fiTHS A STUDY OF THE PROFESSIONAL ASPECTS OF SOCIAL WORK, UTILIZING THE ATTITUDES OF MICHIGAN PSYCHIATRISTS TOWARD SOCIAL WORKERS Mbrton Stanley Perlmutter A PROJECT REPORT Submitted to the School of Social Work Michigan State University in Partial Fulfillment of the Requirements gar the Degree 0 MASTER OF SOCIAL WORK June 1953 Approved: 46‘ Committee ‘k 2% ~)kQ?&Ji/€jgi;bfikfihigrgfl\‘ Director of School {main ACKNOWLEDGEMENT Acknowledgements are gratefully extended to Dr..Lucille K. Barber and to Mr. manfred Lilliefors for the valuable assis- tance which they have given to this writer on the subject matter of this study. Added appreciation is-expressed to Dr. Gordon Aldridge for the extra inspiration, provocative thoughts, and critical evaluation of this writer's efforts. Sincere thanks and appreciation are also extended to Mr. Harold Dukes and to Dr. Warren S. Wills, of the Psychiatric Clinic at the State Prison of Southern Michigan, for their in- terest and help. 11 TABLE OF CONTENTS Page ACKNOWLEDGEMENT . . . . . . . . . . . . . . . . . . . . 11 LIST OF TABLES . . . . . . . . . . . . . . . . . . . . iv Chapter I. INTRODUCTION 0 O I O O O O O O O O O O O O O O 1 Statement of Problem The Approach to the Study Definition of Terms fiethodology II. DISTINGUISHING FERTURES OF SOCIAL WORK AS A PROFESSION, AS SEEN IN THE LITERATLqiE O O O 0 O O O O O O C O O O O O 5 III. QUESTIONNAIRE RESULTS: ATTITUDES OF 40 MICHIGAN PSYCHIATRISTS TOWARD SOCIAL WORK AS A PROFESSION . . . . . . . . . . . . 13 IV. SUIE'IARY AI‘JD COPICLUSIOB‘ES . o g Q o o g Q Q Q o 22 Summary Conclusions APPEImI-X O O O I O O O O O O O O O O O O O O O O C O O 26 BIBLIOGRAPHY . . . . . . . . . . . . . . . . . . . . . 35 iii LIST OF TABLES Table Page 1. Type and Frequency of Psychiatrists' Contacts with Social Workers . . . . . . . 1L iv CHAPTER I INTRODUCTION Statement of Problem The reason for this writer's search for criteria or aspects of professionalism in social work originally arose from student discussions on the problem, coupled with classroom dis- cussions with many people in professional practice. The original statement of problem indicated that there would be an attempt tO' answer specific or general problems connected with eXploratory investigations of aspects of professionalism in social work and of social work's professional relation to psychiatry. The original problem seemed to be so all-encompassing that the amount of time that it deserved would have been tremendous com- pared to the amount of time and attention able to be given to it. The statement of problem was shortened to limit the study to seeking out only professional aspects of social work and utilizing a questionnaire concerning attitudes toward social work which was sent to sixty-one Hichigan psychiatrists. The Approach to the Study While it is true that the original problem concerning identification of professional aspects of social work was primary, it is also true that a secondary goal was the deter- mination of lack of criteria and concepts of professionalism -2- evidenced in the fields of social work. Also, with these goals understood, the necessary research would be useful in pointing up areas in which further research could be done, or in which better theoretical foundations could be laid. It is also felt that identification of these criteria would possibly be the basis for methods of disseminating knowledge which would reach the lay public, thus giving it a clearer idea of the social worker as a professional, or of social work as a profession. It was hypothesized that aspects of professionalism exist in social work, and that these aspects can be identified. Definition of Terms This seemed to be one of the most difficult areas in the planning and coordinating of data for the study, insofar as the definition of terms entailed a definition of what is meant by the terms, ”profession" and "professionalism.” Edith Abbott states that three things are true for a profeSsion to be exis- tent: (1) There are basic principles; (2) these basic principles can be taught; and (3) they must come from two sources -- a critical examination of the methods used to produce cer- tain results and a searching equally for the causes of apparent failures and apparent successes. In general, there seems to be some agreement on the part of writers in the field of social work that there are other aspects of professionalism which can be clearly identified, and which would serve as criteria for further definition in studies of 1Edith Abbott, Sgpial Welfare apd Professional Education (Chicago: University of Chicago Press,W1931-19h2), p. 45. -3- professionalism. Some of these aspects are concerned primarily with characteristics of personality which have been assumed as fundamental for the profession of social work. These person- ality fundamentals have been noted to be emotional maturity, emotional stability, ability to understand and accept limita- tions, both personal and professional, empathy, and the ability to work on a team.2 Nowhere in the search for criteria by which professions could be judged did the writer note any one author as clearly identifying any one set of criteria for the Judgment of a profession. Throughout this study the term "profession" is used in a very broad and general way, and is tahen to mean the total of the derived goals which would denote a profession. It also con- tains the concept that the profession can be recognized in that it possesses all, or most, of the attributes which are readily observable, but not readily definable. Other terms to be utilised will be defined within the general context of the study. Methodology The methodology for discovering the aspects of this pro- fession were: (a) a systematic review of the literature, on the basis of the aforementioned criteria, in the hepe that the literature would reveal certain elements which identify profes- sionalism; (b) an analysis and interpretation of the data 2Solomon Goldfarb, "The Function of the Psychiatric Social Worker as Interpreted by 38 Michigan Psychiatrists" (unpublished Master's thesis, University of Michigan, 1956), p.