Clinical social work and global justice Photo: Nathan Lemon
Krista Osborne

Krista Osborne
Assistant Professor, Faculty of Social Work, University of Calgary
Registered Clinical Social Worker, Canada

Ajwang’ Warria

Ajwang’ Warria
Associate Professor, Faculty of Social Work, University of Calgary; Research Fellow, Department of Social Work, University of Johannesburg, South Africa

Reclaiming Clinical Social Work: Responding to Global Politics Through Emancipatory Social Justice-Engaged Practice

Introduction

Criticisms of clinical social work practice are not new. There have been debates on whether clinical social work practice fulfills our profession's social justice mandates or reinforces systems of oppression (McLaughlin, 2002) and fails to contribute to social change and is indeed a disempowered profession (Brown, 2021). What is new is the global context of this debate. In a world of increasingly oppressive global and political forces, clinical social work practice continues to remain largely silent on the impacts these forces have on the mental health of those seeking care. This makes clinical social work increasingly complicit in maintaining oppressive systems by ignoring the larger forces impacting wellness. To adequately address the moment, clinical social work must move beyond individualized, Western models of practice and reclaim its emancipatory roots by actively responding to the global political forces and allowing multiple ways of knowing and understanding clients’ social worlds

The Political is Clinical: Global Forces and Everyday Practice

The global political climate has a direct impact on mental wellness. Nationalism, racism, transphobia, homophobia, antisemitism and islamophobia are prevalent globally. Intergenerational trauma is at the core of all these social issues, and they have clinical implications requiring social work responses (Jemal, 2024). In this way, politics is clinical and clinical interventions are political.

Shifts towards neoliberal policies have also influenced the ever-growing capitalist need for consumption. This significantly impacts the world’s social, environmental and political climates (Morley & Carrington, 2021). As governments battle over access to control finite resources, climate change and global conflicts have increased, with looming threats to individuals and communities and shaping migration patterns and livelihoods. These shifts create an overload in individual nervous systems, breakdowns in family functioning, and disconnection from communities, the sea and the land (Evans & Coccoma, 2014). These impacts are relevant to clinical practice as they show up in our work through trauma, mental health crises, family breakdowns and community disintegration.

Clinical practice is not ethically neutral. In many clinical social work programs, the training focuses on the smaller units of suffering through relationships with service users. An experienced clinician learns how to use their intuition, assessment skills and relationships to point out patterns of harm, strategies for change and reinforce healthy boundaries. This always happens through the lens of the practitioner, no matter how unbiased the clinical social worker intends to be (Jemal, 2024). The darker side of clinical work is that, for the system, we are often called on as gatekeepers for care. We serve to placate victims rather than advocate for substantive change, leading to fewer victims. In this way, clinicians sometimes unintentionally reinforce systemic inequalities. These interventions and consequences are not neutral and there are calls for critical practices which “disrupts the individual/social binary through counterviewing unhelpful dominant social discourses and producing counter-stories that participate in social resistance” (Brown, 2021, p. 664).

The Myth of Apolitical Practice

Clinical social work practice is also inherently political. Using a critical lens, it encourages people to look deeply into their lives and structures of harm, seek knowledge, and reinforce healthy boundaries. This will encourage clients to question personal, social, spiritual, and political ideologies. It demands critical consciousness and accountability as an act towards personal-collective healing. Holistic clinical social work practice helps people educate themselves and think critically of the relationships and structures around them that contributed to structural determinants of wellness and their dis-eases (Jemal, 2024; Kler et al., 2025; Mayor & Williams, 2024; Korn, 2023). This is political.

Clinical social workers work and/or are paid for by government systems, non-profits or private health care companies – with each of them influenced primarily by neoliberal policies and fiscal restraints. It is in these organizations’ best interests for clinicians to use short-term, “evidence-based”, medical model practices to “treat” those seeking mental health services. The evidence used to justify these interventions is founded mainly in Eurowestern practices focused on individuals, with observable and quantifiable change that ignores the lived experience of healing, community support and relational accountability as positive outcomes. Clinical social workers often work within the medical system thus shifting focus to medicalized interventions. The profession relies on DSM diagnoses to justify the need for care and to identify risks. The focus is on the diagnosis and reinforcement of power structures and dynamics. This can include surveillance, expectations and judgements of those not following through on medical advice. The “problem” is with the individual, and the interventions are often in isolation and without considerations for systemic influences. This, too, is political, reinforcing neoliberal ideologies and minimizing the need for systemic change, social transformation, and/ or collective care.

