 Colonial Impacts in Canada ........................................................................................................................... 24 Intergenerational Trauma and the Transmission of Trauma ................................................................ 26 Sociocultural Model .............................................................................................................. 26 Family Systems Model .......................................................................................................... 27 Genetic or Biological Models ................................................................................................ 28 The Manifestation of Trauma in the Therapeutic Process .................................................................... 29 Trauma-Informed Clinical Social Work Practice .................................................................................... 30 Evidence-Based Clinical Social Work Practice ....................................................................................... 31 Solution-Focused Theory With Families ................................................................................................... 31 Philosophical Tenets of the Solution-Focused Therapy ........................................................ 32 Practical Approaches ............................................................................................................. 33 Dialectical Behavioural Therapy (DBT) in Group and Individual Counselling ............................. 34 Key Practice Components ..................................................................................................... 35 Cognitive Behavioural Therapy in Individual and Family Therapy .................................................. 37 Philosophical and Historical Underpinnings ......................................................................... 37 Chapter Summary ............................................................................................................................................. 38 Chapter Four: Learning Experiences from the Practicum Placement .................................. 39 Reflecting on the Practicum Learning Goals ............................................................................................ 39 Strengthen my Clinical Skills ................................................................................................ 42 iii Establish a Self-Care Plan ..................................................................................................... 44 Explore and Appreciate my Identity ...................................................................................... 45 Contextualize Client Safety ................................................................................................... 46 Creating a Safe Space for Indigenous Culture in Practice..................................................... 47 Engage in Allyship in Practice .............................................................................................. 47 Expand my Knowledge of Intergenerational Trauma ........................................................... 48 Being Cognizant of the Gender and Sex Imbalances ............................................................ 49 Expand my Understanding of Various Mental Health Issues and Their Treatment Plans .... 49 Theoretical Orientations in Practice ............................................................................................................ 50 Chapter Summary ............................................................................................................................................. 51 Chapter Five: Implications for Personal and Professional Practice and Conclusion .......... 52 References .................................................................................................................................... 55 Appendix ...................................................................................................................................... 70 iv Abstract Contextualizing clinical social work practice was the goal of the 450 practicum hours I completed at Walmsley and Validity Counselling Services. The practicum report starts with an overview of clinical social work practice and provides a detailed history of the practicum agency, services offered, and funding. In the following chapters, I explore and weave myself into the theoretical orientations that ground my practicum practice. Also, there is a salient review of literature necessary to contextualize clinical practice, especially in Northern British Columbia. From the practicum experience, I drew connections between the contextualization of clinical social work practice and key elements such as reflexivity, supervision, and training. Keywords: contextualizing, clinical social work practice, reflexivity, supervision, training, theoretical orientations v Acknowledgements I am humbled to have had the opportunity to pursue the Master of Social Work degree. The journey was fulfilling, and, with the supports I have received, I managed to complete it. I would like to extend my sincere gratitude to my academic supervisor, Dr. Si Transken. Her dedication and support over the years have eased the turbulences of graduate school. Her advice and feedback have made my accomplishment possible. I thank Dr. Susan Burke profusely for mentorship and encouragement. Her honest feedback, scholarly advice, and dedication have enriched my academic journey. It is my privilege to thank Jenny DeReis for her unconditional support during the process of my practicum. Jenny DeReis, thank you for your supervision and knowledge sharing. I leave with more insight into the field and with appreciation of your commitment. I owe a deep sense of gratitude to my parents, Mr. Kisima Mkango and Mrs. Ester Mkango, my siblings, Adela Mkango and Henry Mkango, and my nephews, Ian Kimu and Ryan Kimu, for their continued support during my academic journey. The kindness, encouragement, and support you provided have given me strength—Asante, mama, kwa upendo wako (Thank you, Mom, for your love). I am thankful to all the faculty and staff of the School of Social work at the University of Northern British Columbia (UNBC) for their support and cooperation. I am incredibly grateful to Dr. Terrence Barbonis for his honesty, feedback, support, and encouragement. Bedankt (Thank you). vi Land Acknowledgements I respectfully acknowledge that I have the privilege of living and pursuing my education on the unceded and traditional territory of the Lheidli T'enneh First Nations. As a settler, I recognize the settler privilege that I have as a benefit of residing, schooling, and working in this stolen land. My occupancy of the land is proof of the colonial forces responsible for colonization, violence, and dispossession of the First Nations, Métis, and Inuit peoples of their land. As a settler, I recognize the duty to continue learning sustainable ways to nourish the land and to unlearn colonial influences. vii Dedication To my dear family, your love is immeasurable. Kwa familia yangu pendwa, Upendo wenu haupimiki. viii Chapter One: Introduction Clinical social work practice is a specialized field of the social work profession that focuses on assessing, diagnosing, treating, and preventing mental health and psychological challenges (Asakura & Maurer, 2018). Clinical social work practice engages various treatment approaches such as individual, group, couples, and family therapy (Asakura & Maurer, 2018). For my practicum, I had the opportunity to work with individuals, groups, and in family therapy to strengthen my knowledge and skills in these areas. Clinical social workers are in a unique position to support clients who want to address various mental health challenges. As a social worker in a clinical setting, I add a structural perspective for understanding a client’s problems that are the result of the systems in which they are embedded. When I began my journey of pursuing my Master of Social Work (MSW) degree, I was unsure whether I wanted to focus on clinical social work. I carried with me assumptions about what a clinical social worker does and what the field is as a whole. For my foundation-year practicum, as a practicum counsellor, I was riddled with fear about whether I would be able to “fix people’s problems.” The concentration on fixing and being an expert is a common misconception perpetuated in mainstream culture about what counselling is and the counsellor’s role. I believe these mischaracterizations perpetuate the belief that a person seeking counselling is somehow broken and also places the counsellor on a pedestal as a fixer. As I progressed in my learning, engaged in reflexivity, and received clinical supervision, it was interesting to learn (and unlearn) that I did not have to be an expert. As a social worker, it was crucial to build relationships because they are crucial in making the therapeutic process 1 successful. Also, I acknowledge that clients are experts in their own lives and, in most instances, have the solutions needed to address their problems; they may just need validation and empowerment to get there. The process and experience has also been beneficial for my personal and professional growth because, as I travel with clients in their mental health awakening, I also experience my own learning. Working with clients re-affirms the knowledge that clients are not homogenous, and it is important to create space for clients to be their authentic selves. In my practicum experience, I believe I expanded my knowledge of family, group, and individual therapies. Family therapy is uniquely meaningful because, I believe, using a holistic lens to support the whole unit is essential to achieving sustainable wellness and change. When clients receive individual counselling and return to their environment, it can be hard to sustain their progress. However, when the whole unit is supported, it creates an opportunity for family growth. Practicum Placement Agency I undertook in my practicum experience at Walmsley and Validity Counselling. Walmsley and Validity Counselling is an affiliation between Walmsley Counselling Services and Validity Counselling Services (Validity Counselling, n.d). In 1992, Garth Walmsley started Walmsley Counselling Services and incorporated it in 1994 (Cupe 3742, n.d; Walmsley Counselling Services, n.d). Walmsley Counselling Services provides employee and family assistance programs (EFAP) to private and public sectors (Cupe 3742, n.d; Walmsley Counselling Services, n.d). Employers may contract Walmsley Counselling Services to offer EFAP services to their employees (Walmsley Counselling Services, n.d). Usually, EFAP is included in employees’ benefit plans (Walmsley Counselling Services, n.d). 2 Initially, Walmsley Counselling Services provided services only in Prince George, British Columbia; over time, it has grown to provide services to organizations throughout Canada (Walmsley Counselling Services, n.d). Walmsley contracts individual counsellors or other private counselling agencies, such as Validity Counselling, to offer the EFAP services to employees and their immediate family members (Walmsley Counselling Services, n.d). Jenny DeReis started Validity Counselling in 2018 (Validity Counselling, n.d). Validity is a private practice agency with one location in Prince George, British Columbia. Validity Counselling offers a broad range of mental health services to diverse client groups (Validity Counselling, n.d). Employee and Family Assistance Programs Employee and family assistance programs include services such as counselling, management consultation, group wellness initiatives and resources, critical incident stress management, and awareness campaigns (Cupe 3742, n.d; Validity Counselling, n.d; Walmsley Counselling Services, n.d). Counselling Services are available through EFAP. Employees and their immediate family members can access short-term counselling services for various presenting problems (Validity Counselling, n.d; Walmsley Counselling Services, n.d). Initially, employees are approved for five sessions, and may possibly receive three additional sessions if needed. Employees and their immediate family members can access individual, couples, group, and family counselling (Walmsley Counselling Services, n.d). Most services are offered through in-person appointments, phone calls, and doxy (a video platform) (Walmsley Counselling Services, n.d). Individual, couples, and family counselling 3 sessions are typically 50 minutes long (Validity Counselling, n.d). Because of COVID-19 and current public health recommendations, in-person services are minimal. Walmsley Counselling Services (n.d) identify management consultation and group services, EFAP services, that provide consultation and workshops to employees. These services cover various topics, such as conflict resolution, trauma training, grief, and loss can be explored with groups and teams. Employees can also receive support when dealing with critical workplace incidents. Walmsley Counselling Services (n.d) offers wellness initiatives and resources, which are facilitated, promoted, and offered by the agency through wellness initiatives and resources for service users. The agency also provides workplace workshops on physical and mental wellness. These workshops are essential for initiating communication about wellness and bringing awareness to staff about the importance of physical and mental wellness for minimizing stress and burnout in the workplace. Client Group and Services Walmsley and Validity Counselling Services provide numerous services to diverse client groups. As a private agency, Walmsley and Validity Counselling provide flexibility for clients who seek counselling supports during weekdays, evenings, and weekends (Validity Counselling, n.d.; Walmsley Counselling Services, n.d.). Walmsley and Validity Counselling supports clients with diverse needs such as workrelated stress; mental and psychological issues, such as depression, anxiety disorders and phobias; eating disorders; post-traumatic stress disorder (PTSD); and borderline personality disorder (Validity Counselling, n.d.). Counselling services are delivered through individual, couples, group, and family sessions (Validity Counselling, n.d.). 