Clinical Social Work Guide [Careers, Education & Salaries]
A student who is having academic challenges may require a number of different interventions. Perhaps they lack the resources necessary to complete their schoolwork. Or maybe they are being unfairly disciplined. In these cases, a school social worker can step in to serve as an advocate for the student to make the necessary changes to their environment to improve their academic outcomes. But what if the problem relates to a mental or emotional condition? In these instances, a school social worker can still be a valuable asset to the student, but they may require clinical licensing to assess and treat the underlying conditions.
Table of Contents
What is a Clinical Social Worker?
Clinical social work is defined as a specialized area of social work practice that involves diagnosing, treating and preventing mental illness, and helping individuals address psychological, emotional, behavioral and/or social challenges that affect their quality of life. Such challenges include trauma, family conflict, physical illness and difficult life situations such as unemployment or substance addiction.
Clinical social workers work in a wide variety of settings, including hospital departments (ranging from pediatric acute care to oncology, cardiac, ER and geriatrics), community health centers, child welfare agencies, employee assistance programs, schools, primary health care clinics, substance abuse and addictions clinics, eating disorder treatment programs, correctional facilities and hospice and palliative care settings. Licensed clinical social workers (LCSWs) also have the option of entering private practice.
Job Description at a Glance
Clinical social workers typically use a combination of individual therapy, group therapy and/or various case management responsibilities to support their clients; their precise responsibilities depend on their work environment and the populations they serve.
This field of social work is characterized by a holistic, person-in-environment approach; clinical social workers not only assess and help to address their clients’ mental and emotional challenges, but also work to understand how clients’ challenges interact with their family, financial and social lives. Clinical social workers then use this understanding to help people function better in these familial, social and socioeconomic contexts.
Education Requirements and Licensing
Clinical social work is regulated at the state level. In general, clinical social workers are required to hold a master’s in social work degree (MSW) from a program accredited by the Council on Social Work Education (CSWE). While not required for LCSW licensing, there are MSW programs with a clinical social work concentration available. To become licensed as a clinical social worker in their state of residence, individuals must complete state-specific requirements that include:
- A certain number of hours of post-graduate work experience in a supervised clinical environment.
- Passing licensing examinations as outlined by their state’s board of social work licensure. Social work licensure examinations are typically administered by the Association of Social Work Boards (ASWB).
- Completing specific coursework as required by their state.
Social work licensing requirements vary by state, so students should check with their state’s board of social work licensure for the most up-to-date requirements.
Earn Your Master of Social Work From Simmons University
Aspiring direct practitioners can earn their MSW online from Simmons University in as few as 9 months. GRE scores are not required, and the program offers full-time, part-time, accelerated, and advanced standing tracks.
- Prepares students to pursue licensure, including LCSW
- Full-time, part-time, and accelerated tracks
- Minimum completion time: 9 months
Clinical Social Workers vs. Psychologists
Clinical social workers work in a unique field that combines mental and emotional disorder development knowledge and treatment planning with an understanding of socioeconomic, cultural and familial impacts on an individual’s well-being. Often, LCSWs will work with other medical and mental health professionals to provide holistic care and support to clients and their families.
Psychologists help clients by treating underlying emotional or mental problems. Psychologists also conduct and publish original research. They often treat the same clients for long periods, sometimes years.
How much clinical social workers make on average can depend on their job setting and function. The median salary for a social worker can range between $46,650 to $61,230 depending on where they work, according to Bureau of Labor and Statistics (BLS) as of March 2021. The highest 10 percent have the potential to earn over $82,540.
Overview of Careers and Job Opportunities for Clinical Social Workers
Clinical social workers work in many different settings and are often some of the first professionals to help people manage and address difficult life situations. While their core mission is typically to identify and address people’s emotional and mental health challenges, they can complete many types of tasks on top of assessment, diagnosis and therapy, depending on their work environment.
Types of clinical social workers include:
- Child and family social workers.
- Child welfare social workers.
- Criminal justice social workers.
- Geriatric social workers.
- Hospice, palliative care, home care social workers.
- International social workers.
- Medical and health care social workers.
- Pediatric social workers.
- Psychiatric social workers.
- Military social workers.
- School social workers.
- Substance abuse social workers.
Child and Family Social Workers
Child and family social workers work with children, adults, couples and families to help them identify and manage psychological, emotional and behavioral challenges. Places where child and family social workers can work include family counseling centers, residential treatment facilities and community and university-based wellness centers. Child and family social workers can also enter private practice if they are licensed and have accrued sufficient experience.
Child Welfare Social Workers
While they fall under the category of child and family social workers, child welfare social workers work specifically in foster care and adoption services, protecting children from abuse and neglect. Child welfare social workers typically work at child welfare agencies, on teams comprised of “emergency response” social workers who visit families at the first notification of child abuse or neglect; “back-end” social workers who work with children and their families involved in family reunification, family maintenance, and/or long-term foster care; and agency supervisors who allocate resources, triage situations and provide guidance to the team. “The roles and responsibilities of child welfare social workers is first to keep children safe, then to assure their well-being and do both of those things while making sure they have a chance at permanent families,” said Damoun Bozorgzad, ASW, a clinical social worker who worked for Los Angeles County Child Protective Services for three years.
