Should social workers be engaged in these practices?
February 8, 2019 5:25 AM   Subscribe

"Over the past 15 years, we have gathered examples of “ideas” and “activities” associated with social workers as examples of possible deviations from the mission of social work." The authors of this study gathered evidence of social workers who promoted practices that "would not receive universal acclaim and, in some instances, might appear highly questionable."

Examples include ChakraDance, Clearing Spray (YT video) and shamanic services.
The full list of 418 practices is available here.
posted by Biblio (49 comments total) 17 users marked this as a favorite
I notice that prayer isn't on the list.
posted by demiurge at 6:10 AM on February 8, 2019 [7 favorites]

I notice that prayer isn't on the list.

"Given the preliminary nature of this effort we used what one might characterize as a Justice Stewart Potter decision rule: we knew what was questionable when we saw it. Obviously readers may disagree."

One presumes they applied a similar principle to deciding whether calling out a particular practice would be bad for their own reputation.
posted by CaseyB at 6:15 AM on February 8, 2019 [3 favorites]

I am actually going to argue that using ceremony and ritual in healing, particularly from trauma and emotional issues, can be very powerful and that it should be permissible for people to seek licensed professionals who provide trauma care with religious healing options that suit the persons belief system. Given that EMDR is effective not because of the eye movements but because of tying a ritual activity such as clicking or eye movements to stimulate the body to work on deeper issues- I think the reality is evidence based medicine is ignoring an entire field of healing if it really believes that the DSM is "evidence based" rather than a bunch of pet theories tying some actual symptom clusters together in nice little packages designed to sell pills for pharma and to let society label the people it has harmed as "the problem" with a "biological disorder".

Ritual and ceremony have been around for thousands of years, possibly because they do something for us. How that works in healing should be considered without assuming that everyone who sees these tools as valuable is incapable of seeing the value of vaccines.
posted by xarnop at 6:24 AM on February 8, 2019 [43 favorites]

I should add quickly that I think both licensed and unlicensed "healers" are often selling the same bullshit to people, and I am in favor of exposing harmful practices whether they are taught at universities as currently considered standard care or being pushed by some hustlers trying to sell the "secret" to an always happy life in just 4 easy steps that cost hundreds or thousands of dollars to access! I have talked about the ways CBT can have some more questionable results that it was pushed for a long time if you look at longer term research and particularly for trauma; there are some real problems in which I believe our current mental care is actually abusing people and refused to acknowledge or own that. People will turn to anyone when they realize the people they should be able to trust and who are following "the rules" of best care are following the rules of broken system.
posted by xarnop at 6:30 AM on February 8, 2019 [13 favorites]

It depends on what these professionals are selling. If they are selling "these meditations and rituals can help you process trauma", that's fine, but if they are selling "We can contact angels who will heal you", that's a form of fraud - and maybe against their professional ethics. It's about what they claim and what the evidence is.
posted by jb at 6:32 AM on February 8, 2019 [9 favorites]

I mean, opiates are great for relieving emotional trauma, too. Doesn't mean we should be encouraging people to take opiates.
posted by escape from the potato planet at 6:32 AM on February 8, 2019

Listen, if ritual and ceremony manage to out-perform placebos in a double-blind trial I'll be happy to call it medicine

but until then I'm looking pretty askance at all those weaselly "can be helpful" and "possibly because" just because CBT might have unspecified side-effects
posted by Merus at 6:41 AM on February 8, 2019 [6 favorites]

Social work degrees seem to be pretty common for liberal clergy so I don't suppose new age stuff is all that different. I do think a line is crossed when it gets into their professional practice, but the line is necessarily fuzzy.
posted by sfred at 7:17 AM on February 8, 2019 [3 favorites]

But depending on how you define ritual, isn't therapy a ritual? Sitting down in the same place at the same time to speak in a controlled setting?
posted by AlexiaSky at 7:19 AM on February 8, 2019 [8 favorites]

But depending on how you define ritual, isn't therapy a ritual? Sitting down in the same place at the same time to speak in a controlled setting?

