Examining Feminist Social Work Practice in Adult Acute Psychiatry

Ruth Pamela Haddock
BSW., University of Calgary, 2005

UNIVERSITY Of NORTHERN
B RITtS:~~ COlUMBIA
UBRARV

Prine@ Georgi, BC

""""""'·-

Practicum Report Submitted in Partial Fulfillment of
The Requirements for the Degree of
Master of Social Work

The University of Northern British Columbia
January 2009

© Ruth Pamela Haddock, 2009

11

ABSTRACT
This practicum report describes the experience of implementing a feminist practice
integrative method, articulated by Bricker-Jenkins (2002) (see Appendix A) on an adult acute
psychiatric unit. Based on direct observation and reflections collected in a journal over a three
month period, the challenges and possibilities of bringing this approach into a medical setting are
highlighted. The major challenge to implementing feminist social work practice within adult
acute psychiatry was the reliance on the biological medical model for the assessment and
treatment of patients with mental illness. However, feminist social work practice informs and
enhances psychiatric social work practice within adult acute psychiatry, as it challenges the focus
on individual pathology through emphasis on the strengths and holistic needs of patients
receiving care. This report provides strategies for hospital social workers to implement
empowerment based practice methods within the healthcare system.

111

TABLE OF CONTENTS
Abstract

11

Table of Contents

l1l

Acknowledgement

v

Introduction

1

Chapter One

Literature Review

4

History of Medical Social Work Practice

4

Psychiatric Social Work and the Medical Model of Mental Illness

6

Illness

Chapter Two
Chapter Three

Chapter Four

Role and Function of Psychiatric Social Workers in the 21st

8

Psychosocial Rehabilitation Philosophy

9

Feminism

10

Feminist Social Work Practice

11

Feminist Social Work Practice as Method

13

Feminist Social Work Practice- Current Literature

16

Implications of Practicum Report

17

Description of Practicum Setting and Experience

19

Practicum Learning Objectives

20

Methodology for Data Gathering and Analysis

22

Ethical Considerations

23

Limitations of Research Design

24

Discussion of Results

26

Reliance on the Medical Model of Mental Illness in Acute
Psychiatry
Short-Term Nature of Acute Psychiatric Social Work

26
36

The Challenges and Opportunities of the Verbal Processing
Support Group
Chapter Five

47

Implications for Social Work Practice

57

Reliance on the Medical Model of Mental Illness in Acute

57

Psychiatry
Short Term Nature of Acute Psychiatric Social Work

62

lV

The Challenges and Opportunities of the Verbal Processing
Support Group

66

References

70

Appendix A

76

v

ACKNOWLEDGEMENT

Many people have supported me during my graduate studies, including family and
friends, professors, fellow students, and my co-workers and practicum supervisor. I am
especially grateful to a number of people. Specifically:
I would like to thank and acknowledge my academic supervisor, Dr. Judy Hughes, who
thoughtfully guided me throughout the course of my studies and provided me encouragement
and direction with my practicum project. Her knowledge of feminist social work practice and the
time she took to nurture my learning process made this project possible. I would also like to
extend heartfelt thanks to my committee member, Dr. Si Transken, who not only shared all her
books on feminist social work practice with me, but also her passion and enthusiasm for
feminism and academia. A debt of gratitude is owed to my third committee member, and
practicum supervisor, Kristine Henning, who exemplifies the type of feminist social worker I one
day aspire to be. Thank you for not only being my practicum supervisor and role model but also
my friend.
I would also like to offer my sincere thanks to all of my coworkers on the psychiatric unit
where I completed my practicum. Your dedication to promoting the mental health and well-being
of patients with serious mental health issues was inspirational to me throughout my practicum
journey. Of course I must thank all the patients on the unit whose stories of sorrow and courage I
will never forget.
A big thanks to all my friends who supported me every step of the way. I could not have
made it without your kind words, witty jokes, and late night conversations. Darryn MacDonald,
thank you for always being there for me and encouraging me to follow my dreams, even when
those dreams took me away from you. You will always be my favourite person and best friend.
Last but not least I have to thank my family. To my big cousin, Adriana Di Nobile, thank you for
editing my papers over the last six years. I feel so lucky to have someone in my life that knows
me so well and still loves me. My sisters, Mary and Christine, and brother, John, who are always
in my corner, I feel fortunate to have three amazing people who have been by my side from the
very start, in this crazy adventure of life. But most importantly, to my parents, Janice and Joe
Haddock, who always put the love of their children before anything else in this world. Your faith
in me makes me believe I can accomplish anything I put my mind to. I will always live my life to
make you proud.

1

Introduction
Social workers have had a major role in acute (inpatient) psychiatric units
throughout the 20th century (Cowles, 2000). An acute psychiatric unit provides
"assessment, diagnosis, treatment, stabilization and short-term rehabilitation to people
with serious mental illnesses admitted voluntarily or involuntarily to a hospital
psychiatric unit, which often entails emergency psychiatric care" (Best Practices for
B.C's Mental Health Reform, 2002, p.53). Despite this long history, studies suggest a
lack of consensus regarding the focus and functions of psychiatric social workers
employed in hospital settings. The focus of psychiatric social work has shifted over time
between "psychological", "social" and "psychosocial" interventions with patients
experiencing serious mental illness. This changing focus can be attributed to the struggle
to establish and maintain social work's professional identity and function within the
health care system's dominant structure (Cowles, 2000).
Feminist literature (Lundy, 1993; Van Dan Bergh, 1995; Dominelli & McLeod,
1989) provides valuable critiques of the disempowering and oppressive aspects of
psychiatric social work, particularly the use of the biological medical model of mental
illness, which has occupied a central role within acute psychiatric social work practice.
Many feminists (Dietz, 2000; Parker, 2003; Penfold & Walker, 1983; Collins, 1986)
propose that the medical model of mental illness leads to the objectification of people as
diagnosis and ignores the oppressive socio-political structures in which people live.
Consequently, feminists (Bricker-Jenkins, Hooyman, & Gottlieb, 1991; Dominelli &
MacLeod, 1989; VanDenBergh, 1995) have challenged psychiatric social workers to
adopt an explicitly feminist approach to social work practice.

2

Diverse feminist social work practice frameworks have been created (Bricker-Jenkins et
al., 1991; Bricker-Jenkins 2002; Van Den Bergh, 1995; Collins 1986; Wetzel, 1986).
Many of these frameworks are comprised of feminist philosophy, values, and goals,
theories of human behavior and the social environment, and practice methods (BrickerJenkins, 2002). Feminist scholars (Bricker-Jenkins et al., 1991; Dominelli & MacLeod,
1989; VanDenBergh, 1995) argue that feminist ideology; practice perspective and ethical
commitments are sympathetic, if not identical, to that of the social work profession
(Sandell, 1993). Bricker-Jenkins et al., (1991, p. 4) states: "feminist social work practice
is as feminist practitioners do." Feminist social work practice requires practitioners to
continually assess, adapt, and challenge their direct practice based on the needs of their
clients. As, failure to "modify the practice- and its attendant theory- to accommodate
newly discovered or emerging realities is to violate the first principle of the practice"
(Bricker-Jenkins et al., 1991, p.4). Although an emerging body ofliterature suggests that
adopting an explicitly feminist social work practice method would enhance social work
practice in all areas, no studies describe how feminist social work practice methods are
implemented in adult acute psychiatric units (Bricker-Jenkins & Hooyman, 1986;
Dominelli & MacLeod, 1989; VanDenBergh, 1995).
The purpose of this report is to describe how I implemented the feminist practice
integrative method articulated by Bricker-Jenkins (2002) (see Appendix A) within my
practicum placement on an adult acute psychiatric unit. My basic premise, supported by
current literature, is that implementing a feminist social work practice method can inform
and enhance psychiatric social work practice within adult acute psychiatry (Sandell,
1993). The principle data source in this report is my on-going practicum journal that

3
describes the feminist theoretical and value propositions that underpinned my daily
practice while working on an acute psychiatric unit (Bricker-Jenkins et al., 1991). I
identify key themes that describe the challenges and possibilities encountered when
implementing Bricker-Jenkins' (2002) method. Implications for social work practitioners
working within acute care settings are also described. The subjective focus of this report
allows the experiential, dynamic and emerging nature of feminist social work practice to
be described and examined. This report will contribute to the growing literature on the
construction of feminist social work practice.

4

Chapter I: Literature Review
As discussed, there is limited literature that examines how feminist social work
practice is implemented in adult acute psychiatry. The literature review will include the
following: a historical overview of medical andpsychiatric social work, the medical
model of mental illness, psychosocial rehabilitation, the role and function of psychiatric
social work in the 21st century, feminism, feminist social work practice, and a description
of Bricker -Jenkins' (2002) integrative feminist practice method (Appendix A). The
literature review will conclude with an overview of the existing studies that examine the
implementation of feminist social work practice within hospital settings and the
implications of this report.

History ofMedical Social Work Practice
According to Cowles (2000), "the health care delivery system has three basic
levels of services that represent stages of health status: primary, secondary, and tertiary.
These stages revolve around (1) prevention, (2) repair, and (3) compensation" (Cowles,
2000, p. 14). In this discussion of the history of medical and psychiatric social work, I
will focus on social work within acute hospitals, the secondary setting of care. Hospitals
are the site of secondary prevention established to "prevent health problems which have
already emerged from developing into a worsened state." (Cowles, 2000, p. 14).
Dr. Richard Carbot, the medical director of Massachusetts General Hospital,
appointed Ida Cannon to the first medical social work position in 1908 (Rock, 2002).
Cannon and Carbot asserted that the primary function of the medical social worker was to
"teach doctors and nurses about the social and psychological aspects of disease" (Cabot,
1928, p. 265, as cited in Cowles, 2000). In their description of the medical social worker,

5
Cannon and Carbot emphasized the importance of working with patients in the context of
their social environment. Medical social workers, they asserted, are also responsible for
encouraging compliance with medical treatment plans, patient discharge planning and
follow-up (Rock, 2002). Many of these duties continue to dominate the role and functions
of medical and psychiatric social workers employed in hospital settings today.

In the early 20th century, medical social work was grounded in the social
medicine model, which asserted that many health problems were the result of the poor
social conditions of the patients. The social medicine model is compatible with the
person-in-environment perspective, which is the enduring and distinctive perspective that
guides all social work theory and practice today. The person-in-environment perspective
asserts that each individual is unique and has reciprocal interactions with their social
environment (Mattaini, 2002). "The social environment refers to the quality and
characteristics of one life situation, including interpersonal relationships, resources for
one's needs, positions, roles, and participation in the society" (Cowles, 2000, p. 10). The
social environment includes family and home life, employment, income, housing,
educational opportunities, social welfare resources in the community, health services, and
political participation (Cowles, 2000). Thus, social workers can best help clients in the
"context of the conditions and resources of their social environment" (Cowles, 2000,
p.lO).
In the 1920s, the social medical model was challenged by the biological medical
model, endorsed by the medical profession in the health care system (Cates, 2002). This
model is characterized by a focus on individual disease that is accounted for by biological
deviations from an established norm (Rock, 2002). The biological medical model focused

6

on treating individual pathology, which was which was thought to result from
neurophysiological or biochemical processes rather than from the social environment of
the patient. The biological medical model established the medical profession's status and
authority within the hospital settings (Cates, 2002).
During this time the profession of social work was struggling to gain professional
status. Abraham Fle:xner, a physician and leading medical educator, argued that social
work was not a "profession" due to a lack of scientific knowledge base and specific
techniques which could be passed on through professional education (Cates, 2002). This
message caused a rift between "practitioners who continued to see the basic mission of
social work as improving environmental conditions for people and those who sought
professional status through shifting to a focus on person-centred problems, with a
psychoanalytic theory base" (Cowles, 2000, p. 8). The struggle to gain social work's
professional status, the influence of the biological medical model, and the introduction of
Freudian psychoanalytic concepts separated medical social workers into two divisions
which still exist today: medical and psychiatric. Some argue that the division between
medical and psychiatric social work is arbitrary and creates a barrier to clarifying the role
and function of social workers within the hospital setting (Cowles, 2000).
Psychiatric Social Work and the Medical Model ofMental illness
Many psychiatric social workers throughout the 20th century worked alongside
psychiatrists to provide treatment for patients diagnosed with mental disorders (Cates,
2002). Many, influenced by the superior status of psychiatry, adopted the medical

model's understanding of a mental disorder. According to the medical model, a mental
disorder is a fixed and" internal property" which can be detected through tracking