4 Individual counselling is the most accessed service at Validity Counselling, and most clients are covered under EFAP services. Individual counselling allows counsellors and clients to identify the presenting problem and create an individualized intervention plan that will support the client to achieve their goals and reduce the symptoms of the presenting problem (Validity Counselling, n.d.). Group counselling modalities offered by Validity Counselling include dialectical behaviour therapy (DBT) in group settings (Validity Counselling, n.d.). Dialectical behaviour therapy is an evidence-based, skills-based, and structured therapeutic modality developed by Marsha Linehan (Linehan, 2015); it teaches four core skill groups that support clients for learning to manage their behaviour, thoughts, and emotions (Linehan, 2015). These four skills are mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness (Linehan, 2015). Family counselling enables families to access support to address parenting and family issues, trauma, communication breakdown, and other challenges. Funding The services offered by Validity Counselling are funded through various sources. The Employee and family assistance program referrals account for most of the programs and services offered by Validity Counselling (Validity Counselling, n.d.) and are available to employees and their immediate families on a short-term basis (Validity Counselling, n.d.). Insurance coverage is another funding source for the services provided by Validity Counselling (Validity Counselling, n.d.). Some insurance companies, such as Desjardin and 5 Pacific Blue Cross, provide short-term counselling services (Validity Counselling, n.d). Usually, employees are covered for the short term. Another source of funding at Validity Counselling is the self-paying client (Validity Counselling, n.d.). Payments can be made through credit cards, and clients will be billed after sessions (Validity Counselling, n.d.). Private paying clients account for a small source of funding at Validity Counselling. Some services are done on a pro-bono basis, and a few free counselling services are offered (Validity Counselling, n.d.). Clients get counselling services at a lower cost when they are paired with practicum students (Validity Counselling, n.d.). Free services are extended to clients with financial needs. Chapter Summary In this chapter, I began with an overview of clinical social work practice. I also provided a detailed history of the practicum agency, the services offered, and funding models. In chapter two, I explore and connect myself with the theoretical orientations to ground my practicum practice. Chapter three reviews salient literature necessary to contextualize clinical practice, especially in Northern British Columbia. I reflect on my learning goals and journey in chapter four. Chapter five identifies implications for my social work practice and concludes this learning journey. 6 Chapter Two: Theoretical Orientations As I was engaging in clinical practice, it was vital for me to ground myself in theoretical orientations that I identify with and that significantly influences my practice and growth. I believed it is essential to ground my practice in anti-oppressive practice (AOP), strengths-based practice, and systemic approach. Anti-Oppressive Practice When I thought of my clinical practice, it was vital to root it in Anti-Oppressive Practice (AOP). The decision can be contextualized by my identity as a Black woman in a patriarchal Western society. It was vital for me to reflect on the power structures and the social hierarchies they impose and sustain. To dismantle these social hierarchies in a safe clinical setting, I believe it is vital to understand individual problems in the context of the structural barriers, to advocate for social change, and to achieve social justice (Baines, 2017; Coggins, 2016; Dominelli, 2002; Payne, 2014). I love practicing within the AOP framework because it requires social workers to minimize their dynamics of power and privilege and attempt to understand the cultural and structural barriers experienced by clients (Dominelli, 2002; Payne, 2014). The AOP perspective requires social workers to be mindful of the language used in practice and consider its impact on the client’s identity (Dominelli, 2002; Payne, 2014). The AOP framework also demands that social workers analyze their personal power and privileges, deconstruct power imbalance, and share this information with clients (Dominelli, 2002; Payne, 2014). Anti-oppressive practice emphasizes the importance of self-awareness and of situating our identities and experiences within social and structural contexts (Morgaine & Capous-Desyllas, 2015). Social workers who practice within the AOP framework should challenge hierarchal relationships, be transparent, 7 and share power with clients (Dominelli, 2002; Morgaine & Capous-Desyllas, 2015; Payne, 2014). I believe sharing power and having an egalitarian relationship is essential to building rapport, validating, and practicing cultural humility without reproducing the oppressive structures that clients are very likely to experience outside of therapy. Moreover, I am powerfully aligned with AOP principles because of its prioritizing of critical analysis and reflexivity. Studies in the area show that when social workers lack critical analysis and self-awareness regarding issues of power, privilege, and oppression, they will fail to pursue social justice (Baines, 2017; Mullaly & West, 2018). The pursuit of social justice is close to my heart, and to achieve it, I understand I must first acknowledge that social injustice exists. A lack of insight in this area could easily cause social workers to blame clients for their problems and fail to analyze the historical and structural contexts that impact them; social workers cannot effectively work to empower clients without addressing inequality (Mullaly & West, 2018). As a social worker who works within an AOP framework, I must be aware of my individual privileges and analyze how they may impact my practice (Dominelli, 2002; Morgaine & Capous-Desyllas, 2015; Mullaly & West, 2018). Working with an AOP lens, I have become more keenly aware of the colonial powers and structural injustices that affect Indigenous peoples and work to ensure I do not individualize clients’ experiences (Dominelli, 2002; Morgaine & Capous-Desyllas, 2015; Mullaly & West, 2018). I can integrate AOP in individual, group, and family therapy contexts by addressing challenges without blaming clients for the challenges they are confronting. Instead, I aim to locate the problem within social and structural contexts (Dominelli, 2002; Morgaine & CapousDesyllas, 2015; Mullaly & West, 2018). When clinicians fail to acknowledge our privileges, there is a risk we will reproduce the dominant discourse of meritocracy and the blaming of 8 clients for the issues they face and thus fail to build an egalitarian relationship with clients (Bishop, 2015; Mullaly & West, 2018). The AOP framework requires clinicians to become alert to the language used in practice and to avoid pathologizing clients (Dominelli, 2002; Morgaine & Capous-Desyllas, 2015; Mullaly & West, 2018). Clinicians need to critically assess the labels we attach to clients and be mindful of the stigma and challenges these labels carry (Dominelli. 2002; Mullaly & West, 2018). It is crucial that clinicians are aware that deficiency language in clinical settings perpetuates oppression and can impact clients’ identities (Dominelli, 2002; Morgaine & CapousDesyllas, 2015; Mullaly & West, 2018). in addition, a label can be disempowering; for example, identifying a client as “an addict” upon intake and assessment can perpetuate the powerlessness and inadequacy attached to the client (Dominelli, 2002; Morgaine & Capous-Desyllas, 2015; Mullaly & West, 2018). I like AOP because it requires clinicians to collaborate with clients during the whole therapeutic process, from gathering information, to creating intervention plans, to evaluating therapeutic goals (Dominelli, 2002; Morgaine & Capous-Desyllas, 2015; Mullaly & West, 2018). Anti-oppressive practice creates space for the clients’ voices to be heard, which is vital for creating genuine, egalitarian relationships between clinicians and clients (Dominelli, 2002; Morgaine & Capous-Desyllas, 2015; Mullaly & West, 2018). 9 Strengths-Based Practice The strengths-based practice is a postmodern perspective that emphasizes identifying clients’ strengths (Douglas, McCarthy, & Serino, 2014; Payne, 2014). Social workers working with the strengths-based approach focus on possibilities instead of problems and deficits (Douglas, McCarthy, & Serino, 2014; Payne, 2014). The strengths-based approach emphasizes the importance of using positive language with clients (Payne, 2014) I believe strengths-based practice helps provide a holistic view of the client by assessing the client’s challenges and strengths (Rashid & Ostermann, 2009). I believe this approach humanizes the client and may help the social worker understand issues from the client’s perspective. I like that a practitioner working with the strengths-based framework can explore the challenges and assets the client brings with them (Rashid & Ostermann, 2009). The strengths-based approach can be integrated with other psychotherapies like strengthsbased cognitive behavioural therapy (Padesky, & Mooney, 2012). I think strengths-based approach is essential because it allows for clinicians to create room to intervene in the client’s distress and support them building their strengths. The Systemic Approach in Clinical Social Work The systemic approach is a clinical framework that originates from Milan family systemic therapy (Bertrando & Lini, 2019; Carr, 2014; Heatherington et al., 2015; Scheel & Conoley, 1998). I believe the framework helps contextualize the relational influences that affect a client’s behaviour (Carr, 2014). Clinicians can use the approach to support the client’s effort to understand how their behaviours are related to their family system (Carr, 2014). I believe it fosters clinician’s understanding of patterns that stem from the client’s family system and how the systems serves to maintain a given problem or pattern (Carr, 2014). 10 I believe it is crucial to view a client holistically as they function within their family system because to focus only on the client’s issues does not address the root cause of those problems, nor does it address the patterns that maintain the presenting problem (Carr, 2014, 2019). Research shows that systemic approaches may also be used to support clients as they address physical abuse, manage anger, and resolve conflicts (Carr, 2014, 2019). I believe this framework will be useful to integrate into family therapy. Research shows that clients can experience change when they disrupt dysfunctional patterns and beliefs (Scheel & Conoley, 1998). The systemic approach uses circular questions in the treatment process (Bertrando & Lini, 2019; Brown, 1997; Scheel & Conoley, 1998). Circular questioning is an interviewing technique developed by the Milan Associates that is used to in family therapy to establish, “connections and distinctions between family members or people within the larger client system.” (Brown, 1997, pg. 109). Compared to regular interviewing questioning, circular questioning, “focus on behavioural sequences and each person’s interpretation of behaviour, as a way of establishing circularity and new meaning.” (Brown, 1997, pg. 110). The counsellor uses circular questions to better understand a family’s systemic process (Bertrando & Lini, 2019; Brown, 1997; Scheel & Conoley, 1998). Understanding the systemic processes at play helps the social worker hypothesize family dynamics (Scheel & Conoley, 1998). Moreover, circular questioning help family members gain different perspectives by considering other family members’ beliefs and perceptions (Scheel & Conoley, 1998). 