A Ghost in Contemporary Theory: Selma Fraiberg’s Social Work Identity and Her Contributions to Modern Psychoanalysis Abstract Re-examining the work of Selma Fraiberg, an early psychoanalytic social worker, reveals the prediction of two dominant strains in contemporary psychoanalysis: attachment theory and the study of trauma. On the hundredth anniversary of her birth, reading her papers is a reminder of clinical social work’s natural partnering with psychoanalysis. As American psychoanalysis has moved away from its primary focus on intrapsychic conflict toward relational models, it has incorporated the sine qua non of clinical social work: the person-in-environment. Fraiberg’s original identity as a social worker strongly informed her research, casework, writing, and approach to education, and forecast current strains in American psychoanalysis. Reclaiming Fraiberg’s unique contribution should cement both her rightful place as a psychoanalytic pioneer and as an originator of clinical social work identity, as well as the influence of clinical social work on American psychoanalysis.

Discourses of Migration and Belonging: How Language Shapes the Return-Thinking Processes of Ethiopians in Canada Abstract This study examined how 15 Ethiopian-Canadian immigrants define and express their post-migration intentions. Specifically, this paper explores how the linguistic and cultural features embedded in language inform their return-thinking process. This paper contributes to emerging scholarship that expands the dominant conceptualization of language and migration to include a focus on how language becomes integral to the experience of migration through beliefs and value systems. Particularly, this paper argues that it is essential to recognize the multifaceted nature of migration, language, identity, and transnationalism and to recognize how migrants’ agency in straddling two distinct societies shapes their return-thinking process.

Prevalence of Adverse Childhood Experiences Among Veterans Abstract The adverse childhood experiences (ACE) study showed that childhood trauma is common in the general population and has enduring effects on adult emotional and physical health. Levels of childhood adversity among individuals with a history of military service have been found to match or exceed those among individuals with no history of military service. Most studies to date have found that ACEs are associated with poorer mental health outcomes among service members and veterans, although the ways in which childhood adversity may contribute to vulnerability or resilience are not fully understood. Further, the prevalence of ACEs specifically among veterans has not been clearly established. We evaluated the prevalence of childhood adversity at a community-based outpatient mental health clinic within the Department of Veterans Affairs (VA) and found that 85.0% of participating veterans reported experiencing at least one category of ACE before the age of 18, while nearly half of veteran participants (46.0%) reported experiencing four or more categories. We discuss the implications of a high burden of childhood adversity for neurobiological development and psychological functioning among veterans, and for mental health treatment within the VA. Further, we describe the development of a trauma-informed program which utilizes a phase-based, modular approach to better address the psychological sequelae of childhood adversity, and foster resilience and posttraumatic growth. Several case examples are discussed, along with recommendations for future research.

The Orthodox Jewish Couple in Therapy: Addressing Religious Conflict and Confronting the Divine Elephant in the Room Abstract This case study illustrates how religious conflict can define a couple’s therapy. The couple therapist’s understanding of religious background can enable deeper discussion. For example, the therapist’s knowledge of observance creates a therapeutic space to explore broader themes of grief, longing, anger, religious commitment, God, and ultimately, commitment to marriage. Religious themes emblematic in Orthodox Judaism are highlighted in this case study. Changes in one’s religious practice can generate a shift in the marital relationship; how to address religious changes and conflicts in therapy is explored using a framework of emotionally focused therapy. Practice implications are offered, which focus on confronting religious conflict when working with similar couples.

Self-Compassion as a Predictor of Self-Care: A Study of Social Work Clinicians Abstract Despite the promise of self-care in dealing with employee challenges, there is nominal research related to this topic, in general, and among the clinical social work workforce, specifically. This exploratory study examines self-compassion, self-care, and the predictive relationship between the two among a sample (N = 831) of clinical social workers practicing in one southeastern state. In so doing, this paper uniquely addresses several limitations in the current literature. Findings suggest that social work clinicians in this sample engaged in moderate amounts of self-compassion and self-care, respectively. As well, self-compassion proved to be a unique and significant predictor of both personal and professional self-care, respectively. Findings from this study suggest the need to more deftly support clinicians in engaging in self-compassion and self-care, which includes ongoing training, education, and skill development.

Breaking with Norms of Masculinity: Men Making Sense of Their Experience of Sexual Assault Abstract In recent years, the sexual assault of males has received growing attention both in the research literature and among the public. Much of the research has focused on documenting prevalence rates or the psychological consequences of male sexual assault. However, this article aims to understand how men, as gendered, embodied and affective subjects, make sense of their experiences of sexual assault. In-depth interviews with ten adult males who have experienced sexual assault have been analyzed using a phenomenological approach in order to learn more about their lived and gendered experience. Four themes emerged from the analysis: (a) conflicting feelings and difficult conceptualizations, (b) re-experiencing vulnerability, (c) emotional responses and resistance, and (d) disclosure and creativity. The findings suggest that the ways in which men navigate norms of masculinity shape the way they understand, process and articulate their lived experience of sexual assault. As a way of coping with the experience and of healing from a past that is still present, the study participants perform an alternative masculine identity.