Criminal Justice Social Workers
Criminal justice social workers (also known as forensic social workers or corrections social workers) work at correctional facilities, jail psychiatric services facilities and courtrooms to provide incarcerated individuals and people on probation with case management services, individual and group therapy and advocacy within the court system.
Samantha Roberts, LCSW, a clinical case manager at UCSF’s Department of Psychiatry: Citywide Forensics Team, described her work with people recently released from jail.
“Our clients face the challenges of trying to survive with the fewest resources possible. For instance, when a client gets out of jail, they have nothing; no place to live, no money, no food. We do the best we can to support and stabilize them during this difficult time,” she said. “[W]e do everything from getting the clients enrolled in Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI), applying for housing, setting them up with a payee service if that is indicated, managing how they receive their medication, getting them assessed for in home health aides, communicating with family members, helping them learn appropriate ADLs (activities of daily living) and hygiene, helping them buy clothes, etc.”
Criminal justice social workers can also work with people who are victims of crimes, such as domestic violence victims, to provide counseling and support and help with navigating the justice system.
Leandra Peloquin, PPSC, who worked for over a decade at the YWCA Rape Crisis Center in San Jose, California, explained her responsibility as a legal advocate for victims of rape.
“As legal advocates, [my colleagues and I] would notify survivors of their rights, as frequently victims of sexual violence are not informed of their rights throughout the process. We were able to update survivors about the status of their case, as well as explain the criminal justice system process,” she said. “There are many steps to a criminal case, and the process can be confusing, daunting and scary. Our center had strong relationships with law enforcement agencies and the district attorney’s office.”
Geriatric Social Workers
Geriatric social workers (also known as gerontological social workers) provide counseling, resource referrals and care coordination to elderly individuals. They also help optimize patient care to the families of their patients. Geriatric social workers often work in geriatric/gerontological departments in hospitals, hospice and palliative care centers and home care settings.
Hospice, Palliative Care, Home Care Social Workers
Hospice and palliative care social workers specialize in end-of-life counseling and care for patients suffering from severe, life-threatening and debilitating diseases and conditions. Hospice and palliative care social workers also interact closely with the families of their patients to address mental and emotional health challenges brought on by grief and stress. Hospice social workers work for hospices, home care organizations and palliative care organizations.
International Social Workers
International social workers provide case management services, resource referrals and counseling and therapy to immigrants and refugees in need of guidance and support during their transition to a new country. International social workers can work for government departments, such as state departments of health and social services, as well as international nonprofits and community organizations that serve immigrant and refugee populations.
Medical and Health Care Social Workers
Medical social workers work at hospitals (often specializing in particular units, such as intensive care/ER, oncology, cardiology, etc.) and at medical centers and community health clinics. They are often the connection between patients and the medical care staff, serving as advocates for patients and their families.
“Social workers in the medical setting are the bridges that connect the families to the people and resources that can get their needs met. They are the cheerleaders that encourage the family to cross the bridge, [and] the little birdies that help those on the other side of the bridge understand why the family is coming to see them,” said Andrea S. Kido, LCSW, a clinical social worker at Marin Community Clinics who also worked for several years as a pediatric social worker.
Medical social workers also conduct psychosocial assessments for incoming patients, counsel patients and their families about health conditions, help patients navigate their health care rights and services/benefits such as Medicaid, and coordinate patient discharges.
“Social workers truly provide order, direction, and consistency in an environment of so much uncertainty and chaos,” Kido explained.
Pediatric Social Workers
Pediatric social workers are a type of medical social worker that works with pediatric patients and their families. Pediatric social workers interact closely with patients’ families to help them understand their child’s illness and how best to manage it. Pediatric social workers also provide short-term psychotherapy to parents, referrals to community resources, and advocacy when necessary. They operate as part of a larger team of medical and mental health professionals and are often the people who communicate patient needs and feelings to the rest of the team.
“Essentially, [pediatric] social workers act as the primary support to the families of sick children (and, when appropriate, the patients themselves) regarding anything that is non-medical in nature,” said Kido. She added that, when pediatric patients suffer from severe complications or rapid responses (i.e. medical situations that require immediate and acute care), families need social workers to provide support, guidance and information while the medical team is focused on the child and unable to attend to the family.
Psychiatric Social Workers
Psychiatric social workers work with individuals suffering from severe mental illnesses (SMI) and dual diagnoses (for example, mental illness coupled with severe substance abuse) and are often employed by hospitals in departments that serve SMI and high-risk patients, as well as crisis service units at local departments of public health. They can also work in jails and correctional facilities in their behavioral health or psychiatric services departments. In hospital settings, psychiatric social workers can work in psychiatry departments, chemical dependency support programs and forensic units (serving severely mentally ill patients involved in the criminal justice system). Within crisis service units, psychiatric social workers provide intake assessments, case management services, and resource referrals to SMI individuals. Psychiatric social workers collaborate with medical professionals and mental health experts to provide patient intake, care coordination and discharge services, and may also provide short-term or long-term counseling/therapy, depending on the work setting.
Charles Berman, ASW, a psychiatric social worker at the University of California, San Francisco’s (UCSF) Citywide Case Management Program, described the complex nature of his work on the forensic team.
