Social Work - Theses
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ItemIdentifying the key factors shaping the construction of a social work identity in mental health( 2018)A social work identity is ‘difficult to grasp’. Relevant professional literature is scarce, though some authors have recently acknowledged that ‘Social work identity is a contested concept.’ (Mackay & Zufferey, 2015). The notion of a distinctive and unique social work identity is not well recognised or articulated by experienced practitioners, nor does it appear to be adequately emphasised in social work education and training programs. These considerations have significant implications for the profession as a whole. They become especially critical in mental health settings in which adherence to their profession’s well-established values, theories and practice standards may bring social workers into conflict with views, norms, and practices mandated by the prevailing biomedical status quo. There is limited research on social work identity in mental health settings and even less pertaining to students’ efforts to construct a professional identity in such paradigmatically unfamiliar environments. The primary objective of this research was to examine how students understand, experience, and articulate their developing professional identity and to identify specific factors influencing the ‘identity work’ of social work students immersed in mental health settings. Students from one Victorian university undertaking placements within mental health were invited to participate. The project utilised a qualitative methodology with focus groups held prior to placement and individual interviews towards the completion of participants’ 70-day (500 hour) placements. Inductive and deductive methods were used to identify key themes in the resulting data. The thesis presents findings from interviews with students at the end of 70-day placements in mental health settings. Key findings relate to what participants bring to the placement, what they observe, and what they do during the placement. Responses to specific questions about identity were considered. As participants rarely commented on their experience of supervision, reflective processes were also investigated. As services providing mental health care and treatment are paradigmatically unfamiliar to social work students, interviews were analysed for evidence of resistance to the dominant biomedical discourse. These themes were synthesised in an effort to identify key factors contributing to the construction of a social work identity in mental health settings. When asked to talk about their developing professional identity in relatively unstructured interviews students struggled to relate to the concept of a ‘social work identity’ and were unable to articulate what it might be or involve. Students were more at ease describing specific roles they had performed during their placement. However, analysis of their reflections on what they brought to placement, what they observed, and what they did during placement provided rich descriptions of a range of the factors which contributed to and influenced their developing social work identity. Interviewing students on mental health placement highlighted some of the difficulties they and others have relating to the concept of a social work identity. Further research will be required to gain greater insight into factors influencing social work identity development in these unfamiliar settings.
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ItemArchitecture and the design of therapeutic environments: the case of self harm( 2017)This thesis finds that specific design interventions in the spaces providing therapy can improve therapeutic outcomes for those who self harm. Therapeutic interventions for this service user group typically involve various forms of talking therapy, and/or medications. However these service users are amongst the most clinically challenging to treat. The physical environments in which therapy takes place have not been thoroughly examined for their contribution to therapeutic outcomes. Despite a large body of literature affirming the links between good design practice and mental wellbeing, there is a paucity of research addressing specific environmental needs of service users who self harm. Further, existing design guidance is often generic in nature, describing broad principles to be achieved through design, but offering little tangible advice for the designer to integrate these principles into a realised built environment. The research involved an exploratory qualitative design that utilised a triangulated strategy; the method of data collection included three data collection methods: systematic literature review, multi-stakeholder interviews and case study observation. Key findings from the scoping review included the paucity of design guidance for therapeutic environments and counselling workspaces specifically, and that there is no published research examining the design of therapeutic spaces for individuals who self harm, specifically. Key findings from the semi-structured multi-stakeholder interviews included a deeper understanding of the perceptions of spatiality of individuals who self harm, aspects of therapeutic environments that are supportive or unsupportive and in what ways this occurs, and potential design strategies to assist therapeutic activities and psychological engagement. Analysing built therapeutic environments found that there is a limited inclusion or implementation of design recommendations uncovered in this research in existing built spaces. Through the analysis undertaken of the literature, interviews with service users, therapists/counsellors, carers, architects and design researchers, together with a case study examination of existing built therapeutic environments, a series of design recommendations were derived. These principles have been developed from environmental aspects which were commented on by those who self harm, and supported by other interview participant groups and observations in the field. The findings from this thesis are indicative that the design recommendations assist therapeutic outcomes. However, as indicated through the exploratory qualitative analysis undertaken, the built environment is a meaningful agent in therapy. What emerged from the study was the notion that for individuals who self harm, the built environment is not merely the housing of therapy, but an active participant in the therapeutic process. The counselling workspace may be a platform for therapy to unfold in a physical sense, providing aspects such as physical privacy and safety features, but offers many more psychological support mechanisms if designed/manifested in a particular way, including psychological safety and relief, negotiation of relationships, non-verbal communication opportunities, increased body awareness, reduced dissociation, increased sensory engagement and perception, and opportunities for the development of the self. The counselling workspace has active roles in therapy, including being a mediator between therapist and service user and helping to clarify and establish boundaries, being a vehicle for communication, and being a testing ground for the problem solving abilities and aspects of the self. When the built environment design initiatives outlined in this thesis are considered carefully and articulated through design and the curation of space, architects/designers may provide a platform of engagement through counselling workspaces, resulting in positive therapeutic effect. If the design recommendations were to be integrated into the built environments delivering mental health services to individuals who self harm, then the misgivings, difficulties or negative psychological interferences reported by the service users would be mollified and/or eliminated. Therefore, therapy and therapeutic outcomes would be assisted. In this situation, counter-productive stimuli are removed or reduced, assisting the service users to maximise the benefits of their therapy.