Traditional models of therapy are political in what they acknowledge as “good practice”, standards of care and what is seen as healing (Jemal, 2024). These practices privilege and best serve those not experiencing structural oppression, and therefore, White Western European clients benefit most from this type of care. The omission or lip service given to alternative views of healing in clinical social work, such as Indigenous, decolonial, anti-racist and community-based practices, impacts the quality of care that diverse service users receive and the effectiveness of the mental health care. Social work is always political (Androff, 2018). There is no neutral stance. Pretending that there is only reinforces oppressive forces and perpetuates harm.

Righting Wrongs and Reconnecting to Justice in Clinical Training and Practice

Social work has repeatedly failed the social justice roots of the profession. In Canada alone, social work, as a profession, has been complicit in Canada’s most horrific human rights violations (Blackstock, 2019; Choate et al., 2020) and continued gatekeeping against racialized people in children’s services, justice, immigration and social supports. Historically, the wellness industry has lacked diversity, equity, and inclusivity, yet the profession continues to perpetuate issues through the colonial nature of social work education (Blackstock, 2019; Choate et al., 2020) and a refusal to accept that therapeutic/ social work engagements are political processes which are not exempt from the politics of intersectionality. Clinical social work training has also harmed students from diverse backgrounds by the limited critical lens; performative curriculum transformation initiatives, and staff and faculty complement that is not representative of the student population and client realities.

In Canada, social workers have recognized and apologized for the past harms of the profession. (CASW, 2023). This is not enough (Androff, 2018). Jamal (2024) called for transformative accountability in clinical social work practice, which includes “(a) repairing past harm; (b) disrupting current harm; and (c) preventing future harm” (p. 237). It is imperative that all social workers, including clinical social workers, change their practices to reconcile wrongs by decolonizing their practices to expand beyond individual work and towards the incorporation of social structures and actions. Many social workers come from privileged backgrounds that benefit from systemic oppression (Davis & Gentlewarrior, 2015). Consequently, they carry ethical responsibilities and hold positions that can challenge and transform the systems of power that perpetuate inequities and create genuine opportunities for clients to resist and/or reconstruct dominant ideas about themselves as relates to marginalization, oppression or victimisation.

Models for Emancipatory Practice

Highly relational approaches to therapy that support healing and embrace cultural, spiritual, and racial curiosity from a social constructivist standpoint whilst reflexively situating the client’s struggles within broader structural dynamics are the most promising. Critical trauma-informed practice centres the multitude of ways “-isms” and other societal inequities impact a person’s individual and collective ability to function in and experience the world (Evans & Coccoma, 2014; Jemal, 2024; Kler et al., 2025). Anti-racist or abolitionist practices focus on systemic racism and its impact on the wellness of racialized people to encourage wellness (Mayor & Williams, 2024). Somatic modalities prioritize how an individual’s body holds and releases difficult and traumatic experiences in the nervous system (Korn, 2023). Narrative practices focus on the meaning and story people tell themself about their place in the world (Tessneer, 2015). Art-based therapies can help people explore and release their struggles (Talwar, 2019). These modalities are a constructivist therapeutic approach to individual social realities that supports multi-cultural and anti-racist practice.

Cultural interventions support creation of communities and social networks, feelings of connections to aspects greater than oneself, and recognition of the systemic oppressions that contribute to their struggles (Duran, 2019). Critical clinical social workers must encourage socio-cultural, Indigenous spiritual, and somatic interventions, with nuanced social justice-engaged solutions. These have potential to provide socio-political analysis and in the co-development of counter-stories which highlight diverse experiences, multiple voices and individual-communal resistance. They also acknowledge the fact that identity-making is complex, never complete and is always in a state of be-coming.

Conclusion: A Call to Action

Clinical social workers must take on critical lens’ and become active agents of change, transforming not just individual lives but the oppressive systems that shape them. This is not neutral nor apolitical, but necessary to work against global forces to protect, embolden and support the individuals and communities that we walk with and the violence that we continue to witness – from Gaza to DRC, US to Ukraine and Sudan. Practitioners must commit to justice-oriented approaches and collaborative knowledge construction allowing for multiple ways of knowing and emancipatory practice by challenging oppressive structures. The practitioners must recognize that clinical practice and skills are practices of power - replete with possibilities for social justice practice as well as for oppressive practice. They must broaden their reflective critical clinical approaches to serve diverse clients and families in their clinical practice with an increased holistic, decolonized, anti-racist and equitable lens. This is what is required for healing individually and collectively.

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