Therapy is supposed to be based on the current best understanding of how to help people get better, which should come from peer-reviewed study of the efficacy of various approaches, and be open to modification based on further research and developments in the field. So maybe it will involve repeated behavior set to a schedule, but that doesn't make it a ritual, anymore than the procedure for changing a car's oil or open-heart surgery is a ritual.
posted by skewed at 7:29 AM on February 8, 2019 [8 favorites]

I worry that "shamans" or shamanic is accurate. And there are some very bad shamans out there. Not just the incompetent ones. Once you've convinced yourself that the World operates in particular ways...
posted by aleph at 7:43 AM on February 8, 2019

I know, I know- anecdotes are just that. But here was my surprising realization.

I’ve always tried hard to be rational, and as and adult, rejected belief and mysticism in favor of science and evidence.

After my husband’s death, I was shocked to find how much that changed.

I do not believe in the supernatural components. And yet, for a number of reasons, found myself participating in various rituals or spiritual activities. One was partially just because a close friend of mine is a hopeless new age crystal guy with a cultural heritage that has a large spirituality component.

I gotta say, they’re on to something.

First ritual I was exposed to was funeral planning. It was likely Cold Chef that pointed out the ritualized nature of it all was part of what helped people cope. You HAD to plan it, but the steps were pretty well defined. But those steps also provided and forced a level of closure. Hard ritual to learn about rituals, but it also made the value glaringly obvious.

I chose a non-religious funeral, and while I’d do it again to respect his beliefs, I have an inkling that a religious funeral would have offered even more.

The next experience was the aforementioned friend did a smuding at my old house. I initially agreed to let him do what he wanted to do, as I have realized people have different needs after a death. It wasn’t going to hurt anything. But he asked me to participate. After some initial reluctance. I did. And wow, I was surprised how much relief it gave me. It wasn’t everything, but it was something.

The book Stealing Fire, which I’m admittedly only part way through, discusses rituals as a way of reaching different states of consciousness. They tie altered states of ritual, meditate, psychedelic drugs, extreme exercise, and I think a few others all to the same process of reaching outside of normal waking conciousness for a number of benefits. Ritual and spiritual practice is an ancient way humans intuited on these beneficial practices, even if we didn’t understand the why.

I do not believe in magic or supernatural parts of any of this. But I am now open to indulging in many things I had dismissed in the past out of the belief they were, well, beliefs. I’ll “play pretend” for the moment and suspend my disbelief as best I can, because it does seem to make for a better experience.

Just one persons lived and probably flawed experience.
posted by [insert clever name here] at 7:47 AM on February 8, 2019 [23 favorites]

I remember an old film "Dinner with Andre" (Louis Malle, Wallace Shawn?). Andre was talking about an incident where he visited an Eastern European (IIRC) who was also involved in the Theater. He talked about going through this theatric "ritual" in the forest that really seemed like it was located out in that borderland of magic, ritual, "spiritual practice". Made me think.
posted by aleph at 7:52 AM on February 8, 2019 [2 favorites]

There’s a qualitative difference between culturally oriented practices like funeral preparations and exercise in ritual dance than something like “acutonics,” which is one of the things on the list. Anecdotes about the former make the latter look OK in comparison.

People can be so open-minded that their brains fall out.
posted by Cool Papa Bell at 7:55 AM on February 8, 2019 [6 favorites]

I work in the field, though my interventions are incredibly brief just based on that I do social work in a medical (and non mental health) setting which is an extremely specific context.

A dear friend is basically a tarrot reader, she gets paid significant amount of money to read cards, pretty much equivalent to what people pay in cash for psychotherapy . I'm pagan, and as a licensed practitioner I have tons of feelings about this. And my belief versus my clinical practice the two seperate things that just don't meet. I sincerely worry that she has clients who would be better served by mental health professionals. I also worry about my professional peers who do non evidenced based things in evidenced based therapy. My friend probably better and more compassionate than some of the professionals I've met and atleast she's not presenting herself as a licensed professional. In my own therapeutic journey, have been subjected to Christian nonsense, crystal whatever's, inner part work, all sorts of stuff as a client. I've definately hand hands laid on me, hypnotized, had emdr without consent. It's a minefield out there.