“Many of my clients have schizophrenia, schizoaffective disorders, or bipolar with psychotic features, so using psycho-education to promote med compliance is important,” he said. “Nearly all clients are dually diagnosed so I use harm reduction for substance abuse. All of my clients face trauma, some extremely complex, and so I try to use exposure therapy for specific experiences or refer to our seeking safety group for globalized trauma. A few clients have borderline personality disorder and so I teach dialectical behavior therapy skills and refer to our dialectical behavioral therapy (DBT) day-treatment program.”
Military Social Workers
Military social workers work with active and former military service members to help them identify, manage and overcome mental, emotional and social challenges that result from their experiences in the military. Embedded military social workers provide counseling and therapy to active military men and women with the aim of helping them address the mental and emotional barriers that affect their ability to function at their job. Embedded military social workers often work as part of a larger team of medical and mental health professionals that serve a particular battalion. Military social workers also help veterans who are struggling with the mental and emotional repercussions of their past work; these military social workers are often employed by the Department of Veterans Affairs and/or its affiliated organizations, such as the Veterans Health Administration.
School Social Workers
School social workers work at schools to provide counseling and support to students on a regular and as needed basis. They also design and implement interventions when necessary – for example, in the case of bullying incidents, school violence or other serious issues on campus. School social workers collaborate with school administrators, teachers, school counselors and parents to identify, prevent and address issues that pose barriers to student learning and well-being, such as family conflicts, parental neglect, truancy, substance abuse, bullying and community violence.
Substance Abuse Social Workers
Substance abuse social workers work with people struggling with chemical dependency and/or other addiction behaviors. Substance abuse social workers work with individuals to assess, diagnose and help them treat/manage their addictions and the underlying causes of these dependencies (for example, anxiety disorders, emotional trauma, family or social hardships, etc.) through therapy, resource referrals and care coordination where applicable. They work at specialized medical clinics, hospitals (within certain departments or programs that address chemical dependency), residential treatment/rehabilitation centers, VA and community health centers.
Private Practice Social Work
Working in private practice can offer social workers the ability to specialize in a certain area of social work practice, control their schedule and the types of clients they see, and build creative and innovative ways of helping people address their problems. Most licensed clinical social workers (LCSWs) who go into private practice do so as psychotherapists, though some LCSWs may start business consultancies or, if they have macro-level experience, practices that help social service organizations with program development and research.
Clinical Social Work: A Broad and Varied Professional Field
Students interested in becoming social workers should note that clinical social work in and of itself is not a career, but rather a broad field that can include many types of roles and work environments (as the list above illustrates). In addition, the problems that clinical social workers help their clients tackle are often complex and multifaceted; therefore, some careers may fall into more than one of the roles described above. For example, a criminal justice social worker who works with inmates in a correctional facility may also effectively work as a psychiatric social worker, due to the nature of the mental and emotional challenges their clients face (dual diagnoses, severe mental illnesses coupled with substance abuse, etc.). Some clinical social work roles are more interdisciplinary than others and, in general, the more complex and/or severe the problems a practitioner’s clients face, the more likely it is that this practitioner will have to engage in multiple areas of clinical social work to be effective at his or her job.
Techniques Used by Clinical Social Workers
Clinical social workers serve as client advocates and connections to community resources, while also implementing assessment techniques and therapeutic modalities. These modalities include risk assessments, psychosocial assessments, counseling, cognitive behavioral therapy, dialectical behavior therapy, motivational interviewing, creative arts therapy, and experiential therapy. Below are descriptions of several of the core methods that clinical social workers use when working with clients in various settings. These methods are divided into four categories:
- Psychotherapy and Evidence Based Practices.
- Case Management.
Note: The following information is a result of our in-depth interviews with a clinical psychiatrist and several clinical social workers and our independent research on the methods clinical social workers use in their practice across multiple fields. While every effort has been made to ensure the information is accurate and up-to-date, we cannot guarantee its accuracy. The information in this section should be used for educational purposes only.
Whether they are working in private practice, in a hospital setting, or within a jail intake department, clinical social workers must conduct assessments of their clients’ mental, emotional and physical well-being at the beginning of their work with a particular client, and at key points within clients’ treatment. Two essential types of assessments social workers use are:
A psychosocial assessment is a written report that presents and synthesizes essential information about a client across many categories, with the aim of producing a treatment plan that addresses the client’s problems across multiple domains. As the name suggests, psychosocial assessments bring together information about clients’ psychological and physical health and their social circumstances to provide an understanding of their well-being and needs. They are generally completed at the beginning of a client’s treatment, and at intervals throughout the treatment plan.
Typically, the psychosocial assessment describes the reason for the referral, summarizes the client’s strengths and hurdles to treatment, gives a diagnosis, and describes a treatment plan. It is usually detailed enough to provide readers with a picture of a client’s daily life, relationships, employment, medical history, substance abuse history, psychiatric history, psychological state, legal status, mental status, resources and support systems.