11 The Practicability of Systemic Approach in Clinical Social Work Practice I believe a systemic approach is suitable for use in the clinical social work setting in particular because I approach clinical social work from a strengths-based perspective. I do not believe people are empty canvases; instead, they are the products of their environments. As I continue to grow in my career, I ascertain that our respective upbringings play a significant role in our behaviours. I like using circular questions because I believe they can effectively capture the complexities of problems in the context of the family system (Heatherington et al., 2015; Scheel & Conoley, 1998). Circular questions help reduce blaming and allow for different perspectives to existing in therapy and the solution-seeking process (Scheel & Conoley, 1998) Circular questions are essential for understanding a client’s perspective on the presenting problem (Bertrando & Lini, 2019; Scheel & Conoley, 1998). A clinican can ask questions that gage the presenting problem and the intensity, for example, “what seemed to be the problem in the family in the past?”, “who felt more helpless when the problem was not managed?”; or “how is his behaviour different now?” (Bertrando & Lini, 2019; Scheel & Conoley, 1998). Circular questions are also useful for understanding the behaviour patterns of a client’s family system (Scheel & Conoley, 1998). When clinicians ask questions such as, “when there is a problem, what would your family do?”, and following up with “what would you do then?” they can help a client see overarching family dynamics and patterns that have served to maintain their behaviours (Scheel & Conoley, 1998). Circular questions can be used to inquire about a family’s desired future and explore possible solutions (Bertrando & Lini, 2019; Scheel & Conoley, 1998). Clinicians can ask questions to illicit goals that the family want to work on to achieve their desired futures, for 12 example, “if things were to continue as they are right now, what would be the family problem?”; and following up with “what would you do differently if this family problems did not exist?” (Bertrando & Lini, 2019; Scheel & Conoley, 1998). Chapter Summary In this chapter, I explored theoretical orientations that will ground my practice during the practicum placement. My practice model aims to combine anti-oppressive practice, a strengthsbased practice, and an approach that considers systemic nature of presenting issues. The combining of these theoretical frameworks, I believe, enables me to align my beliefs with my practice. 13 Chapter Three: Literature Review My practicum interests involved exploring suitable ways to contextualize clinical social work practice complexities in Northern British Columbia. Throughout this chapter, I review salient literature on important features that are significant in clinical practice. At its core, the themes of learning, unlearning, and reflexivity are obvious. Identity and Clinical Social Work Practice Identity is a complex construct that I believe to be fluid. Identity is socially constructed and may vary with social location (Bonifacio et al., 2018). Factors such as culture, race, gender, and sexual orientation have ways of influencing the formation of our identities (Bonifacio et al., 2018; Miville & Ferguson, 2014; Mohanty, 2012). When these factors are linked to positive experiences, our identities can help build self-esteem and self-confidence (Bonifacio et al., 2018; Miville & Ferguson, 2014; Mohanty, 2012). Identity, as a social construct, carries privileges and oppressive experiences that define our worldview (Bishop, 2015; Bonifacio et al., 2018; Dominelli, 2002; Miville & Ferguson, 2014; Mullaly &West, 2018). As a clinical social worker, I need to become aware of who I am, my own experiences of oppression and privilege, and how they may impact my work (Bishop, 2015; Dominelli, 2002; Miville & Ferguson, 2014; Mullaly &West, 2018). Studies support the conclusion that we each approach our work from a perspective influenced by our personal and professional identities (Bonifacio et al., 2018; Kern, 2014; Miville & Ferguson, 2014). In practice, when working with clients from diverse backgrounds, a social worker’s identity plays a crucial role in establishing therapeutic safety and showing empathy (Chao, 2012; Kern, 2014). An inability to reflect one’s identity could impact how a social worker empathizes 14 and validates a client’s experiences, which could damage the therapeutic relationship (Nutt & Sharpe, 2007; Yotsidi et al., 2019). Moreover, being mindful of one’s identity is important because we may influence the therapeutic intervention used in practice (Chao, 2012; Kern, 2014). For example, a social worker whose identity is influenced by a narrative culture is more likely to prefer narrative therapy. Also, as social workers, being self-aware of one’s identity can help minimize therapy biases, support empathy, and promote egalitarian therapeutic relationships with clients (Chao, 2012; Kern, 2014; Stewart, 2009). Allyship in Clinical Settings Allyship is the action of members of privileged groups joining oppressed groups to fight for the rights of the oppressed groups (Baskin, 2016). Allyship requires a commitment on the part of the privileged to critically examine their privileges, the positions of power they occupy and their commitment to challenging the status quo (Baskin, 2016; Erskine & Bilimoria, 2019). I believe allyship is congruent with clinical social work. If explored in a meaningful way, it may well help create space for social workers to appropriately integrate allyship into their practice. I also believe that allyship could enable social workers to engage in acts that challenge the status quo and could lead to social change. 15 Reflexivity in Clinical Social Work Practice Reflexivity is the ability of the clinical social worker to engage in self-reflection, selfpositioning, and critical analysis of the self in practice (Kern, 2014; Lay & McGuire, 2010; Trevelyan et al., 2014). Reflexivity requires clinical social workers to reflect on their experiences and biases and how these elements may influence their practice (Lay & McGuire, 2010). Clinical social work practice exposes practitioners to clients’ traumatic experiences and emotions (Kern, 2014). Reflexivity may help the social worker become aware of countertransference and thus minimize vicarious trauma and burnout (Kern, 2014). Without reflexivity, it might be hard for the practitioner to stay grounded in the here and now with the client. Reflexivity also helps social workers become aware of their sources of knowledge and to acknowledge biases they may have before they impact practice (Kern, 2014; Lay & McGuire, 2010; Trevelyan et al., 2014). Knowledge is socially constructed, and consequently societal biases become intertwined. As practitioners, it is paramount that we question the sources of our knowledge: “how do I know this?” or “where did I learn this?” and “how do I know this to be true?” Ultimately, reflexivity benefits clients because it helps put clients at the centre of the therapeutic process by reducing the social worker’s biases from guiding treatment (Lay & McGuire, 2010; Trevelyan et al., 2014). Moreover, reflexivity may help minimize the power imbalance between the social worker and their clients and reduce the likelihood of social workers pushing their beliefs and ideologies on clients (Lay & McGuire, 2010; Trevelyan et al., 2014). 16 Fostering Clients’ Safety in the Clinical Social Work Context I believe clients’ safety is essential in the therapeutic process. When clients feel safe in therapy, they are better positioned to advocate for their needs and feel empowered (Westergaard, 2013; Yotsidi et al., 2019). Studies support the conclusion of the importance of training, relevant education, and supervision in the building of safety, especially in northern, remote, and rural BC (Nutt & Sharpe, 2007). Clients access counselling for various reasons, such as managing mental health issues. I agree with research that shows that when clients feel safe in therapy, they self-disclose, engage with the process, learn coping skills, and engage in personal growth (Yotsidi et al., 2019). Exploring the topic of safety and its cultivation is essential because psychotherapy can harm clients (Nutt & Sharpe, 2007). When social workers are not adequately reflexive, they may engage in countertransference and influencing clients in therapy. In addition, they might demonstrate a lack empathy and sensitivity, which could be harmful (Nutt & Sharpe, 2007; Yotsidi et al., 2019). In my experience, receiving supervision improved my understanding of what it meant for clients to feel safe and how I could manifest it in practice. Furthermore, I agree with research that suggests that when clients do not feel safe, they are more likely to lie within the counselling relationship about their therapeutic experiences and progress (Blanchard & Farber, 2016). As a counsellor, I believe it is vital to mirror safety by being predictable; studies show that clients do not feel safe when the counsellor is unpredictable (Blanchard & Farber, 2016). Also, I believe receiving supervision and feedback is essential to improving clinicians’ knowledge about engaging with clients purposefully and creating safety (Many et al., 2016; Westergaard, 2013). 17 Challenges of Conceptualizing Clinical Practice in Northern, Remote, and Rural Areas It is somewhat challenging to define northern, remote, and rural B.C. However, I want to define these places based on the existing geographical landmarks in Canada and B.C. Even in British Columbia, northern B.C. is divided into different regions: the Cariboo, Nechako, Northeast, and North Coast Remote communities are characterized by isolation and by limited access to resources (Government of Canada, 2011). In 2011, there were an estimated 86 remote communities in B.C., of which 25 were Indigenous communities and 61 were non-Indigenous communities (Government of Canada, 2011 Northern, remote, and rural areas have distinct features that practitioners need to take into context in their practices (Collier, 2006; Graham et al., 2008). However, social workers are sometimes ill-prepared to work in northern, remote, and rural areas, a fact that may disrupt clients’ sense of safety (Clark et al., 2013). Social workers may lack the knowledge of and experience with northern, remote, and rural practice locations and they may not stay long enough to become effective practitioners in a given community (Graham et al., 2013). Research shows that high turnover of counsellors disrupts clients’ attachment and hinders the continuity of therapeutic safety (Clark et al., 2013). If the turnover of counsellors is frequent, clients can become skeptical and lose motivation to build a relationship with new counsellors because they anticipate those counsellors will leave as well (Clark et al., 2013). Moreover, studies show that northern, rural, and remote areas are lenient with service providers’ qualifications, hence, attracting less qualified workers, and new graduates with limited experience (Collier, 2006). As a result, workers may be less competent, which increases the 18 likelihood of transference, countertransference, and power struggles with clients, which can further disrupt clients’ safety in the therapy context (Yotsidi et al., 2019). It can be challenging to facilitate professional training and supervision in northern, remote, and rural practices areas. I believe adequate supervision is vital in clinical practice because it helps foster reflexivity and critical analysis. Research shows that supervision has significant implications on workers’ job satisfaction, especially in northern, remote, and rural areas (Reese et al., 2009). Cultural Humility in Clinical Social Work Practice Cultural humility is the ability to acknowledge other cultures as they relate to our own and to engage in self-reflexivity to recognize and challenge one’s biases and knowledge of other cultures (Hook & Davis, 2019; Hook et al., 2013; Perera-Diltz & Greenidge, 2018; Stewart, 2009). Cultural humility requires humbleness to understand and acknowledge that one cannot be an expert in other people’s culture and that one’s cultural experiences are not superior to those of others (Hook & Davis, 2019; Hook et al., 2013; Perera-Diltz & Greenidge, 2018; Stewart, 2009). Prince George is a culturally diverse city. When working with clients from different cultural backgrounds than mine, it is necessary for me to be humble and respectful of cultural differences to ensure clients feel heard and validated (Hook & Davis, 2019; Hook et al., 2013; Perera-Diltz & Greenidge, 2018; Stewart, 2009). Research suggests