7
causality and interpreting symptoms of an individual. Thus, diagnosis plays the central
role in the medical model for interpreting and classifying mental disorders (Warner &
Wilkens, 2004). In 1952, the American Psychiatric Association created the DSM, or
diagnostic and statistical manual: a handbook that lists mental disorders and criteria for
their diagnosis. According to the American Psychiatric Association, this manual was
devised to create more consistency in diagnosis of mental illness. This would better
inform research and the treatment of people with mental disorders (Wetzel, 1991). The
DSM assumes that disorders of the mind can be grouped together and differentiated into
separate categories based on the way symptoms presented by individuals cluster together
(Warner & Wilkens, 2004). The expert psychiatrist, who conducts the diagnosis, assesses
whether the presenting symptoms are pathological or normative. If deemed pathological
the psychiatrist uses the DSM to classify which mental illness best fits the individual's
presenting symptoms. The individual is then given the mental illness diagnosis/label that
is intended to inform treatment (Lundy, 1993).
The biological medical model dominated the understanding and treatment of
mental illness throughout the 20th century within acute psychiatric units. Some maintain
this model continues to dominate today (Parker, 2003; Chesler 1997; Dietz, 2000). The
extent to which psychiatric social workers abided by this model of mental illness is
debated in the literature (Cates, 2002; Rock, 2002). Many argued (Katz, 1996; Rock,
2002; Bricker-Jenkins, 2002) that this adoption of the medical model by psychiatric
social workers undermined the profession's search for a unique and "professional"
identity: "If psychiatric knowledge and technique were fundamental to social work, then

8

what distinguished the social worker from the psychiatrist, and social work, casework
from psychotherapy, except the social worker's inferior training?" (Katz, 1996, p. 117).
Role and Function of Psychiatric Social Workers in the 2F1 Century

As reported, the focus of psychiatric social work has shifted over time between
~t

"social", and" psychosocial" interventions with patients experiencing

serious mental health challenges (Cowles, 2000). The change in focus is due in part to the
changing philosophical foundations held by the health care system in which psychiatric
social work is embedded. Psychiatric social workers employed in hospitals work in a
secondary setting of practice where the primary organizational function is medical care
rather than social work (Cowles, 2000). The challenge of working in such a setting is
balancing the mission and practice foundations of social work with those of the primary
organization. Inevitably, the philosophical foundations held by the hospital where the
psychiatric social workers are employed influence the services they provide to patients

(

with serious mental health concerns (Austin & Roberts, 2002).
According to the mission ofsocial work in the acute-care medical hospital:
Social work services are provided to patients and their families to meet their
medically related social and emotional needs as they impinge on their medical
condition, treatment, recovery, and safe transition from one care environment
to another (NASW, 1990, as cited in Cowles, 2000, p.130).
The main functions emphasized by the National Association of Social Workers are the
use ofholistic practices to meet the needs of patients, their families, the community, and
the organization (Cowles, 2000). According to Levine, "a holistic practice perspective
takes into account the health, mental health, educational, and spiritual aspects of clients

9
and their environment" (Levine, 2002, p.838). Holistic practices employed by psychiatric
social workers in acute psychiatric units include " ... preadmission planning and discharge
planning, direct services and treatment to individuals, families, and groups, information
and referral, client advocacy within and outside the organization, promotion and
maintenance of health and mental health, prevention, remedial and rehabilitative
measures and provision of the continuity of care" (Cowles, 2000, p. 31).

Psychosocial Rehabilitation Philosophy
In 1998 the government in British Columbia released a new mental health care
reform policy that emphasized that psychosocial rehabilitation philosophy would guide
all mental health care services in British Columbia (Community-Based Mental Health
Services in BC, 2006). Psychosocial rehabilitation emphasizes the patient's full
involvement in developing and realizing their treatment and life goals. This approach to
psychiatric services focuses on helping patients with serious mental illness overcome the
"functional deficits" associated with their disability through "the augmentation of
support, the development of skills, and the reduction of barriers, and the creation of
opportunities to advance their quality of life" (Levine, 2002, p.842; Best Practices for
B.C's Mental Health Reform, 2002). The range of psychosocial services applicable to
adult acute psychiatry includes rehabilitation, case management, peer support and family
support (Best Practices for B.C's Mental Health Reform, 2002).Psychosocial
rehabilitation marks a departure from the reliance on the medical model of mental illness
for the assessment and treatment of mentally ill patients on acute psychiatric units (Sands,
1991; Rock, 2002).

10
Feminism

Feminism can best be understood as a philosophical framework or way of viewing
and understanding the source of female oppression. There are multiple feminist
perspectives that differ according to the analysis of oppression, conceptions of human
nature, and the best means to achieve societal change and liberation for women. The three
dominant feminist perspectives are classified as Liberal, Socialist, and Radical feminism.
"Liberal feminists emphasize human rights and view women's oppression in terms of
discrimination and unequal access to opportunities reserved for men" (Sandell, 1993,
p.12). Socialist feminists emphasize the diversity of women and the ways in which
women are divided by socio-economic status, race, and ethnicity. Socialist feminists call
for the complete restructuring of society from the standpoint of women. Like Socialist
Feminists, Radical feminists agree that society must be completely reconceptualised from
a female perspective but they also emphasize the importance of community and unity
among all experiences of women. Radical feminists propose that the source of women's
oppression lays in the "universal male control of female sexuality and reproduction"
(Sandell, 1993, p. 13; Bricker-Jenkins & Hooyman, 1983).
Feminism consists of evolving theories, which attempt to explain the phenomena
of women's oppression in society (Collins, 1986). It offers an awareness and critique of
patriarchy - a "structural arrangement that privileges the views, interests and activities of
men over women" (Bricker-Jenkins & Hooyman, 1983, p. 9) - and its relation to other
oppressions including capitalism, racism, ableism, ageism, and heterosexism. Early
feminist thought focused on the oppression of women by socio-political structures in
western culture, which allocated power and authority to white men and constrained the

11

regulated status of women (Bricker-Jenkins, 2002). At present time, current feminist
thought is concerned with how to work to end patriarchy so that the full development and
potential of all people can be realized (Eisenstien, 1983).
Since these early foundations, feminist scholars have re-formulated traditional
psychological theories by placing the role of gender, power, and oppression at the core of
understanding human behavior. Feminists have created new psychological theories on
human development and personality that was based on researching the lives of women.
Up until the 1970's psychological research was based only on men and thus it did not
recognize the unique life experiences of women (Parker, 2003). All feminist theories
emphasize a systemic perspective on viewing problems in a socio-political and cultural
contextual role rather than at the individual level. Many feminists believe that social
change is the key to bringing about individual change, which is why feminism can be
defmed as a social movement (Corey, 2004).

Feminist Social Work Practice
A review of the literature suggests that the social work profession has concerned
itself with women's issues since the 1970s. This interest reached its peak in the 1980s,
and since then, some argue, it has declined (Bricker-Jenkins & Hooyman, 1983; BrickerJenkins, 2002; VanDenBergh, 1995). Early articles regarding feminist social work
practice focused on the similarities between feminism and social work values and
perspectives (Wetzel, 1986; Collins 1986).
Wetzel (1986) reports that both feminism and social work share common ideals.
These include the acknowledgment of the intrinsic value and worth of every person, the
development of human potential for growth through service, and the prevention of all

12
forms of discrimination and oppression in society. Collins (1986) proposes that social
work is fundamentally feminist in nature and that social work's person-in-environment
perspective is similar to that of the feminist's "the personal is political." "The personal is
political" was the slogan of the second wave of the women' s liberation movement and
remains the core "analytical and methodological tool for feminist practice" (BrickerJenkins, 2002, p. 133). This perspective asserts that the social and personal dimensions of
life cannot be separated. "We change our world by changing ourselves as we change our
world. It is by this process that fundamental structural changes may occur" (BrickerJenkins & Hooyman, 1983, p. 13). This perspective holds that "individual and collective
pain and problems of living always have a cultural and/or political dimension" (BrickerJenkins, 2002, p. 132). Wetzel (1983) reports that these two dominant perspectives share
the common foundation that a person is best understood in the context of their
environment. Thus service must focus on creating transactions between persons and their
environments which support the inherent dignity and worth of all people. These early
articles articulate that feminism and social work are both committed to the transformation
of persons and their social environments. Therefore, feminism can enhance and inform
social work practice (Wetzel, 1986; Collins, 1986, VanDanBerg, 1995).
More recent articles emphasize the tensions that exist between feminist values and
social work practice and as weli as among differing approaches to feminist social work
practice (Bricker-Jenkins, 2002). Bricker-Jenkins (2002) warns against a simplification
and generalization of feminist social work practice. She proposes that feminist social
work practice is a complex phenomenon that is still evolving and developing (Bricker-

13

Jenkins, 2002). In defining feminist social work practice, I will focus on the work of
Mary Bricker-Jenkins, (1983; 1991; 2002) who is a leading scholar in this area.
Feminist Social Work Practice as Method

Bricker-Jenkins (2002) proposes that "feminist social workers concern themselves
with all forms of oppression, discrimination and exploitation, and they work for the
mobilization of the power of people to create just relationships in all spheres of life"
(p.131). Bricker-Jenkins (2002) defmes three overlapping approaches to feminist social
work practice as identity, conceptual framework and method. These definitions were
revised from the 1983 National Association of Social Work sponsored Feminist Practice
Project. This pilot project surveyed a small number of feminist social workers in attempts
to ground the definition of feminist practice in the collective experience of this diverse
group of feminist social work practitioners who work in varied practice settings (BrickerJenkins & Hooyman, 1983; Bricker-Jenkins et al., 1991; Bricker-Jenkins, 2002).This
discussion will focus on Bricker-Jenkins' (2002) definition of feminist social work as a
method (see Appendix A). This is the definition I most closely subscribe to as a feminist
social work practitioner. Feminist social work practice as an integrative method presented
by Bricker-Jenkins (2002) forms the basis of the inventions I implemented and explored
in my practicum placement.
Feminist practice as an integrative method is the attempt to integrate feminism
with the full range of the social work mission. Bricker-Jenkins (2002) reports that an
integrative method for social work has been a central goal for feminist social workers,
one that continues to be advanced but not yet realized. The defmition of feminist practice
as integrative method (see Appendix A) is based on the feminist analytical and

14
methodological tool discussed earlier: "the personal is political." Feminist social work
practice as a method is concerned with creating change across the continuum from
personal to political and individual to institutional. This overarching framework attempts
to move women's personal struggles into the political arena and hence deindivdualize
them and introduce them to social analysis (Baines, 1997).
Feminist social workers who use an integrati:ve method use a wide range of
approaches, modalities, methods and techniques that have been revised and adapted in
accordance with feminist principles and values. Although diverse, feminist social work
methods share many central concepts. Feminist social workers are united in their belief
that the client, not the practitioner, is the expert on his/her own life. The worker-client
relationship is characterized by respect, collaboration, and empowerment. Feminist social
workers believe that one does not have the ability to empower another, but rather can
work with the client so that the client can empower themselves (Parker, 2003).
From a feminist perspective, empowerment is the process of changing power
arrangements so that all people can access resources to meet basic human needs
and participate in the social, political, and economic decisions that affect their
lives. Empowerment is collective in process and outcome, and requires change
in both consciousness and the structures that determine resource allocation
and decision making (Levine, 2002 p.835).
Thus, the feminist social work practitioner helps her clients advocate for themselves and
develop their own self-sufficiency and self-direction. Feminist social work methods use
reflexive and transparent practices with clients. The feminist social worker recognizes
that she brings her own life and professional experiences into the worker-client

15
relationship. She uses appropriate self-disclosure about her own life and how she is
affected by the interactions she has with the client. The feminist social worker also tries
to be explicit about every method used in practice. Lundy (1993) reports that explicitness
is the unspoken mandate that underlies all feminist social work practice. Explicitness can
be defined as the open, honest discussion the social worker has with the client about
every aspect of assessment and intervention (Corey, 2004; Lundy, 1993). The feminist
social worker uses explicitness and self-disclosure to try and establish a more egalitarian
relationship with her clients that encourages empowerment and self-actualization.
Feminist social work methods are not limited to the assessment and diagnosis of
pathology like the medical model, but rather their focus is on bringing attention to the
client's strengths and abilities to transform and transcend their current situation (Dietz,
2000).
Feminist social workers using the integrative method view all forms of social
work practice as a political act (Cowger, 1994). The feminist social worker engages the
client in power sharing dialogue about how institutionalized sexism and other oppressive
ideologies have created problems in the client's life. Through this dialogue, internalized
oppression is made visible and the client is enabled to change the way in which she views
the world and herself. Feminist social workers propose that individual insight is not
sufficient to create personal change. The client and social worker must both be dedicated
to challenging cultural, social, and political beliefs that discriminate and restrict nondominant members of society (Corey, 2004). The feminist social worker believes that the
collective action breaks the client's isolation. She may encourage the client to join a peer
support group in which she could join with other people who have experienced similar

