ORIGINAL PAPER

Preparing MSW Students for Integrative Mind–Body-SpiritPractice

Salome Raheim • Jack J. Lu

Published online: 16 March 2014

� Springer Science+Business Media New York 2014

Abstract Knowledge of new developments in social

work education supports clinical practitioners’ professional

development and their supervision of students and early

career social workers. Integrative mind–body-spirit (IMBS)

practice is a holistic paradigm that is emerging in social

work education and the profession. IMBS modalities have

a growing evidence base and are congruent with the heal-

ing practices of many cultures, thereby supporting cultur-

ally competent practice. This article explores the

development, implementation, and outcomes of an elective

MSW course designed to critically examine the IMBS and

biomedical paradigms and introduce students to IMBS

practice. Two sections of this course were piloted (n = 35)

and pre- and post-assessments administered. Findings

suggest that experienced clinicians can support the pro-

fessional development of novice practitioners by encour-

aging ongoing exploration and critical assessment of the

IMBS and biomedical paradigms and incorporation of

evidence-based mind–body-spirit practices in their clinical

work and self-care.

Keywords Integrative practice � Mind–body-spirit

paradigm � Social work education � Complementary and

alternative medicine

Introduction

Western scientific discoveries during the past 20 years

align with conceptualizations of healing, health, and well-

being held by Eastern traditions, indigenous peoples of the

Americas and many U.S. racial-ethnic groups. Findings

from neuroscience (Froeliger et al. 2012; Siegel 2007,

2012; Siegel et al. 2010), psychoneuroimmunology (Irwin

2008; Irwin and Miller 2007), psychosocial genomics

(Garland and Howard 2009; Rossi 2002a, b), and epige-

netics (Curley et al. 2011) affirm the mind–body-spirit

(MBS) connection and the dynamic interplay between

individual well-being and the physical and social envi-

ronment—principles that are common among many ancient

cultural traditions (Cassidy 2011). Studies have also shown

the efficacy of healing modalities that arise from these

traditions, such as acupuncture, mindfulness meditation

(Froeliger et al. 2012; Garland et al. 2012; Gaylord et al.

2011; Garland and Roberts-Lewis 2013), qi gong, and yoga

(Coffey and Hartman 2008; Coffey et al. 2010; Greeson

2009). This growing evidence base and the profession’s

commitment to effective practice across of a wide range of

human differences (i.e., culturally competent practice)

require that social workers increase their knowledge of

MBS approaches and their ability to work with clients who

use or may benefit from these practices.

From the standpoint of conventional practice, these

modalities and the healing systems from which they

emerge are decentered and viewed as ‘‘complementary and

alternative medicine,’’ defined by the National Center for

Complementary and Alternative Medicine (NCCAM) as ‘‘a

group of diverse medical and health care systems, prac-

tices, and products that are not generally considered part of

conventional medicine’’ (U.S. Department of Health and

Human Services 2011, para. 1). This perspective privileges

S. Raheim (&) � J. J. Lu

School of Social Work, University of Connecticut, 1798 Asylum

Avenue, West Hartford, CT 06117, USA

e-mail: salome.raheim@uconn.edu

J. J. Lu

e-mail: jlu2699@gmail.com

123

Clin Soc Work J (2014) 42:288–301

DOI 10.1007/s10615-014-0484-3

the allopathic tradition, more commonly referred to as

biomedicine. When not subjugated by the dominant bio-

medical paradigm, these practices can be understood within

a MBS framework and may be used independently or in

tandem with, but not subordinate to, conventional approa-

ches. In this paper, the term MBS practice will be used

instead of complementary and alternative medicine (CAM)

to refer to these healing systems and modalities, unless

citing literature or the context requires use of the term

CAM. The authors use the term MBS in this paper to center

this paradigm and related practices rather than subordinate

them to biomedicine.

The integrative mind–body-spirit (IMBS) paradigm

supports the use of all appropriate approaches within a

holistic framework to promote health and healing. Few

social workers have had the opportunity to study this par-

adigm and related modalities during their graduate training.

Despite the documented efficacy of MBS practices, such as

acupuncture, mindfulness meditation, qi gong, and yoga,

these modalities are not widely incorporated into social

work education or clinical practice. Clinical social workers

are positioned to practice more effectively when they have

a critical understanding of the philosophical and theoretical

foundations of the biomedical and IMBS paradigms and

related modalities, as well as the power and privilege

dynamics that promote or constrain their use. These critical

and analytic tools allow clinicians to recognize personal,

institutional, and societal biases for or against specific

practice methods. With these prejudices uncovered, clini-

cians are enabled to use a range of evidence to select or

advocate for efficacious approaches and attend to ethical

considerations, contraindications, and risks related to all

modalities and interventions in which they may engage or

use for referral.

This article discusses an elective MSW course the

authors designed to address the need for greater inclusion

of IMBS practice in social work education and support

development of critical and analytic tools to recognize and

assess practice paradigms. Descriptions of the content,

pedagogical approach, and outcomes of the course are

intended to increase clinicians’ awareness of this emerging

trend in social work education. With knowledge of the

training that some students and earlier career practitioners

are receiving, experienced clinicians are poised to provide

clinical supervision that supports and encourages their

ongoing learning and professional development.