Risk assessments gauge the chances that a client will experience an adverse outcome. Such assessments are an essential part of providing mental health care, because they determine what level of treatment is needed. If a patient is at high risk of harming himself or other people, he may need hospitalization, whereas if he is at low risk, he can receive outpatient treatment. Learning to assess risk requires an understanding of predictive and protective factors associated with adverse outcomes, and the ability to elicit them in an interview. For example, a depressed mood, hallucinations, substance abuse, or access to firearms are risk factors for suicide, while access to care, and cultural beliefs that discourage suicide are protective factors that reduce risk. Notably, assessment of risk requires aspects of the psychosocial assessment, as well as diagnosis of mental disorders.
Diagnosis of Mental Disorders
To choose an effective treatment, social workers must understand and accurately describe the nature of a client’s mental illness. Without the correct diagnosis, mental health care providers may risk using therapies that will not help the client. Clinical social workers will make a diagnosis of a client’s condition based on the information they have gathered in their psychosocial and/or risk assessment. Making the correct diagnosis requires an understanding of diagnostic criteria for the various kinds of mental illnesses and an understanding of how to observe the presence of these criteria in clients based on an interview. Most commonly in the United States, providers use diagnostic criteria established in the Diagnostic and Statistical Manual (DSM) published by the American Psychiatric Association (APA).
Psychotherapy and Evidence-Based Practices
Psychotherapy is a broad term to describe non-pharmacologic treatment to improve mental wellness, whether it stems from a diagnosable mental illness such as major depressive disorder (MDD), emotional suffering and anxiety or other life stressors. It typically involves talking with a therapist individually or in groups. There are hundreds of kinds of psychotherapies, which vary from highly structured to open-ended and from a focus on behavior to a focus on emotions and unconscious processes. Examples of common psychotherapies include:
- Cognitive Behavioral Therapy (CBT).
- Dialectical Behavior Therapy (DBT).
- Problem Solving Therapy.
- Psychodynamic Psychotherapy.
- Supportive Psychotherapy.
- Harm Reduction Techniques.
- Motivational Interviewing.
- Mindfulness Based Stress Reduction.
- Experiential Therapy.
- Theory of change.
Many forms of therapy have been used for decades because providers claim they are effective but have not actually been tested using rigorous scientific methods. On the other hand, evidence-based interventions such as cognitive behavioral therapy have been shown to be effective in controlled clinical trials, where clients have a specific mental illness and providers follow a highly specific treatment manual when providing therapy. A specific treatment for a specific illness is considered evidence-based when it has been shown to be effective in a scientifically rigorous study. Some forms of treatment have a lot of evidence, while others have limited amounts.
Cognitive Behavioral Therapy (CBT)
CBT is a form of psychotherapy that teaches clients to examine and ultimately understand the relationship between their thoughts, feelings and behaviors, and the core beliefs that underlie maladaptive patterns of thought. By examining situations in terms of the thoughts, feelings and behaviors involved, clients learn to modify maladaptive thought patterns that lead to a wide range of emotional, psychological and/or behavioral problems, such as anxiety, depression and psychosis. CBT exercises often include recording one’s thoughts, feelings and behaviors on paper, connecting them to core values and beliefs, and then investigating the validity of these beliefs. There are many versions of CBT, but they are all based on the core principle of understanding and modifying the relationship between thoughts, feelings and actions. Many therapies, such as dialectical behavior therapy and problem-solving therapy, also make use of CBT principles.
Dialectical Behavior Therapy (DBT)
DBT is a form of psychotherapy that incorporates elements of CBT with mindfulness principles and a consideration of how one interacts with friends, family and society. According to the Linehan Institute , DBT was developed by Dr. Marsha M. Linehan and was initially geared toward the treatment of patients with borderline personality disorder (BPD). These patients tend to have difficulty regulating their emotions and controlling their impulses, and struggle with chronic suicidality and self-injury. DBT was the first psychotherapy to show clear benefits in treating BPD but is now used to treat many forms of mental illness. True DBT involves treatment by an individual therapist and a group therapist and includes phone coaching and collaboration and consultation between all providers on the treatment team.
Problem Solving Therapy
Problem solving therapy is a form of cognitive behavioral therapy that focuses on empowering patients to restructure their views on the meaning of problems, and how to solve them in a healthy manner. To do these things, patients first learn to cope with stress and become aware of negatively biased thought patterns, leading to increased resilience.
Psychodynamic psychotherapy is a type of psychotherapy that attempts to help patients describe aspects of the unconscious. The unconscious refers to aspects of the psyche that govern conscious patterns of thought and behavior and are based on past experiences, but the patient is not aware of them. By identifying elements of the unconscious, patients develop a better sense of themselves and the ways they relate to others, alleviating many types of suffering, including poor self-esteem, unhappiness and anxiety. In psychodynamic therapy, the ways that the patient relates to the therapist function as an important tool for understanding the unconscious.
Supportive psychotherapy is a form of psychotherapy in which the therapist takes an emotionally supportive role. Goals include maintaining the client’s self-esteem, reinforcing healthy and adaptive behaviors, and aiding in problem solving. Unlike psychodynamic therapy or CBT, supportive psychotherapy does not focus on the deeper motivations underlying behaviors or conflicts, nor does it investigate the role of past experiences.
Harm Reduction Techniques
Harm reduction techniques are founded on the philosophical stance that reducing the negative consequences of harmful behaviors is a more feasible, attainable and effective goal than trying to eradicate harmful behaviors entirely. Common examples of harm reduction approaches include needle exchange programs, opioid maintenance therapy, or designated driver campaigns.