16
issues and offer and receive mutual support and understanding. The feminist social
worker may also recommend client involvement in social action strategies that seek to
create social justice by challenging existing oppressive structures in society. Under the
feminist principles of collaboration, equality, and empowerment the client decides what
social action would be most helpful for her (Penfold & Walker 1983). Feminist
practitioners attempting to use a feminist integrative method work " ... to create options for
and with people, and while preserving safety, respect, and support for their natural
healing and helping in process and the choice they make in relation to their own
conditions" (Bricker-Jenkins, 2002, p. 133).
Feminist Social Work Practice- Current Literature
As reported, there is limited literature that describes how feminist social work
practice can be implemented within an adult acute psychiatric unit. The majority of the
literature examines how feminist perspectives have been integrated into direct practice
within medical social work in hospital settings (Gary, 1991). In her article, Baines,
(1997) examines how her use of feminist practice methods was both helpful and
obstructive within an underfunded inner-city public hospital. She found that aspects such
as "equalizing power in the intervention" which, as stated, is a central ideal of feminist
social work theory and practice, did not take into consideration the ways in which race,
class and gender are played out within a hospital setting. For example, she reported that
the techniques of self-disclosure and explicitness did not equalize the worker-client
relationship; rather, it alienated, frustrated, and further marginalized the clients she
worked with. "Self-disclosure is based on the notion of sameness that does not recognize
the role that racism and class play in women's lives" (Baines 1997, p. 306). Baines

17
(1997) reported that the use of the slogan "the personal is political" as a central tenet for
her implementation of feminist social work practice was helpful in informing
interventions that brought women from similar personal-political circumstances together
for mutual support and care.
Other articles focus on using feminist social work practice within managed care
environments (Dietz, 2000; Austin, 2002). Dietz (2000) reports that managed care
environments, which focus on profit making, provide an exceptional challenge to
feminist social workers. She proposes that the only way for feminist social workers to
respond to managed care is at the macro level; for example, organizing service providers
and users to lobby for regulations of managed care at the state and national level. Many
articles examine how feminist social work practice can be implemented in therapeutic
environments, such as counseling non-profit agencies (Parker, 2003; Lundy, 1993;
Sandell, 1993). Parker (2003) reported that feminist social work interventions such as
same-gender therapy groups, social education, and community projects have been
effective in a family therapy agency at addressing issues of equality and justice within
clinical social work practice.
Implications ofPracticum Report
There are several implications for feminist social work practice that can be
derived from this practicum report. As noted throughout, I could not fmd any studies in
the literature that describes how feminist social work practice methods can be
implemented in adult acute (inpatient) psychiatric units. This indicates a gap in the
literature, which this practicum report contributes to. Bricker-Jenkins (2002, p.132)
reports that feminist social work practice is by "no means uniformly understood or

18
applied." She reports that much work is needed in order to identify how feminist social
work practice as an integrative method shapes individual practices. She reports that many
structural changes in the environment of practice hinder the use of many feminist social
work practice methods. The structural environment of a health care setting and the role of
the medical model of mental illness is one such environment that may hinder feminist
social work practice methods. This practicum report describes how feminist social work
practice as an integrative method is implemented within the structural environment of the
health care system. The use of reflexivity in the report will allow me to describe my
experience in my own voice (Gilligan, 1983). "In a profession where the majority of
workers and clients are women, this represents a necessary and important contribution"
(Sandell, 1993, p.18).

19
Chapter II: Description of Practicum Setting and Experience
My practicum setting was an adult (in-patient) acute psychiatric unit at a regional
hospital in British Columbia, Canada. In order to protect the confidentiality and
anonymity of the patients and fellow staff members I worked with, this report will not
include the name of the hospital where the study was conducted. My practicum
placement was on the adult acute (inpatient) psychiatric unit, which was comprised of
two programs: the general inpatient program and the Psychiatric Intensive Care Unit.
A general acute psychiatry program is defmed as:
The general inpatient program which applies to all patients requiring psychiatric
care who do not meet admission criteria for other specialized units (e.g.
Psychiatric Intensive Care, adolescent, geriatric).
All inpatient programs should be designated to admit involuntary patients under
the Mental Health Act. The general inpatient program provides concurrent,
multidisciplinary assessment and treatment of people with psychiatric disorders as one
component of a continuum of care (Best Practices for B.C's Mental Health Reform, 2002,
p. 3). Continuum of care is defined as the "variety in spectrum of services" which
currently exists in the health system (Best Practices for B.C's Mental Health Reform,
2002, p. 9).
There are 20 beds on the general adult acute psychiatric unit (K. Henning,
personal communication, March, 2008). The Psychiatric Intensive Care Unit (PICU) is a
"secure (locked) unit for patients requiring the highest level of observation and
containment" (Best Practices for B.C's Mental Health Reform, 2002, p. 4). The PICU is
only used temporarily for patients who are at imminent risk of harming themselves or

20
others. The patient is then transferred to the general inpatient unit once he or she is
stabilized and safe (Best Practices for B.C' s Mental Health Reform, 2002). There are four
beds on the PICU on the adult acute psychiatric unit (K. Henning, personal
communication, March, 2008).
Under the supervision of my practicum supervisor, the psychiatric social worker
on the unit, I was a member of an interdisciplinary team of health care professionals
employed on the adult acute psychiatry unit. The interdisciplinary team was comprised of
members from various professions or aisciplines who work together collaboratively. The
team included psychiatrists, medical students, registered nurses and psychiatric nurses, an
occupational therapist and one psychiatric social worker, who worked together to provide
24-hour care to patients with serious mental health concerns (K. Henning, personal
communication, March, 2008). The rationale for interdisciplinary teams was that multiple
kinds of knowledge and skills were required to provide comprehensive and coordinated
services to patients receiving care (Cowles, 2000). The psychiatric social worker on the
adult acute psychiatric unit's many responsibilities and functions included discharge
planning, patient advocacy, facilitation of a patient support group, psycho-social patient
assessments, assisting patient's in accessing government and community resources, and
providing patients and their families with support while on the unit.

Practicum Learning Objectives
I achieved the following learning objectives while in my practicum placement:
1. Gained an in-depth understanding of Bricker-Jenkins' (2002) feminist integrative
practice method (Appendix A) and learned how to implement this method within
my practicum setting.

21
2. Achieved a greater understanding of the role of a psychiatric social worker within
adult acute psychiatry.
3. Increased my knowledge of the current policies, procedures, and practice
frameworks that guide psychiatric social work practice within the adult acute
psychiatric unit.
4. Identified the possible challenges and possibilities that existed in implementing
Bricker-Jenkins' (2002) feminist integrative practice method (Appendix A) within
my practicum placement, and devised strategies to overcome any challenges.
5. Critically analyzed and evaluated whether implementing Bricker-Jenkins' (2002)
feminist integrative practice method (Appendix A) within the adult acute
psychiatric unit was helpful when working with patients.
6. Completed a literature review which includes: an historical overview of medical
and psychiatric social work, the medical model of mental illness, psychosocial
rehabilitation, role and function of psychiatric social work in the 21st century,
feminism, feminist social work practice, and a description ofBricker-Jenkins'
(2002) integrative feminist practice method.
7. Made recommendations for hospital social work practice and policy.

22
Chapter III: Methodology for Data Gathering and Analysis
During the course of my practicum I wrote in an on-going journal. This journal
focused on describing my experiences with implementing Bricker-Jenkins' (2002)
feminist integrative practice method within my practicum setting at the adult acute
psychiatric unit. The journal chronicles my process of self-understanding and selfquestioning regarding my daily practicum activities. In this journal I made explicit the
cultural, political, social, and ideological origin of my perspective and role within my
practicum placement. The focus on owning my perspective and placing this perspective
within the political and cultural context is in keeping with the feminist, reflexive research
traditions (Patton, 2002). In this journal I explicitly used my 'self as the subject of
intellectual inquiry (Stanley, 1999). The perceptions and experiences of the colleagues
and patients I worked with in my practicum setting, although valuable, were not
documented in the journal.
The data from the journal emerged throughout the course of my practicum
placement. Feminist social work practice is experiential, open, and dynamic; thus, the
content of the journal was dependant on the honest description of my experiences when
applying a feminist practice method within my practicum placement (Bricker-Jenkins,
2002).There was ongoing supervision and consultations with my practicum supervisor,
the psychiatric social worker on the unit. In these meetings we discussed my learning
process and reflected upon the content of my practicum journal. She provided me with
constructive feedback regarding my practice and made suggestions on how I could
continue to implement feminist social work practice on the unit. There were two
evaluations with my practicum supervisor and academic supervisor at the mid and end

23
point of my placement, in these evaluations we discussed my practicum activities and my
process of implementing feminist social work practice within acute psychiatry.
Upon completion of my practicum, I read and analyzed all the journal entries I
maintained throughout its course. I indentified key themes which describe the challenges
and opportunities I encountered when I implemented Bricker-Jenkins' (2002) method on
the unit. These themes are explored in the results section of this practicum report.
Included in this section are my recommendations on overcoming these challenges. My
recommendations provide the basis for implications for hospital social work practitioners.
Upon completion, I compared my experiences with the current feminist social work
practice literature to place this report in the larger scholarly context. The analysis of my
journal deepened my self-awareness and knowledge of feminist social practice within
adult acute psychiatry and contributes to the literature on the construction of feminist
social work practice.

Ethical Considerations
As reported, this practicum report focuses completely on my experiences
implementing a feminist integrative practice method within the adult acute psychiatric
unit. I did not conduct any interviews with patients or colleagues and thus informed
content was not necessary for this practicum report. Neither did I include any names or
identifying information of the patients or their families with whom I worked with at my
practicum setting. My on-going practicum journal, which is primary data source in this
report, also does not report any of the patients and their families' identifying information.
I did not report any of the names or identifying information of the staff with whom I
worked with. The Research and Ethics Board at the University ofNorthem British

24
Columbia (UNBC) approved this practicum report. Upon publication, my practicum
report will be available to my practicum supervisor and the library at UNBC.

Limitations of Research Design
One of the limitations of the practicum report is that the sole focus is on my
subjective experiences within my practicum setting. This focus does not allow for the
direct experiences of the patients or colleagues to be voiced and documented in this
study. Patients with serious mental health issues who receive care within acute
psychiatric units could provide valuable insight into how 'they' experience feminist
practice methods and thus increase my understanding and evaluation of this method.
Patients with serious mental health concerns have been silenced by traditional research
studies. While the research design focuses on my experiences as a professional, there is a
need for studies that allow patients to speak for themselves in their own 'voice' (Gilligan,
1983).
A second limitation of this practicum report is that I only described how feminist
integrative practice methods can be implemented within the one hospital I worked at, and
thus the results can not be generalized to other health care settings. A third limitation is
the short duration of my practicum placement (560 hours). This length of time may limit
a full description on how feminist integrative practice methods can be put into operation
in a practicum setting. Lastly, my role in the practicum setting is that of a graduate
practicum student and not a feminist psychiatric social worker. This role could prohibit
the full range of opportunities I have for applying a feminist integrative practice method.
Thus, through my findings I may not be able to completely articulate how a feminist

25
social work practitioner can use feminist practice methods to enhance psychiatric social
work practice within adult acute psychiatric units.

27
can seldom be understood from the reliance on a singular theoretical orientation. This
statement captures the major challenges I encountered when implementing BrickerJenkins' (2002) feminist practice integrative method within a psychiatric unit that relied
predominately on the biological medical model for the assessment and treatment of
patients experiencing mental illness.
As stated in the literature review, the biological medical model of mental illness
postulates that mental illnesses are "proven biological diseases of the brain and that
emotional distress results from chemical imbalances in the brain" (Double, 2004, p.153).
The assumption that the biological medical model of mental illness is backed by
"scientific fact" has led to the authority and reliance on this model for the diagnosis and
treatment of mental illness (Double, 2004; Carpenter, 2002). Carpenter (2002) reports
that psychiatric services have accepted that mental illnesses are biological and organic
diseases, even though research does not back these assumptions. The American
Psychiatric Association (APA), the most prominent supporter of the biological medical
model of mental illness, acknowledges that "brain science has not advanced to the point
where scientists or clinicians can point to discernible pathological lesions or genetic
abnormalities that in or of themselves serve as reliable or predictive markers of mental
disorders" (Double, 2004, p.153). The APA does, however, speculate that, eventually,
they will be able to prove that organic deficits in the brain, such as disrupted neural
circuitry, are the cause of mental disorders (Double, 2004). Double (2004, p. 154) reports
that "acting without proof as though these speculations are true" has lead to the near
reliance on the medical model within psychiatric services.