Contrasting Paradigms

Prior to the mid-1800s, diverse approaches to health and

healing were commonly used in North America, and

diverse types of practitioners engaged in treating health and

behavioral health problems. Indigenous spiritual and herbal

healing practices, homeopathy, naturopathy, and allopathic

medicine co-existed and were practiced without regulation.

Of these, allopathy or biomedicine was distinct in its bio-

logically based approach to healing. With the 1848 for-

mation of the American Medical Association (AMA) by

allopathic physicians and their subsequent success in

advocacy for legislation and standards that privileged their

approach to treating disease, allopathic medicine’s rise to

dominance began. The Flexner (1910) Report of North

American medical education played a decisive role in

advancing the biomedical approach and discrediting any

approach not based on the scientific paradigm. The result

was the closure of medical schools that did not use allo-

pathic methods (Stahnisch and Verhoef 2012; Wheatley

1989). Biomedicine was positioned as mainstream health

care, and other approaches to healing were dismissed as

ineffective.

Biomedicine is rooted in the Western materialist

worldview, which holds that ‘‘everything that exists is

material’’ and all phenomena, including consciousness, are

the results of material interactions (Mosher and Trout 2002,

p. 1). The biomedical model is conceptually grounded in

Newtonian physics and Cartesian dualism that inform

understanding the body as a mechanism that is separate

from mind. Together, the materialist world view, Newto-

nian mechanics, and Cartesian dualism reduce conscious-

ness to electro-magnetic impulses of the brain and ‘‘spirit’’

is relegated to the domain of philosophy and religion.

Arising from the Western scientific paradigm, biomed-

ical approaches to health care are guided by the paradigm’s

four core principles:

(1) objectivism—the observer is separate from the

observed; (2) reductionism—complex phenomena are

explainable in terms of simpler, component phe-

nomena; (3) positivism—all information can be

derived from physically measureable data; and (4)

determinism—phenomena can be predicted from a

knowledge of scientific law and initial conditions

(Micozzi 2011, p. 8).

The application of these principles has led to the rise of

pharmaceutical health solutions and significant advances in

health care during the last century. Concurrently, biomed-

icine’s advocates have constrained the development and

use of competing approaches to health and healing through

aggressive lobbying efforts to restrict or prohibit these

practices. While the scientific paradigm is only one con-

struction of how human knowledge is generated, it has

risen to such dominance that other ways of knowing are

ignored, discredited, or even worse, vilified.

Despite historical opposition of biomedicine’s propo-

nents, non-allopathic approaches to healing have persisted

Clin Soc Work J (2014) 42:288–301 289

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and interest in these approaches has grown significantly

over the past 30 years (Centers for Disease Control and

Prevention 2011; Eisenberg et al. 1993). In 1991, United

States (U.S.) legislation established an office within the

National Institutes of Health (NIH), the forerunner of

NCCAM, to ‘‘investigate and evaluate promising uncon-

ventional medical practices’’ (National Center for Com-

plementary and Alternative Medicine 2013). The

establishment of this NIH center created a space for non-

allopathic practices to gain legitimacy, while at the same

time, decentering these practices as ‘‘complementary and

alternative’’ to biomedicine.

The IMBS paradigm is guided by the principles of

holism, multi-systemic connectedness, and balance.

These principles are at odds with the principles of

objectivism, reductionism, positivism, and determinism

that guide the biomedical model. Holism is ‘‘an eco-

logical concept that the totality of biological phenom-

ena in a living organism or system cannot be reduced,

observed or measured at a level below that of the whole

organism or system’’ (Smuts 1926 as cited in Micozzi

2011, p. 10). Gant et al. (2009) define this connected-

ness as:

The dynamic interdependence of micro and macro

units of analysis at multiple interacting levels (e.g.,

person, cultural, organ system, cellular structure,

work organization); connectedness of mind, body,

and spirit, social, kin, or business relationships;

physical elements; neural circuitry; and health care

practices.

The IMBS paradigm is not simply using modalities

that are not embraced by biomedicine. Instead, practice

guided by this paradigm seeks to restore connectedness

and facilitate a ‘‘state of harmony and balance between

MBS and between individual and other individuals,

community, and cosmos’’ (Lee et al. 2009, p. 53). The

practitioner’s role is to support clients to regain harmony

and balance in all dimensions of their lives—physical,

mental, emotional and spiritual. The principle of con-

nectedness in the IMBS paradigm also acknowledges the

influence of the practitioner’s state of well-being in the

healing process. Consequently, self-care that helps restore

the practitioner’s sense of harmony, balance, and con-

nectedness is essential for the practitioner to be able to

engage in effective practice.

The IMBS paradigm aligns with health practices of

U.S. racial-ethnic groups that biomedical dominance has

undermined (Goodkind et al. 2010). The IMBS wellness

orientation, reliance on self-healing, focus on the bio-

energetic aspects of healing, and emphasis on spiritual

growth (Lee et al. 2009) are more consistent with the

cultural orientation of many groups than biomedicine’s

focus on disease diagnosis and use of pharmaceutical

interventions to treat illness. Resisting a ‘‘one-size fits

all’’ approach to health care, IMBS practice advances

cultural competence by recognizing the importance of

unique personal and cultural histories and acknowledg-

ing the healing practices of communities of color that

have been historically marginalized (Brown 2008).