In her work with adolescents struggling with substance abuse, Roberts implemented the Adolescent Community Reinforcement Approach (ACRA), which consisted of 17 procedures aimed at supporting youth in addressing their addictions.
“ACRA was considered a harm reduction approach and was coupled with incentives to motivate the clients to cut down and eventually stop their drug use. We were also provided with cellphones and were encouraged to text with our clients since this was the main way they communicated. It was an engagement tool that ended up being invaluable to our team,” Roberts explained.
Motivational interviewing is a goal-oriented therapeutic approach focused on identifying and cultivating an individual’s motivation to change behaviors. Factors addressed include a client’s readiness to change, what is required to make changes, and any ambivalence they may have about change. Motivational interviewing was an innovative development in therapy techniques because of its emphasis on the client’s intrinsic motivation to change, and not the ability of the therapist to convince the client to change.
Mindfulness Based Stress Reduction
Mindfulness is defined differently by different cultures and thinkers, but generally describes a state of non-judgmental awareness and acceptance of present experience. Mindfulness-based stress reduction (MBSR) was developed by Dr. Jon Kabat-Zinn (PDF, 324 KB) to treat chronic pain. The original MBSR program included weekly group meetings and focused on several types of meditation exercises. Mindfulness approaches are now used to address many forms of mental illness, including anxiety and depression. For example, dialectical behavior therapy (DBT) makes significant use of mindfulness principles.
Experiential therapy engages clients in concrete tasks or experiences (rather than talk-based therapy) under the guidance of a therapist. These therapeutic tasks/experiences aim to reveal the underlying thoughts, emotions, and beliefs of the client that are not easily accessible through talk therapy alone. Examples of experiential therapy include equine-assisted psychotherapy (i.e. having clients interact with horses in an arena to utilize and evaluate their problem solving and stress management skills), psychodrama (role playing with other individuals in a group therapy setting to help clients express their emotions and examine how they interact with others), music therapy (using music to connect with one’s thoughts and feelings), and expressive arts therapy (using art as a medium to express feelings).
Experiential therapy can be helpful for clients in scenarios in which talk-based therapies such as motivational interviewing and supportive psychotherapy are seeing limited results. For example, Donna Maglio, LCSW, a military social worker with her own private practice, uses equine-assisted psychotherapy (EAP) with many of her clients.
“EAP can be a great alternative approach to traditional office sessions, or can also be used to enhance office sessions,” she said. “Since EAP is an experiential modality, clients have reported that one session in the arena can be equivalent to about three sessions in an office. By engaging clients both physically and emotionally, the effect can be much more profound and apparent.”
Theory of Change
Theory of change is a model for the stages of therapeutic change that can help practitioners contextualize their clients’ progress and determine the appropriateness of certain therapeutic modalities. The treatment of mental illness, including the use of all the modalities explained above, among others, depends upon a theoretical framework for understanding change and how it happens. According to the American Psychological Association, one classic and widely used model for therapeutic change originated with the work of psychology professors and alcoholism researchers Carlo C. DiClemente and James O. Prochaska, who conceptualized change as having defined stages. During precontemplation, a client does not intend to change, and may not even be aware of reasons to change. During the contemplation stage, clients are considering making a change, but remain ambivalent. When clients feel ready to change, and begin to make actual plans to change, they have reached the preparation stage of change. Once one actually makes a change, he reaches the action stage of change, which is followed by a maintenance stage. Considering how change happens in the individual, and how to support this change, is important in cases of addiction but is more generally important to many forms of mental illness.
Case management brings together the practices of assessment, diagnosis and therapy, along with other tasks such as coordination of care, advocacy and resource connection. Case management also encompasses record-keeping and reporting, which are necessary in evaluating a client’s progress toward his or her goals. For example, a child welfare social worker is required to keep records and submit documentation to the dependency court regarding a parent’s ability to care for his or her child, and the progress this parent makes toward this goal. Similarly, medical social workers and geriatric social workers must keep consistent records of their clients’ physical and mental health over time to ensure adequate and effective medical and mental health care. According to the National Association of Social Work , case management is typically a core responsibility of clinical social workers who must help their clients navigate complex social systems or manage challenging or ongoing physical, mental and/or social challenges. Examples of settings that often require clinical social workers to practice case management include:
- Geriatric care settings.
- Mental health and substance abuse clinics.
- Child welfare agencies.
- Correctional facilities.
- Hospice and palliative care settings.
- Employee assistance programs.
- Health and medical care settings.
- Housing services.
- Immigrant and refugee services.
- Military and veteran support programs.
The 10 Core Competencies of Clinical Social Work
Clinical social work roles and techniques such as the ones described in the previous two sections are expected to abide by the standards in the 2009 publication Advanced Social Work Practice in Clinical Social Work (PDF, 467 KB). This document was the product of a convention of clinical social workers who met in response to the Council on Social Work Education’s development of 10 core competencies, which were established in 2008 as part of the CSWE’s Education Policy and Accreditation Standards (EPAS) to ensure that social work programs across all areas (from micro to macro social work) sufficiently prepare their students for the workforce. According to Advanced Social Work Practice in Clinical Social Work, clinical social workers across all fields of practice should:
- Identify as professional social workers and conduct themselves accordingly. Clinical social workers should possess and demonstrate an awareness of the history and core mission of their profession, and to continually engage in professional development through self-awareness, self-correction and lifelong learning.