28
The reliance on the medical model of mental illness held in the assessment and
treatment of patients on the psychiatric was a salient issue that I identified in my journal
from the first day of my practicum placement. As reported in my practicum journal:
The first task of the day was to have "rounds" a meeting in which we discuss the
patients currently on the unit and any new patients who had just been admitted.
The occupational therapist, social worker, psychiatrist, medical student, team
leader who is a nurse, and the in-charge nurse, attended this meeting. Each
member of the team was provided a form which states the name of each patient on
the unit followed by their DSM diagnosis, their doctor, which nurse is caring for
them that day, their date of admittance, possible discharge date and which
community agency they are working with. I was struck by the fact that almost all
the patients had a DSM diagnosis and almost all the patients were prescribed
psychotropic medications (05/01/08).
I view the medical model of mental illness as a set of hypothesis and theories, and
as such, reject the notion that this model represents the "facts" or "truth" about the origin
and appropriate treatment of mental illness. It was my experience that the biological
medical model of mental illness can be helpful in the assessment and treatment of some
patients with mental illnesses. I witnessed how the appropriate DSM diagnosis informed
the use of psychotropic medications, which in turn helped many of the patients on the
unit gain the mental and emotional stability necessary to cope with the day-to-day
struggles oflife. I concur with Carpenter (2002, p.87) who acknowledges that "medicine
has clearly made vital contributions for people with psychiatric disabilities." Examining
and treating the neurobiological aspects of a person's mental health clearly has its place

29
within acute psychiatric units. However, the danger arises when psychiatric social
workers rely on only one model to assess and treat mental illness.
The reliance on this model of mental illness can lead to a reductionist view of individuals
as diagnosis or "tendency to treat people as brains that need their lesions or disrupted
neutral circuitry cured" (Double, p.l54, 2004). The focus, commonly employed on the
psychiatric unit where I completed my practicum, was on treating the individual's
presenting symptoms, through the use of diagnosis and treatment with psychotropic
medications. Feminists assert that mental illness is not based on biological deficits but
rather is a communication and resistance against a socially oppressive environment.
Feminists believe that the cause ofhuman suffering is based on the oppressive sociopolitical structures, which impinge on individuals. The individual diagnosed with a
mental illness has developed coping strategies to deal with the oppression and abuse
found within their social environment that have become maladaptive. Thus the pathology
is not found within the individual, but rather, the oppressive conditions of their social
environment. It was my experience within my practicum placement that issues such as
poverty, racism, sexism, violence, oppression and abuse affected the majority of the
patients on the unit. The biological medical model fails to recognize how these social
issues affect a person's mental health. My findings in this area reflect the feminist
critique of the biological medical model of mental illness, which is well developed in the
literature (Dietz, 2003, Parker, 2003, Bricker-Jenkins, M. 2002).
The sole focus on assessing and treating the symptoms of a person's neurological
pathology differs from feminist social work's holistic interventions aimed at
understanding and treating the biological, psychological, social and spiritual needs of a

30
person (Mattaini, Lowery, & Meyer, 2002). Bricker-Jenkins' (2002) integrative method
emphasizes interventions based on empowering individuals to create personal, relational,
and social changes to support the individuals natural healing and "the choice they make
in relation to their conditions" (Bricker-Jenkins, p. 133, 2002). Feminist social work
practice asserts that all problems in living, such as mental illness, must be understood by
examining the social and cultural context of a person's life. The feminist assumption ''the
personal is political" and social work's "person-in-environment" perceptive differs from
the biological medical model of mental illness by focusing on the inseparability of the
personal and political aspects of a patient's life (Parker, 2003).
The challenges I encountered in implementing Bricker-Jenkins' (2002) feminist
integrative method within the psychiatric unit was to not become influenced by the
dominant model and thus lose my commitment to feminist practice. The social worker is
a part of the hospital setting, and as such, must be knowledgeable and respectful of the
dominant model for the assessment and treatment of mental illness. At the same time the
social worker has an obligation to the values and practices of their profession which, as
reported, can differ from those endorsed by the hospital environment. As a feminist social
worker and practicum student, I had to balance both perspectives when working with
patients on the unit.
I accomplished this by recognizing the biological component of a patient's mental
illness while working with the patient to create changes in their social environment. This
required continuous critical self-reflection of how I was impacted by the environment. I
found that maintaining my practicum journal aided in this process of self-awareness. I
was thus able to identify when I was losing sight of the values and goals of feminist

31

social work practice in favor of the biological medical model of mental illness, which I
was constantly being exposed to on the unit. One example of how the environment in
which I worked influenced my personal practice is captured in the following journal exert
on the power of language and the medical model of mental illness:
The first thing I noticed upon commencing my practicum on the adult psychiatric
unit was the DSM or medical model of mental illness language used in this
environment when talking about and with the patents on the unit. As stated most
patients on the unit were provided a DSM diagnosis or label. Many feminists,
including myself, believe that language creates reality and that there are multiple
realities that are created by individuals. Feminists have raised the importance of
language and have created many changes to address the sexist language used by
many institutions. I believe these changes in language have changed the way
people construct and perceive reality.
When a mental health professional label's someone with a DSM diagnoses they
create a person's identity and thus their reality. I concur with feminists who report
that people can become their diagnoses and thus are pathologized by mental
health professionals who are treating them. I can see the appeal of placing
complex issues and situations in a box or constructing a label rather than
addressing structural issues like poverty, racism, sexism, and other forms of
oppression and abuse. I flnd addressing the oppressive conditions in which
many of the patients live can be overwhelming and make me feel powerless to
create change. If I place the pathology or dysfunction within the patient I only

32
have to focus on "fixing" the "dysfunctional" patient and not the dysfunction
found in society.
Before I started my practicum at the adult inpatient psychiatric unit I was always
very careful with the language I used when talking with and about the people I
worked with. When I did use DSM diagnoses I would use externalizing language
borrowed from Narrative Therapy. Externalizing language separates the
diagnoses from the person. For example, I would say "depression is
overwhelming a person at this point in time." This ensures that I am not
pathologizing the person by referring to them as their diagnosis. Their mental
health diagnosis is affecting them but they are not their diagnosis. A person
is too complex to be defmed by a label or DSM diagnosis. If we state that a
person is schizophrenic we are creating an identity for that person; an identity
that is false and acts to stigmatize that person.
I have noticed that since I started my practicum on the adult psychiatric unit that I
have been using the DSM language of mental illness more often. I have caught
myself saying things like; "she is totally borderline personality disorder" or I
have referred to people has "that bi-polar guy." I think I may be changing the
language I use because I am so immersed in it on the unit. I still believe in the
importance of language in the construction of reality and I must work to monitor
the way I use language with and about patients on the unit. I have noticed the
social worker on the unit is careful with the way she uses language. She does not
refer to people has their diagnosis. I must ensure that I do not place the pathology
within the person and ignore the social environment in which people live. By

33
using this type of language I am neglecting the principles and practices of
feminist social work.
The on-going supervision I had with the psychiatric social worker on the unit also
aided in my process of critical self-reflection. This proved essential to implementing
Bricker-Jenkins' (2002) feminist integrative method on the unit. It was through those
meetings that I was able to verbalize the challenges I was experiencing while attempting
to apply a model of practice that differed from the dominant model on the unit. It was
through my supervisions with the psychiatric social worker, and my observations of her
practice that I learned how the social worker on the unit is in the unique position to help
individuals with serious mental health concerns create mutually supportive relationships
with their environment.
My journal noted throughout that the psychiatric social worker on the unit is in
the best position to address the holistic needs of the patients and does so in her daily
activities. Some of the daily responsibilities of the psychiatric social worker include:
1) Ensuring patients have a place to live when they are discharged from the unit,
which includes assisting patients in finding affordable housing, such as, shelters
or transitional housing.
2) Helping patient's access financial and material aids, such as, applying for
Ministry of Finance and Social Development assistance, disability, unemployment
insurance, clothing allowances, and finances to help with childcare,
transportation, clothing, and household goods.
3) Connecting with family members to get information about the patient's history,
interpersonal relationships, and current problems in functioning. This may include

34

arranging and facilitating a family case conference. This conference is an
opportunity for all people involved in the patients care to come together to discuss
and develop a care plan for the patient on the unit.
4) Educating patients about resources in the community such as activity centres, long
term counselling organizations, addiction services, immigrant and multicultural
centres, elderly services and organizations mandated to meet the needs of the First
Nations population.
5) Conducting risk assessments and reporting to the Ministry of Child and Family
Services when child protection issues arise. In these cases it is the social worker's
responsibility to attain more information from the patient about the patient's
children and their overall welfare and to notify the Ministry if there is any
suspected child abuse and neglect.
6) Completing psycho-social-assessments with patients. These assessments examine
the patient in the context of their social environment.
7) Advocating on behalf of patients to help them access needed services by
removing existing barriers.
8) Facilitating patient verbal processing support group.
Through my observations and participation in these functions I was able to
implement Bricker-Jenkins' (2002) feminist integrative practice method on the unit. I had
the opportunity to work collaboratively with the patients on the unit in accessing needed
supports, whether it was in their immediate family or in their community. I formed
relationships with patients on the unit in which I tried to equalize the power dynamics
that exist in the social worker-patient relationship. I did this by respecting the inherit

35
dignity and worth of all patients on the unit, and thus not treating them as a labeled
diagnoses. I had many conversations with patients and their families about how issues of
oppression and abuse were affecting their mental health. These interactions allowed me
to learn about the patient's strengths and resilience in coping with mental illness and their
oppressive socio-political environment. Focusing on the patients strengths took me away
from the sole focus on 'pathology' and 'disease' employed on the psychiatric unit.
Through these conversations I was able to work with patients in a collaborative goalsetting process in which we developed plans of action based on their own self-defined
needs to support their healing and recovery process.
I also facilitated groups, family meetings and attended staff meetings. These
opportunities allowed me to educate the patients and fellow staff members on the unit
about social issues, such as child abuse, domestic violence, and sexual assault, and how
these forms of violence affect a person's mental health. When discussing the care of
patients on the unit with other team members the social worker and I informed the team
of the psycho-social challenges the patients were currently dealing with. This information
provided a context for the patient's current mental health crisis that allowed for a more
holistic assessment and intervention. These roles and functions allowed the psychiatric
social worker and I to implement feminist social work practice on the unit.
The biological influences affecting the patient's mental health were not our main
concern. The social worker's functions on the unit focused on social and interpersonal
issues that co-occurred with the patients biological mental health concerns. These issues
included "insufficient financial resources, interpersonal conflict, social isolation or
housing instability" (National Health Policy Forum, 2007, p.4). The social worker helped

36
the patient create changes within the context of their social environment, which is
compatible with the principles of feminist social work practice. The social worker's
interventions are focused on the biological, psychological, and social factors that
influence the patient's mental health. The social worker's role within the interdisciplinary
team is thus of vital importance to providing holistic mental health services to the patients
on the unit. The psychiatric social worker, however, still works within the dominant
medical model paradigm and, as such, is influenced and at times limited by this
perspective of mental illness.

Short-Term Nature ofAcute Psychiatric Social Work
A second theme I identified through the analysis of my practicumjournal was the
short-term nature of acute psychiatric social work, which provided a challenge to fully
implementing Bricker-Jenkins' (2002) feminist integrative method within practicum
placement. The psychiatric social worker and I worked on an acute (inpatient) psychiatric
unit located in an inpatient hospital setting, which provided "short-term response to the
urgent needs of an individual experiencing a mental health crisis" (National Health Policy
Forum, 2007, p. 2). Mental health crisis is a broad term that is open to the interpretation
and definition of the individual and mental health professional. Based on my time on the
unit, I observed that often a mental health crisis involved situations which included risk
of harm to self or others. This included danger of suicide, mental and emotional
instability resulting in the inability to care for one's self, and function at home and in the
community. Other patients commonly admitted to the unit were those with serious and
persistent mental illness who, due to their condition, required frequent hospitalization for
recurrent mental health crises (National Health Policy Forum, 2007).