Integrative MBS Practice, Social Work, and Social

Work Education

Lee et al. (2009) argue for a fundamental paradigm shift in

social work to IMBS practice that maintains a client-cen-

tered, strengths-based perspective, and:

[F]ocuses on the mind–body-spirit relationship, rec-

ognizes spirituality as a fundamental domain of

human existence, acknowledges and utilizes the

mind’s power as well as the body’s, and reaches

beyond self-actualization or symptom reduction to

broaden a perception of self that connects individuals

to a larger sense of themselves and their communities

(p. 39).

Integrative mind–body-spirit practice addresses the

spiritual dimension of human experience, over which social

work has historically stumbled.

Beyond the ground-breaking work of Lee et al. (2009),

the IMBS practice paradigm has not been addressed in the

social work literature. Social work scholars have explored

‘‘CAM,’’ in general, or specific modalities in a variety of

practice contexts—health and mental health settings (Block

2006; Cook et al. 2000; Dziegielewski and Sherman 2004;

Finger and Arnold 2002; Henderson 2000), social work

(Hicks 2009), and substance abuse treatment agencies

(Larkin et al. 2012); with specific populations—children

(Van Pelt 2011), families (Becvar 2010), older adults

(Behrman and Tebb 2009; Wang 2010), oncology patients

(Runfola et al. 2006), trauma survivors (Lee et al. 2011)

and youth sex offenders (Derezotes 2000); and for specific

health and behavioral health conditions—addiction (Carl-

son and Larkin 2009; Kissman and Maurer 2002; Plasse

2002; Temme et al. 2012), depression (Hicks 2009), and

schizophrenic disorders (Leahy 2005). Other scholars have

addressed the use of specific modalities in social work

education (Birnbaum 2008; Brenner 2009; Lynn 2010;

Mensinga 2011; Napoli and Bonifas 2011; Shier and

Graham 2011), with mindfulness and other meditation

approaches being the most frequent type of modality

explored.

Gant et al. (2009) assert the need for social work

education to prepare social workers for practice in the

290 Clin Soc Work J (2014) 42:288–301

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growing context of ‘‘integrative health services.’’ The

authors identify several roles that social workers may

play in relation to integrative health services, including

CAM-related health educator, client advocate for CAM

services, and CAM practitioner. Data on national trends

affirm the need that Gant and colleagues identify. The

2010 Complementary and Alternative Medicine Survey

of Hospitals found that 42 % of hospitals surveyed

offered one or more CAM therapies (Ananth 2011).

Additionally, the number of integrative health programs

in academic medical centers has grown substantially

over the past decade (Consortium of Academic Health

Centers for Integrative Medicine 2013). Whether in

medical centers, non-academic integrative health care

programs, or other practice contexts, the need for edu-

cation and training to support social workers in these

settings is compelling.

Gant et al. (2009) define integrative health services as an

evidenced-based approach that uses:

(1) a biopsychosocial/spiritual, non-pharmacologi-

cally limited framework of health that affirms the

importance of considering conventional, comple-

mentary, and alternative medical modalities in

developing plans for health and wellness; (2) client

education, advocacy skills, and services that help

people (a) make better informed health decisions,

(b) communicate with health care practitioners, and

(c) explore health-related decisions and choices in

the context of personal history, meaning, beliefs,

and lifestyles; and (3) a simple set of vetted mind–

body skills for teaching basic coping and stress

reduction approaches to clients (p. 410).

Gant and colleagues describe a foundation course

designed to build knowledge about ‘‘CAM systems and

modalities’’ used by U.S. ‘‘ethnic subcultures’’ and increase

awareness that ‘‘forms of healing [are] central to an indi-

vidual’s cultural values’’ (p. 413). The course used a

knowledge-building strategy to increase cultural sensitivity

and willingness to collaborate with ‘‘alternative healing

practitioners.’’ The description the authors provide does not

indicate that the course analyzed issues of power and

dominance that may influence individual and societal

perceptions of healing systems and modalities that are not

biomedically based. It is also not apparent that the course

critically examined how these healing systems and

modalities may be constrained if used subordinately to the

biomedical model. Although the course developed by the

authors of the current paper is similar in aim to the one

Gant and colleagues described, we incorporated critical

analysis to achieve learning objectives, coupled with

knowledge-building to advance social work and social

justice.

The Course

The authors designed a special topics MSW course entitled

Integrative Social Work Practice—Mind–Body-Spirit-

Approaches, which was offered as a one-semester, three-

credit elective. The course introduced students to IMBS

practice and encouraged critical reflection on the underly-

ing assumptions related to integrative and allopathic

approaches to health and well-being. In the course design

process, the authors were guided by the literature and their

experience as MBS practitioners. One author has many

years of clinical practice experience in several community

hospital settings and uses a range of MBS modalities in

private clinical practice, including family constellation

therapy (see Cohen 2006 for description of family con-

stellation therapy). The other author is trained in yoga, as

well as Reiki and other energy healing modalities, has over

20 years of experience with energy therapies, and provides

these services at a local healing center. Both authors are

trained in mindfulness-based stress reduction (MBSR) and

maintain a personal meditation practice for self-care.