that when social workers are aware of their own cultural backgrounds and biases, this awareness increases their cultural sensitivity to clients from diverse cultural backgrounds (Chao, 2012; Hook & Davis, 2019; Hook et al., 2013; Perera-Diltz & Greenidge, 2018) When working with clients in a clinical social work setting, cultural humility is essential to create therapeutic relationships and clients’ sense of safety (Hook et al., 2013; Perera-Diltz & 19 Greenidge, 2018; Stewart, 2009). As practitioners, we need to understand that we cannot become competent in other people’s cultures.; however, we can create a safe space in which clients become genuinely expressive about their experiences (Hook & Davis, 2019; Hook et al., 2013; Perera-Diltz & Greenidge, 2018; Stewart, 2009). Cultural humility creates space for a holistic approach to therapeutic healing (Hook & Davis, 2019; Stewart, 2009). Research shows that counselling could hinder therapeutic progress if it does not integrate cultural practices into healing (Stewart, 2009). In therapy, being grounded in cultural humility enables making space for clients to explore and integrate their cultural practices in the intervention process (Stewart, 2009). As social workers in clinical practice, we need to strive to embody cultural humility because it improves clients’ therapeutic experiences and progress (Hook & Davis, 2019; Hook et al., 2013; Perera-Diltz & Greenidge, 2018). Without cultural humility, clinicians are more likely to be blind to their biases. When counsellors have cultural biases, they may surface in the counselling context in the form of microaggressions (Perera-Diltz & Greenidge, 2018). Experiences with microaggressions are associated with clients terminating therapy early (Perera-Diltz & Greenidge, 2018). Social workers with deeply integrated cultural humility tend to be more culturally sensitive and are less likely than those who are not to commit racial and cultural microaggressions (Perera-Diltz & Greenidge, 2018). Even when they do, they have the humility and insight to acknowledge their biases and repair the therapeutic relationship with the client (Perera-Diltz & Greenidge, 2018). 20 Contextualizing Clinical Social Work Practice with Indigenous Peoples Working in Prince George, in the traditional unceded territory of the Lheidli T’enneh Indigenous peoples, I need to create space for Indigenous clients to feel safe in my clinical practice. In clinical social work practice, client safety is of particular relevance to Indigenous peoples because of the historical role social workers have played in preserving and executing oppressive colonial policies (Stewart, 2009). I write from a privileged position because I am in a position of learning about—instead of experiencing directly—the adversities that stem from the colonial acts of violence and cultural genocide experienced by Indigenous peoples. With reflexivity at the core of my practice, I approach my practice with humility and commitment to not reproduce oppressive relationships with Indigenous peoples and communities. To ensure my clinical social work practice nurtures safety, I believe that as a social worker I need to create space for Indigenous knowledge and practices to prosper within psychotherapy (Stewart, 2009). For example, in practice, it could be important to create space for Indigenous clients to explore traditional Indigenous approaches if they desire. However, clinicians need to be cautious not to assume that every Indigenous client wants to use Indigenous approaches. I believe a crucial part of safety is helping clients feel safe enough that they advocate for their needs and preferences (Yotsidi et al., 2019). As a non-Indigenous practitioner, I am mindful of what I know about Indigenous peoples and their ways of knowing; I also ensure my sources of knowledge are credible. I would love to continue building healthy relationships with Indigenous peoples and communities. I would also like to attend the teachings of Indigenous Elders, leaders, and healers to improve my knowledge (Stewart, 2009). 21 As a Black person in Canada, it can be difficult for me not to over-identify with the oppression experienced by most Indigenous peoples. However, to align with Indigenous peoples in a meaningful way, it is crucial to learn about the similarities and differences of the forms and nuances of oppressions we experience and carry with us and to ensure I do not project my experiences of oppression onto our alliance (Kouri, 2020). I believe grounding myself, acknowledging Indigenous peoples’ strengths, and following the lead of Indigenous leaders will be paramount in practice (Baskin, 2016; Bishop, 2015; Davis, 2010). Efficacy of Clinician’s Self-disclosure in the Clinical Social Work Setting A clinician’s self-disclosure is the act of sharing personal or professional information and experiences with clients in practice (Edwards & Murdock, 1994; Paine et al., 2010; Stewart, 2009). Self-disclosure with clients can be indirect (such as displaying personal images or wearing identifying items), or direct (such as sharing demographic information and professional qualifications) (Edwards & Murdock, 1994; Paine et al., 2010). Self-disclosure in practice may help normalize a client’s experiences and minimize their fear of being judged (Kern, 2014; Paine et al., 2010; Stewart, 2009). Social workers’ selfdisclosure may help clients feel comfortable with and open about issues they are facing in their lives (Kern, 2014; Stewart, 2009). Research supports the use of self-disclosure if it is in the best interest of the client’s therapeutic healing (Edwards & Murdock, 1994; Kern, 2014; Paine et al., 2010; Stewart, 2009). Studies show that self-disclosure by clinicians may help the client build trust the social worker and strengthen a therapeutic relationship (Edwards & Murdock, 1994; Paine et al., 2010; Stewart, 2009). A strong therapeutic relationship is an essential factor that fosters therapeutic 22 progress in counselling (Stewart, 2009). The therapeutic relationship helps clients feel safe, which increases their willingness to share, engage, and work on their issues (Stewart, 2009). When used effectively, self-disclosure models healthy behaviour for clients (Edwards & Murdock, 1994; Paine et al., 2010). Research suggests that some clients learn how to use necessary tools to change their behaviours as demonstrated through a clinician’s self-disclosure (Paine et al., 2010) Self-disclosure may help bridge the power imbalance between the counsellor and the client by normalizing mental health challenges and vulnerability (Edwards & Murdock, 1994; Kern, 2014; Paine et al., 2010). Studies show that clients may interpret non-disclosure as a sign of the clinician’s unrelatability, thereby hindering connectedness (Paine et al., 2010). Selfdisclosure by the counsellor in a clinical setting could promote the destigmatizing of mental health challenges and illness (Kern, 2014). Self-disclosure by the counsellor should generate therapeutic benefits for clients (Kern, 2014; Stewart, 2009). Social workers need to engage in reflexivity about their decision to engage in self-disclosure and be mindful of the benefits and drawbacks of disclosing and not disclosing (Kern, 2014; Paine et al., 2010). Clinicians need to carefully assess whether or not disclosure would help clients find progress toward their goals (Kern, 2014; Paine et al., 2010). Before disclosing, social workers need to be reflexive about whether self-disclosure could prompt the client to focus on the counsellor’s experiences instead of addressing the client’s issues (Edwards & Murdock, 1994; Paine et al., 2010; Stewart, 2009). Also, it is important to consider the potential biases clients may possess; for example, clients may want to see their clinical social worker as an expert and self-disclosure may cause the client to doubt the practitioners’ professional abilities and judgement (Kern, 2014). 23 Colonial Impacts in Canada I believe it is of critical to examine the centuries of structural oppression to understand the intergenerational trauma experienced by Indigenous peoples, Black peoples, and racialized peoples in Canada. For example, in Canada, Indigenous people and Black people were enslaved until the 19th century, when slavery was abolished (Donovan, 2014). Even after abolishing slavery in Canada, the segregation of and discrimination against racialized peoples persevered in Canada. In 1872 the Indian Act was passed to strip Indigenous peoples of their culture and assimilate them into Eurocentric standards, which were considered superior (Bombay et al., 2013; The Canadian Encyclopedia, 2020b). The violence of the Indian Act was magnified in the 1880s by the introduction of residential schools established by the Canadian government and administered by the Roman Catholic, Anglican, Methodist, and Presbyterian churches from inception until the last school closed in 1996 (Bombay et al., 2013; Elias et al., 2012). Residential schools, which claimed to instill Eurocentric knowledge, skills, and values in Indigenous children, forcefully removed Indigenous children from their families and institutionalized them in residential schools (Menzies, 2020). The residential schools used punishment, abuse, coercion, and control as a means to “instruct” and parent (Menzies, 2020). Many survivors of residential schools reported experiencing physical and sexual abuse, psychological torture, and spiritual abuse while attending residential school (Bombay et al., 2013; Menzies, 2020). With extended exposure to trauma and limited validation and nurturing contact with adults, most residential school survivors have struggled with mental health issues such as depression, post-traumatic stress disorder, suicide, and anxiety (Bezo & Maggi, 2015; Elias et al., 2012; Menzies, 2020). 24 Indigenous communities continued to experience widespread colonial violence through the Sixties Scoop, which was the mass abduction of Indigenous children from their families and communities and subsequent delivery into the child welfare system and placement in the homes of white settlers (Fachinger, 2019; The Canadian Encyclopedia, 2020b). In the Canadian context, a settler is any non-Indigenous person who enjoys the advantages of living on stolen land and using stolen resources (Baskin, 2016; Blair & Wong, 2017; Kouri, 2020; Mitchell et al., 2018; Nixon, 2019; Regan, 2010; Sullivan-Clarke, 2019). The dispossessed Indigenous children were prevented from speaking their languages in Eurocentric foster families (Fachinger, 2019; The Canadian Encyclopedia, 2020b). Cultural genocide was perpetrated on Indigenous children by stripping their identities and cultural connections (Elias et al., 2012). In Canada, there is still an overrepresentation of Indigenous children in the foster care system (Fachinger, 2019; Sinha, Trocmé, Fallon, & MacLaurin, 2013). Because of the adversity they have experienced, research findings show that a significant number of Indigenous peoples are disposed to poverty, substance abuse, and addiction than their non-Indigenous peers (Elias et al., 2012; Fachinger, 2019). 25 Intergenerational Trauma and the Transmission of Trauma When trauma has not been dealt with and healed, it can be transmitted from one generation to another (Bombay et al., 2013; Elias et al., 2012; Fachinger, 2019; Lehrner & Yehuda, 2018; Menzies, 2020). The intergenerational transmission of trauma can be explained through sociocultural factors, family systems model, and biological aspects (Menzies, 2020). Sociocultural Model Sociocultural factors—such as the parenting style of the trauma survivors—and environmental factors are likely to impact child development (Bezo & Maggi, 2015; Elias et al., 2012; Fachinger, 2019; Lehrner & Yehuda, 2018; Menzies, 2020). Most survivors of the residential schools struggle with mental health issues, and when they became parents they struggled with parenting and nurturing of their children in healthy ways (Bezo & Maggi, 2015; Menzies, 2020). Menzies (2020) describes the transmission of intergenerational trauma in this way: If you subject one generation to that kind of parenting and they become adults and have children, those children become subject to that treatment, and then you subject the third generation to a residential school system the same as the first two generations. You have a whole society affected by isolation, loneliness, sadness, anger, hopelessness and pain. (From Individual Trauma to Intergenerational Trauma, para. 4) The use of numbing coping mechanisms has been shown to prevent survivors from seeking help (Elias et al., 2012; Fachinger, 2019). When the environment and culture are infused with trauma and pain, children are exposed to adversity at an early age, which may interfere with stages of development if intervention is not prompt (Lehrner & Yehuda, 2018; Menzies, 2020). 