37
The goal of the acute psychiatric unit was to stabilize the patient and diffuse the
immediate mental health crisis. Services provided to the patients on the unit were thus
short- term and focused on crisis intervention. These short-term services included
assessment, supervision, diagnosis, and treatment with psychotropic medications. Other
short-term interventions included one- on- one patient interviews, family meetings,
patient support and educational groups. The psychiatric social worker and I also provided
short-term services for the patients on the unit and their families. As reported in previous
sections ofthis report, some of those services included, discharge planning, patient
advocacy, psycho-social assessments, helping patient's access government and
community resources, and providing patients and their families with support while on the
unit. The acute psychiatric social worker and I only provided these services to patients
who were currently admitted to the unit. Once the patient was discharged from the unit all
our social work services were terminated.
The length of stay for most patients on the unit was brief, ranging from a couple
days to a few weeks. I saw very few patients who stayed on the unit for longer than one
month. Many patients on the unit did require long-term treatment that was to be provided
as an outpatient service and accessed in the community. These outpatient services
included individual, couple, family and group therapy and or services geared at helping
the patients meet their needs for housing, employment and finances. The following
excerpt from my practicum journal illustrates the fast paced nature of acute psychiatric
social work:
It seems that patients are continually coming and going and thus the psychiatric
social worker and I have very limited time to work with the patients and perform

38
our social work functions. Due to the large numbers of patients admitted to
the unit, 20 inpatient beds on the unit, and 4 beds in the Psychiatric Intensive
Care Unit (PICU), along with the short stay of each patient it is not possible for
the social worker to provide services to all the patients on the unit. Due to time
restraints it is not even possible to meet all the patients on the unit and assess if
they required social work intervention.
Canada and the United States have seen a significant decrease in the number of
acute psychiatric beds in public-run hospitals. The trend in mental health care services
over the past four decades has been to decrease institutional, long-term care for people
with serious mental illness and develop a system aimed at prevention, early intervention,
and community-based services (National Health Policy Forum reports, 2007). Under this
mental health care system hospitalization for a mental health crisis should be avoided
whenever possible and the patient should be treated in his or her home and community. If
hospitalization is necessary, the patient's stay should be short, with a rapid return to
outpatient community based services (Geller, 2000). Many argue that these changes in
the mental health care system have lead to the inadequacy in acute psychiatric services
both in scope and availability. An article for the National Health Policy Forum reports
(2007):
Institution-based treatment resources are, in fact, contracting, but this reduction in
inpatient psychiatric services in not being balanced by the development of strong,
comprehensive community-based systems of care. New outpatient models are
being developed, but they have not been implemented at the scale necessary to
compensate for the decrease in inpatient beds (p.2).

39
The acute psychiatric unit where I completed my practicum was influenced by
this trend in mental health care services. The medical model places pathology within the
individual which is compatible with the short -term micro- level services offered to
patients on the unit.
Unlike the medical model feminist social work interventions have a "dual focus"
on individual and social change (Dietz, 1997). Thus feminist social workers cannot
ignore the macro- level structures, which are interconnected with micro-level issues.
Bricker-Jenkins' (2002) feminist integrative method emphasizes the "political," libratory,
and transformative aspects of practice, which seek to remove the structural barriers which
impede a person from controlling the conditions of their lives. In an acute psychiatric
unit that emphasized short- term crisis interventions and rapid discharge to home and the
community practicing feminist social work created challenges.
The greatest obstacle to fully implementing Bricker-Jenkins' method on the unit
was lack of time. The time constraints placed on the psychiatric social worker and I
resulted in a focus on micro-level social work practice that left little time for social action
and justice. Dietz (1997, p. 371) reports "many social workers understand institutional
and social problems at a perceived, discrete micro level, focusing on interventions on
individuals while failing to confront institutionalized oppression." Social work as a
profession has been criticized for its failure to practice in accordance with its code of
ethics, which emphasizes social justice. As Elliott (1993, p.22-23) states: ''the social
worker should act to prevent and eliminate discrimination and should act to expand
choice and opportunity for all persons, with special regard for disadvantaged groups."

40
As a feminist social worker I believe our interventions must be geared at creating change
in the patient's psychosocial environment. Macro-level social work interventions within
adult acute psychiatry may include: lobbying for changes within mental health care
policy to increase funding for inpatient and outpatient services or challenging the
provincial health authority to increase funding for the acute psychiatric unit. This may
include increase in inpatient beds, staffmg, and resources for patients on the unit.
Additionally, interventions could involve advocating with and for patients to provincial
agencies to remove some of the barriers which currently exist for people with mental
illness to access affordable housing, financial aid, child care, and vocational training;
challenging societies stigma and ignorance against people with mental illness, which may
involve public educational campaigns; and working collaboratively with feminist
organizations who provide services, like sexual assault counseling, to meet the unique
needs of women experiencing mental health concerns.
I agree Dietz (1997) and Elliott (1993) who report that social work, as a
profession, has lost sight of the importance of macro-level practice. However, many
social workers work within agencies that provide short -term services or crisis
intervention and as such are constrained by the mandates of the system in which they
work. On the adult acute psychiatric unit where my practicum took place there was only
one social worker for 24 patients and their families. Providing short-term micro-level
services for these patients and their families kept the social worker very busy. Applying
macro-level interventions to work towards creating structural changes in society requires
an immense amount of time and effort. There simply was not enough time in the day to
implement the "dual" focus of feminist social work practice. Furthermore, the psychiatric

41
social worker on the unit had to work in accordance with her job description that focused
on psychosocial interventions with patients and their families. Community organizing
and lobbying for policy change was not part of her job description. As Bricker-Jenkins
(2002) reports, the structural environment may limit feminist social worker practice. I
found that working within a hospital setting limited the full realization of feminist social
work practice.
The heavy workload placed on the psychiatric social worker, reliance on an
individualistic pathology model and working within an environment that does not share
the same commitment to creating societal transformation resulted in a focus on microlevel interventions. Not having enough time to work towards creating changes in the
systems, which act to oppress and disenfranchise the patients on the unit, was, at times, a
source of frustration in my practicum. As reported in my journal:
At times I feel like the only thing I can do is to provide a patient with a list of
community resources and send them on their way. It seems like our social service
system makes it as hard as possible for people to receive fmancial assistance and
the assistance they do receive is hardly enough for them to meet their basic needs.
The governmental systems, which are supposed to help people with mental
illness, seem to blame patients for their condition. I sometimes wonder if the
short- term services I am providing the patients really create any meaningful
change in their life. It seems like I am putting a band-aid on a gaping wound.
These frustrations were the result of working predominantly towards creating
individual change. I helped the patients on the unit access the needed resources available
in the community and through government agencies, but I did not work to change the

42
way these systems operate or lobby to create much needed services for people with
mental illness. This micro-level focus in social work practice leads to burn out. It seems
that all helping professionals work within a "broken" system and it is this system that
oppresses the clients we serve. If we only focus on helping the clients we work with to
survive in an oppressive socio-political environment then we are only perpetuating that
same system and not creating societal transformation.
My experience working on the adult acute psychiatric unit taught me that
implementing feminist social work practice is a considerable challenge. It is one thing to
identify how institutionalized oppression and sexism affected patients, however it is
another to actively work to change those oppressive ideologies and systems in direct
practice. In analyzing my practicum journal I identified a "gap" at times between feminist
ideology and my direct practice. As reported in my journal:
I have to admit that over the course of my practicum there have been times when I
have blamed the patient for their current mental health crisis. I have caught
myself thinking things like, "ifthey would only just stop using drugs or get
a job they would not have these problems." "They need to just get it together
and pick themselves up by their boot straps." When I have these types of
thoughts about the patients on the unit I know I act in a detached fashion when I
am suppose to be forming relationships based on respect and empowerment.
When I catch myself thinking and acting in this way I remind myself that we are
all human beings and thus all the same and interconnected. This is an
important aspect of feminist philosophy that guides feminist social work
practice methods. The patient's pain is my pain and so we have to work

43
together to end human suffering. I happen to be in the position of social worker
and practicum student at this point in time but that makes me no better than any of
the patients on the unit. I sometimes think to myself, "what if I suffered a mental
health crisis and had to be admitted to a psychiatric unit, how would I like to be
treated?" The answer is always with respect and compassion.
As Bricker-Jenkins (1991, p.28) reports, "for feminist practitioners, ideology is at
the core of practice-the measure of all choices to be made-and is consciously used to
motivate and evaluate action." The evaluation of my actions on the adult acute
psychiatric unit taught me that my feminist social work practice model is, as BrickerJenkins (1991) reports, incomplete, evolving and replete with contradictions. Throughout
the course of my practicum I struggled to practice in accordance with feminist ideology
and principles. However, I found that having made my ideology explicit I was able to
evaluate my practice and learn from those experiences. Feminist social work practice is
an evolving model of practice. I too am evolving as a feminist social work practitioner.
Although I discovered that creating individual and socio-political change could be a
challenging endeavor I feel no less committed to these principles of practice. I have
realized throughout the course of my practicum that although I encountered challenges to
implementing Bricker-Jenkins' (2002) feminist integrative method on the unit, I also
identified many opportunities.
One opportunity to implement feminist social work practice on the adult acute
psychiatric unit was through my participation in a housing committee meeting. The
psychiatric social worker on the unit was also part of a housing committee. The housing
committee was made up of professionals who work for the provincial governmental,

44
health authority, and non-profit organizations that are concerned with the lack of
affordable housing for persons with mental illness in our community. In this meeting the
psychiatric social worker advocates for patients on the unit who she believes would
benefit from fmancial aid to help them live independently. In this meeting the
professionals also decide how to best use the funding they are granted from the provincial
government towards creating programs to help people with mental illness find and
maintain housing in the community.
For example, this committee has used some of the funding to create an RRSP
program for people with mental illness. For many who have serious mental health
concerns maintaining full time employment is not possible. Due to their challenges
maintaining full time employment they rely on 'welfare' or provincial assistance and
disability. The amount they receive is hardly enough to live on let alone save for the
future. In a system that focuses on short-term help, the housing committee identified the
need to create a program that looked at assisting people in planning for their future. This
RRSP program is an example of how, when professionals from various organizations
work collaboratively on behalf of the clients they serve they can create programs that
truly meet the needs of their clients. The housing committee meeting provides an
opportunity for the psychiatric social worker to join with other members of the
community to address macro-level issues, like lack of affordable housing, which affects
the patients on the unit.
Another opportunity I found to implement Bricker-Jenkins (2002) feminist
integrative method was through effective discharge planning, a key responsibility of the
psychiatric social worker. Discharge planning is the process of"assisting patients with

45
timely arrangements for their post hospital care" (Cowles, 2000, p.142). As reported
previously in this chapter, the focus of acute psychiatric care is on patient stabilization
and rapid discharge to home and the community. The long-term treatment and support
services, required by many of the patients on the unit, are provided as outpatient services
by community agencies. I implemented Bricker-Jenkins (2002) feminist integrative
method by working in partnerships with the patients and their families to identify what
resources were needed to support their post hospital care; Assessment was thus a
dialogical process "in which client and worker shared their perspectives, meanings, and
analyses" (Bricker-Jenkins, 1991, p.286).
After the patient identified what support services were needed to support their
healing and recovery process, I then educated the patient about the resources available in
the community and how to access these services. I found that not only learning about the
agencies in the community was needed but also forming relationships with the
professionals who worked at those agencies. I accomplished this in my practicum by
touring community organizations and getting to know the staff that worked there.
Familiarizing myself with the resources and supports in the community allowed me to
feel confident that I referred the patient to the appropriate organization. Examples of
community agencies I would refer the patients on the unit to include: activity centers for
patients who experienced social isolation, women's shelters for women fleeing abusive
relationships, feminist rape crisis centers for patients who experienced sexual assault,
vocational training centers for people in need of assistance in gaining employment, and
advocacy organizations who work on behalf of people living in poverty.