The intended learning outcomes of the course were for

students to: be able to critically examine the biomedical

and IMBS paradigms; gain knowledge of MBS approaches,

patterns of usage, current research on their efficacy, con-

traindications, and risks; be able to critically examine the

expansion of MBS approaches in the U.S, their historical

and cultural origins, and responses of allopathic health care

systems and practitioners; demonstrate understanding of

the integration of MBS approaches in social work practice

and related ethical considerations; and demonstrate com-

mitment to culturally competent practice with client sys-

tems who use MBS approaches. Learning was facilitated

through lectures, discussion, presentations by guest MBS

practitioners, demonstrations of MBS modalities, videos,

experiential exercises, reading assignments, and written

assignments that required critical analysis and self-

reflection.

Several written and electronic resources supported this

course. Integrative body–mind-spirit social work: An

empirically based approach to assessment and treatment

(Lee et al. 2009) was used as the primary textbook. The

text was supplemented by conceptual and empirical arti-

cles. Two web resources were of particular value for def-

initions of practices and empirical research: NCCAM

(2013) and the Stanford Health Library—Stanford Uni-

versity Hospital (2013). The technology, entertainment,

design (TED) website was a valuable resource for short

lectures by international experts, such as Daniel J. Siegel,

MD, Executive Director of Mindsight Institute (2009).

These resources present IMBS concepts and empirical

studies that examine the efficacy, contraindications, bene-

fits, and risks of a wide range of MBS modalities.

Clin Soc Work J (2014) 42:288–301 291

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The course examined the theoretical and philosophical

foundations of the IMBS paradigm and the biomedical

paradigm, in which social work’s bio-psycho-social

approach is rooted. In addition, the course critically

examined the socio-political-economic forces that enable

the dominance of the biomedical paradigm, as well as those

that have promoted and constrained MBS approaches.

Students were introduced to Ayurveda, Traditional Chinese

Medicine, and the National Indian Child Welfare Associ-

ation’s Relational Worldview Model (Cross 2013) as

exemplars of MBS health and healing systems that are

rooted in non-Western conceptualizations. The course

provided an overview of types of MBS modalities,

including meditation, body movement and manipulation,

and energy therapies, and explored specific modalities,

such as acupuncture, mindfulness meditation, Reiki, and

yoga. Research on the applications, efficacy, contraindi-

cations, and risks of each modality were presented. The

instructors stressed that the introductory content provided

was not sufficient preparation to practice specific modali-

ties with clients and emphasized the ethical responsibility

for training and licensure, where appropriate, to practice

the modalities discussed.

Held during the late afternoon, each class session began

with a brief mindfulness exercise led by one of the

instructors to assist students to be fully present and enhance

their ability to release the stresses and concerns of the day,

as well as provide experiential learning of mindfulness.

These exercises generally began by inviting students to

become still, notice their body, focus on their breathing and

notice thoughts that emerged without attachment or judg-

ment. Variations were introduced, such as mindfully eating

a raisin, which is used in MBSR training. After each

exercise, students were invited to reflect on their experi-

ence in a brief discussion.

As students became more familiar with mindfulness

practices, they discussed applications to their self-care, as

well as their work in field placements. Students reported

using grounding exercises before stressful meetings and

teaching clients simple grounding exercises. For example,

one student introduced breathing exercises at the begin-

ning of an open-ended adolescent skills group to manage

hyperactivity and difficulty with focus in a school envi-

ronment. The student recounted experiencing some ner-

vousness about ‘‘starting something new and different’’

with clients, but found that with practice in class and on

her own, she was able to bring a playful curiosity to the

group. Furthermore, she reported that her focus and

patience with her adolescent group improved and

observed greater attentiveness and ability to focus among

group members.

The in-class exercises and discussions were important

aspects of the experiential learning process and provided

insights about applications to social work practice. Stu-

dents were able to gain perspective on the benefits and

challenges of mindfulness and potential uses for self-care

and clinical practice.

The instructors and guest speakers used lectures, dem-

onstrations, and exercises, when appropriate, to introduce

MBS principles and modalities. For example, the guest

practitioner who discussed energy therapies presented

information on the connection between thoughts, difficult

emotions, and physical discomfort in specific locations of

the body and guided a meditation to assist students to

increase awareness of this link. The conceptual information

combined with experiential learning promoted an embod-

ied understanding of an otherwise abstract idea of mind and

body connection.

Guest speakers also discussed their education, training,

and licensure, when relevant, that prepared them for

IMBS practice. They addressed legal and ethical issues

relevant to specific practice modalities. One master’s level

social work guest speaker discussed her difficulties as a

biofeedback practitioner because of legal challenges from

the American Medical Association regarding the use of

biofeedback for medical conditions. This guest speaker

discussed the advocacy efforts of an organization she co-

founded to demystify MBS practices and facilitate

awareness and understanding between federal elected

officials, MBS practitioners, and communities that utilize

these practices. Other guest speakers, who were also

licensed clinical social workers, discussed their MBS

approach to social work practice. Each of them empha-

sized the importance of maintaining their own balance

and well-being in their work with clients and stressed the

critical role of self-care in the effectiveness of their

practice.