- Apply social work ethical principles to guide professional practice. Clinical social workers are expected to apply the National Association of Social Workers’ Code of Ethics and, where applicable, the International Federation of Social Workers/International Association of Schools of Social Work Ethics in Social Work, Statement of Principles to their daily professional practice. Clinical social workers are expected to combine the aforementioned standards with their own understanding of ethical principles when addressing morally ambiguous situations on the job.
- Apply critical thinking to inform and communicate professional judgments. Clinical social workers consistently combine research-informed methods with wisdom derived from clinical practice to effectively assess, understand, diagnose and address client challenges. Clinical social workers also use critical thinking skills to help clients identify and use their internal strengths and external resources to tackle difficult social, emotional, behavioral and psychological issues.
- Engage diversity and difference in practice. Clinical social workers have an in-depth understanding of how diversity impacts people’s experiences, perspectives and interactions with others. They acknowledge that differences in age, race, gender, class, culture, political views, sexual orientation and other characteristics can lead to marginalization, alienation, oppression and/or harmful power dynamics within society that can negatively impact people on an individual and community level. Clinical social workers also understand how demographic differences and the marginalization that can result from them affect how clients present and discuss their challenges during therapeutic sessions.
- Advance human rights and social and economic justice. In addition to addressing client challenges at the individual level, clinical social workers should be invested in examining, understanding and working to address social oppression on a national and international level. Clinical social workers serve as scholars of and advocates for human rights, social and economic justice, and accessibility to social support.
- Engage in research-informed practice and practice-informed research. Clinical social workers understand the interplay between social work research and clinical practice, in that they utilize evidence-based interventions and use recent and relevant research to inform their work with clients. Additionally, clinical social workers may engage in research by contacting research institutions and communities about problems they have encountered in the field.
- Apply knowledge of human behavior and the social environment. Clinical social workers have sound and functional knowledge of human development, psychology and behavior across the lifespan, and use this knowledge to effectively address clients’ challenges in the context of their biological, intellectual, behavioral and social development.
- Engage in policy practice to advance social and economic well-being and to deliver effective social work services. Clinical social workers are active scholars of state and national policy as it relates to the well-being of vulnerable populations and society as a whole. They also serve as advocates for policies that support and improve the lives of people in need.
- Respond to contexts that shape practice. Clinical social workers are flexible and adapt their clinical practice to the changing social, organizational and professional contexts in which they work. They remain aware of evolving social, political, organizational and economic climates, and work to not only respond to these changes, but also lead positive developments in these areas as part of a larger group of human service professionals.
- Engage, assess, intervene and evaluate with individuals, families, groups, organizations and communities. Clinical social workers should have the knowledge and skills to assess, identify, analyze and address clients’ challenges through a combination of empathetic and culturally sensitive engagement with individuals, families and groups; rigorous and multifaceted bio-psycho-social-spiritual assessment methods; evidence-based interventions that aim to help clients address, manage and/or prevent issues that negatively impact their well-being; and evaluate the effectiveness of clinical assessments and interventions, with the intention to always improve one’s practice through continued research and professional development.
(Note: The CSWE released a 2015 update to the core competencies, condensing them into nine competencies that place more emphasis on engagement, assessment, intervention and evaluation. However, an official statement on the application of these new core competencies to the clinical social work profession has not yet been developed.)
By combining the core competencies with some or all the clinical social work techniques, clinical social workers across a wide variety of specializations can help individuals, families, groups and communities to tackle stubborn problems that affect their well-being and happiness.
Challenges Clinical Social Workers Face
The field of clinical social work is fast-paced, challenging and complex, and can be stressful due to the serious nature of clients’ struggles and the depth of responsibility that social workers feel for their clients’ well-being. While the types and degrees of stress on the job vary across different clinical social work fields and settings, almost all clinical social workers face the challenge of trying to motivate clients to minimize harmful behaviors and implement constructive changes. During this process, clinical social workers may encounter clients’ resistance to changes, and must find ways to work with clients’ goals, preferences, circumstances and present beliefs to make progress.
While clinical social work in general involves helping clients identify, manage and overcome trauma or hardship in their lives, certain fields of clinical social work – such as child welfare social work, international social work (working with refugees and/or immigrants), hospice/palliative care social workers, pediatric social work, and forensic social work – expose clinical social workers to particularly high levels of trauma or tragedy that can impact their own emotional well-being.
Jessica Beitch, LCSW and pediatric social worker at UCSF’s Benioff Children’s Hospital, noted: “Death is challenging, but that is not the most challenging for me personally. Encountering instances of neglect, severe mental illness, or the infliction of harm (physical or emotional) –those are the things that are most challenging for me to deal with, and the hardest for me to recover from.” When social workers feel distressed or otherwise affected by their clients’ trials, it is important for them to engage in regular self-care, and to consider individual or group therapy of their own to sort through and manage the emotions they feel.