26 Family Systems Model The family systems model uses family dynamics, learning theory, and attachment theory to understand the transmission of trauma from one generation to another (Menzies, 2020). Numerous studies have presented the importance of infants having healthy attachments with caregivers for brain development and self-regulation (Cowan et al., 1996; Frewen et al., 2015; Goldfinch, 2009; Menzies, 2020). Early adversity can cause cognitive delays and destructive survival skills (Fenerci & DePrince, 2018; Menzies, 2020). Studies have shown that parents’ attachment style is usually reflected in their parenting style; therefore, if their attachment has been disrupted and left unrepaired, it will continue to repeat across generations (Bezo & Maggi, 2015; Cowan et al., 1996; Lazaratou, 2017). Advocates of learning theory argue that children learn behaviours and attachment from their caregivers (Elias et al., 2012). For example, children may learn through conditioning how to respond to an event, and thus may imitate how their caregivers respond (Elias et al., 2012; Fachinger, 2019). Therefore, when unhealed trauma exists, children learn coping skills like those of their traumatized parents. Family dynamics play a significant role in transmitting trauma from one generation to another. Numerous studies have established that witnessing violence, experiencing sibling conflict, and troubled parent-child relationships have adverse psychological consequences (Frewen et al., 2015; Lehrner & Yehuda, 2018). Dysfunctional family dynamics are reflected in parenting style and act as a catalyst that transmits trauma from one generation to another (Cowan et al., 1996; Frewen et al., 2015). 27 Genetic or Biological Models Intergenerational trauma can also be transmitted biologically through the intrauterine transmission of maternal stress hormones and epigenetic changes (Bezo & Maggi, 2015; Fenerci & DePrince, 2018; Lazaratou 2017; Lehrner & Yehuda, 2018; Mosby & Galloway, 2017; Park, 2019; Yehuda & Lehrner, 2018). Epigenetics alter the survivor’s genetic expression throughout their lives (Bezo & Maggi, 2015; Mosby & Galloway, 2017; Park, 2019). These epigenetic changes are inherited from one generation by the next and influence neurodevelopment, behaviours, and the overall health and welfare of the subsequent generation (Bezo & Maggi, 2015; Lehrner & Yehuda, 2018) Studies of residential school survivors show that chronic exposure to hunger during the residential school years changed their physiology and caused their bodies to accumulate fat more quickly when nutritious food became available; this can contribute in higher risk of obesity and chronic disease (Mosby & Galloway, 2017). Studies show that a survivor passes the physiological change through pregnancy to their unborn children (Lehrner & Yehuda, 2018; Mosby & Galloway, 2017). These changes affect the second generation and generations that follow (Mosby & Galloway, 2017). 28 The Manifestation of Trauma in the Therapeutic Process Chronic exposure to early adversity increases the risk of emotional and behavioural difficulties among survivors, especially at an early age, which affects overall growth and development (Fenerci & DePrince, 2018; Goldfinch, 2009; Mosby & Galloway, 2017). Studies have shown that chronic exposure to stress conditions the amygdala to become especially sensitive to potential threats and hinders emotional and behavioural development (Goldfinch, 2009). Prolonged exposure to stress has been shown to impact the nervous and the immune systems, increasing chances of infections and illnesses (Goldfinch, 2009; Kiecolt-Glaser et al., 2002). Diseases and conditions such as cancers, heart disease, diabetes, irritable bowel syndrome, and alopecia can result from chronic exposure to stress (Kiecolt-Glaser et al., 2002). Suppressing stress responses is a common survival skill among people who have experienced trauma (Goldfinch, 2009). It is common for survivors to withdraw, detach, and avoid activities and environments that remind them of a given trauma (Goldfinch, 2009). As a result, trauma survivors may use high-risk behaviour to numb their pain (Fachinger, 2019; Goldfinch, 2009). Studies have shown that when trauma is unhealed, survivors are more likely to engage in risky activities such as drug and alcohol misuse, self-harm, suicide, aggression, eating disorders, and other impulsive behaviours as escape mechanisms (Elias et al., 2012; Goldfinch, 2009). 29 Trauma-Informed Clinical Social Work Practice Trauma-informed practice is a tool used by social workers to recognize the influence of trauma when they confront clients’ substance use and addiction, mental illnesses, and unhealthy coping techniques (Bent-Goodley, 2019; Brown et al., 2013; Bruce et al., 2018; Carello & Butler, 2015; Knight, 2015; Knight, 2019; Levenson, 2017; Powers & Duys, 2020; Vaswani & Paul, 2019). Trauma-informed practice is not a single approach; instead, it combines the social worker’s reflexivity, humility, and sensitivity to clients’ experiences of trauma to create a therapeutic environment for healing (Bent-Goodley, 2019). Research shows that trauma-informed practice needs to have four core principles (BairMerritt, 2015; Bent-Goodley, 2019; Levenson, 2017; Powers & Duys, 2020; Vaswani & Paul, 2019; Wilson et al., 2015). First, a trauma-informed practice should create safety for clients, fostering trustworthiness and transparency between social workers and clients. Second, it needs to encourage peer support, engaging in collaboration and create mutuality between social workers and clients. Third trauma-informed practice should create space for empowerment, voice, and encouraging clients’ choice. Fourth, it should be responsive to cultural, historical, and gender issues.These principles create an environment to validate clients’ experiences and prevent retraumatization (Bent-Goodley, 2019; Knight, 2019; Vaswani & Paul, 2019). The trauma-informed practice helps the clinician to minimize the occurrences of retraumatizing clients, which could happen for various reasons, such as when a social worker invalidates clients’ traumatic experiences or when clients are exposed to triggering, traumatic memories (Bent-Goodley, 2019; Brown et al., 2013; Bruce et al., 2018; Levenson, 2017; Vaswani & Paul, 2019). Trauma-informed practice includes the practitioner’s ability to see the client holistically, beyond being the victim of trauma (Bent-Goodley, 2019). Social workers are 30 encouraged to model appropriate behaviours for clients during the different stages of practice, such as intake, assessment, intervention, and termination (Levenson, 2017). Evidence-Based Clinical Social Work Practice Evidence-based practice utilizes evidence obtained from research and clinical studies on the efficacy of particular interventions in mitigating client issues (Drisko, 2014; Melnyk et al., 2010). I believe clinical social work practices should use evidence-based practice to ensure that clinical interventions are effective (Aarons et al., 2012; Drisko, 2014; Melnyk et al., 2010). Counselling has been shown to support clients in addressing various psychological and mental challenges; however, it can sometimes cause harm to clients (Nutt & Sharpe, 2007). Using evidence to inform practice ensures specific clinical approaches have proven effective and beneficial to clients (Drisko, 2014; Melnyk et al., 2010). Research shows that while evidence-based approaches are efficient, there are times when generalizing research evidence may not be helpful to clients (Blom, 2009). Factors such as cultural background, gender, and developmental challenges may hinder the generalizability of research evidence. There is a need for social workers to engage in continuous professional development to update their knowledge (Blom, 2009). Solution-Focused Theory With Families Solution-focused therapy (SFT) is a strengths-based practice that was pioneered in the 1980s by Steve de Shazer and Insoo Kim Berg and focuses on supporting families in identifying and utilizing their strengths and resources to formulate solutions for their problems (Bannink, 2007; Coggins, 2016; Franklin et al., 2001; Kim et al., 2018; Taylor, 2009). Solution-focused therapy aims to help families shift from focusing on their problems to concentrating on possible solutions (Bannink, 2007; Brockman et al., 2016; Kim et al., 2018). Counsellors who practise 31 SFT focus on the strengths of families and support families in devising the solutions (Bond et al., 2013; Corcoran & Pillai, 2009). The key questions used in SFT encourage clients to explore the strengths they possess and find suitable solutions to their problems (Bond et al., 2013; Corcoran & Pillai, 2009; Gingerich & Peterson, 2013; Lutz, 2017). For example, by using the miracle question, I can encourage families to imagine their lives without the presenting problem. Also, I can collaborate with families and support them in setting goals to help them achieve desired outcomes (Bond et al., 2013; Brockman et al., 2016; Roth, 2019). Philosophical Tenets of the Solution-Focused Therapy Solution-focused therapy requires practitioners to keep therapy brief and see clients only when they have problems (Bond et al., 2013; Zatloukal et al., 2019). During therapy, clinicians should not focus on the nature of the problem; instead, they should get information to know their presenting problem (Zatloukal et al., 2019). The solution-focused therapy framework conceptualizes change as inevitable and encourages the practitioner to acknowledge even slight therapeutic progress in a client’s life because these small steps can lead to significant changes (Bond et al., 2013; Zatloukal et al., 2019). Moreover, SFT assumes that clients do not experience their problems all the time; there are times that they may not be as affected by the problems (Bond et al., 2013; Roth, 2019; Zatloukal et al., 2019). As a clinician, it is important to collaborate with clients to identify exceptions to their problems because they helps client to identify strengths and resources and to build solutions for presenting issues (Bond et al., 2013; Roth, 2019; Zatloukal et al., 2019). Additionally, SFT highlights the conviction that clients have the power to create the life they desire (Zatloukal et al., 2019). For example, by using the miracle question, the client can 32 envision preferred outcome sand build solutions that help them attain the desirable future (Bond et al., 2013; Brockman et al., 2016; Roth, 2019). Practical Approaches Solution-focused therapy uses solution-building questions to promote goal setting and identify clients’ strengths and resources (Bond et al., 2013; Brockman et al., 2016; Roth, 2019). It is important to build rapport in the first session and understand the client’s problem (Bannink, 2007; Bond et al., 2013). During sessions, the clinician uses coping questions, scaling questions, questions that highlight exceptions to the client’s given issue, and the miracle question; it is also important to offer appropriate compliments and feedback at the end of the sessions (Bannink, 2007; Bond et al., 2013). Coping questions are beneficial in solution-focused practice because they help the family gain insight into their strengths and resourcefulness by exploring how they have coped and managed problems (Bond et al., 2013; Roth, 2019). A counsellor can use coping questions to gauge the problem-solving skills that clients already possess by asking clients how they managed to live their lives with the presenting problem (Bond et al., 2013; Roth, 2019). Scaling questions help measure the intensity of the family’s problem, progress, and solutions (Brockman et al., 2016; Roth, 2019). The scale can run from 1 to 10, and the counsellor needs to specify what the numbers represent (Roth, 2019). Scaling questions are also used in follow-up sessions to assess the family’s improvement and reflect whether the interventions are beneficial (Brockman et al., 2016; Roth, 2019). Exception questions stem from SFT beliefs that families do not experience their problems daily and that there will be some exceptions (Roth, 2019; Zatloukal et al., 2019). After identifying exceptions, families can explore what practices and processes that would help them 33 to bring about more exceptions. The exploration of the exceptions helps highlight a family’s strengths and limitations (Taylor, 2009). The Miracle Question aims to discover a family’s desired outcomes by encouraging them to imagine that their presenting problem is resolved (Brockman et al., 2016; Roth, 2019). The technique enables a family and the clinician to collaborate in setting goals and finding viable solutions. The miracle question is compelling because the family is encouraged to envision and articulate a future they would prefer, which can help set counselling session goals (Bond et al., 2013; Brockman et al., 2016). Dialectical Behavioural Therapy (DBT) in Group and Individual Counselling Dialectical behavioural therapy is an evidence-based, skills-based, and structured therapeutic modality developed by Marsha Linehan (Linehan, 2015). Initially, DBT was developed to treat borderline personality