The authors were explicit with students about the values

that guided their teaching and the themes that served as

common threads throughout the course. These values and

themes directed course design, interaction with students

and interaction with each other:

• Centrality of self-care for effective practice

• Holism in practice

• Importance of mindful practice that includes on-going

self-reflection

• Value of maintaining awareness of the operations of

power and privilege that normalize dominant groups

and practices, while marginalizing practices not rooted

in or embraced by the dominant group

• Importance of practicing ‘‘beginners mind’’ when

292 Clin Soc Work J (2014) 42:288–301

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learning about new, unfamiliar practices, as well as

familiar, conventional practices

• Value of openness and critical analysis of healing

systems and modalities, whether indigenous/traditional,

MBS, or biomedical, and the importance of recognizing

their benefits and limitations

• Importance of recognizing the implications of the

paradigm in which healing systems and modalities are

situated

Consistent with these values and themes, self-care, self-

reflection, mindfulness, and ethical practice were encour-

aged throughout the course in lectures, classroom discus-

sions, and written assignments. To facilitate self-reflection,

as well as analysis and synthesis of course material, several

writing assignments required students to identify insights

that emerged from exploration of course topics, applica-

tions to students’ personal development and self-care, and

implications for social work practice. The final paper

required students to complete a critical analysis of one

MBS modality, including its historical, cultural, and

philosophical foundations, and examine the evidence-base

regarding its use. Students were also required to analyze

the level of acceptance of the modality within the allo-

pathic health care system and among insurance providers,

as well as critique the power and privilege dynamics

related to the modality’s availability and accessibility.

Finally, students were asked to reflect on ways that the

practice was consistent or in conflict with their personal

conceptual framework and beliefs about how to maintain

and/or achieve health and wellness.

Methodology

Sample

Thirty-seven students enrolled in the MSW course ‘‘Inte-

grative Social Work Practice: A MBS Approach’’ during

the spring terms of 2012 and 2013. The course was a

special topics, 14-session elective offered at a graduate

school of social work program in the U.S. All enrolled

students were invited to complete a pre- and post-course

survey, which the instructors designed to assess students’

prior knowledge and course outcomes. Participation was

voluntary. All 37 enrolled students completed the pre-

course survey. Of these, 35 completed the course and 32

completed the post-course survey.

Demographic data were not collected to protect stu-

dents’ privacy, since they could easily be identified in these

small classes. However, instructors’ observations estab-

lished that both classes were predominately white and

female, but with some racial-ethnic and gender diversity.

Students’ voluntary verbal self-reports during the semester

indicated a diverse mix of micro and macro concentrations

were represented in the class.

Data Collection

The pre- and post-course survey instrument contained

fourteen quantitative and four qualitative items (see

‘‘Appendix’’). Data collected consisted of 37 pre-test and

32 post-test surveys. Pre-test surveys were conducted at

the end of the first class session each semester, while

post-test data were collected at the end of the final

session. Surveys had no personal identifiers when col-

lected. Quantitative survey items explored knowledge,

skills, and behaviors related to MBS and CAM practices,

and cultural competence. Each item was measured on a

five-point Likert scale, ranging from: strongly disagree,

somewhat disagree, undecided, somewhat agree, and

strongly agree. Qualitative items focused on students’

prior experience with MBS and CAM practices, reasons

for electing the course, expectations of and actual

learning, and understanding of how MBS and CAM

practices relate to social work.

Results

Survey responses revealed that most students had some

prior experience with MBS and/or CAM practices. These

included acupuncture, energy therapies, including Reiki,

herbal medicines, homeopathy, massage, meditation,

reflexology, and yoga. Means and standard deviations

scores were calculated for each survey item to measure

central tendency. The non-parametric Mann–Whitney U

test was used to determine if differences existed between

pre-test and post-test scores. Statistically significant levels

are reported for p values less than or equal to .05. Highly

significant levels are p values B.001.

The Mann–Whitney U test revealed significant dif-

ferences in scores for items that measured knowledge

and use of MBS practices, knowledge and use of CAM

practices, and knowledge of cultural competence.

Scores indicated an increase in students’ perceptions of

their knowledge of MBS practices, CAM practices,

applications of MBS and CAM in professional practice,

and cultural competence. Scores did not change sig-

nificantly for items that measured personal practice of

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MBS modalities, CAM practices, and the ability to

effectively work with people who utilize unfamiliar

MBS modalities and CAM practices.

Both descriptive statistics and the Mann–Whitney U test

results are presented for each item in Tables 1, 2 and 3.

Although systematic qualitative data analysis of the open-

ended survey questions was completed, only selected

responses are presented to inform quantitative results.

The Mann–Whitney U test results showed significant

change in key course learning outcomes. MSW students

reported having ‘‘stronger understanding’’ of MBS prac-

tices, CAM practices, and cultural competence after com-

pleting the course. Improvement in students’ understanding

of these practices was also reflected in their final papers as

compared to earlier written assignments. Results showed

an increase in students’ identifying their use of MBS and

CAM practices in their professional work through aware-

ness, recognition, and knowledge of both types of practice

applications. Additionally, students reported stronger

understanding of cultural competence. This finding relates

to one of the central aims of the course, which was to

increase students’ knowledge and commitment to cultur-

ally competent practice.

MBS and CAM Practices

The course exposed students to the IMBS paradigm and

related MBS modalities, which includes addressing the

spiritual dimension as fundamental to holistic practice.