I know there are plenty of pagans and other minorities who avoid standard evidence based care for variety of reasons that have to do mostly with bias and outright discrimination. I'm not sure what the balance is that signals to someone that a licenced professional may share similar spiritual belief systems and may be a safe person versus engaging in whatever ritualistic practice with no education or way to evaluate their work.
posted by AlexiaSky at 8:00 AM on February 8, 2019 [9 favorites]

No, no, this is totally stuff that is good to provide people with serious needs. It'll be a tremendous help. Much better than that humdrum practical work dullards do.

BioGenesis: Atlantean Glass Healing Tools

BioGenesis is a technology that is millions of years old, and was re-introduced to Earth in 1999 by an Atlantean Ascended Master, Lantos. The BioGenesis Tools helps restore harmony to all levels of your life, as well as your home, workplace and life.

posted by gusottertrout at 8:01 AM on February 8, 2019 [5 favorites]

Yeah, they can. And over time some of that get's sorted out. (And some doesn't)
posted by aleph at 8:02 AM on February 8, 2019 [1 favorite]

I am actually going to argue that using ceremony and ritual in healing, particularly from trauma and emotional issues, can be very powerful and that it should be permissible for people to seek licensed professionals who provide trauma care with religious healing options that suit the persons belief system.

Am I really missing something? Surely the problem here is not whether anyone should ever go to someone doing acutonics or whatever, but that people who are in a position of authority and influence over others, often because they hold actual government positions dealing with vulnerable people, should not be promoting such practices.
posted by praemunire at 8:04 AM on February 8, 2019 [14 favorites]

In case it wasn't clear, I'm in favor of pretty close to an "evidence based" medicine, if I understand what it is meant by that. I'm also aware of some other stuff that doesn't fit that.
posted by aleph at 8:05 AM on February 8, 2019 [1 favorite]

My last post was worded a bit wrong so let me clarify, (sorry!) Because I said above... versus engaging in whatever ritualistic practice with no education or way to evaluate their work.

It really not a versus. You can't use non evidence based practices. But Finding the line between advertised beliefs and practices and in session signaling that provides affirtmation versus when that becomes non evidenced based practice is blurry.
posted by AlexiaSky at 8:06 AM on February 8, 2019

praemunire: that would be my objection. But it seems to bleed into a lot of "people shouldn't believe what they believe!" stuff. Maybe they shouldn't. But they are the ones that get to decide that.
posted by aleph at 8:07 AM on February 8, 2019

Of course, they're human beings. They can do whatever they want. But they can't do it *as part* of their social work profession. In Ontario, Social work is a regulated profession and social workers and have a code of ethics which states pretty clearly: "A social worker or social service worker who engages in another profession, occupation, affiliation or calling shall not allow these outside interests to affect the social work or social service work relationship with the client"

So yes, if they want to burn crystals to heal your chakras or align your auras with your the stars or whatever, in their spare time, that's all fine, as long as they don't say they're doing social work while they do it and don't do it with their social work clients.
posted by If only I had a penguin... at 8:09 AM on February 8, 2019 [17 favorites]

Oh, I disagree there. Or maybe I just misunderstand. I think people *can* use non-evidence based practices (or at least what I think are non-evidence). Whether they *should* is a different question.
posted by aleph at 8:09 AM on February 8, 2019

"...can't do it *as part* of their social work profession"

Sure. Got particular standards for public servants/services.
posted by aleph at 8:11 AM on February 8, 2019

Placebos have a well established roll in medicine.

We do not have a tool kit of high-success, safe, evidence based treatments for many mental conditions and family situations.

There is little funding available for people who need help to do anything but talk briefly with a person, or talk in a group and take pills.

Want something better than placebos? Fund orphanages, adult homes, mental hospitals, and research.