disorder (BPD) and was shown to be effective in supporting clients to reduce suicidal and parasuicidal behaviours (Lihenan, 1993). The modality is valued for its ability to integrate acceptance, validation, and change (Linehan, 1993). The dialectical process is a critical philosophical tenet of DBT, which focuses on accepting opposing perspectives and balancing polarized and polarizing worldviews (Linehan, 1993). Dialectical thinking emphasizes the avoidance of extreme thinking and acceptance of disparate viewpoints, even when they differ from one’s perspective (Bonavitacola et al., 2019). Moreover, research highlight that non-dialectical thinking and acting have generated cognitive dysregulation (Bonavitacola et al., 2019; Linehan, 1993). Dialectical behavioural therapy has been modified to treat various psychiatric disorders (Linehan, 2013). The approach can be used in individual or group settings, and there is evidence 34 of its efficacy with diverse demographic groups, including youths and adults (Waters et al., 2014; Wilks and Ward‐Ciesielski, 2020). Key Practice Components Dialectical behavioural therapy teaches four core skills that support clients’ efforts to learn the skills necessary to manage their behaviours, thoughts, and emotions (Linehan, 2015). The four core skills are mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness (Linehan, 2015) The core mindfulness skills are used to teach clients to become aware of and grounded in the present moment (Linehan, 2015). Clients first learn about the three states of mind: the reasonable mind, the emotional mind, and the wise mind (Linehan, 2015). When people are in the reasonable mind they focus on rationality and logic for assessment and problem solving (Linehan, 2015). The emotional mind reflects one’s susceptibility to one’s current emotional state and its effects on one’s reactions and thinking; when one is acting from the emotional mind, that person may not be logical or reasonable (Linehan, 2015). The wise mind integrates the emotional and reasonable minds and adds intuition when navigating between emotions and logical analysis (Linehan, 2015). The use of mindfulness skills teaches clients to balance the emotional mind and the reasonable mind (Linehan, 2015). Additionally, clients learn “what” and “how” mindfulness skills (Linehan, 2015). The “what” skills guide clients what to observe, describe, and participate in (Linehan, 2015). The “how” skills guide clients to take on a non-judgmental stance, to do one thing at a time and be effective in what we do (Linehan, 2015). In addition, clients learn distress tolerance skills that help them to accept temporary discomfort, seek meaning, and tolerate distress (Linehan, 2015). Linehan (2015) argues that our 35 inability to accept and tolerate pain increases our pain and prevents us from seeking change. Some of the skills learned in working with distress tolerance are crisis survival skills, reality acceptance skills, and radical acceptance (Linehan, 2015). Emotion regulation skills help clients regulate and manage painful emotions that trigger challenging behaviours (Linehan, 2015). Linehan (2015) contends that dysfunctional behaviours such as suicidality, eating disorders, and substance use disorders result from a client’s inability to tolerate painful emotions. Therefore, to reduce dysfunctional behaviours, it is important to teach clients how to regulate painful emotions (Linehan, 2015). Clients learn how to understand and name their emotions, change unwanted emotions, reduce vulnerability to emotion, and manage extreme emotions (Linehan, 2015). Interpersonal effectiveness skills are used to give clients the tools necessary to develop and maintain relationships, attain self-respect, achieve learning objectives, and balance acceptance and change in relationships (Linehan, 2015). Linehan (2015) asserts that a client’s inability to tolerate distress and the challenges they have with the regulation of emotions can predict difficulties with maintaining relationships. Clients learn to let go of extremes, how to make the best of their challenges, nurture relationships, and embrace change (Bonavitacola et al., 2019). 36 Cognitive Behavioural Therapy in Individual and Family Therapy Cognitive behavioural theory (CBT) is an evidence-based approach widely used to treat various mental health challenges (Fenn & Byrne, 2013; Kouimtsidis et al., 2012). The framework explores the link between thoughts, feelings, and behaviours (Fenn & Byrne, 2013). It also highlights how cognitive distortions may lead to undesired emotions and behaviours (Fenn & Byrne, 2013). Cognitive behavioural theory sessions tend to be structured and suitable for individual sessions and group clinical settings (Fenn & Byrne, 2013). Over the years, CBT has been modified to treat various psychological challenges such as anger issues, eating disorders, anxiety, depression, obsessive-compulsive disorder (OCD), addiction, and post-traumatic stress disorder (PTSD) (Fernandez et al., 2018; Kouimtsidis et al., 2012; Mennin et al., 2013; Moreno et al., 2019). The modified versions of CBT have added the trauma lens in CBT which is vital because emphasizing change without validation can harm clients, especially trauma survivors. Philosophical and Historical Underpinnings Dr. Aaron T. Beck developed CBT through his efforts to find a treatment suitable for people with depression (David et al., 2018; Fenn & Byrne, 2013). Through his work on cognitive theory, Dr. Beck found that the clients’ conceptualizations of a given event had a more impact on clients’ feelings of depression than the event itself (David et al., 2018; Fenn & Byrne, 2013). Cognitive behavioural theory emerged from the integration of cognitive theory and rational therapy, the latter of which was pioneered by Dr. Albert Ellis (David et al., 2018). Dr. Ellis’s work on rational therapy, which was later known as rational emotive behaviour therapy, was an essential foundation upon which CBT emerged (David et al., 2018). 37 Cognitive behavioural theory seeks to help clients identify and correct dysfunctional core beliefs, automatic thoughts, and assumptions, and it aims to minimize distress and change maladaptive behaviours (Chawathey & Ford, 2016; Fenn & Byrne, 2013). In CBT, core beliefs are associated with the deep beliefs learnt, especially during childhood, that influence a person’s view of themself, others, and the world in general (Chawathey & Ford, 2016; Fenn & Byrne, 2013). Cognitive behavioural theory uses various techniques such as exposure therapy, behaviour experiments, cognitive reframing, maintenance of a positive data log, and psychoeducation to foster cognitive and behaviour change (Chawathey & Ford, 2016; Fenn & Byrne, 2013). Cognitive behavioural theory operates on the belief that when clients change how they conceptualize their cognition, their maladaptive behaviour and emotions will change (David et al., 2018; Fenn & Byrne, 2013). Chapter Summary In this chapter, I have reviewed crucial concepts necessary for contextualizing clinical practice, especially in Northern British Columbia. I explored salient factors such as identity, allyship, reflexivity, client safety, and cultural humility. Additionally, it was important to touch on the role of colonization in generating intergenerational trauma and working with Indigenous peoples. The importance of clinician self-disclosure, trauma-informed practice, and evidencebased practice in clinical social work were also explored and evidence-based modalities such as CBT, SFT, and DBT were addressed. 38 Chapter Four: Learning Experiences from the Practicum Placement As a requirement of my Master of Social Work degree, I completed a practicum placement. The goal of the practicum is to expose a student to the application of theories to practice and to gain practical experience in a social work field. I completed 450 practicum hours with Walmsley and Validity Counselling in a full-time role between May 2021 and August 2021. Before starting the practicum, I had set goals to gain specialized, practical knowledge of working in family and group therapy settings to improve my existing clinical skills. As I reflect on the end of the journey, I believe I have learned more than anticipated. In this chapter, I am elated to share reflections on my learning, because, as I review the experience, I am reminded of the growth I experienced as a practitioner. Reflecting on the Practicum Learning Goals As I was preparing to begin my practicum, I proposed nine goals that I wanted to achieve by the end of the practicum. These goals are the following: o I wanted to strengthen my clinical social work skills in the different phases of practice, such as intake, assessment, treatment, and termination. I wanted to become comfortable integrating evidence-based modalities when working with families, couples, and groups. I also wanted to continue working on reflection, paraphrasing, becoming comfortable using silence, and immediacy. I believed silence is a valuable tool in counselling because it allows clients to contextualize their feelings, thoughts, and experiences (Harms & Pierce, 2011). o I wanted also to establish a self-care plan for myself during the practicum. Over the years, I had noticed that I overlooked self-care and overworked myself. However, as a social worker, I am aware of the importance of self-care in nurturing and maintaining 39 good mental health. During my practicum, I wanted to establish a list of activities that I enjoyed doing and that kept me grounded. o Additionally, I wanted to explore and appreciate my identity and its influence in my practice. As a Tanzanian, African, and Black woman in Canada, I have found that my identity has been politicized and is strongly influenced by colonial powers. As I approached my practicum, I wanted to connect with and meaningfully explore my identity and culture. I must ground myself in who I am because identity and culture strongly influence our experiences, biases, values, and beliefs, and they show up in the clinical social work setting (Bishop, 2015; Mullaly & West, 2018). o Also, I wanted to contextualize client safety in a clinical social work setting. I wanted to understand different ways to foster clients’ sense of safety in the clinical social work practice. I believed that it was a fundamental goal because research shows that when clients feel safe in the counselling setting, they take part, advocate for themselves, and are more likely to be empowered (Yotsidi et al., 2019). o Additionally, working in Prince George, in the traditional unceded land of the Lheidli T'enneh First Nations, I believed in the importance of creating a safe space for Indigenous clients to explore their culture in practice. Advocates argue that cultural safety in clinical social work practice is not the absence of the Western lens; instead, it is the welcoming of the Indigenous culture, worldview, and knowledge of mental health and being into practice (Stewart, 2009). I believed that integrating a client’s culture plays a significant role in their healing (Stewart, 2009). o Finally, I wanted to engage in allyship in practice (Asakura & Maurer, 2018). As I approached my clinical social work practicum, I wanted to challenge the hierarchy 40 between the social worker and the client. I wanted to create space for a client-centred practice and an egalitarian relationship. Moreover, I hoped to make sue of knowledge from different cultures, not just a Western lens. Clinical social work practice individualizes clients’ problems; in my practicum, I wanted to engage in allyship and advocacy to bring awareness to structural issues that may impact the clients (Asakura & Maurer, 2018). o Furthermore, I wanted to expand my knowledge of intergenerational trauma and shape a holistic experience in the integration of trauma-informed treatment in practice. I wanted to become more cognizant of how intergenerational trauma shows up in practice and to learn how to validate and support clients while they experience and work towards breaking intergenerational trauma. o I wanted to expand my understanding of the various mental health issues and their treatment plans. I wanted to educate myself about diagnosis as outlined in the Diagnostic Statistical Manual of Mental Disorders (5th ed) (DSM-5). I believed that educating myself about these disorders, their symptoms, and treatment plans would be helpful in expanding my knowledge about working with clients. o I wanted to be cognizant of the gender and sex imbalances that operate in most couple and family dynamics. As a woman living in a patriarchal society, I am aware that the heavy burden of relationships and nurturing is unevenly placed on women. For my practicum, I wanted to ensure that women felt supported and safe to unpack their experiences. Reflecting on these goals, I recognized the importance of improving my reflexivity and overall skills as a clinician. When I think of the processes of learning and of improving my 41 clinical practice, it reminds me