Acknowledging and understanding clients’ spiritual beliefs

and their relevance to matters of health and healing are

essential for engaging in client-centered, culturally com-

petent care. One student notes in the post-course survey:

Table 1 MBS learning outcomes

Understanding

MBS practices

Personal use of

MBS practices

Professional use of

MBS practices

Ability to develop effective relationships with

people who utilize unfamiliar MBS practices

Pre Post Pre Post Pre Post Pre Post

n = 37 n = 32 n = 37 n = 32 n = 37 n = 32 n = 37 n = 32

Mean 3.89 4.72 4.16 4.47 3.00 3.84 4.32 4.47

SD .81 .46 .93 .51 1.08 .88 .78 .76

Z -4.81 -1.19 -3.19 -.85

p .000** .234 .001** .396

* p \ .05, two-tailed, ** p B .001, two-tailed

Table 2 CAM learning outcomes

Understanding

CAM practices

Personal use of

CAM practices

Professional use of

CAM practices

Ability to develop effective relationships with

people who utilize unfamiliar CAM practices

Pre Post Pre Post Pre Post Pre Post

n = 37 n = 32 n = 37 n = 32 n = 37 n = 32 n = 37 n = 32

Mean 3.38 4.69 3.49 4.03 2.49 3.53 4.22 4.41

SD 1.14 .47 1.30 .91 1.12 1.02 .71 .80

Z -5.25 -1.71 -3.58 -1.34

p .000** .088 .000** .180

* p \ .05, two-tailed, ** p B .001, two-tailed

Table 3 Cultural competence learning outcomes

Understanding of cultural competence

Pre Post

n = 37 n = 32

Mean 4.57 4.94

SD .50 .25

Z -3.46

p .001**

* p \ .05, two-tailed, ** p B .001, two-tailed

294 Clin Soc Work J (2014) 42:288–301

123

‘‘Adding the spiritual aspect to mind and body practices

completes an individual and therefore society as a whole. I

also learned to be more sensitive to client’s voices because

everyone is different.’’ Survey results showed that students

perceived that their understanding of MBS practices

increased (pre-test mean = 3.89, post-test mean = 4.72,

p = .000). These results suggest that students learned to

recognize the holistic framework of MBS practices.

Complementary and alternative medicine modalities

were discussed as holistic in their origin and that their

application may or may not be holistic, depending upon

the broader paradigm that guides their use. Health and

behavioral health professionals who practice within a

biomedical paradigm may use CAM modalities in ways

that are not holistic. For example, yoga may be

understood in ways that are disconnected from the

traditional practice, for example, as simply a series of

stretching exercises. Used in this way, the practice is a

reflection of the biomedical mechanistic view of the

body, which is likely to be beneficial for clients who

are sedentary. However, if yoga is conceptualized and

used in this way, clients may not benefit fully from the

MBS connection and balance that this modality is

designed to facilitate when properly practiced. Since the

field of biomedicine frames CAM practices through a

biological lens, CAM practices used in this context may

not be used holistically nor accomplish the intended

outcomes of a MBS approach. Although survey results

showed that students perceived that their understanding

of MBS (pre-test mean = 3.89, post-test mean = 4.72,

p = .000) and CAM practices (pre-test mean = 3.38,

post-test mean = 4.69, p = .000) had increased, open-

ended post-test responses indicated some students were

not clear about the distinction between the two. One

student wrote: ‘‘Honestly I don’t know how to differ-

entiate between MBS and CAM except that CAM is

more based in health and medicine.’’ Since most liter-

ature makes no distinction between MBS and CAM

practices, students likely received inconsistent messages

about the potential differences between these practices,

despite course lectures and discussion.

Cultural Competence, IMBS Practice, and Engaging

Diverse Populations

Effective practice in the context of cultural and ethnic

diversity is a core commitment of social work. The

National Association of Social Workers Code of Ethics

(2008) takes a strong stand on cultural competence and

outlines social work’s commitment to vulnerable,

oppressed, and marginalized populations. These popula-

tions may have cultural healing practices that conflict with

the dominant biomedical approach to healing. For example,

Goodkind et al. (2010) assert that for American Indian/

Native American youth, the divergence of western and

traditional indigenous approaches to health and behavioral

health is a major impediment to improving services, and

that the impact of prohibiting, disregarding, and discredit-

ing traditional and indigenous health practices has been

detrimental. The profession’s value of cultural competence

and commitment to social justice compel social workers to

address barriers in the U.S. health care system to effective

work with diverse populations (National Association of

Social Workers 2008). The value of using a holistic

framework with diverse cultures is interwoven within the

fabric of IMBS practice.

IMBS’s holistic approach is in greater alignment with

indigenous and traditional healing approaches than con-

ventional biomedicine because of similarities in their

underlying conceptualizations of the healing process.

Implicit to IMBS practice is recognition of the centrality of

the client’s role in the healing process. Centering the client

in this way makes cultural competence an essential aspect

of IMBS practice. Student post-test surveys indicated a

self-reported increase in their understanding of cultural

competence. While the change was significant (p = .001),

mean scores were high at the outset of the course (pre-test

mean = 4.57; post-test mean = 4.94). However, students’

open-ended responses indicated that some understood the

link between IMBS and cultural competence:

‘‘In our [social work] practice it [mind–body-spirit

practices] matches as more culturally competent

when dealing with diverse populations.’’

‘‘I learned about many practices which I was not

familiar with before taking this class as well as the

barriers for treatment based on how our system is set

up.’’

Since students were simultaneously enrolled in other

graduate courses that likely focused on cultural compe-

tence, it is impossible to know with certainty what con-

tribution this course made to the increase in their general

understanding of cultural competence.