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ItemAn exploratory study into the use of Christian spirituality in counselling( 2012)A growth in popularity of Christian counselling (Buri 1990; Garzon, Worthington et al. 2009; McMinn 2010) and use of Christian spirituality in psychology (Richards 2010) highlights the need for more research exploring the effectiveness of Christian counselling (Pargament 1999; Koenig 2007; Pargament 2007; Rice 2009; Richards 2010). In order to explore the unique role of Christian spirituality and how it impacts on mental health, a grounded theory approach has been used to research how counsellor-client relationships, counselling methodology and faith in a supernatural God have influenced Christian counselling outcomes and client satisfaction. Clients and counsellors were categorised according to their counselling methodology: pastoral care, Christian psychology, Christian (prayer) Ministry, and Biblical counselling – all categories suggested by McMinn et al (2010). A fifth category combining Christian psychology and prayer ministry was added as this was prevalent amongst the participant responses received. Themes around the influence of love and authority in impacting mental health and of healing by the Holy Spirit emerged from participant comments. Client participants indicated that they trusted Christian counsellors more than secular counsellors, partly because they both held the same Christian world view and also because they believed the counsellor considered the will of God within the sessions. Counsellor participants demonstrated that they use both secular and spiritual therapies. A hierarchical organizational chart inspired by Attride-Stirling’s (2001) networking approach, unraveled a thematic pathway to sustained mental and emotional health. This pathway began with clients first having their immediate needs met and experiencing Christian love from their counsellor. They began to feel they have value to God and to realise that God loves them. As this belief is appropriated in their lives they increasingly were able to overcome their mental and emotional problems and came to seek out truth from the Bible and to submit to its teachings in a gradual process called sanctification. An hypothesis has emerged from the ordering of these themes that suggests: “Spirituality as used in Christian counselling supports sustained improvement in mental and emotional health.”
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ItemSocial work in secure forensic mental health inpatient services: towards cultural competence( 2011)International migration has moved to the forefront of the global agenda and has become a challenge for governments around the world. According to the Department of Immigration and Citizenship [DIAC] (2007), Australia has become “one of the most culturally diverse societies of the 21st century” with more than six million migrants having arrived since 1945 (p.1). This is despite Australia’s history of racist immigration and indigenous policy, and continued social disadvantage and discrimination experienced by many indigenous and CALD (Culturally & Linguistically Diverse) Australians. Secure forensic mental health inpatient services, like many services, are not meeting the needs of the indigenous and CALD population. This paper will use a critical literature review, from a critical theory and social constructionist perspective, to answer three fundamental questions: What are the problems for indigenous and CALD patients in secure forensic mental health inpatient services? What factors contribute to, and sustain, these problems? What can social workers do about these problems? While cross-cultural forensic mental health research is scarce and often methodologically flawed, key themes emerge. Secure forensic mental health inpatient services are influenced by a complex, socially constructed tangle of institutions, policies and practices. The ‘caring’ mental health system and the ‘custodial’ criminal justice system often have conflicting goals and expectations. Furthermore, public and media perceptions of danger frame the policy context. This leaves patients commonly experiencing discrimination, disempowerment and social exclusion. However, patients from indigenous and CALD populations are further marginalised and have reduced ‘social quality’ (social inclusion, socio-economic security, social cohesion and empowerment) (Huxley & Thornicroft, 2003). The literature attributes this to factors including: discriminatory and reactive government policies, an ethnocentric mental health system that relies on culturally invalid classification systems, and culturally incompetent clinicians and organisations. Social workers have been implicit in these systemic failures through their lack of contribution to the literature and their lack of influence in forensic mental health. This is despite the compatibility of the social work person-in-environment perspective, and its focus on social justice and social quality, with good cross-cultural practice. Frequent references to ‘unexplored’ socio-cultural and environmental factors in the literature, and a mental health policy shift in Victoria towards social inclusion and community development, provide a timely opportunity for social work to assert itself. In this paper, my purpose is to demonstrate how social workers can affect structural change on a professional ecosystem that impedes culturally competent practice. Through this conceptual framework, I have developed Culturally Competent Guidelines for Social Workers in Secure Forensic Mental Health Inpatient Services. These guidelines aim to provide social workers with tools that might empower them to become more culturally competent clinicians, and in the process, enable them to strive for social justice by improving social quality and cultural competence at all levels.