Vitamins, herbal supplements, chiropractic, massage, astrology, numerlogy, technical analysis of stocks. Heck, check out what physical therapists do for certain injuries and try to find peer-reviewed outcomes assessments.
posted by Anchorite_of_Palgrave at 8:14 AM on February 8, 2019 [3 favorites]

"Want something better than placebos?"
There are many people out there who will tell you about all of the other ways there are to get from where you are to where you want to be. And there are many people who will believe them (for various reasons). :(
There are limited options to deal with that. Or at least ones who don't seem to have large unintended consequences.
posted by aleph at 8:20 AM on February 8, 2019 [1 favorite]

As many of the people in this thread are trying to say, the hippy nonsense is just that. And because these alternative practices are full of either pseudoscience or supernatural beliefs, they’re not really investigated to the lengths the should be. Few researchers are going to want to taint their research and reputation by saying “wait, let’s see what these do and why.”

Tarot cards mentioned above are a great example. As with other spooky practices, I was first pulled in reluctantly to humor a friend. And I almost immediately saw their benefit- it lets you play with intuition, and approach problems from a different direction than you might otherwise. The intuition part is part of the playing pretend; by allowing yourself a safe space to throw any idea out there, you can come up with ideas and solutions that you otherwise might dismiss as ridiculous. As for the problem solving approach, you’re giving prompts with enough constraints to view whatever problem in ways you wouldn’t otherwise consider.

Honestly, tarot, if you stop looking at as predictive or otherwise supernatural, has a lot in common with various approaches to encourage creative problem solving within various fields. My first thought was “oh, this is just like ideation I’ve done in this design thinking workshop.”

The point being the value isn’t in the wishy washy belief structure, and I do agree that it shouldn’t be presented as anything but a tool, not a psychic practice with the ability to make predictions (outside our intuition).

(I really would like to take tarot cards into a few business meetings where there was issues with overcoming certain problems, to see what kind of utility they might have. I suspect a lot more than one would expect. But also, tarot, so 🤷‍♀️)
posted by [insert clever name here] at 8:23 AM on February 8, 2019 [9 favorites]

Scanning through the list, why am I not surprised to see so many white people promoting themselves as experts in spiritual techniques taken from other cultures and given a bit of a freshening up? Under Native American Journeying for example:

Brenda is able to see and hear the loving guidance of the angels, and she shares this with clients to facilitate a conversation with the angels about whatever concerns a client may have. Under the angels’ direction, sessions sometimes include loved-ones who have passed, information about past lives, and other guidance from a larger perspective — Divine Wisdom.

Brenda also uses her energy healing training as a source of guidance and support to clients. Brenda is able to see clients’ energy fields and the angels as they do their energy healing. After the energy work, she is then able to share with clients what she experienced being done and any Divine messages given for the client during the energy healing.

posted by gusottertrout at 8:25 AM on February 8, 2019 [2 favorites]

Sure. Got particular standards for public servants/services.

The professional code of ethics and standards of practice apply to social workers working for any employer, not just public servants.
posted by If only I had a penguin... at 8:39 AM on February 8, 2019 [1 favorite]

I would suggest that EMDR works through ritual, as well as the positive results of both acupuncture and sham acupuncture for many conditions. It feels a bit awkward to have this conversation where people are saying "well if there's any actual research done maybe we could know these things" and not discuss all the actual research done.

Sham acupuncture vs acupuncture- many of these results are things like fifty percent reduction in hot flashes. This kind of success is worth understanding.
acupuncture vs sham acupuncture for IBS- "A total of 53% in the true acupuncture group met their criteria for a successful treatment intervention, but this did not differ significantly from the sham group (42%)."

The value of nurturing care, social support, physical touch, and intimacy are in fact being researched right now and there's SO MANY studies we could all talk about if we wanted to inform ourselves about these subjects. Placebos themselves are incredibly effective for many conditions and again, we're back to the ritual and attention and care, as well as the trust and positive emotions of being valued enough to be cared for (among many other variables) as being possible reasons that placebos themselves have actual impacts on health conditions.

placebos for allergic rhinitis- "Placebos without deception can improve symptoms in allergic rhinitis. Positive expectations do not contribute to the efficacy of open-label placebos, but seem to have an effect on more global and subjective well-being (mental or emotional quality of life)."

Placebo effect in depression treatment - "The researchers found that the participants reported significant decreases in depression symptoms when they took the active placebo, compared to when they took the inactive placebo. These reductions were linked to increased µ-opioid receptor brain activity in regions of the brain associated with emotion and stress regulation."