Although students reported that their knowledge and

application of MBS modalities (p = .000 and p = .001

respectively) and CAM (p = .000 and p = .000 respec-

tively) to professional practice significantly increased, sur-

vey responses did not reflect an increase in students’

perceived ability to build effective relationships with people

who use MBS and/or CAM modalities unfamiliar to the

Clin Soc Work J (2014) 42:288–301 295

123

student. Pre-test scores on this item were high (MSB

mean = 4.32, CAM mean = 4.22). Since most students

reported prior experience with MBS and/or CAM practices,

knowledge gained in the course was unlikely to increase their

skills in this area. Perhaps a more skills-based practice

course would be needed to increase student competencies

in working with people who use unfamiliar healing

modalities.

Personal Practice

Finally, indicators to measure students’ changes in personal

use of MBS and CAM modalities did not yield significant

results: MBS modalities (pre-test mean = 4.16, post-test

mean = 4.47, p = .234) and CAM modalities (pre-test

mean = 3.49, post-test mean = 4.03, p = .088). The main

purpose of this class was not to enhance students’ personal

practice. However, the authors believed it was important to

measure if a change occurred as a result of exposure to

course content, especially the experiential learning.

Although the class did not require students to actively

engage in MBS modalities or CAM practices outside of

class, the literature supports the value of social work stu-

dents and practitioners using MBS modalities for self-care

and to strengthen their professional practice by enhancing

mindfulness with themselves, colleagues, and clients

(Birnbaum 2008; McGarrigle and Walsh 2011; Napoli and

Bonifas 2011; Shier and Graham 2011).

Reflections

Using the IMBS paradigm to guide course development

and implementation, we engaged in an on-going process of

mindful reflection, peer-debriefing, and shared learning. As

co-instructors, we met weekly prior to and after each class

session. Post-session meetings were used to share obser-

vations, insights, and reflections about the content and

dynamics of the session, with particular attention to how

effectively the shared values and common themes (stated in

‘‘The Course’’ section) were reflected in the session. Our

self-reflections and feedback included focus on self-care,

our degree of ‘‘presence’’ in the classroom, and strategies

for improvement, when needed. These discussions

informed areas of growth and were helpful to fine-tune

plans for future class sessions. When guest speakers lec-

tured, they were invited to join these reflective discussions.

Analogous to clinical peer supervision, this shared, safe

space to process the classroom experience enhanced our

learning. From a holistic perspective, creating this safe

space for interactions outside the classroom supported our

mindful interactions inside the classroom to enhance stu-

dent learning. We shared selected self-reflections from our

peer-debriefing sessions with students, which encouraged

them to share insights and experiences, both positive and

negative, about their personal and professional growth. The

safe space allowed for an open and honest dialogue to

respect diversity in professional and personal realms.

As co-instructors, we developed keen awareness that

experiential learning and reflection are as important as

conventional teaching tools (e.g., reading assignments and

lectures accompanied by PowerPoint presentations) in

building knowledge about IMBS practice. Demonstrations

and simulations led by guest speakers who are expert

practitioners in their fields were vital for accomplishing the

aims of the course. Consistent with the Kolb Experiential

Learning Model (Kolb 1984), the combination of reading

assignments, lectures, guest speakers, experiential exer-

cises, and self-reflective discussions moved learning

beyond abstract concepts to active experimentation, con-

crete experience, and reflective observation.

We noted in classroom discussions early in the

semester that students tended to harshly criticize bio-

medicine and favored familiar MBS modalities. Their

acceptance of familiar MBS modalities was often without

critical analysis of their benefits and contraindications.

Since students who enrolled in this elective course were

likely to be positively pre-disposed to MBS modalities,

we encouraged critical assessment of all practice

approaches and encouraged an unbiased view of their

benefits and risks. By the end of the course, students

expressed a deeper appreciation for the critical role of

biomedical interventions and their use within an integra-

tive approach to health and healing. This stance is con-

sistent with the IMBS paradigm, which supports the use

of all effective and appropriate approaches to maintain

and restore health and well-being.

Maintaining focus on self-care throughout the course

was an important pedagogical strategy for fostering

understanding of the personal and professional relevance

of course content. Given the high rates of burnout or

‘‘compassion fatigue’’ that social workers and other

helping professionals experience (Gillespie 2013), this

self-care focus had practical, as well as pedagogical

benefits. We found that students recognized the signifi-

cance of a holistic paradigm when they understood how

self-care affected them and those around them in their

personal and professional lives. We placed a higher pri-

ority on self-care than is common in the traditional

classroom setting by beginning each class session with a

mindfulness exercise (as described earlier), as well as on-

296 Clin Soc Work J (2014) 42:288–301

123

going discussion during the semester of students’ expe-

riences with self-care.

Recognizing that self-care may be different and unique

for each person, a range of self-care practices were

encouraged, including attention to mind (e.g., guided

imagery and positive reflection), body (e.g., breathing

exercises, gentle stretching, nutrition, and hydration), and

spirit (e.g., seeking meaning, purpose, and connection;

engaging in one’s own spiritual practices). In class dis-

cussions, students commented that their experiences with

self-care exercises introduced in class validated the critical

need for attending to their own well-being, unlike classes

that focused primarily on their intellectual development.

