Methods: We used simulation as a research methodology, in which we observed social workers’ engagement with a Simulated Patient (SP; i.e., trained actor) who portrayed a realistic and complex client character experiencing racism and other forms of social injustices. Experienced social workers (n = 8) were recruited to first conduct a video-recorded 30-minute session with the SP on Zoom. Participants then completed a 45–75-minute post-session interview with a researcher to review the video-recorded session and discuss how they translated their racial and social justice commitments into the client session. These interviews were audio-recorded and transcribed verbatim. Both types of data (sessions and interviews) were analyzed inductively, using coding methods from Grounded Theory and constant comparative methods.
Findings: The following therapeutic processes emerged in the data: (1) create and hold a space of safety, (2) maintain an unassuming position while holding theoretical assumptions, (3) peel off the layers of the presenting problems, and (4) take an anti-oppressive therapeutic stance. First and foremost, participants focused their efforts in intentionally creating a space of safety, using a variety of techniques such as taking a non-directive approach, pacing, and asking for permission. These participants came into the sessions with the theoretical assumption that we live in a society embedded in structures of racism and social injustices, which contribute to health disparities among marginalized groups. While maintaining this theoretical assumption, participants approached the client from an intentionally unassuming position. This enabled them to listen and digest the client’s subjective affect-level experience, rather than expecting that the client’s narrative would fit into the theoretical assumption. In assessing the client’s presenting concerns, participants focused beyond initial presenting problems (e.g., insomnia) to develop a contextual understanding by linking them to surrounding systems of oppression. In further engaging the client, participants took an active, anti-oppressive stance by not engaging in a traditional therapeutic neutrality. Rather, they validated and joined the client by making explicit their own emotional reactions, social locations (e.g., experience with racism), knowledge about others in similar situations, and personal and professional commitment to social justice.
Conclusion and Implications: Grounded in the rich and robust simulation-based data, findings signal concrete ways social workers can apply their commitment to racial and social justice in direct practice. This study also offers a methodological innovation well-suited to attend to the complex nature of social work practice through the real-time observation of simulated practice, while addressing ethical concerns involving clients from vulnerable populations in research.