Placebos, of course, do not help with everything, (differential effects of placebo responses depending on specific mental health condition) and studying more in depth the ways that "alternative" health options both help and don't help is extremely important.

Yoga and meditation for PTSD: "These findings suggest that meditation and yoga are promising complementary approaches in the treatment of PTSD among adults and warrant further study."

Somatic experiencing is a technique that involves very similar meditative and body awareness techniques found in advanced yoga and meditation. It may have efficacy is PTSD. EMDR using various types of movements (ritual) tied to healing traumatic events also has results.

And this is where I think researching long term impacts of techniques not currently classified as standard medical care is essential- people need sound medical advice about which conditions they might safely attempt to use something like diet and exercise, yoga and meditation for, and which conditions require immediate treatment with standard. Reiki for example has consistently poor results EVEN IN the complementary health journals. Why is that? I would love to see better research into what works and doesn't and why. Frequently the research being done on "alternative health" is not being funded as well and is often done by places called "Integrative health institute" which might not be using as rigorous study criteria. Therefore after they do the research- their studies can simply be ignored. Meanwhile getting anything that not's pharma centered funded can be a challenge.

One of the difficulties of standardizing clinical care treatment for mental health is that people often respond to - CARE- of any kind, making it hard to tease out which techniques are providing the best long term results or if it even matters which techniques are used. Some studies indicate certain types of therapy are superior, but later studies with different variables might contradict that. The idea the mental health is a field with hard rigorous science that shouldn't be questioned because we are already right about everything, is a very comforting and understandable myth.

My hope however is not that we stop using research but that we consider investing in deeper research into therapeutic models and challenging the sexist, capitalistic, racist (and other ists) assumptions still within the foundations of models we're still using. There's a lot we need to rethink given the actual evidence we have and change is hard.
posted by xarnop at 8:42 AM on February 8, 2019 [12 favorites]

Does money exist in any more real way than, say, ancestral spirits or the transubstantiated body of Christ? Maybe it's the veneration and exchange of money, and praying for the intercession of insurance companies, that makes therapy a ritual. Even when the actual therapy is 100% rock-solid peer-reviewed quintuple-blind study-based applied science. Sometimes I feel as though I ought to burn the thighbones of a fatted calf to fend off unmet deductibles or through some haruspicy determine next year's drug formulary.
posted by XMLicious at 8:44 AM on February 8, 2019 [1 favorite]

Nobody believes placebos are anything but placebos.

But some people really do believe in the healing power of crystals. You can’t help these people.

And some people sell crystals to these people knowing they don’t work yet claiming they have magic powers beyond placebo effects. These latter people are known as assholes, parasites and fucking evil plagues upon humanity.
posted by Cool Papa Bell at 8:47 AM on February 8, 2019 [4 favorites]

Yeah, we don’t have to have an argument about whether any of these things have value in order to say government social workers shouldn’t be engaging in them. You can set up a tarot or crystal practice on your own time perfectly well without exploiting vulnerable people under your care.
posted by corb at 9:17 AM on February 8, 2019 [4 favorites]

So it's ok to exploit vulnerable people if not a government worker or is that too much a derail? Or we're saying we can't do much about it but can for government workers?
posted by aleph at 9:22 AM on February 8, 2019 [1 favorite]

In social work there is an ethics board and you sign the ethics statement. Ethics questions are included on the test. In the US you can lose your licence over ethics violations via board review. Each state is different, but it's similar to lawyers and doctors in that way.
posted by AlexiaSky at 9:26 AM on February 8, 2019 [6 favorites]

Ah? Didn't know there was that much control over it. Thanks.
posted by aleph at 9:35 AM on February 8, 2019

So it's ok to exploit vulnerable people if not a government worker or is that too much a derail? Or we're saying we can't do much about it but can for government workers?