In addition to trauma exposure while on the job, clinical social workers can also struggle with the intense demands this field places on their time, as well as their physical, mental and emotional reserves. Whether they are in private practice, working at a hospital with pediatric patients, or supporting the elderly in a palliative care setting, clinical social workers typically manage heavy caseloads and must find ways to provide individualized care to their clients/patients in an efficient manner. Furthermore, as clinical social work is inherently interdisciplinary, and requires its practitioners to balance so many moving pieces (from crisis interventions, intake assessments, and individual/group therapy, to care coordination and community resource referrals), social workers may sometimes feel overwhelmed.
Many social workers report feeling the urge to stay long hours at their job, as they feel no job is ever “finished” and that there is always so much that needs to be done to help a given client and/or his or her family.
“I feel the most challenging aspect of this work was the inherent inability to meet the needs of every family. Given the number of patients to which we were assigned, the complexity of their lives and illnesses, the scarcity of resources both within and outside the hospital system, and the expectations of the medical teams, there was simply no way to achieve everything I set out to,” Kido said. “The most difficult part, and for what I would advise MSW students to prepare, was the acceptance that there is only so much you can do. You will not change someone’s life completely. […] You have to be satisfied with knowing that you made an overwhelmed mother feel like she has someone she can call and won’t be judged; that you gave a father enough financial help to be able to eat tonight, even if he won’t have enough for breakfast tomorrow; that your smile made a child feel safe instead of scared. The small moments that, in reality, do mean so much to families must mean as much to you.”
Due to the physically, mentally and emotionally demanding nature of clinical social work, many social workers encourage fellow practitioners to establish boundaries and implement self-care to help prevent burnout. Jana Morgan, LCSW, a clinical social worker in private practice who has also supervised numerous MSW students, explained how she tries to consistently remind her students about the importance of self-care.
“I see self-care as integral to professional survival. I try to teach by example in this area, while reminding my students that self-care is not an easy task, and requires conscious effort and time,” she said. “I remember in my own training how run down many of my female mentors were. […] Even as I write this, years after my training experiences, I recall some of my mentors and have a sense of concern. I see that, at that time, I was in an environment where very few people spoke to this phenomenon. With the interns in my charge, I create openings to discuss such matters.”
Aside from proper self-care and setting of healthy boundaries, finding mentors and peers who have experience in one’s field of work and can provide sympathy and support is important. Being able to seek advice from and commiserate with people who are truly familiar with one’s challenges can help social workers stay resilient in the face of daily challenges at work.
The Importance of Understanding Addiction in Clinical Social Work
Addiction, whether it is to illicit substances or unhealthy practices and patterns, is central to many mental, emotional and behavioral problems.
“Addiction is such a large part of our society that it permeates and reflects into almost all human behaviors and endeavors,” Morgan said. “It is so recognized that even county social services have been merged so that mental health and substance recovery services are now one department, having one director. […] In private practice, I always assess and monitor for co-occurring substance abuse and chemical dependency.”
Describing her work with youth and incarcerated individuals struggling with substance abuse, Roberts explained how harmful addictions can originate from and cause or exacerbate psychological and emotional issues.
“From my experience, there is an inherent connection between mental illness and substance abuse, and the longer I’ve worked in the field, the more difficult it is to determine which came first and how to treat both in the best possible way,” she said. “Most clients I have worked with have a co-occurring disorder (substance use, as well as a mood/psychotic disorder), but depending when you begin to work with them, it is difficult to see which one has impacted the other. Many people with mental health issues turn to substance use to self-medicate and cope with their illness. There is also the chance that people with a predisposition to mental illness may be more inclined to use substances as a way of coping, and therefore create the perfect environment for a mental illness to grow.”
In a similar way, substance abuse and/or addictive behaviors can be both a symptom and a source of familial, social and financial problems.
“We see the main causes of substance abuse to be dysfunctional systems dynamics and life stressors that lead to negative coping mechanisms,” noted Tech Tran, ACSW, lead case manager and social work program supervisor at the Rainbow Community Center (RCC). Tran also explained how chemical dependency dramatically impacts not only an individual’s well-being, but also his/her environment.
“Substance abuse/addiction affects individuals and their families in the short term by causing strain on the individual’s life as well as the family’s life,” he said. “Substance abuse typically occurs alongside other mental/social/physical/psychological challenges. These co-occurring/dual disorders have an impact on our internal and external systems as everything is interconnected.”
As the experiences of the social workers noted above illustrate, substance abuse and addiction are very prevalent issues that require clinical social workers to have a deep understanding of how emotional, psychological, social/socioeconomic and cultural problems develop and manifest themselves as behavioral and relational issues at the individual, familial and community levels. This person-in-environment understanding isn’t just applicable to chemical dependency. Many, if not most, behavioral problems follow the same pattern as addictions do, in that they involve an attachment to actions that lead to emotional reward or relief – for instance, the expression of anger as a way to cope with difficult life circumstances, or an addiction to food, or exercise as a way to escape uncomfortable emotions. The treatment of these harmful behavioral patterns also follows the same essential structure and progression as the treatment of substance abuse does – that is, identifying the internal and external causes of the addiction (psychological issues such as anxiety, social and familial context, etc.), and using a person-in-environment approach to address both the causes and the effects of the harmful behaviors. As a result, understanding how addictions originate and develop, what the symptoms of addiction are, and what therapeutic modalities are important in treating these addictions can be a crucial aspect of clinical social workers’ training. The best therapeutic modalities and case management strategies for a given client vary according to that client’s circumstances and emotional and mental disposition; knowledge of a wide range of clinical techniques can therefore be very helpful for clinical social workers, as it enables them to customize their treatment plan for each of their clients.