Students also reported that their self-care practices

informed their work with clients. For example, students

indicated that the benefits (e.g., feeling more relaxed) and

barriers (e.g., time, resources, and space) they experienced

in their efforts to engage in self-care increased their

appreciation of clients’ efforts and challenges. Students

said that these new insights helped them to support clients

more effectively in their self-care efforts. For example, one

student reflected upon how his response to a client’s

established self-care practice changed after developing his

own self-care experience. The client had been using

breathing exercises and positive, spiritual affirmations to

calm her anxieties during stressful times. However, the

student had given the client no acknowledgment of these

efforts she was making, because they did not seem sig-

nificant. Once the student had a greater awareness of the

usefulness of these self-care strategies, he was able to

acknowledge their value and affirm the strengths the client

was demonstrating by using these practices. The student

expressed greater understanding of the connection between

his self-awareness and the effectiveness of his practice with

clients.

As co-instructors, our intentions were to create a

learning environment that was shaped by the IMBS para-

digm and use all appropriate pedagogical tools to promote

a critical and experiential perspective on MBS approaches

in social work practice.

Conclusion

Master’s level social work education is designed to

enhance students’ knowledge and abilities to use effective,

culturally competent practices. While the course discussed

in this paper contributed to students’ practice knowledge,

skills, and values, training for IMBS practice requires far

more than this course was intended to accomplish. The

results reported here suggest that an introductory IMBS

course is best used as a platform to engage in an explora-

tion of a holistic paradigm that appropriately and ethically

employees MBS and conventional modalities. Despite the

breadth of knowledge provided in the course, students

noted that there is much more to learn:

‘‘[T]here is a vast amount of alternative methods that

I was unaware of. I learned about the importance of

knowledge in these areas to be able to provide our

clients with the most effective service.’’

‘‘I learned a lot about how many different types of

MBS and CAM practices there are. I know there are

far more than were covered in this class.’’

Lessons learned from implementing the course suggest

that experienced clinicians can support the professional

development of novice practitioners by encouraging (1)

ongoing exploration and critical assessment of the IMBS

and biomedical paradigms; and (2) incorporation of evi-

dence-based MBS practices in their clinical work and self-

care. Details presented in this paper on the content, peda-

gogical approach, and outcomes of the course may also

support clinicians to reexamine the paradigm that guides

their practice, consider a wider range of evidence-based

practices in their clinical work, and recommit to their own

self-care.

Appendix: Integrative Social Work Practice—ST

5318-001: Post-test

Clin Soc Work J (2014) 42:288–301 297

123

Integrative Social Work Practice – ST 5318 – 001: Post-Test

In the following questions, please rate to what degree do you agree or disagree with these statements.

• I have a strong understanding about what mind-body-spirit practices are.1................................2................................3................................4................................5

Strongly Disagree Somewhat Disagree Undecided Somewhat Agree Strongly Agree

They include_______________________________________________________________________________________________________________________________________________________________________.

• I use mind-body-spirit practices in my personal life.1................................2................................3................................4................................5

Strongly Disagree Somewhat Disagree Undecided Somewhat Agree Strongly Agree

• I use mind-body-spirit practices in my professional work.1................................2................................3................................4................................5

Strongly Disagree Somewhat Disagree Undecided Somewhat Agree Strongly Agree

• I am able to build effective relationships with “people who utilize mind-body-spirit practices that I am not familiar with.”

1................................2................................3................................4................................5Strongly Disagree Somewhat Disagree Undecided Somewhat Agree Strongly Agree

• I have a strong understanding about what complementary and alternative medicine (CAM) practices are.

1................................2................................3................................4................................5Strongly Disagree Somewhat Disagree Undecided Somewhat Agree Strongly Agree

They include_______________________________________________________________________________________________________________________________________________________________________.

• I use complementary and alternative practices (CAM) in my personal life.1................................2................................3................................4................................5

Strongly Disagree Somewhat Disagree Undecided Somewhat Agree Strongly Agree

• I use complementary and alternative practices (CAM) in my professional work.1................................2................................3................................4................................5

Strongly Disagree Somewhat Disagree Undecided Somewhat Agree Strongly Agree

• I am able to build effective relationships with “people who utilize complementary and alternative medicine (CAM) practices that I am not familiar with.”

1................................2................................3................................4................................5Strongly Disagree Somewhat Disagree Undecided Somewhat Agree Strongly Agree

• Institutions in our society discriminate against people based on race, class, and gender, and I understand how this discrimination serves as a barrier to the successful use of health and human services, and to getting valuable opportunities.

1................................2................................3................................4................................5Strongly Disagree Somewhat Disagree Undecided Somewhat Agree Strongly Agree

• I understand what cultural competence is.1................................2................................3................................4................................5

Strongly Disagree Somewhat Disagree Undecided Somewhat Agree Strongly Agree

• I understand what health disparities are.1................................2................................3................................4................................5

Strongly Disagree Somewhat Disagree Undecided Somewhat Agree Strongly Agree

• I understand the role that cultural competence plays in eliminating health disparities.1................................2................................3................................4................................5

Strongly Disagree Somewhat Disagree Undecided Somewhat Agree Strongly Agree

• I understand what health care disparities are.1................................2................................3................................4................................5

Strongly Disagree Somewhat Disagree Undecided Somewhat Agree Strongly Agree

298 Clin Soc Work J (2014) 42:288–301

123

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