Trying to think of a way to respond to this question that doesn't imply that you are somehow insulated from the super-ultra-basic fact that government social workers can wield huge coercive powers over their "clients" and getting stuck.
posted by praemunire at 10:03 AM on February 8, 2019 [4 favorites]

I think there’s a big difference between doing yoga for PTSD and seeing a LCSW who claims to be an expert in fairies!
posted by Biblio at 10:14 AM on February 8, 2019 [4 favorites]

Trying to think of a way to respond to this question that doesn't imply that you are somehow insulated from the super-ultra-basic fact that government social workers can wield huge coercive powers over their "clients" and getting stuck.

I think the point isn't "if non-government social workers are allowed to do it why can't government social workers", it's "why should non-government social workers be allowed to do this."
posted by If only I had a penguin... at 10:47 AM on February 8, 2019

Oh no. I'm not disagreeing that it's wrong about the government social workers. And maybe I'm getting off into the weeds, I'm just concerned by the non-government types out there as well. But I don't seem to convey that that well so it's best if I don't.
posted by aleph at 10:48 AM on February 8, 2019

Also remember we do not have enough therapists and other mental health services available to people in this country. Some, and i’d argue much of the psychic/shamanistic/healer role is essentially sitting and listening with someone. Or as aleph points out, in the service of performing care. Could that be better served by just sitting and listening and/or performing said care rituals? Maybe. Probably. But if the how isn’t there, then maybe the gap isn’t as poorly served as one would expect? I don’t know.

What I do have a strong suspicion is that evidenced-based care is better than superstitious care. But superstitious care is better than no care. How do we tease that out?
posted by [insert clever name here] at 11:28 AM on February 8, 2019 [2 favorites]

"How do we tease that out?" Beats me. Reminds me of trying to control what gurus and cults are allowed to do to their members. Whatever we're going to do it looks like another case of "it will be wrong". But hopefully "better". And also hopefully we learn from our mistakes and keep improving. But to argue for something like that when what exists is so lacking/nothing seems to be missing the point.
posted by aleph at 11:57 AM on February 8, 2019 [1 favorite]

Does the government still court order people to AA? Do social workers still integrate it into their treatment plans? I'm pretty sure the answer to both of those is yes, but I'd be happy to be wrong. Forcing people to pray to a man-god in a puritanical setting does not receive my "acclaim" and I find it quite questionable. Especially given mixed results in AA's efficacy. (I say this as a 12 stepper myself).
posted by avalonian at 12:53 PM on February 8, 2019 [4 favorites]

The authors of this study didn’t research government social workers and the techniques/methodologies they use, they researched *licensed* social workers. The third paragraph of the study discusses the Google search strings they used; all the acronyms except for MSW indicate licensure. I was licensed as an LMSW in the past and could have had my license revoked by the state of Iowa (the issuer) if I was providing services outside the scope of my licensure, as many of the practices in this list are.
posted by epj at 1:32 PM on February 8, 2019 [1 favorite]

Well I know what I'm feeding into my neural net generator next...
posted by danhon at 3:57 PM on February 8, 2019 [1 favorite]

No, they researched websites that talk about licensed social workers. For instance, this woman doesn't claim to be currently working as a social worker, and I doubt she gives a shit about her license.

Now, I blend my years of clinical experience with consciousness shifting tools including my clairvoyance, knowledge of the brain and meditation, spiritual concepts, quantum play and so much more!
posted by the agents of KAOS at 11:08 PM on February 8, 2019

It's worth noting that in some states the licenses don't actually expire, too, although they can be revoked. My understanding is that NY for instance has just recently added a requirement for ongoing training. Perhaps the goal of the list is to argue that states should be more aggressive about hunting out people with licenses who start doing crazy stuff, and protecting the use of the term?
posted by the agents of KAOS at 11:23 PM on February 8, 2019

Some of the items on that list are generally well-regarded therapy practices. Somatic Experiencing, Hakomi, and various breathing techniques are not super out-there. And I would expect LCSWs working with clients with eating disorders to be versed in intuitive eating.
posted by lazuli at 10:06 AM on February 11, 2019 [1 favorite]

And the "Vipassana therapist" is just someone who does Vipassana meditation and talks with clients about mindfulness, which is certainly an evidence-based practice.

I get the authors' overall point, but the list is sloppy.
posted by lazuli at 10:21 AM on February 11, 2019 [1 favorite]

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