-22. -4. collected from the literature, and (c) the collection of atti- tudinal responses from the psychiatrists who answered the ques- tionnaires. The evaluation of responses on the questionnaires was made on the basis of’the responses themselves, in that they were self-limiting and self-explanatory. CHAPTER II DISTINGUISHING FEATURES OF SOCIAL WORK AS A PROFESSION, AS SEEN IN THE LITERATURE William J..P-icGlothlinl recently pointed out that part of professional competence is based upon knowledge and skill to do what is necessary at the appropriate time. He also noted that increasing knowledge of’"professional" theory and principles would illuminate the use of skills. This, then, would indicate that there is some definite feeling about the importance of the body of knowledge, and in transmittible basic principles, since McGlothlin's findings were based upon a comparative study of ten professions, including medicine, engineering, law, and clinical psychology. Some social workers are now considering practice itself to be an integral part of the body of transmittible knowledge. Wessell, for instance, states that, "when we speak of profes- sions, such as medicine or law, by mere reference to professions we are millennia further along in man's develOpment as a social being. ...We are adding a new dimension to practice."2 It was 1WilliamMcGlothlin (Southern Regional Educational Board), "Comparative Patterns in Professional Education," Address before the Council on Social Work Education National Conference, Janu- 8?? 39) 19580 ‘Rosa Wessell, Faith hessell, and Goldie Basch, Professional Education Based in Practice (Philadel his: University of Penn- syIvania, School of Social Work, 1953 , p. 3. -5- 10 M06113 ”0 bedntoq (linseed "nsicieomot‘. .1. ”H115? ’w‘ ‘ It: I has Igbebteml noqy 5.65.. i sonsaoqroo fmolsse’lotq “m can of! .enls edshqmqqs an: a: mseeooen e1 3341' c ‘j t - writ has vised: "IBISOIuRQFG'1"" If egneixcni sniscmonl “In”: W med: .3.th .311qu It ea: :3- r edmvlsmlli DIRW . $:->v' ‘. 0&ij {Mme-[m1 eds dyed; pause: 53.71! 192: am 31‘ ens—‘33 33d? ”13 .Mklnahq Diced eIdla‘dlssnmJ ..~1 m. .. .sgLerenfi to (bed WW affiliation .6 acqu based exec emron'r'l s'nllrldoIDoM 15$ QIII 33111091113113 .enlnibe-r gamm, :‘. assignment: as: u" ‘ f .13 .lodowzeq Leanna W 00.232574 annebianoo we . 91.5. 3252*: 1. 15,130; snot. wad bddlddimsnsw 'io (bod eyf‘ ‘1 Joe. {s'zgemi as ed ed M to begs en new-I“ Ids-dz: seams. .eos: 33IQI 10'! Lionel We“: cd eone'xe‘le': exam {6 wsi '13 9111310912: as done .sncte Me In 8365101670!) I'm at gnole defiant}. sinneIIIm 918 at Int! ghesmnq ed nomcemib was s gutbbs ms ei'v'... .3111“ u ‘ - __ I I I _ AA— ‘ - - - - I h * _ _ ‘r_ w I; inciesoub‘d Imogen instance) andeoiooe" mutual 3.0wa ”.nomsovbl Indonesia? 15!. made»? urns-23330.3: W. .Oomb‘tnoo Inserted ncueow Moi 131908 no flange... .8691)“in W 019883 035100 bans Iieees’e.’ dale"! mag“ ”03 o wine-4’3. in!) :ehielsbslld‘i) e c ..f .E 4 Jam: Mow -. - .. . -6- also felt by weasell that the professional contributions of social work, namely, learning to practice fer someone else and to give service, creates new psychological problems for man in relation to concepts of self and others. Each of the professions has formulated its own way of meeting these problems and becoming professional, or has ignored these problems which have hindered the fullest advancement as a profession. Wessell states: Social work, more explicitly than most professions, has taken these problems into account and has dealt with them as the most basic elements in a deliberate educational program. It has elected to teach professional practice - within the practice itself.3 Here lies the secondary problem of definition, namely, the con— cepts of practice as a process and practice as an activity. For our purpose, we shall consider practice as a process which is transmittible through the practice itself. Hence, we may see the evolvement, in social work, of a new concept in professional knowledge, namely, that of the process of practice itself being transmittible, or ”learnable" through active and dynamic, but controlled, participation. Ralph W. Tyler proposes as one distinguishing feature of a profession: ... the basing of its techniques of'operation upon prin- ciples rather than rule-of-thumb procedures or simple routine skills. A profession not only utilizes basic principles, rather than depending on a rule-of-thumb pro- cedure, but as it becomes more mature it recognizes that the principles used in the profession must be viewed in an increasingly larger context, and that, correspondingly the science needed by the profession must be continua Iy 31bid., 3-5. -7- extended to more basic content rathei than restricted only to the obvious applied science. This concept may appear to be in direct contradistinction to the practice-based orientation which has been readily observable in social work in the past. There is at present, however, a real seeking for basic concepts and theories within the fields of social work. This does not infer that the practice orienta- tion is useless, but rather that practice, without an under- standing of underlying theory of practice, has definite drawbacks so far as transmissibility of this practice is concerned. It may also be noted that social work has begun to extend its understanding of human problem areas beyonds its fields of immediate professional practice to those in which social work has been heretofore uninterested. New areas of social states- manship have more recently become inculcated into professional education for social work. There may be points in the profes- sional practice of social work which are not readily distinguish- able from similar features of other professions, and which appear to be areas of overlap between social work and other professions. We shall not cover these points in this study, since they may rightfully deserve further study in themselves. Actually, what we are considering here is a new concept in education for the professions, namely, the learning of new attitudes through the process of practice, and underlying ARalph‘W. Tyler, Education for Social work (New York: Pro- ceedings of Fifth AnnualProgram Meeting, Council on Social Work Education, 1957), pp. 13-15. -8- theory, combined with a change of values and attitudes. Human beings are complex organisms, including a composition of atti- tudes and values. This, of course, is true of the worker as it is of the client. In order to better or'more completely un- derstand the client, the worker must of necessity be successful in understanding himself. He must possess a sincere and earnest desire for continuing to understand himself. Kost individuals have developed basic personality patterns by which protection from unpleasant aspects of self and life can be afforded. Self- searching attitudes, therefore, are difficult to master and to maintain.’ This, then, is the type of learning comprised of shifting attitudes and values which come about through the merge of the process of practice, coupled with an understanding and acceptance of basic theory of practice. Introspection, self-appraisal, and self-criticism are not only processes, but are also attitudinal in nature, and are integral parts of what social work has termed the ”professional self." Since effec- tive use of self is dependent upon self-knowledge, we may then assume that the aforementioned attitudes and processes are basic attributes of professional social work. From the aforementioned aspects of professionalism, we may begin to see that there is a predominant involvement of’profes- sional training with develoPment and understanding of person- ality. There has been a tendency on the part of some writers 5Elizabeth Russell, Professional Growth on the Jab (Family Service Association of America, n.d.T, p. h—S. -9- ‘ to feel that certain aspects of personality are prerequisite to professional education and practice in social work. Gold- farb's findings6 indicate that emotional maturity and stability, among others, are considered to be essential requisites to social work as a profession. His findings also indicate that the very aspects which are desirable in professional training, according to writers in social work, are also indicated as be- ing important by psychiatrists: (a) emotional stability; (b) warmth and human understand- ing; (c) minimum narcissism, coupled with maximum self- knowledge; (d) integrity; (e) interest in others; (f) flexibility and adaptability, and (g) psychological orien- tation and grasp. If we are to assume that Flexner's definition of profession8 is of a basic nature, than we must also assume that the assumptions of professionalism necessitate certain personality characteris- tics and preperties. The professional acquires status through Special knowledge and training, and is organized and oriented for service rather than pecuniary gains.9 This type of behavior, which we consider basic in the professional, must rest upon an attitudinal base in the personality, which has to be free enough emotionally and strong enough intellectually to maintain these ficoidrarb, cit., pp. 22-39 71bid., pp.i%§-9l. 8Lula Jean Elliott, Social werk Ethics (New'York: American Association of Social Workers, 1931), p. h. (MUTE: Flexner's definition: (1) involves essentially intellectual operations with considerable individual reaponsibility; (2) derives its materials from science and learning; (3) has a definite and practical end; (h) Possesses a technique which is educationally communicable; (5) tends to self-organization, and (6) becomes altruistic in its motivation.) 9Ib1ge, p. 5e values as an integral part of its own system. Other person- ality characteristics deemed necessary for professional status have been defined by other authors, and include: (a) keenness of perception of symptoms of difficulty; (b) capacity to identify with the client without becom- ing personally involved' (c) courage in facing emotional upsets in clients, and d) inneriaecurity that comes from successful contacts with peeple. Hence, we may readily see that ability and flexibility in personality adjustment and attitudinal change are considered elemental aspects of professionalism in social work, and these elements are inherent in the processes of education for, and practice in, social work. This writer feels that an essential attribute for*any profession is the extent to which the activity, in which the individual is engaged, permeates his existence. We may, for example, consider many trades as being professions if they meet the aforementioned requirement, but it is doubtful if there is no generalization of the vocation or activity in the indivi- dual's living patterns. Grace Coyle11 states that professional . philOSOphy and ethics are distinguishing factors in social work as in other professions. Philosophy and ethics help in deter- mining the wisest use of the professional skills and knowledge. It is apparent that philosOphy and ethics, in order to be effec- tive, must be integrated in the attitudinal structure of the 1OLois Mhredith French, Esychiatric Social were (New York: Comminwealth Fund, 1940): p. 235. lGrace Doyle, Social Science in the Professional Education EQLgogial Worker; (New York: Council of Social Work Education, 95 . -11- individual, hence must be part of the person in a holistic rather than specific manner. The effectiveness of the worker is determined to a large extent by the degree to which these value systems have been integrated. Since this cannot be accom- plished by mere rote, we can assume that philosophical and ethical values become integral parts of the professional psychic anatomy, and further, that social relationships and living pat- terns are influence by them. / A major characteristic of a profession is its adherence to a code of ethics. While social work's written code of ethi- cal standards does not maintain as much internal agreement as some other professions, it appears to encompass ethical tenets basic to other recognised professions.12' 13 Elliott notes that professional ethics evolve from uniformity or consensus of’group thought and experience. They become articulate as a profession becomes integrated and definitely defined, each professional group having its own peculiar ethical problems. With a background of’ experience, fairly definite systems of professional standards become accepted. The distinctive nature of‘a :gggeigigggfired through the peculiar function of the ‘As noted above, social work has its base in the process of’prac- tice, hence it would seem that the ethical standards must be operational in nature. This concept is demonstrable in the three key beliefs and aspirations of a democratic society upon lzDirectory of Medical Spegialist , Vol. VIII (Chicago: Mhrqxssl "who's was“, 1957). Standards_for the Professional Practice of Social Work (New York: American Association of Social Werkers, 1951), p. 3. lhElliott, op cit., p. l. whose principles social work is based: (1) from faith in the dignity, worth, and creative power of the individual; (2) belief in his right to hold and express his own Opinions and to act upon them, as lon as by so doing he does not infringe upon the rights 0 others, and (3) conviction of the inherent, inalienable right of each human being to choose and achieve his own destiny in the framework of a progressive, yet stable, society. The dynamism necessary in social work ethics is noted in this statement made by Grace Coyle: It is obvious, therefore, that professional education must include in its function an understanding by students of the professional goals and ethics, insofar as they are developed, and an acceptance of them as guides to prac- tice. This implies no rigid inculcation, but does imply the profession's obligation to assume that its members can be trusted to use their professional knowledge and skills, not only efficiently, but also for the benefit of its clientele and for the social good. Professional edu- cation is not a training in techniques, although technical skill is essential. It requires a commitment of the self to the values embodied in the goals of the profession and to the ethics to which the profession has agreed. _ The aforementioned attributes, definitive statements, and identifiable aspects of social work as a profession have emerged from the literature in redundant fashion. This writer has at- tempted to take the most representative statements made by individual authors of the totality of ideas on one particular aspect of social work as a profession. The statements made in this chapter are not merely those of one individual, but are representative of groups of thoughts describing any, or’all, of the attributes outlined in this chapter. 