“I utilize two main evidenced-based practices – the first is motivational interviewing, an approach aimed at increasing change and overcoming ambivalence to change, and the second is the seeking safety model, an innovative treatment modality that focuses on PTSD and substance abuse,” Tran said. “By using this therapeutic strategy, I aim at the underlying or root causes that drive the youth I work with to turn to alcohol and other drugs.”
He also explained the importance of treating clients within the context of their environment and recruiting support from clients’ family and friend networks.
“Working with families is essential in helping students overcome their addictions; we look at the student as a person in their environment,” he said. “We work with families to promote a safe environment for healing and recovery from addiction through a research informed practice, and this research shows us that the most influential system in a young person’s life is their immediate family, then their nurturing support systems consisting of their friends and other people whom they trust and perceive to gain or give love towards.”
During her time working with adolescents and young adults who suffered from chemical dependency at The Odyssey House, Roberts also used therapeutic and case management techniques that aimed to address clients’ substance abuse with the support of their families.
“The main method used to deal with these clients’ addiction issues was the Adolescent Community Reinforcement Approach (ACRA) and Assertive Continuing Care (ACC),” she said. “These are evidence-based methods proven to work with adolescents and TAY (transitional age youth). … ACRA involves using one or more of 17 specific procedures that aim to address the social, mental, emotional, behavioral and environmental factors that contribute to substance abuse among youth. These procedures include ways to work with youth and their caretakers (separately and together) to improve communication, problem solving and stress management.”
Social work students and clinical social workers who are interested in learning about addiction and developing therapeutic skills that are useful in treating addictions should take the initiative to learn about these issues, not only during their undergraduate and graduate programs, but also through continuing education and post-graduate trainings. Tran found this additional post-MSW training to be instrumental in his work with clients with substance abuse issues.
“This additional training has been profoundly helpful in my work as an addictions counselor,” he said. “As a counselor with training focused on the recovery model coupled with the social justice perspective, I am more equipped to intervene with counseling techniques aimed at reducing substance use especially in serving clients with dual disorders. … I highly recommend that students who wish to work with individuals struggling with substance abuse complete continuing education in this area because … these classes can provide the opportunity to learn from professors that are invested in providing accurate and up-to-date information regarding this population.”
Why People Become LCSWs
Despite the aforementioned challenges, clinical social work can also be incredibly rewarding, and indeed, the difficult aspects of this profession can, in some cases, be the very reason why this field of work is deeply gratifying for some. For example, the strong emotions of distress, frustration and vulnerability that clients often feel are sometimes matched by their gratitude toward clinical social workers for helping them through some of the most difficult experiences of their lives (hospitalization, the death of a family member, incarceration, chemical dependency, eating disorders, etc.).
Beitch said despite the challenges, she finds the connections she makes with her patients and their families to be very fulfilling.
“The most rewarding aspects of my experience as a clinical social worker are the relationships I form with patients and families, who are the strongest people I have ever met, and the lessons they teach me about the true meaningful moments of life,” she said. “I get to witness and honor their journey, and lift them up when they are weary – or at least hold the emotion for a moment while they take a breath. It is powerful work.”
Additionally, some social workers report the fast pace and multifaceted nature of their work is intellectually stimulating and prompts them to constantly grow personally and professionally.
Morgan described how the unique, collaborative relationship with her clients in her private practice is incredibly gratifying and educational.
“The work is so collaborative and becomes increasingly meaningful as my clients and I get at what brings them to treatment,” she said. “Together we begin the challenge of self-discovery, acceptance, tolerating the heat and redirecting energy into self-healing out of self-loathing.”
Rewards of clinical social work as a profession can also be field-specific. For example, people who find working with youth particularly gratifying might enjoy school social work, while social workers with several years of experience under their belt and who would like to be more creative with the therapeutic services they provide may find private practice to be a rewarding challenge.
“[Having] my own practice gives me the flexibility to set my own hours and fees, offer modalities such as EAP that might not otherwise be feasible, and be selective about which client populations I feel I am best suited to serve,” said Maglio. “It also gives me the opportunity to expand beyond the direct client sessions, by presenting workshops, giving presentations, writing articles and guest lecturing in graduate classes.”
Regardless of their specific field, and in the face of the difficulties of their profession, many social workers are satisfied knowing they are directly impacting people’s lives for the better, at the individual and the societal level. Whether it is keeping a family together, protecting a child from abuse or neglect, holding the hand of a daughter who has lost her parent, providing support and guidance to inmates, or helping military service members overcome trauma, the daily responsibilities and accomplishments of clinical social workers are powerful, far-reaching, and incredibly necessary.
Interested in becoming an LCSW? Check out our “How to Become a Licensed Clinical Social Worker” guide.