of a multileveled game because, as I finish one level of knowledge acquisition, I unlock another level. While the baseline concepts are the same, each level tends to raise a new challenge that needs a more complex understanding and learning. I will no doubt integrate this considerable practical knowledge and the skills I have acquired into my practice. Below, I want to expand my reflection on the learning goals I established early on. Strengthen my Clinical Skills Through my practicum experience, I have gained knowledge and experience that will help me with case conceptualization and creation a treatment plans that incorporates evidencebased modalities. During this time, I pursued accredited courses in dialectical behaviour therapy (DBT), cognitive behavioural therapy (CBT), Motivational interviewing (MI), acceptance commitment therapy (ACT), and solution-focused therapy (SFT) through the Association for Psychological Therapies (APT). The courses provided solid links between theories and practice by explicitly elaborating on the use of these modalities in practice. The training was very informative, engaging, and practical. Gaining practical training in evidence-based modalities gave me confidence to employ DBT group therapy and to use DBT in one-on-one sessions with clients. During my practicum experiences, I had the opportunity to work with families, individuals, and groups; however, I did not engage in couples’ therapy. Supervision served to solidify my learning by providing me with the confidence to apply my knowledge and add further layers to my learning. For example, through supervision, I reflected on and explored the differences between validation and assurance. I sometimes believe, as a clinician, that—with good intentions—we can assure clients that things will improve. The need to provide assurance can emerge from a clinician’s need to “save” the client. While it may 42 stem from empathy—an essential component of clinical work—its impact can be harmful to a client’s journey because it could also appear to invalidate the client’s experience. As a clinician, I learned the importance of using validation and teaching clients to self-validate. I felt that validation gave power back to the client and empowered them to first see their concern not as an individualized deficit but, instead, as a response to their environment. For example, for a client worried about their health following a given diagnosis, validating what they are feeling is natural and suggesting that anyone else might also feel the same. As a clinician, I also learned the importance of psychoeducation in therapy. Working with clients, I have found they sometimes invalidate themselves by minimizing the challenges they are navigating. Through supervision, I learned the importance of sharing psychoeducational information with clients and, for example, working with clients to understand the difference between fear and anxiety. Psychoeducation was critical because I realized there is a risk of coparticipating with a client in invalidating them if the differences between real fear and anxiety in not clear. I believe my clinical skills, such as paraphrasing, summarization, reflection, and the use of silence, have improved significantly. Learning to use immediacy effectively was interesting because I noticed how, sometimes, clients presenting problems could also be observed in the therapeutic relationship. To deliver feedback in a nonthreatening way, I used statements such as this: “On the one hand I hear you say you have wanted to learn to use new skills, and on the other hand I notice that often counselling homework is not done. What do you think might be happening?” I have found that such a statement does not place blame; it does not trigger a client’s defensive mechanisms, but, instead, it encourages them (in this example) to reflect on the here-and-now connection between their goals and their commitment to achieving them. 43 Ultimately, my quest to learn and use family counselling skills highlighted the complexity of approaches in comparison with those used in individual counselling. In individual counselling, my practice is client-centred and seeks to create space for clients to navigate their needs in our sessions. As a counsellor, I learned the importance of taking the lead in family therapy to ensure that a family does not simply reproduce the same problematic dynamics or issues in session that they struggle with outside the office. As a counsellor, I learned the importance of validating family members and supporting each of them as they work to understand each other. Establish a Self-Care Plan When I was approaching my practicum, I considered it vital to establish a self-care routine. The need for a self-care plan came from my need and desire to stay grounded and balanced. I remembered when I took a course in advanced social work practice with Indigenous peoples an assignment focussed on self-care. Engaging intentionally in self-care was very productive because I learned my tendency to overwork and overscheduling myself. The lessons I learned were precious for me as a student and a social worker. It was vital that I have different activities I could use for self-care, for example, visiting friends, taking nature adventures, talking to my family, mindfulness, exercise, and watching movies. I believed these activities would help me stay grounded as I went through my practicum placement. To be honest, I also selected these activities because they have worked for me in the past. When I created my self-care journey, I first wanted to structure the activities and set a schedule. However, self-care needs to respond to an immediate need; therefore, I settled on a semistructured plan. Throughout the practicum, I maintained walking with my dog, which was 44 grounding and relaxing. I also used walks in nature as a time in which to reflect on my learning and think of potential treatment plans. Explore and Appreciate my Identity Identity can be fluid, and can change in response to different social factors. Factors such as race, gender, and sexual orientation influence our identities and, when internalized, shape our views of self. For most of my life, I did not think much about my identity. Born and raised in Tanzania as a member of the majority group, I was granted the privilege of being treated like a human being and not merely relegated to a racial category. When I came to Canada, my skin colour gained significant power in defining my identity. Unfortunately, because of the historical prejudices and current biases, being Black in North America comes laden with numerous stereotypes, most of which are negative and portray Black people as inferior. My identity in Canada is tied to systemic oppression and injustices. I believe it is essential that I, as a practitioner, need to feel securely grounded in my identity to support clients in exploring their identities. As a clinician, I am mindful that I process my experiences of oppression to avoid overidentifying with the clients’ experiences of oppression. For example, when a client shared numerous experiences of systemic injustice, , it was vital for me—as a clinician—to create the safe space in which to validate and process those experiences instead of simply engaging in comparing our respective experiences. Having a support system enables me to find a safe space to process my experiences and minimize transference and countertransference with clients. Language is compelling in clinical practice. I notice, for example, the influence my first language, Swahili, has on my gendered English pronouns. The Swahili language uses non-binary pronouns in both singular and plural forms. As a clinician, it was vital that I be mindful of 45 pronoun use. Using the correct pronouns is important to show respect for gender non-binary and transgender clients in particular. Although I did not work during my practicum setting with any clients who identified as non-binary, I believe it is important that I to continue to be mindful and ensure I don’t inadvertently invalidate non-binary and transgender clients. Nonetheless, as I am grounding myself in clinical practice, I am sometimes humbled by the experiences. If I mistakenly use an unpreferred pronoun, I have the humility to apologize and make the repair as a clinician. Contextualize Client Safety When I was beginning my practicum journey, it was essential for me to ensure that the therapeutic process creates safety for clients. I entered the therapeutic relationship reflecting my role as a clinician and the power that I bring with me. It was important for me to distribute power by first arranging my environment in a welcoming, non-authoritative way. I then communicated with clients like an equal in a manner that wasn’t burdened with professional jargon. When it became useful to share some psychoeducation information, I aimed to communicate respectfully and without being condescending. Throughout the practicum process, I committed to being sensitive, predictable, empathic, and validating with clients. As supported by relevant research, I found that clients became more effective self-advocates, became insightful about their challenges, more willing to learn coping skills, and to continue with therapy. For example, clients who came into therapy believing they were helpless, grew to gain insights into their strengths and advocated for what is in their best interests, such as session time. Such improvements made me believe clients felt safe in therapy with me and felt safe to nurture their strengths. 46 Creating a Safe Space for Indigenous Culture in Practice Going into my practicum, and having educated myself about the historical, cultural, and structural contexts of Indigenous peoples, I believe myself to be in a position to create a safe space for Indigenous culture in my practice. While working with indigenous clients, I remained grounded by studying numerous Indigenous scholars who have advocated for non-Indigenous practitioners to be mindful that they not perpetuate colonial hierarchies that may not exist among Indigenous peoples. During my practicum, I had some Indigenous clients, and I considered it vital to follow their lead in understanding their preferences. As suggested by Stewart (2009), I experienced Indigenous clients’ desire for a communal outlook into their treatment goals in therapy. I observed that family and community connections were essential aspects of their mental health wellness journeys. Engage in Allyship in Practice I trust that in my practicum I cultivated a client-centred practice and egalitarian relationships. I approached it by locating the client at the center of the therapy and by believing the experiences they told me about. I also shared information about therapy and encouraged discussion about the confidentiality and limitations agreement and about the therapeutic process itself. I also engaged in allyship and advocacy. Allyship and advocacy can take various forms; in clinical practice, my allyship took the form of providing services to a pro-bono client. I felt I demonstrated my allyship to the client by supporting the client as they became aware of some of the structural elements of their problems and did not internalizing them. While working with families, I was aware of the power dynamics between children and parents. I used allyship to 47 distribute power during therapy by, for example, negotiating ground rules that would allow children to share openly in sessions without consequences. Expand my Knowledge of Intergenerational Trauma Through my practicum placement, I have further expanded my knowledge of intergenerational trauma and how it may show up in therapy. Working with clients who have been exposed to intergenerational trauma, it was important for me to ground my practice in trauma-informed practice. It was humbling for me to reconcile theory and practice. In practice, trauma symptoms exist on a spectrum, and people respond differently on various factors such as personality traits, childhood conditioning, stress responses, and so on. As a clinician, I believed that improving my understanding of trauma and the manifestation of trauma in therapy would decrease the likelihood of reproducing invalidations. For example, when working with a trauma survivor, it was crucial to balance attention on both validation and change, because to focus primarily on change could overemphasize deficit. Moreover, working with the framework of trauma-informed practice, I noted my ability to contextualize a client’s trauma in session. Through supervision, I was able to navigate the complexities of trauma treatment in therapy. I found that creating space for clients to explore and heal trauma awhile also providing room to explore other areas of their lives helped empower clients so that their experiences of trauma did not define them. 48 Being Cognizant of the Gender and Sex Imbalances Through supervision, I expanded my knowledge of the complexities of the gender- and sex-role imbalances in family systems. For