46
Once a patient had identified what supports services they would need after discharge and
was provided the information about how to access these supports. I would then encourage
the patients to get in touch with that organization and set up an appointment. In these
situations my role in the discharge plan was that of educator. I did not impede upon the
patients right to self-determination by performing these tasks for them. This is in keeping
with feminist social work's emphasis on promoting the empowerment and self-efficacy
of the people we work with.
Bricker-Jenkins' (2002, p.133) feminist integrative method reports that the
feminist social worker "approaches all issues and opportunities presented by social living
and social relationships with a view of identifying the power dynamics operating in them
and their implications for diverse groups of women." After identifying these power
dynamics and their implications for the client the feminist social worker uses specific
actions to create opportunities and remove any barriers that are infringing upon the client
(Bricker-Jenkins, 2002).
Through the analysis of my practicum journal I found that I employed these
actions, described by Bricker-Jenkins (2002), in the discharge planning process. I was
cognizant about how people with mental illness are stigmatized by our society, as being
"weak" or "lazy" individuals who cannot cope with the daily challenges of life. This
ignorance and stigmatization of people with mental illness is, at times, institutionalized
by governmental and community organizations who provide services to people diagnosed
with mental illness. This institutionalized oppression is compounded by the fact that
many of the patients I worked with on the unit were members of an oppressed population.
These included women, First Nations people, homeless individuals, and or ethnic

47

minorities. The multiple forms of oppression institutionalized by social service
organizations created a barrier for patients to access these supports after discharge. As a
white middle class educated social worker I recognized that I was in a position to use my
"expertise, resources, cultural capital, and connections" to help patients obtain services
which would have been denied to them (Baines, 1997, p. 308). Because I recognized the
power differences in the social worker- patient relationship there were situations when I
acted as an advocate for patients on the unit. As an advocate I took a more active role in
the discharge planning process. I directly contacted the agency, by telephone or through a
letter, and advocated that the patient I was working with obtain the services they required
after discharge. This was a way in which I used my 'power' as a social worker to
"redistribute the power on a larger social level" to remove the existing barriers and create
opportunities for patients to access supports after discharge (Baines, 1997, p. 308).
The Challenges and Opportunities of the Verbal Processing Support Group
Throughout my journal, I identified the verbal processing support group as an
opportunity to implement Bricker- Jenkins' (2002) feminist practice as integrative
method in my practicum placement. The verbal processing group was a support group for
patients held Monday through Friday on the unit and was facilitated by the psychiatric
social worker. For the first few weeks of my practicum I observed the group and by week
three I had the opportunity to facilitate the group. Verbal group was an opportunity for
patients on the unit to get together and talk openly about any issues they would like
support with. This could include: the events and or issues leading up to their admittance
on the unit, their relationships with friends and family, their experience with staff on the
unit, what was helpful about their time on the unit, what was not helpful, and any fears

48
they may have about their discharge. The objective of the group was to give the patients
the opportunity to provide and receive mutual support and understanding to one another
by sharing their experiences in a safe environment. The use of this group represents an
interruption to the reliance on individual and medical interventions.
However, creating and negotiating power differentials between social worker and
patient presented its own challenges for feminist practitioners. I believe the verbal
processing support group is modeled after feminist self-help groups making it compatible
with Bricker-Jenkins' (2002) feminist practice integrative method. This was reflected in
my practicum journal:
I was surprised that the unit had implemented verbal group as a component of
inpatient care. Verbal group is based on empowerment and the self-direction and
determination of the patients. This is quite different from the other services
provided on the unit, which focus on treating "pathological" symptoms. I found
that the functioning of verbal group was much like feminist self-help groups. I am
fmding that verbal group is a great opportunity for me to apply feminist social
work practice.
Group work has played a central role in the feminist movement since the 1970's.
The women's liberation movement saw the birth of consciousness-raising feminist
groups. Consciousness-raising groups were an opportunity for women to come together
and share their life experiences and collective goals for achieving women's equality in all
spheres of life. Consciousness-raising groups promoted non-hierarchical structures, equal
sharing of resources and empowerment of women by practicing new skills in a safe
environment (Collins, 1986). Many ofthese groups were based on a self-help model in

49
which traditional mental health professionals were replaced by lay feminist women; this
structure was thought to foster the empowerment of women as opposed to the powerless
victim role endorsed by the traditional biological medical model (Corey, 2004).
Consciousness-raising groups provided the model for later self-help groups that
are a central component to feminist social work practice. Professionals in health care
recognized the importance of group work and have thus implemented support groups in
acute care settings (Jones, 1980). The major difference between the earlier models of
feminist self-help groups and the verbal processing support group on the acute care unit
was the role of the psychiatric social worker within the group, and the fact that the
psychiatrist determined which patients could attend the group.
Memberships to feminist self-help groups are determined by the group and
usually open to any individuals who share similar issues or concerns that the group
addresses. When self-help groups, like the verbal processing group, are implemented
within an acute care setting the professionals and not group members determine who is
appropriate for group. The doctor referred the patients on the unit to verbal group. The
doctor determined if a patient was suitable for the group based on their ability to
verbalize their emotions and talk freely about the issues in their life. Some patients on the
unit, due to their mental illness, were not able to participate. I found that this requirement
was necessary. Some patients on the unit were mentally, physically, and emotionally
unable to participate. For example, some patients who were actively psychotic were
unable to verbally process their emotions and therefore verbal group was not appropriate.
Although I recognized the necessity of the doctor's referrals for verbal group, it is
an example of how the patient's self-determination was limited by the structural

50
environment of an acute care setting. The fact that it was the professionals on the unit
who determined who could attend comprised the empowering nature of the self-help
model. The strategy I used to overcome this challenge was to advocate that certain
patients on the unit be provided the opportunity to attend verbal group. This ensured that
as many patients as possible could attend and benefit from verbal group. I did, however,
recognize the power that I yielded in determining which patients could attend and how
this influenced the self-help model of verbal group. In my facilitation of this group I
discovered that the role of a professional in the group can threaten the self-help model;
however, through critical self reflection, I realized that when I maintained my
commitment to feminist social work values and methods these challenges could be
overcome. This will be explored in the following sections of this report.
Through observations and participation in verbal group I noticed that the psychiatric
social worker' s role within the group was to help facilitate discussion. She took a nondirective approach to facilitation that placed the responsibility of the content and
direction of the group on the group members. The group members rather than then the
social worker chose the topics of discussion. The participants choose to share as much or
as little information as they felt comfortable with. The group was also responsible for
leading the discussion and providing mutual support and input to fellow group members.
The social worker started each group by explaining the purpose of the group and laying
down a few group guidelines. One guideline was the importance of group confidentiality.
The confidentiality pertained to the patients in the group and meant that what was shared
in the group stayed in the group and was not to be discussed with others on the unit.
Confidentiality was an important guideline that ensured that verbal group was a safe

51
place for patients to share with each other their life experiences. Because the patients in
group were all coping with issues related to their mental health, which are highly
personal and emotionally charged issues, creating this safe environment was an essential
component of verbal group; however, maintaining group confidentiality was not possible
for the psychiatric social worker. She had the obligation to chart on each patients
involvement in the group. This meant that the social worker had to write up brief notes
about each patient's participation and what they discussed in group which then became
part of their patient file. The obligation for the social worker to chart on group is an
example of how the feminist self-help model can be changed when a professional in an
acute care setting facilitates it.
With the patients knowing that what they discuss will be recorded by the social
worker and then become part of their file, this charting could threaten the safety and
openness of the group. I agree with the feminist position that asserts that charting and
composing patient files creates "living" documents. These documents, composed by
professionals and based on their perceptions, create a 'story' or 'identity' of patients that
will follow them for the rest of their lives. This gives the professionals a tremendous
amount of power 'over' the patients. It is the professional's 'voice' that is reflected in the
files rather than the 'voice' of the patients (Swartz, 2006). The patient's autonomy and
self-determination is restricted by the process of charting on the unit as the patients do
not have any say over what is written in 'their' file. This is a disempowering aspect of
acute psychiatric social work, which created challenges to implementing feminist social
work practices within verbal group.

52
When I had the opportunity to facilitate verbal group I used the feminist
techniques of explicitness and transparency to ensure that my obligation to chart did not
threaten the positive, safe, and open environment of the group. According to Lundy
(1993, p.l84): "Explicitness is the frank, precise, and unequivocal discussion of every
aspect oftherapy" (Lundy, 1993, p.184). I told the patients that I had the obligation to
chart on the group and explained that I would only document that they attended and
briefly what issues they discussed. I also told the group that if they would like to see what
I charted they would have the opportunity to do so. I was explicit and transparent about
my charting so that the group members would be fully aware that their confidentiality
would be comprised by my obligation to chart. I wanted to ensure that the group
members had all the necessary information so they could make an informed decision
about how much information to share in group. I believe these feminist techniques reflect
the respect which feminist social workers have for their clients.
Feminist social workers acknowledge the differing roles of the social workerpatient relationship and how these roles reflect differences in power. Talking about this
power in an explicit manner helps to equalize that power and thus creates a more
equalitarian social worker-patient relationship (Lundy, 1993). Respect for the patients
was also reflected in the way in Which I charted and maintained patient files. When I
charted on verbal group I was very cautious that what I wrote was creating a 'living
document' that would follow the patients for the rest of their lives. I therefore, ensured
that my notes were brief, and only included what the patients discussed in the group. I
was careful to not include my interpretations, judgments, and opinions of the patients.
Realizing the significance of charting and monitoring what we write in patients file is a

53

way social workers can express respect for the patients we work with. Putting into
practice these feminist techniques helped to maintain the safety and openness of verbal
group while maintaining my professional obligation to chart.
The other group guideline was that everyone would show respect to fellow group
members by listening and keeping an open non-judgmental attitude. This guideline was
modeled by the psychiatric social worker who listened respectfully to all group members.
I observed that she was part of the group and was not there to 'take over' or 'lead' the
group. Her facilitation style differed from that traditionally employed by the medical
model in which the doctor or mental health professional is in a "superior position socially
and has discretionary powers over patients thus people are encouraged to feel vulnerable
and reliant" (Jones, 1980, p.86). Modeled after feminist self- help groups, verbal group
was an opportunity for patients to feel empowered by owning the process of the group.
The patients were in the position to provide and receive help from fellow group members.
"It has been found that by such interaction, people can start to help themselves because

they are aided by others. It has been said that it is the helper who gains as much, if not
more, from this experience" (Jones, 1980, p.85). One strategy the psychiatric social
worker employed to ensure that the group was in charge of their own process was
through the use of silence. When no one was talking or sharing in the group the social
worker did not intervene. She allowed the silence to remain until one of the group
members decided to share. Because the social worker was careful not to dominate or
control the group, she was able to maintain the self-help model of verbal group in this
acute care setting.

54
One of the strengths of verbal group is that it breaks down the social isolation
experienced by many people who struggle with mental health issues. Society's dominant
attitude is that mental illness only happens to 'other' people who are mentally and
emotionally 'weak.' This attitude creates an 'otherness' which stigmatizes people who
are diagnosed with mental illness. I believe people with mental illness feel misunderstood
by their friends, family members, and even the mental health professionals they seek help
from. This ignorance can leave people with mental illness socially isolated. Verbal group
thus helps the patients realize that they are not alone in their experiences with mental
illness.
By hearing other group members share experiences they identify with they can
take comfort in the fact that someone has 'walked in their shoes' and understands their
experiences on a deeply personal level. Members of the group realize that because they
are not alone in their experiences they will not be judged by fellow group members. This
open non-judgmental environment allows members of the group to explore personal
issues and challenges and to learn new coping strategies from group members who have
encountered similar experiences. I believe the understanding and support offered by
patients in verbal group is as important as the assistance I offered as a social worker on
the unit.
I recognized that due to my position as a social worker on the unit, many patients
may have perceived me with mistrust and apprehension. The role of social worker on an
acute psychiatric unit symbolizes professional power and carries with it the obligation to
chart and share information on our perceptions of the patients on the unit with other staff
members. The patients recognized this power difference and that I was part of the

55

'system.' This created a barrier to creating an egalitarian relationship based on mutual
respect which is a central component of feminist social work practice.
One way I tried to overcome this barrier in my facilitation of the verbal
processing support group was by utilizing the feminist technique of self-disclosure. The
following section of my journal discusses my use of self-disclosure in verbal group:
Today in group I discussed some of my mental health challenges. I did this not to
say "that I totally understand what you're going through," but rather that as a
human being I can relate too many of the feelings expressed by group members. I
also wanted the group to realize that because I have my own "story" full of
mistakes and challenges. Thus I am in no position to judge anyone. I decided to
disclose some personal information in the group because I ask members of the
group to share in an open and honest way. I think that because I am truly 'part' of
the group I should be expected to do the same.
Through my use of self-disclosure I helped reduce the barrier that my professional
position created with patients on the unit. The patients were provided the opportunity to
get to know me as a "real" person and not just a social worker in a position of power and
authority. This helped create more egalitarian relationships with patients in the group.
The creation of these relationships also ensured that my professional role within the
group did not compromise the safe, non-judgmental atmosphere, which was an essential
component of verbal group. I also realized that any support or understanding I offered did
not replace that which the group provided. An important aspect of verbal group is that
mutual self-care is provided and received by peers who are struggling with similar life
challenges. This fosters empowerment of group members by encouraging them to take

56
responsibility for their healing and recovery. It is important that the professional does not
interfere with this important group process.
I believe my participation in verbal group benefited me as a feminist social
worker as much as it benefited the patients who were part of the group. I learned a great
deal from the patients about their life, and how it feels to be a person with a mental
illness. I also learned about the strengths and resilience of the patients. I believe the
verbal processing group allowed me to get to know the patients on a deeper level. A great
deal of my knowledge of the patients came from their charts and other professionals.
Having the opportunity to talk in depth with the patients, I learned more about who the
patients really were. At times this was completely different from their chart or the
information I received from professionals on the unit. I feel encouraged that the acute
psychiatric unit saw the value in implementing a verbal group based on the feminist selfhelp model. This leads me to believe that although the medical model of mental illness
remains the dominant model on the unit, staff is starting to recognize the values and
usefulness of differing approaches to practice. I hope the psychiatric unit continues to
implement empowerment-based services for patients on the unit.