15A.A.S.W. Op cit. p. 3. l6605'1'3. simian p: #0- CHAPTER III QUESTIONNAIRE RESULTS: ATTITUDES OF 40 MICHIGAN PSYCHIATRISTS TOWARD SOCIAL WORK AS A PROFESSION A total of sixty-one questionnaires1 was sent to Michigan psychiatrists. The sample was the total number of psychiatrists practicing in institutions in the state who had passed board examinations and met requirements for certification by the American Board of Psychiatry and Neurology, Incorporated.2 The other requirement was that there be a social work staff of one or more social workers with whom the psychiatrist had contact. Of the sixty-one questionnaires mailed, there was a total response of forty (approximately 68 percent of the total). All respondents indicated that they were in institutional practice. The mean number of years of institutional practice is 19.2, with the fewest number of years being 2.0 and the greatest being h5.0. The mean number of years of private practice is 7.0, with the fewest number of years being 1.0 and the greatest being 30.0. The first check table was designed to provide some clari- fication as to the type and frequency of psychiatrists' contacts with social workers: lAppendix, copies of questionnaire and letter sent to psy- chiatrists. zDirefithof Medical Specialists, Vol. VIII (Chicago: .Msrquas o s o , 95 . ngbined Directgix for lgfi-lgfié of the Michigan Sogigty of Neugo o ang_Psych atrxg chigan strict Branc _gl the e an sychiatric lssociatIoh. -13- Type and Frequency of Psychiatrists' Contacts with Social Workers Contacts Frequent Occasional Seldom Never IndiflduEIOOOIOOOOOOOAOOOOO 21 3 2 1 Part of Clinical Team..... 23 2 2 l BothOOOOOOOOOOOOOO00...... 17 1 O 1 otherOOOOOOOOO0.00.0000... 2 O 1 1 An overlapping of contacts will be noted in the above table, due to the fact that several psychiatrists had contacts with various social workers in addition to the one or more so- cial workers which comprised his clinical team. The two re- spondents who indicated contacts in the "Other" category had the responsibility for teaching social work students, and had contacts with the students and instructors in departments and schools of social work. In response to the question, "Do you consider social work to be a profession?", there was a total of 38 "Yes" answers, while one of the remaining two answered ”No" and the other gave no response to the question. The second part of this question asked for an explanation of the original answer. There were 28 responses, and 12 non-responses. A selection of the reaponses to this question indicates that emphasis is placed upon training and experience as criteria for professionalism. Many of the responses indicated that social work is considered to be a -15- profession because of the specialized knowledge and training deemed necessary. One psychiatrist stated that, "preparation has been so improved that it (social work) can be considered a profession, in much the same way as nurses, psychologists, school teachers, etc." Other reaponses tend to indicate that social work is a profession because of the level at which the workers Operate: ”They deal at a clinical level with problems affecting the welfare of patient and family alike." There were other responses than those which were obviously positive. One respondent saw no need for any more training, ”than many who cer- tainly are not professional.” This is the only response which was obviously negative toward social work as a profession. No- where in the responses to this question did any of the psychia- trists relate social work as a profession to psychiatry as a profession. ZanderA notes that psychiatrists perceive themselves as having greater professional competence than members of other mental health professions, although "competence" is not defined in the Zander study. Psychiatrists feel that they have greater competence, knowledge, and skills than social workers. Many negative stereotypes were attributed to social workers, and social workers were described as being "dogmatic," "not mercen- ary,‘ ”threatening," "defensive," and ”striving.'. Another finding which indicates the psychiatrists' lack of correlation of social work as a profession to psychiatry as a profession is “Zander, et al, Role Relations in the Kental Health Pro- {essions (Ann Arbor: University of Michigan Press, 1957), p. 2 -220 -16- their selection of social work as a last choice (with psychiatry, psychology, and social work being the choices involved), should they have to choose careers again. One hundred percent chose psychiatry, while 88 percent chose clinical psychology and 12 percent chose social work as alternate careers. These findings tend to support the idea that there may be attitudes among psy- chiatrists which might prohibit a true picture of their percep- tions of social work as a profession. In reaponse to the question, "What improvements are necessary in social work, either in academic presentation or'in practice7”, six psychiatrists gave no responses at all, while two did not feel qualified to answer this question, and six others felt that no improvements are necessary in either area. Some of the 26 remaining reapondents stated definite areas of improvement, while others in this group stated only that improve- ment is necessary. There does not appear to be any trend in the respondent's answers indicating a need for*improvement, however some of the responses tend to favor improvements in academic areas, while others call for a definition of function. Typical of'the former response is, "more orientation to medical informa- tion and methods of getting pertinent and medical information from others," while typical of the latter reSponse is, "the limitation of practicing boundaries should be more exact regard- ing psychotherapy," and, "probably definition of areas in which to work, in the instance of psychiatric medical practice --, believe this is something in process of development, but no individual can define area accurately now.” \ -17- There was some emphasis placed upon the value of the social worker's personality, which was manifested by such state- ments as, "Selection of suitable, stable individuals," and ' -- practically, better people." These were, Specifically, the only reactions which were registered so directly in this area. There was some emphasis placed upon inter-role relation- ships. Some responses in this area registered a criticism prevalent in the field at this time, for example: "I have worked with very few social workers who were not excessively conscious of status. The bulk of the social workers' careers seems to be spent in either being supervised or supervising. Independent