example, in my practicum placement, I noted such complexities when the women in a family aligned with one another, and the son felt like an outsider. The matriarchy reproduced patriarchal gender roles to protect a daughter and expected the oldest son to become the head of the family. I found that such expectations contributed substantially to the feelings of inequality experienced by the son. Going into the practicum, I had imagined typical gender role imbalances in which men had more power than women in families. However, my practicum experiences forced me to acknowledge the complexities of power structures that family dynamics reproduce. Expand my Understanding of Various Mental Health Issues and Their Treatment Plans As a result of the practicum experience, I believe I have expanded my understanding of the various mental health issues and their treatment plans. I familiarized myself with the Diagnostic and Statistical Manual of Mental Health Disorders (5th ed.) (DSM-5) during my practicum. Because of my commitment to use evidence-based approaches, it is important to me to inform myself about mental health diagnosis. Although I cannot diagnose clients, I felt that as a social worker, I would be better positioned to conceptualize clients’ cases and integrate evidence-based treatment plans relevant to the presenting symptoms if I had a better understanding of mental health issues and their treatment regimens. For example, I believed DBT would benefit clients who had experienced chronic invalidation, were overwhelmed by emotions, and struggled with interpersonal issues such as poor assertiveness. The unique blend 49 of validation and the encouragement of change made DBT an ideal evidence-based approach for such clients. I believed that understanding symptoms enabled differentiation for clients between naturally occurring emotions and the symptoms that manifest due to a mental health illness. For example, sharing some psychoeducational information with clients about the differences between anxiety and fear was validating. I was concerned that some clients were experiencing ongoing dangers, threats due to their physical health or other aspects of their lives. After learning about the difference between anxiety and fear, the clients started to gain more confidence. For example, clients demonstrated self-validation, acknowledging that the adversities they were experiencing warranted the level of fear they had been experiencing. Moreover, they were more receptive to learning about and using tools that would help them better manage their fears and worries. Theoretical Orientations in Practice I was grounded throughout my practicum placement by my chosen theoretical orientations: Anti-oppressive practice, strengths-based practice, and the systemic approach. I believe my theoretical orientations assisted me in achieving my learning goals. The antioppressive framework has a focus on critically analyzing ourselves and our practices. As a Black-Canada woman of African heritage, I have had my share of oppression, injustices, and privileges. During practicum placement, I engaged in self-reflection, self-care, and supervision as tools to minimize my personal biases from influencing my practice. I was keen to locate clients' problems in the structural powers instead of individualizing their problems. I also used a systemic approach to support clients to become insightful of the roles their systems, such as families and friends, have in their presenting issues and understand 50 behaviours that maintain the problem. I believe these approaches are important in removing blame from the client as they learn tools to manage their issues. I noticed the intertwining of the theoretical orientations during practice. For example, both the AOP and strengths-based practice have a strong emphasis on using language that is empowering. In practice, I learned to navigate and gauge the influence a diagnosis had on each client. Some clients felt validated by diagnoses, while others were riddled by the label and the stigma of the diagnoses. I believe empowerment looks different for each client, and as a counsellor, I need to continue eliciting clients' needs and strengths and supporting them in meeting their goals. I believe these theoretical orientations are a good fit for me, and I hope to continue grounding my practice. Chapter Summary In this chapter, I have reflected on my practicum experiences as they related to the goals I set out for my practicum. The experience was humbling and prompted insights into my practice and my personal growth. Going into practicum, I had ambitious goals, most of which I attained; in some areas, I gained new and unexpected perspectives, particularly around issues of genderand sex-role imbalances within families. I believe it is important to have the humility and practicality to reconcile theory and practice. I believe I have expanded my clinical skills by creating safe therapeutic space for clients of various cultural background and expanding my knowledge of treating trauma in therapy along with various mental health diagnoses and their treatment plans. Moreover, I grounded myself by establishing a self-care plan and by exploring my identity and its influences on my practice. 51 Chapter Five: Implications for Personal and Professional Practice and Conclusion My journey to obtain an MSW at the University of Northern British Columbia was a transformative experience professionally and personally. I feel that I embraced a humbleness fostered by the importance of engaging in reflexivity. Experiencing the rigorous coursework and my foundation practicum, I believe I gained insight and passion, and built confidence in myself for my advanced year’s clinical practicum. As I reflect on social work practice in northern, remote, and rural areas, I grow more curious about where I will go from here. I acknowledge the importance of contextualizing clinical social work practice to continue to better myself as a social worker and benefit clients. As a social worker working in clinical practice, I can support clients with their mental health journeys and advocate for them when faced with structural injustices. Training is central to preparing clinical social workers to work within their competencies as mandated by the British Columbia College of Social Workers Code of Ethics (British Columbia College of Social Workers, 2009). As I concluded my practicum, I was reminded of the need for clinical practitioners, especially in the northern, rural, and remote contexts. During my practice, I worked with clients outside of Prince George via virtual platforms as well as in person. I believe it would be beneficial to continue to prepare social workers for practice in northern, rural, and remote areas. For example, social work education can promote students’ instruction about and contextualize northern, remote, and rural practices through its inclusion in curriculum and practicum experiences. If new social workers have opportunities to explore their interests in northern, remote, and rural areas, it could help reduce the shortage of clinicians in these areas. 52 During my practicum, I have continued to affirm the importance of supervision in practice. In my future practice, in keeping with suggestions by Reese et al. (2009), I intend to continue with supervision to enhance my learning, processing, and case conceptualization. I believe northern, rural, and remote service providers should offer their employees supervision. Because of technological advancements, I am hopeful that, if needed, I can access supervision virtually to overcome the obstacles of distance and isolation (Reese et al., 2009). In assessing myself now, I’m aware of the confidence I have gained because of the opportunity to practice and learn under the supervision of Jenny DeReis. Her supervision granted me enough independence to grow and fly alone, and enough safety to seek support and validation. As a new clinician, I will continue to seek supervision to ensure my practice adheres to ethical considerations. When I was preparing for the practicum, I had goals that focussed on growth and learning, for my practice and myself. Now, I believe I achieved most of these goals at the end of the journey. Achieving these goals is a steppingstone in building my clinical practice as a professional registered by the British Columbia College of Social Workers, adhering to established codes of ethics, and remain grounded in my commitment to support clients. As I have come to the end of my MSW formal education, I am continuously reminded of the importance of being grounded in reflexivity. Reflexivity is vital in clinical practice, especially in northern, rural, and remote regions. When introspectiveness is part of my practice, knowledge, and approach, I can better evaluate my suitability for practice in northern, rural, and remote contexts. I believe reflexivity will help me nurture the strengths and resources that clients in northern, rural, and remote regions possess. 53 During my practicum time at Walmsley and Validity Counselling Services, I learned and gained experiences that strengthened my ability to contextualize my clinical social work practice, especially in northern British Columbia. Northern British Columbia is of particular interest to me because Prince George is my home. For clinical social work to effectively support clients as they address mental health challenges, it is vital clients feel safe in therapy contexts. 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Expand my Achievement Plan a. I will educate myself on the diagnosis as illustrated in the fifth understanding of edition of the Diagnostic Statistical Manual of Mental Disorders various mental health (DSM-5). issues and their b. I will consult with my supervisor and experienced colleagues. treatment plans. c. I will observe my supervisor and other experienced practitioners during sessions to see how they incorporate theory into practice. 2. Strengthen my clinical social work skills in the different phases of a. I will learn how to integrate evidence-based modalities when working with individuals, families, and groups. b. I will continue working on becoming comfortable using silence, practice, such as reflection, paraphrasing, and immediacy. intake, assessment, c. I will utilize supervision and team consultation. treatment, and termination 3. Creating a self-care a. I will have a schedule of my practicum work hours. plan for myself during b. I will identify activities that help me stay grounded. the practicum c. I will take two 15-minutes breaks and a lunch break. d. I will maintain a reasonable caseload that will facilitate my learning. I will start with a small caseload and gradually increase the number of clients I support 70 4. Explore and a. I will appreciate the strengths of the different factors appreciate my identity contributing to my identity and how these strengths may be and its influence in translated into practice. practice. b. Because of non-binary pronouns in my native language, I will be mindful of using clients' preferred pronouns in practice. c. I will notice the influence of my collective culture in practice. d. I will acknowledge the influence of the Swahili language in my communication style. 5. Contextualize client safety in a clinical social work setting a. I will observe how my supervisor and experienced counsellors create safety for clients b. I will integrate client-centred approach c. I will create room for clients to share freely without judgement. d. I will receive supervision e. I will engage in peer case consultation. 6. Creating a safe space for Indigenous culture in practice a. I will welcome and be willing to learn about Indigenous culture, worldview, and knowledge of mental health and being. b. I will observe how my supervisor nurtures cultural safety with Indigenous clients. 7. I will engage in allyship . a. I will deconstruct the client-social worker hierarchy b. I will create space for a client-centred practice and an egalitarian relationship c. I will centre knowledge from different cultures, not just a western lens. 71 d. I will engage in allyship and advocacy to bring awareness to some structural issues that may impact the clients 8. Expand my knowledge of intergenerational a. I will improve my awareness of how intergenerational trauma shows up in practice b. I will learn how to validate and support clients who are trauma and grasp a experiencing and working towards breaking intergenerational holistic experience trauma. with the c. I will engage in supervision conceptualization of d. I will engage in peer support consultation and case trauma-informed conceptualization. treatment in practice 9. Cognizant of the a. I will create a non-judgmental environment for clients gender and sex b. I will integrate feminist lens in practice imbalances in most c. I will engage in advocacy. couples and families’ d. I will learn and identify resources available for women dynamics. e. I will utilize peer consultation and supervision. 72