57
Chapter V: Implications for Social Work Practice
Reliance on the Medical Model of Mental Illness in Acute Psychiatry
The reliance and authority of the biological medical model of mental illness,
which included the use of the DSM to assess, diagnose, and treat all patients on the adult
acute psychiatric unit created challenges to implementing feminist social work practice.
The challenge resulted from attempting to implement a model of practice which, at times,
conflicted with this dominant perspective. As reported in the literature review, hospital
social workers rely on a person-in-environment perspective that is compatible with the
feminist "personal is political" framework. These perspectives take a holistic approach to
understanding and treating patients in acute care settings. Hospital social workers help
clients in the "context of the conditions and resources of their social environment"
(Cowles, 2000, p.l 0). Feminist social workers focus on the strengths and the internal
resources of individuals; this differs from the medical model's focus on internal
pathology and disease. The challenge encountered by all hospital social workers is to
balance the dominant philosophical practice perspective of the health care system, while
maintaining a commitment to the unique mission and practice foundations of the social
work profession (Cowles, 2000).
I employed many strategies to overcome this challenge while in my practicum
placement. This included on-going critical self-reflection of my practices, which involved
on-going supervision and consultation with the psychiatric social worker; maintenance of
my practicumjoumal; and participating in interdisciplinary team meetings, where I took
a leadership role in educating fellow staff members about the psycho-social aspects of
mental illness. These strategies enabled me to maintain my commitment to the values and

58

practices of feminist social work within an environment which relied on the biological
medical model of mental illness.
I recommend that hospital social workers, working in acute care settings, engage
in on-going supervision and consultation with fellow hospital social workers. This can be
a challenge as often hospital social workers work alone on units with members of other
health disciplines. Although consultation with these professionals is valuable, it cannot
replace the need for peer supervision and consultation. This can be arranged informally
by hospital social workers setting aside time, on a regular basis, to interact with fellow
hospital social workers. Social work departments in hospitals can arrange formal social
work meetings, to provide social workers with the opportunity to support and supervise
their peers. This will help maintain their commitment to the profession of social work
within the acute care setting where they work. Having on-going hospital social work
meetings will also help form a cohesive social work program within the hospital. This
will establish a clear social work identity and function within the healthcare system,
reported in the literature as a significant need (Cowles, 2000). Clarifying the role of
hospital work is necessary for social workers who need to educate patients, families, and
fellow staff members about their role and function within the healthcare system.
Social workers can also play a leadership role in educating and promoting new health
care policy and 'best practices' within the health care system. The B.C's Mental Health
Reform (Best Practices for B.C's Mental Health Reform, 2002) provides an alternative
form of practice for these settings. In 1998 British Columbia released a new mental
health care reform policy, which emphasized that psychosocial rehabilitation philosophy
would guide all mental health care services, including acute psychiatry, in British

59

Columbia. "The plan pledged increase of annualized funding for mental health care
services including supported independent living beds, residential care resources, and
increases to staffing and training for community based services (Community-Based
Mental Health Services in BC, 2006). Psychosocial rehabilitation philosophy is based on
an "empowerment" paradigm, which postulates that people with mental illness should
determine their care and their lives. The "provision of mental health care services is seen
as just one aspect of a continuum of care that includes social supports and access to the
"elements of citizenship"-housing, education, income, and work" (Community-Based
Mental Health Services in BC, 2006, p.ll ). This philosophy highlights the links between
mental illness and social determinants of health such as poverty and social
disenfranchisement. Psychosocial rehabilitation philosophy marks a paradigm shift away
from the reliance on the medical model for the treatment of mental illness in mental
health care services in British Columbia.
My studies found that psychosocial rehabilitation philosophy had not yet been
fully implemented within the acute psychiatric unit where I completed my practicum.
This fmding is backed by the 2006 report on mental health by Senator Michael Kirby,
Out of the Shadows at Last: Transforming Mental health, Mental fllness and Addiction
Services in Canada. He reports that the mental health care system in Canada continues to

be driven by the biological medical model, which emphasizes symptom management and
treatment with psychotropic medications with much less attention focused on addressing
the social determinants of mental heath (Kirby, 2006). Based on the responses of2000
mental health care 'consumers' in Canada, Kirby found that people living with mental
illness reported a need for employment, safe and adequate housing, and peer support. His

60
findings emphasize the need for holistic mental health care services based
"empowerment" paradigms, such as psychosocial rehabilitation philosophy and feminist
social work practice.
The Community-Based Mental Health Services in BC (2006) report, sponsored by
the 2001 Ministry of Health's Advisory Council on Mental Health found that British
Columbia was behind on implementing the province's mental health care reform policy,
especially in regards to providing community resources, housing, clinical care,
rehabilitation, and crisis services for people with mental illness (Community-Based
Mental Health Services in BC, 2006). Both this report (Community-Based Mental Health
Services in BC , 2006) and Kirby (2006) state that the 2001 provincial government cuts
and changes to policies related to mental health care, disability, and social welfare have
resulted in the abandonment of psychosocial rehabilitation philosophy and "best
practices" in favor of a model of mental health services fueled by a corporate, costcontainment orientation.
These cuts and policy changes made by the British Columbia provincial
government in 2001 focus mental health services on treating symptoms rather than
addressing the social determinants of mental health. Despite the cuts to psychosocial
rehabilitation services, research (Kirby, 2006; Community-Based Mental Health Services
in BC, 2006) continues to emphasize the importance of "empowerment" based services,
which address the psychosocial needs of patients receiving treatment for mental illness on
psychiatric units.
Psychosocial rehabilitation philosophy is compatible with social work's "personin-environment" perspective and the feminist "personal is political" perspective. These

61

frameworks share the common foundation that psychiatric services must focus on
understanding people' s problems within the context of their social environment. Wetzel
(1983) reports that services based on these perspectives aim to create transactions
between persons and their environments, which support the inherent dignity and worth of
all people. Psychosocial rehabilitation philosophy, social work's person-in-environment
perspective, and feminist social practice, are all based on an "empowerment" paradigm,
which emphasizes the patient's strengths and ability to realize their treatment and life
goals (Best Practices for B.C's Mental Health Reform, 2002).
Social work practice is based on holistic empowerment focused interventions,
which are clearly compatible with psychosocial rehabilitation philosophy. This
knowledge and skill base emphasizes the importance of the role of social workers on
interdisciplinary teams in acute care settings. Carpenter (2002) reports that social workers
are well suited to the tasks of implementing psychosocial rehabilitation philosophy within
acute care settings based on their functions within the healthcare system. These functions
include:
supporting people as they draw on natural resources in their environments;
operating from the perspective that all consumers have both profound immediate
worth and the potential for tremendous growth, self-defmed growth; advocating
for meaningful system change at all levels; and working toward community
change and enrichment that will facilitate the recovery of all people with
psychiatric disabilities (p.92).
I believe social workers working within acute care psychiatry should take a
leadership role in promoting psychosocial rehabilitation philosophy within the healthcare

62
system. This can be accomplished through in-service meetings in which social workers
educate fellow team members about social determinants of health; empowerment based
interventions, the role and function of hospital social workers, and psychosocial
rehabilitation philosophy. The leadership and education provided by social workers in
adult acute psychiatry will be an important step to challenging the singular reliance on the
biological medical model and realizing "best practices" for BC's Mental Health Care
Reform (2002).

Short Term Nature ofAcute Psychiatric Social Work
The other major challenge I encountered in implementing Bricker-Jenkins' (2002)
feminist practice integrative method on the psychiatric unit was lack of time. The shortterm nature of acute psychiatric social work focuses on providing micro-level services
aimed at stabilizing the patient's immediate mental health crisis. The focus on
interventions intended towards correcting dysfunction within the individual ignores the
conditions in the individual's environment which are contributing to their mental health
crisis. Feminist social workers adopt a "dual" approach of working to create change at
both the individual and societal level (Dietz, 2000). This approach requires the need for
macro-level interventions, which seek to change the oppressive ideologies and structures
in the social environment that oppress and marginalize people with mental illness. It was
difficult, at times, to put into practice these macro-level interventions within an
environment which emphasized short-term crisis services.
I was able to implement the "dual" focus ofBricker-Jenkins' (2002) feminist integrative
practice method by implementing the following strategies: participating in a housing
committee meeting with members of other government and non-profit mental health

63
agencies; building relationships and connections with community organizations; and
creating comprehensive discharge plans which, at times, required me to advocate on
behalf the patients and their families to access needed resources. These strategies allowed
me to work towards creating change within the patient and their social environment.
Furthermore, engaging in micro and macro level practice enabled me to maintain feminist
social work's commitment to social justice and societal transformation.
Heavy patient workloads made it difficult to fmd the time necessary to implement
macro-level interventions. Finding the time needed to work towards creating change
within the economic, political, and social structures in the patient's social environment is
a common challenge for hospital social workers. If social workers are to fulfill their
professional and ethical commitments to social justice and social change they cannot
solely provide micro-level services to patients and their families. Additional social
workers employed in healthcare settings are necessary.
Social workers provide a valuable and necessary role in providing the needed
holistic services to patients and their families. An increase in hospital social workers
would decrease heavy workloads and provided the necessary time for social workers to
advocate for structural level changes within the hospital, healthcare policy and social
services. If social workers had the opportunity to apply the "dual" focus of feminist
social work practice there would be less "burn-out" and more meaningful structural level
change. This would benefit social workers, patients, and society in general. The hiring of
more hospital social workers can be accomplished through the creation of a clear social
work identity and function within the healthcare system. Health care systems can then
recognize the need for social work services in acute care settings. To help facilitate the

64
hiring of more social workers, chief hospital social workers could advocate to their health
authority for the hiring of more hospital social workers.
As stated in the results section of this report, the recent trend in mental health care
policy emphasizes that people experiencing a mental health crisis should receive shortterm intervention in acute psychiatric units with rapid discharge to home and the
community. Mental health community organizations are intended to provide the longterm treatment and holistic supports needed to enable people to manage their mental
health concerns without the need for hospitalization. The role of discharge planning and
linking patients to the appropriate out-patient services thus becomes an important
function for hospital social workers.
Familiarity with community organizations and relationships with the staff of those
agencies, allows hospital social workers to ensure that they are providing the appropriate
referrals for patients and their families. Having relationships with community service
providers also helps hospital social workers when they advocate for patients to receive
out-patient services. As reported in the results section of this report, I advocated on behalf
of patients to receive supports from governmental and non-profit organizations. I
recognized that institutionalized oppression acted as a barrier for patients with mental
illness to attain needed resources. In order to remove this barrier, I used my professional
position and status and advocated on behalf of patients.
I would recommend that hospital social workers follow suit and engage in the
political use of resources through patient advocacy. In her study, Baines ( 1997) examines
the strengths and limitations of feminist social work practice in an under-funded inner
city hospital in the United States. She reports that social workers must recognize the

65
professional power they hold and use this power to serve the patients' best interests. She
found, as I did, that the crisis issues which brought patients in "contact with social
workers demanded immediate concrete action and resources" (Baines, 2000, p.307). This
requires hospital social workers to use their cultural capital to connect patients with
services that would have been denied to them based on their "inferior" social position.
It is also important that the healthcare system and community service providers work

collaboratively to foster continuity of care to meet the needs of patients and their
families. Creating continuity of care requires service providers to learn about the role and
functions of other agencies and communicate their purpose within the continuum of care.
This can be accomplished by having in-service meetings where service providers visit
other agencies to share their mandate and build partnerships. I would also recommend
that committees be formed which bring together professionals from the healthcare system
and the community to work together on joint projects. Like the housing committee that
focused on creating programs to help people with mental illness maintain affordable
housing and fmancial savings, committees can form to tackle macro-level issues which
affect people with mental illness. These committee meetings provide professionals with
the opportunity to discuss challenges and service gaps within the continuum of care and
work towards creating innovative solutions. This may include lobbying for changes
within mental health care policy to provide more funding for community based mental
health services.
Baines (2000) also discovered that building committees with other like-minded
service providers can challenge the dominant mode of service delivery and create new
programs to serve the needs ofhealthcare consumers. Similarly Dietz (2000) reports, that