functioning and consulting as colleagues or equals seems to be a rarity." While this criticism appears quite negative at first glance, it is the only response in the ques- tionnaires which suggests some identification of professional equality between psychiatry and social work. It appears that the respondent assumes status for social work, and finds fault with social work‘s inability to accept and operate within its professional status. Another reSpondent states, "There is some tendency on the part of individual social workers to com- pete with psychiatrists, rather than to contribute to a distinct discipline." While it is difficult to know exactly what is meant by ”contribute to a distinct discipline", it is assumed (by the writer) that social work does not appear to the re- spondent as a discipline, when viewed through the respondent's frame of reference. It is suggested by this writer that this -13- response, as do others, points up a basic problem in interpre- fessional relationships, in that the semantics may prohibit a great deal of communication and understanding between professions. It is also suggested that research is necessary in definitive work on such areas as discipline, professional art based on science, and the terminology used in the description of areas of practice. Another respondent saw improvements in social work as, being, "In academic areas perhaps greater emphasis on the back- ground of interprofessional relationships.“ This response was compared with the responses made by psychiatrists in the Zander5 study. The Zander study indicates that 90 percent stated that they were highly satisfied concerning relationships with social workers, 8 percent expressed intermediate degrees of satisfac- tion, and 2 percent expressed feelings which bordered on dis- satisfaction. The final written question.appearing in the questionnaires is, "Should the social worker be part of’a clinical team? Ezh plain." There were 38 "Yes" answers, while one reapondent felt that this function of social work is unnecessary, and the other respondent was undecided, but stated cryptically, ”Yes -- in psychiatry.” The trend in responses indicates that after-cars orfollowbup work, along with community contacts, are within the realm of social work. Typical of these feelings are these 51b1d., p. 57. -19- responses: "The worker is needed before, during, and particu- larly after psychiatric treatment.” "Transition from hospital to home is one of the most vital steps and consequently should be guided by social workers." And, "It is my Opinion that the social worker is an important part of the team, especially as a go-between between the patient and his family and community." So far as professional competence and skill are concerned, there was a split in opinion, as is evidenced by these responses: 'Yes -- because the social worker as a professional person has an area of contribution in which they are better qualified than other’members of the psychiatric team,' and ”The social worker brings a body of’knowledge and a technique which significantly expand the effectiveness of the team approach," as opposed to "The pressure of time and large numbers of‘patients require the team approach," and "Only a few cases in general hospital work (mental hospital)6 require social service -- if’the doctor is not too rushed to take preper care of the patients himself. In larger institutions where doctor-patient ratio is one to one thousand or greater, you may use any substitute available." These reaponses were viewed in light of professional“ skills and competence because of the obvious reference made in former responses and the lack of attribution of such skills and competence in the latter reaponses. The latter type of response was not common throughout the questionnaires, which does not V correspond to Zander's findings. They indicate that 69 percent 6This writer's parenthetic statement. -20... of the psychiatrists used in the study state that their own professional skills and knowledge are greater than that pos- sessed by the social worker. Twenty-eight percent of their re- epondents indicate that psychiatrists and social workers have equal skills, and 3 percent felt that social workers possessed more knowledge and skills than they.7 Question #5 requested the reapondents to rate the value of social workers' services on a scale which arbitrarily regis- tered gradations from 0.0 to 10.0, with the former being headed ”Poor” and the latter "Good," while 5.0 is headed "Fair.“ There was a total of 3% reSponses to this scale. ihe median re- “ sponse was 8.6, with the highest response being 10.0 (which was also the mode) and the lowest being 6.0. The highest values were assigned by psychiatrists who had frequent professional con- tacts with social workers, who were seen both as individuals and as part of the clinical team.8 The converse was found to be true in relation to the assignment of low values. Psychiatrists who seldom had contacts with social workers as individuals or as part of the clinical team, or had only occasional contacts in both categories, assigned the lower values on the scale. It was concluded from these findings that interprofessional familiarity and interrelationships on an Operational level permitted the at- tribution of high values to social workers' services, while less glbid" . 56. See Tab 0 1, Chapter III, p. l. -21.. frequent interprofessional contacts with lowered professional familiarity led to a lower assessment of the value of social workers' services. Question #6 asks the respondents to clarify their Opinions of social work in general, according to their feelings as to whether it is "Necessary,” "Unnecessary," or if they "Could A e A. function adequately with or without social work."9 The re- sponses were as follows: a A) Necessary 38 B) Unnecessary 0 AC) Necessary - Could function adequately with or without social work 1 BC) Unnecessary - Could function adequately with or without social work The majority of those respondents who felt that social work was "necessary" were also the same respondents who rated social work high onflthe value scale, who answered Question #2 positively, and were also those who had frequent or occasional contacts with social workers as individuals and as clinical team participants. 