An Attachment-Informed Approach to Trauma-Focused Cognitive Behavioral Therapy Abstract Trauma-focused cognitive behavioral therapy (TF-CBT) is a widely utilized evidence-based practice for treating children exhibiting symptoms of trauma. The model is theoretically grounded in principles of cognitive behavioral therapy (CBT) and incorporates a safe caregiver throughout treatment. TF-CBT’s use of a safe parental figure is supported by attachment theory, but the model does not fully address the complex needs of the families frequently served by social service organizations. Through the lens of attachment, the TF-CBT model holds more potential by directly supporting the parent/child bond and enhancing a caregiver’s role as a secure base. As the field of neuroscience advances rapidly, new research supports attachment based interventions, and thus, also supports the importance of enhancing the parent child bond in trauma treatment. The purpose of this paper is to highlight ways that attachment theory, if made more explicit in training and education programs, could enhance clinicians’ understanding and involvement of the caregiver in TF-CBT, thus making the model more applicable to families who have experienced complex, intergenerational trauma. An overview of literature related to attachment and trauma and the efficacy of TF-CBT will be provided, as well as a case illustration integrating TF-CBT and attachment principles with a highly complex family.

Clinical Social Work Scope of Practice Related to Diagnosis Abstract This paper discusses a relatively undocumented movement by clinical social workers to gain mental health diagnostic privileges as part of their scope of practice across the United States. The primary purpose of this paper is to identify which states permit social workers to diagnose. Reviewers located the state regulatory codes on social work scope of practice to determine if diagnosis of mental disorders was permitted and contacted corresponding state boards and NASW chapters to understand diagnostic privileges and grassroots movements in this area. We found that only three states do not authorize social workers to diagnose mental disorders: Alabama, Pennsylvania, and Indiana. The secondary purpose is to determine what percentage of graduate social work programs require a mental health assessment course to understand how graduate students are being prepared to diagnose. A minimum of two reviewers evaluated social work curricula for Masters-level programs (N = 226) accredited by the Council on Social Work Education. A majority of programs offered or required coursework on the assessment of mental disorders. We also discuss the state training requirements as they apply to diagnosis. As clinical social workers begin to practice in new areas, it is worthwhile examining efforts in addressing policies to expand social work scope of practice. This paper provides examples of successful and unsuccessful efforts to expand scope of practice on diagnosis to inform future efforts to impact policy change as applied to professional practice. A coordinated effort to align academic requirements with clinical social work scope of practice and professional practice guidelines can better prepare the clinical social work workforce.

Counseling Women Who Have Terminated a Pregnancy Due to Fetal Anomaly (TOPFA): The ACCEPT Model Abstract Women who have terminated a pregnancy due to fetal anomaly (TOPFA) may experience disenfranchised grief, societal stigmatization, and lack of support. A history of legislative attempts to criminalize TOPFA providers, public misunderstanding, and poor healthcare experiences may create reluctance in women to seek face-to-face counseling. While recent publications have assessed the grief reactions and help-seeking of women who TOPFA, few have provided an informed approach to therapeutic intervention for clinical social workers. This article attempts to provide a practice model through a composite case study utilizing the proposed ACCEPT model. The ACCEPT model incorporates elements of modern grief theory and consists of acknowledging disenfranchised grief, connecting emotions to the loss, continuing bonds, exploring distortions, practicing new skills, and telling the story. Implications and recommendations for social work engagement, awareness, and therapeutic support of this population are also provided.

Coping with Transitions: The Case of Combat Reserve Forces Abstract Reserve duty is described as cyclical, ambivalent, and complex and as involving traumatic elements in all militaries. However, to our knowledge, little has been written about how the soldiers themselves phenomenologically define the experience within specific social contexts. Israel has mandatory military service for all citizens, many of whom continue to serve in the reserves. Given the ongoing conflicts in the region, combat reservists are often called upon to serve. Our aim in this paper is to investigate these soldiers’ transitions from their call up to their engagement in battle, and finally, to their return home. Our methods will be to use the narratives of twelve such soldiers. The central themes describe a deep conflict between collective versus individual cultural narratives that create dilemmas and stress at each of these stages of transition. The narrative framework and culturally contextualized, rather than trauma-related, focus of the findings shed new light on combat soldiers, self-defined stressors, and their relationship to specific socio-cultural contexts.