66
in order for social work micro-practice to be truly empowering it must be explicitly
political. She recommends that social workers become involved in political organizing
"to ensure that consumers' voices and experiences inform mental health policy, as well as
individual practice" (Dietz, 2000, p.381). Furthermore, she agrees with my conclusion
that feminist social workers must work on both the macro levels and micro levels to
ensure that mental health consumers have access to supports they need to maintain
optimal health and functioning (Dietz, 2000).
Hospital social workers can play a leadership role in connecting the healthcare
system with the community and other service providers. Hospital social workers can then
educate all hospital staff about the resources and supports available for patients and their
families in the community. These strategies will allow for effective discharge planning,
which will help patients and their families access the needed resources to manage their
mental health concerns in their home and community. These strategies also allow hospital
social workers to become involved in macro-level change interventions. This will help
social workers implement the "dual" focus of feminist social work practice.
The Challenges and Opportunities of the Verbal Processing Support Group
I discovered that my participation in the verbal processing support group provided
the opportunity to implement feminist social work practice within my practicum
placement. Verbal group, which was based on the feminist self-help model, allowed
patients to come together to provide and receive mutual care and support. The group
broke down the social isolation many patients with mental illness experience by creating
a safe and open place for patients to discuss any issues related to their experience with
mental illness. Patients in verbal group had the opportunity to examine how oppressive

67
structures and ideologies contributed to their mental health crisis and formulate solutions
to cope with and challenges these systems and beliefs.
Verbal group was based on feminist empowerment principles which postulate that
people have the resources and strengths to cope with their problems in living and provide
guidance to other people who are struggling with similar issues. The group marked a
departure from the medical model's focus on individual pathology and disease by
emphasizing community and recovery. The presence of verbal group within the acute
psychiatric unit is in keeping with psycho-social rehabilitation philosophy, feminist social
work practice foundations, and empowerment models for mental health care reform.
The implementation of the group within an acute care setting presented many challenges.
I noted how my involvement, as a professional social worker in the group had the
potential to compromise the self-help model and principles. I was aware that as a social
worker I may be perceived as having professional power which may provide a barrier to
fostering egalitarian relationships with group members. I also acknowledged that my
obligation to chart on the participation and content of the group threatened the safety and
openness of the group. I overcame these challenges by adopting feminist techniques such
as explicitness, self-disclosure, and transparency. Lundy (1993, p.l87) reports that these
feminist techniques "form the bedrock of egalitarian social work relationships." I was
also cautious to only chart on what group members shared and not my personal
judgments and opinions. Baines' (1997, p.313) study also emphasizes the importance of
"reflective, careful use of case documentation and reports to superiors." These strategies
ensured verbal group upheld the self-help model, which assets that group members, not
the professionals, are responsible for the leadership and direction of the group.

68
In Sandell's (1993) unpublished doctoral dissertation, which examined the
experiences of seven feminist social work practitioners, she reported that many of the
feminist social workers interviewed cited the importance of peer support groups for
bringing women together to examine the political dimensions of their personal problems.
I concur with Sandell's (1993) finding that self-help; peer support groups are a necessary
aspect of fulfilling feminist social work's practice commitment to making the "personal
political." Jones (1980, p.86) also stipulates, that self-help groups challenge the medical
model's power structure, which "encourages the public to be dependent, by claiming a
monopoly over knowledge." He argues that implementation of self-help groups within
inpatient settings will challenge the relationship between healthcare professional and
patient, and "force a redefinition of professional roles (Jones, 1980, p.86)." I agree with
this argument, and believe that the presence of the verbal processing support group in my
practicum placement was one service that challenged the unit's reliance on the medical
model .This group created services based on egalitarian relationships between
professionals and patients.
I believe hospital social workers should take a leadership role in creating peer
support, self-help services within acute care settings. This can be accomplished by social
workers sharing with their colleagues the research (Kirby, 2006) which cites the
importance of these services for helping patients cope with all types of health concerns.
Hospital social workers can then facilitate these groups, and teach other health care
professionals how to implement these services within the healthcare environment without
compromising self-help, peer support principles. The ethics and practice foundations of
social work emphasize peoples' inherit dignity, strengths and right to self-determination.

69
Thus hospital social workers are equipped with the necessary training and values to
challenge the healthcare system's reliance on the individualistic, pathology focused,
medical model towards an empowerment paradigm focused on the patients' strengths and
recovery.

70
References
Austin, D., & Roberts, A. (2002). Clinical social work research in the 21st century:
Future, present and past. In A.R Roberts & G.J. Greene (Eds.), Social workers '
desk reference. (pp.822-828). New York: Oxford University Press.
Baines, D. (1997). Feminist social work in the inner city: The challenge of race, class,
and gender. Affilia,12 (3), 297-317.
Best Practices for B.C's Mental Health Reform (2002). Inpatient/Outpatient Services:
British Columbia Ministry of Health and Ministry Responsible for Seniors. (pp. 158). Retrieved March 18/2008 from
http://www.health.gov .bc.ca/mhdlbpelementsbc.html
Bricker-Jenkins, M. (2002). Feminist issues and practices in social work. In A.R Roberts
& G.J. Greene (Eds.), Social workers' desk reference (pp. 131-136). New York:

Oxford University Press.
Bricker-Jenkins, M., Hooyman., N., & Gottlieb, N. (Eds.). (1991). Feminist social work
practice in clinical settings. Newbury Park, CA: Sage.
Bricker-Jenkins, M. & Hooyman, N. (Eds.). (1983). Not for women only: Social work
practice for a feminist future. Silver Spring, MD: National Association of Social
Workers.
Carpenter, J. (2002). Mental health recovery: Implications for social work. Health &
Social Work, 27(2), 86-94.
Cates, J.R. (2002). The profession in historical context. In M.A. Mattaini & C.T. Lowery
& C.H. Meyer (Eds.), Foundations of social work practice: a graduate text

(pp.319-339). Washington, DC: NASW Press.

71
Chesler, P. (1997). Women and madness. (3nd ed.). New York: Four Walls Eight
Windows.
Collins, B. G. (1986). Defining feminist social work. Social Work, 31(3), 214- 219.
Community-Based Mental Health Services: Changes to income, employment, and
housing supports, (2006). An economic security project report: Canadian Centre
for policy alternatives BC office. Retrieved September 12/2008 from
WW\V.policyalternatives.caldocuments/BC Office Pubs/be 2006/community me
ntal_health_services.pdf
Corey, G. (2004). Theory and practice ofcounselling and psychotherapy. (7nd ed.). New
York: Brooks/Cole.
Cowger, C. D. (1994). Assessing client strengths: Clinical assessment for client
empowerment. Social Work, 39(3), 262-268.
Cowles, L. A. (2000). Social work in the health field: A care perspective. New York: The
Haworth Press, Inc.
Creswell, J. (2007). Qualitative inquiry and research design. Thousand Oaks, CA: Sage
Publications.
Dietz, C.A. (2000). Responding to oppression and abuse: A feminist challenge to clinical
social work. Affilia, 15(3), 369-385.
Dominelli, L., & McLeod, E. (1989). Feminist social work. London: Macmillan
Education Ltd.
Double, D.B. (2004). Biomedical bias of the American psychiatric association. Ethical

Human Psychology and Psychiatry, 6(2), 153-159.

72
Eisenstien, H. (1983). Contemporary feminist thought. Boston, Massachusetts: G.K Hall
&Co.
Elliott, D. (1993). Social work and social development: towards an integrative model for
social work practice. International Social Work, 36 (1), 21-36.
Gary, L.T. (1991). Feminist practice and family violence. In M. Bricker-Jenkins &
N.Hooyman & N.Gottlieb (Eds.), Feminist social work practice in clinical
settings (pp.19-34). Newbury Park, CA: Sage.
Geller, J.L. (2000). The last half-century of psychiatric services as reflected in psychiatric
services. Psychiatric Services, 51(1), 41-67.
Gilligan, C. (1983). In a different voice: Psychological theory and women's development.
Cambridge, MA: Harvard University Press.
Jones, P. (1980). The emergence of self-help groups. Health Education Journal, 39(3),
84-87.
Katz, M. (1996). In the shadow ofthe poorhouse: A social history ofwelfare in America.
New York: Basic Books.
Kirby, M.J.L. (2006). Out of the shadows at last: Transforming mental health, mental
illness, and addiction services in Canada: Final report of the standing senate
committee on social affairs, science, and technology. Retrieved September
12/2008 from
www.parl.gc.ca/39/1/parlbus/commbus/senate/Com-e/SOCI-E/rep-e/rep02may06e.htm- 255k-

73
Levine, E.R. (2002). Glossary. In A.R Roberts & G.J. Greene (Eds.), Social workers'

desk reference. (pp.822-828). New York: Oxford University Press.
Lundy, M. (1993). Explicitness: The unspoken mandate of feminist social work. Ajjilia,

8(2), 184-199.
Mattaini, M.A. (2002). Knowledge for practice. In M.A. Mattaini & C.T. Lowery &
C.H. Meyer (Eds.), Foundations ofsocial work practice: a graduate text (pp.95130). Washington, DC: NASW Press.
Mattaini, M.A. & Meyer, C. H. (2002). The ecosystems perspective: Implications for
practice. In M.A. Mattaini & C.T. Lowery & C.H. Meyer (Eds.), Foundations of

social work practice: a graduate text (pp.95-130). Washington, DC: NASW
Press.
Marlow, C. (2005). Research methods for generalist social work. 4th edition. Nelson:
Thomson/Brooks/Cole.
Martin, J. (2003). The hope ofbiography: The historical recovery of women educator
activists. History of Education, 32(2), p.219-232.
Parker, L. (2003). A social justice model fqr clinical social work practice. Ajjilia, 18(3),
272,.286.
Patton, M. (2002). Qualitative research and evaluative methods. 3rd edition. Thousand
Oaks, CA: Sage Publications.
Penfold, S.P., & Walker, G. (1983). Women and the psychiatric paradox. Montreal,
Quebec: Eden Press Inc.

74
Rock, B. D. (2002). Social work in health care for the 21st century: The biopyschosocial
model. In A.R Roberts & G.J. Greene (Eds.), Social workers' desk reference (pp.
131-136). New York: Oxford University Press.
Rossiter, A., Boer., C., Narayan, J., Razack, N., Scollay, V., Willette, C. (1998). Toward
an alternative account of feminist practice ethics in mental health. Ajjilia, 13( 1),
9-30.
Sandell, K.S. Different voices: Articulating feminist social work. Unpublished doctoral
dissertation, Mandel School of Applied Social Sciences. Case Western Reserve
University, Case Western Reserve University, Cleveland, OH.
Shaw, C. & Proctor, G. (2005). Women at the margins: A critique of the diagnosis of
borderline personality disorder. Feminism & Psychology, 15(4), 483-490.
Stanley, L. (1999). On auto/biographical in sociology. In A.B. Bryman & R.G. Burgress
(Eds.), Qualitative Research (pp. 156-165). Thousand Oaks, CA: Sage
Publications.
Swartz, S. (2006). The third voice: Writing case-notes. Feminism Psychology, 16(4), 427444.
Taylor, E.H. The weaknesses of the strengths model: Mental illness as a case in point.

Best Practices in Mental Health, 2(1), 1-30.
VanDenBerg, N. (1995). Feminist social work practice: Where have we been... where are
we going? InN. VandenBerg (Ed.), Feminist Practice in the
xxxv). Washington, DC: NASW Press.

2r century (pp.xi1

75

Warner, S., & Wilkens, T. (2004). Between subjugation and survival: Women, borderline
personality disorder and high security mental hospitals. Journal of Contemporary
Psychotherapy. 34(3), 265-288.

Wetzel, J. (1991). Universal mental health classification systems: Reclaiming women's
experience. Affilia, 6(3), 8-11.
Wetzel, J. (1986). Social work ethics day to day: Guidelines for professional practice.
New York: Longman.

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Appendix A: A definition of Feminist Practice as Integrative Method
(Source: Adapted from Bricker-Jenkins, 2002, pp. 133).

In general, feminist practitioners attempting to use an integrative method ..
•
•
•

•
•

•

Approach all issues and opportunities presented by social living and social
relationships with a view of identifying the power dynamics operating in them
and their implications for diverse groups of women;
Are concerned with the ways in which institutionalized sexism (and, usually,
other oppressive ideologies and behaviours) create problems for all persons and
for women in particular;
Are committed to the development and use of specific actions and techniques to
create opportunities for and remove structural barriers, both material and
ideological, to the fullest possible development of the abilities of individuals and
groups; whenever possible, to do so in alliance with those directly affected;
Are committed to collaborative relationships with people with whom they are
working while recognizing and negotiating the differential power inherent in all
relationships, including professional ones;
Tend to view social work practice as a "political," liberatory, and transformative
practice, that is, as a normatively based and directed effort to enable people to
control the conditions of their lives by redefining and moving the individual and
institutional power in a more egalitarian direction;
While working to create options for and with people, and while preserving safety,
respect, and support for their natural healing and helping process and the choice
they make in relation to their conditions.