9The structure of the phrase, "Could function adequately with or without social work is rather misleading, in that it could be construed to ask the extent to which the reapondent is dependent upon social work to function adequately. This was not intended. CHAPTER IV SUMMARY AND CONCLUSIONS Summary This study is concerned with definitions and attributes of social work as a profession. Certain obstacles presented themselves in terms of’the original study undertaken, in that it was so broad that adequate treatment could not be given. The major problem was to find professional attributes from social work literature and from the questionnaires sent to sixty-one Michigan psychiatrists. The dearth and repetitive materials in the literature presented quite a task, in terms of sorting and presenting a unification of central ideas. It will be noted, however, that the ideas presented which appear to be those of a particular author are in actuality representative of an entire group of authors. Some of the attributes of a profession were readily identifiable. Such attributes as a transmittible body of knowh ledge, and the basing of techniques of operation upon principles, presented themselves quite readily. New concepts, peculiar to social work as a profession, also became evident. For instance, the learning of new attitudes through the process of practice was evident to only a few authors in the field. Coupled with this concept of education in attitudinal structures were the findings concerning the desirability of certain personality -22- -23- characteristics in the professional social worker. Again, these attributes were of an attitudinal nature, and some of them were described as being emotional stability, integrity, flexibility and adaptability, and interest in others. This writer presented as one attribute something which was seen in the literature but not clearly defined, namely, the extent to which the activity in which the person is engaged permeates the personality struc- ture and the living patterns of the individual. Finally, philosOphical and ethical standards were deemed essential by almost the entirety of'authors in this field as attributes of social work as a profession. Psychiatrists' attitudes, as measured by the question- naires sent to sixty-one Michigan psychiatrists, indicate in general a rather tenuous acceptance of social work as a profes- sion. The responses to direct questioning of the psychiatrists' considerations of social work as a profession were quite posi- tive, although some negative reaponses were given. This posi- tivism was not seen in reaponses to other questions pertaining to professional social work which appeared in the questionnaires. There was little identification with the social worker, by the psychiatrist, as a professional colleague or peer. Only one respondent felt this strongly enough to state that this is one of social work's major areas of difficulty, namely, the failure of social workers to perceive themselves as colleagues or peers. Some of the respondents indicated specific needs in the area of professional education in social work, while others felt that social work education had already attained professional -24- qualifications. Some respondents also offered qualifications or attributes of what they felt constituted a profession, and these attributes were so closely aligned with those found in the literature that it would have been redundant for them to appear again in this project. Conclusions The terms, ”profession,” “professional,” and “profession- alien" tend to have some nebulous attributes which are not ad readily identifiable and definable as others. many of the authors, as did many of the questionnaire respondents, stated that some elements of the concept of professionalism are not readily definable. However, so many of the concepts and attri- butes of professional social work were found in the literature, and such tenuous attribution of these qualities to social work as a profession was made by the respondents to the question- naires, that the gap between these two areas of information seems unexplainable to this writer at this time. This indicates an area for further research. For the most part, those attributes which are presented within this project report were readily identifiable. Many of them are peculiar to social work as a profession, but were deemed to be attributes of a profession. As noted in Chapter III, many attitudes on the part of the respondents may have come into play, hence prohibiting and permitting certain re- sponses which are not in accord or'in agreement with the findings in the social work literature. -25- The findings of this study tend to support the hypothesis that attributes of professional social work can be identified. The findings of this study also tend to support the concept that social work as a profession does exist, but is as yet not clearly defined. There appears to be a definite need for furb ther research in this area, particularly on an interprofessional level. APPENDIX -26.. -27- 929A Cherry Lane East Lansing, Michigan Dear Doctor: I am presently engaged in a research project in which I must obtain the Opinion of a select group of eXperienced psychia- trists. Currently, I am in field training at the Psychiatric Clinic at the State Prison of Southern Michigan at Jackson, under the directorship of Dr. Warren S. Wills, Psychiatrist. The research project is a requirement for the Master of Social Work degree of the School of Social Work, Michigan State Uni- versity. It is heped that from this research will come some concepts of professionalism in social work, and working rela- tionships with psychiatry. It is quite important that you answer the questionnaire, as the group is so small and each response so valuable. It may also be necessary to obtain further information on a followup basis, but this will depend a great deal on the reaponses to this form, and this will be decided by my thesis committee. At no time will your name be used, either in print or discus- sion, and at no time will you or your Opinion be publicly identified. Please feel free to ask any questions you wish. You may use the back of the questionnaire if you wish for re- marks or questions. Thank you for your attention and consideration. Sincerely, Morton S. Perlmutter Social Work Student Michigan State University Warren S. Wille,.E.D. Psychiatrist Director, Psychiatric Clinic State Prison of Southern Michigan MSP:e -28- Name: Title: Setting of current practice: No. of years engaged in active practice: Private Inst. (1) Please indicate with checkmarks the types and frequency of your contacts with social workers: Contacts Occasions Seldom Never Frequen Individual Part of Clinical Tea Both h s: * If 'Otherl, please eXplain: (2) Do you consider social work to be a profession? Yes No Please state your reasons: (3) what improvements are necessary in social work, either in academic presentation or in practice? (h) Should the social worker be part of a clinical team? Yes No EXplain: (5) By checking a point on the following scale, please rate the value of the social worker's services: {ngLglljmlplllplplgL I ' I I I I I I ' l I I I 0.0 1.0 2.0 3.0 l..0 5.0 6.0 7.0 8.0 9.0 10.0 Poor Fair ' Good (6) Please check the answer below which most nearly reflects your Opinion of social work in general: (a) Necessary (b) Unnecessary (c) pg_Could function adequately with or without social work ‘lilll‘flllT‘lII 4 I .l -29- NOTE: This portion of the appendix contains three of the ques- tions asked in the questionnaires whidh were mailed to sixty-one Michigan psychiatrists, and the responses are recorded exactly as they were received. The psychiatrists concerned are identified by number only fer the sake of convenient tabulation of responses. Non-responses have been disregarded. #*#** QUESTION #2: Do you consider social work to be a profession? Please state your reasons. RESPONSE‘ #2: The preparation, curricula, etc., have been so improved, and standards are so high, that it certainly can be con- sidered a profession in much the same way as nurses, psycholo- gists, school teachers, etc. #3: An attempt to provide a human service, not as an employee of the "client", but as an objective and scientific pre- scription fer what he needs -- as distinguished from what he "wants". #h: It is the specialized relationship with people in regards definite academic and personal preparation. #7: In a broad sense, any individual who has earned a graduate degree and who has accumulated a back,round of eXperience in a particular field is one who pursues a profession". #8: The long training and eXperience period followed by type of responsibility. #9: They deal at a clinical level with problems affecting the welfare of patient and family alike. #10: The work that a psychiatric social worker does, and the training necessary to achieve proficiency, deserve profes- sional status. #13: Because of special education and training required. #lh: Particularly ever since Comte, there has been an effort to systematize in a scientized way the principles underlying the human individual's living of his social interests. #18: Because of background, training, and high caliber of indi- Vidualo #21: #23: -30- more emphasis on practical clinical diagnosis and treat- ment. This is a profession requiring special training and back- ground in dealing with problems relating to individuals rather than anything commercial, mechanical, or agricultural. #27: #32: #36: #37: Because of the academic and field training necessary for social work. Fulfill the usual criteria for a profession. Requires a special training in a highly specialized field. Because of the need for adequate long training and experi- ence befbre one can properly carry out the duties of’a social worker. #38: A great deal of education and eXperience is required ~- and the services rendered are of a professional nature. #40: Provided a social worker has completed a rec0gnized train- ing program. #AL: A social worker must be trained to evaluate the social and economic conditions in which a client is to be placed. ##5: To do certain types of work, I see little reason for people any better trained than many who certainly are not profes- sional. In other types of'medical social work (not all types), much more training is valuable, and if it makes them feel happy to be considered a profession, they are welcome to call themselves such. #50: #51: #52: #53: #sa: #55: meaning. Because social service meets the qualifications of’a pro- fession. The training necessary, and if it is their life work. Because at least ideally it requires a sense of dedication to human work as well as special knowledge. Requires degree and graduate studies and professional type of responsibility. An unqualified yes or no cannot be given. The definition of profession should be further defined. I do not get the point of the question -- namely, the implication that the term profession has a circumscribed I guess so! -31- #59: Cannot answer because the meaning of "profession" is by no means always the same. ~ ~ #60: Body of professional knowledge, orientation, and loyalty to the individual or a professional level. ***** QUESTION #3: What improvements are necessary in social work, either in academic presentation or in practice? RESPONSES #2: If possible, an increase in the amount of field work seems desirable, in order to apply the excellent theoretical and basic knowledge the workers seem to have. Social workers nowadays use psychiatric terms, phrases, etc., to a high degree, but un- fortunately, while a theoretical knowledge is excellent the workers have had comparatively little practical application of that knowledge. I would also suggest that heavy emphasis be placed on the various theoretical viewpoints, rather than having the major field of active emphasis in the psychoanalytic school of thought. It is my feeling that a variety of theoretical view- oints should be represented, otherwise, trainees and/or students ecome narrow or doctrinaire, with their minds closed to new thinking. The personality, attitudes, etc., of the social worker (psychiatric social worker) are important. Hence, selec- tion of individuals trained is important. #3: I do not feel qualified to offer any critical comment. #4: I do not feel qualified to discuss this. #6: Clear delineation of the limits of the worker's sphere of activity. #7: It is my feeling that too many social workers belittle the importance of establishing a supportive relationship with their clients, and are somewhat too interested in dealing with unconscious factors reaponsible for the individual's maladjust- ment. #8: The limitation of practicing boundaries should be more exact regarding psychotherapy. #9: I think the training program for social workers is evolving quite well. #10: -32- Most social work schools apparently feel that history- taking should be delegated elsewhere. I do not agree with this opinion. #13 would recommend one or two years of actual training for psychiatric social workers as a requirement for completion of training. #lh In my opinion, the chief improvement of each direction of human effort lies in the develOpment of the insight that each man's life is lived entirely by each man. #18 Broader academic training. #19: I have worked with very few social workers who are not ex- cessively conscious of status. The bulk of the social worker's career seems to be spent in either being supervised or supervising. Independent functioning and consulting as colleagues or equals seems to be a rarity. - #23: analytic approach. Academic training should include broader scope of various psychological schools of thought, with less emphasis on here definite distinction between trained and untrained social workers. #27: more adequate salaries. #32: Fbre practical work as part of the work for a degree. #33: Teamwork. One cannot work independently. #34: more social workers. #36: Present program of training is adequate. #37: Broader generalized approach to psychiatry, including more definite work in a directive, supportive type of thera- peutic situation, and less emphasis on analytic theories and therapy. #38: An increase in number of trained workers is needed -- par- ticularly for field work. #40: Completion of recognized training for psychiatric social work. #41: I have no criticism of social work as it is now practiced. However, is in all fields of endeavor, there is always room for imprOVement. -33- #44: Any group dealing with the psychologically misfitted per- son should contain psychiatrist, psychologist, and social worker in order to aid that person to again adjust socially. #45: To do a good job as a social worker and not try to be a psychotherapist. To be practical and not idealists. #47: More study in personal contacts and in abnormal psychology. #50: None. #51: Selection of suitable stable individuals. #52: Academically, more imagination and breadth, to include anthropology and social psychology. Practically -- better people. #53: Mbre orientation to medical information and methods of getting pertinent and medical information from clients. #54: Present training is satisfactory. We do find that much training is required of staff members without supervised casework. #55: Nothing specifically -- in some individual cases more at- tention to history taking and less to personal Opinion. #58 There is some tendency on the part of individual social workers to compete with psychiatrists rather than contri- bute to a distinct discipline. #59: Probably definition of areas in which to work in the in- stances of‘psychiatric medical practice -- I know of other areas too little to comment. Believe this is something in pro- cess of deve10pment, but no individual can define area accurately now. #60: In academic areas perhaps greater emphasis on the back- ground of inter-professional relationships. #*#** QUESTION #4: Should the social worker be part of the clinical team -- explain. RESPONSES #2: Yes, this is especially true in settings such as found in institutions, adult and child clinics, etc. -34- #3: Yes. The problem is seldom simply social. #4: Yes. I feel that the team approach is the most rewarding and practical in my field. #7: Yes. The social worker brings a body of knowledge and a technique which significantly expand the effectiveness of the team approach. #8: Yes. Pore important member than psychologist. Social ‘ worker does what the psychiatrist ---- . #9: Yes. Working alone and unsupervised there is danger. In a team situation social workers (well trained) have much to offer. $10: Yes. The worker is needed before, during, and particu- larly after psychiatric treatment. #13: Yes. The pressure of time and large numbers of patients require team approach. #14: Yes. Teamwork is excellent when each member of the team sees his whole team as his own. Using my social worker as a member of my medical team has been most practical. #18: Yes. The transition from hospital to home is one of the most vital steps, and consequently should be guided by social worker. #23: Yes. A social worker has a background (basic) to take an active part in a therapeutic setting. #27: Yes. Because of Specific skills and contributions social workers can make with reapect to the fields of management and prevention of mental illness. #36: Yes. Because the social worker works in the td3al push program . #37: Yes. In large state hOSpitals social workers take a very valuable role in the maintaining of adequate therapy and supervision of patients. #38 #40: Yes. To assist other members of the team, see the total situation, and provide the history, and have contact with community and family. Yes. I am speaking of heapital social workers. #41: Yes. It is my opinion that the social worker is an impor- tant part of the team, especially as a go-between between the patient and his family and the community. -35.. #45: Only a few cases in general hospital work require social service. If the doctor is not too rushed to take proper care of the patient himself. In larger institutions where doc- tor-patient ratio is l-lOO or greater you may use any substitute available. Here, where it is 1-6, this is unnecessary in most cases. #47: Yes. In order to aid in family problems and environmental factors. #50: Yes. Because the social worker as a professional person has an area of contribution in which they are better quali- fied than other members of the psychiatric team. #51: Yes. The past history and development as a child is neces- sary in complete evaluation and also home evaluation. #52: Yes. There are non-clinical roles for social workers, but if they assume a clinical role they should be on the team. #53: Yes. The training and function tend to be on some aspects of a client's problem. They are freed to have other areas dealt with by other members of the clinic team. #55: Yes. In the same sense that a nurse is. Should function alone only in emergency states. #58: Yes. Particularly in institutional work or public clinics. In private practice the situation doesn't seem appropriate for social workers. #59: Sometimes yes, some no. This would seem to depend on what the worker is engaged in doing. In psychiatry, yes, as there is no way to handle purely medical aspects alone. 'BIBLIOGRAPHY BOOKS Abbott, Edith. Social Welfare and Professional Education. Chicago: University of Chicago Press, 1931-1942. Combined Directory for 195521956 of the Richigan Society of Neurology and Psychiatry. Michigan Listrict Branch of The American Psychiatric Association. Coyle, Grace. Social Science in the Professional Educatiqg of Social Workers. New York: Council on Social hork Education (C.S.W.E.), 1958. Qirectory of Fedical Specialists. Vol. III. Chicago: American Board of Psychiatry and Neurology, Incorpor- ated, 1957. (marquis' "Who's hho".) Elliott, Lula Jean. Social Work Ethics. New York: American Association of Social Workers, 1931. French, Lois heredith. Payphiatric Social Work. New York: Commonwealth Fund, 1940. Russell, Elizabeth. Professional Growth on the Job. Family Service Association of America—Tn.d.). Tyler, Ralph W. Education for Social wogk. Proceedings of Fifth Annual Program Meeting, Council on Social Work Education (C.S.W.E.), 1957. Wessell, Rosa; Wessell, Faith, and Beach, Goldie. Afirofessional Education Based in Practigg. Philadelphia: University of Pennsylvania, School of Social Work, 1953. Zander, et al. Role Relations in the Rental Health Professions. Ann Arbor: University of nichigan Press, 1957. UNPUBLISHED MATERIAL Goldfarb, Solomon. "The Function of the Psychiatric Social Worker as Interpreted by 38 Michigan Psychiatrists." Unpublished Master's thesis, University of Michigan, 1956. -36- -37- OTHER SOURCES McGlothlin, William (Southern Regional Educational Board). "Comparative Patterns in Professional Education." Address of January 30, 1958 before the Council on Social Work Education National Conference. ORAL COMMUNICATION Dukes, Harold, Director, Social Service Department, Psychiatric Clinic, State Prison of Southern Michigan, Jackson, Michigan. Wills, Warren 3., M.D., Psychiatrist, Director, Psychiatric Clinic, State Prison of Southern Michigan, Jackson, Michigan. Os.“ '~l ‘A‘ - ‘