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A COURSE ON IMBS SOCIAL WORK PRACTICE

We designed an elective, 3-credit MSW course currently titled “Integrative Mind-Body-Spirit Social Work.” Despite both of our extensive experiences and long histories with IMBS modalities as practitioners and clients, this course was the first venture either of us had made into teaching content related to IMBS practice in a higher education setting.

During this 14-week course, we engage with students as co-learners in a critical examination of the philosophical, theoretical, and cultural foundations of the IMBS and biomedical paradigms; the sociopolitical-economic forces that have enabled the dominance of the biomedical paradigm; and those that have promoted and constrained IMBS approaches to health and healing in the United States. During this examination, we situate Abraham Flexner's historic 1915 speech, during which he concluded that social work was not yet a profession, in the broader context of the publication of his earlier 1910 report on North American medical education (Flexner, 1910). This report promoted the scientific method as the only legitimate approach to knowledge generation and played a pivotal role in advancing the current biomedical approach to health care.

We analyze the juxtaposition of Flexner's aim to improve medical education, which was sorely in need of reform, “with a general political one in order to promote modern biomedical and reductionist strategies in medical and psychiatric education” (Stahnisch & Verhoef, 2012, p. 4). As we study the consequences ofthe Flexner Report on medical education, we identify ways that it promoted the rise to dominance of the biomedical paradigm, with the aid of subsequent aggressive legislative advocacy that privileged this approach to health care and restricted or prevented the practice of other approaches (Micozzi, 2011). The consequence for medical education was the closure of medical schools that did not use allopathic methods (Barkin, Fuentes-Afflick, Brosco, &Tuchman, 2010; Stahnisch & Verhoef, 2012; Wheatley, 1989), including schools of homeopathy and naturopathy. An additional outcome of the report was “closure of five out of seven predominantly black medical schools. Also noteworthy ... was Flexner's utilitarian argument that black physicians should serve as sanitarians and hygienists for black communities in villages and plantations” (Sullivan & Mittman, 2010, p. 246). Six of seven women's medical schools also closed. These school closures combined with discriminatory medical school admission policies that excluded most African Americans and women resulted in “modern medicine” becoming an overwhelmingly white male profession (Sullivan & Mittman, 2010).

Flexner's (1915) admonition that professions “derive their raw material from science” (p. 576) and the undoing of medical schools throughout the nation set the stage for social work education to embrace the scientific method as the only valid way of knowing and the biomedical paradigm as the only credible approach to medicine. Considering Flexner's well-known 1915 speech through this broader contextual lens, we invite students to critically examine how social work education has been recruited by the current dominant narrative to view biomedicine as “mainstream” and legitimate while marginalizing approaches that have emerged from indigenous and/or culturally grounded ways of knowing as “complementary and alternative” or trivializing, dismissing, and/or discrediting them.

In the course, we explore Ayurveda (i.e., a system of traditional Indian medicine), Traditional Chinese Medicine, and the National Indian Child Welfare Association's relational worldview model (Cross, 2013) to gain perspective on conceptualizations of health and healing that are rooted in cultural knowledges and paradigms that differ from the biomedical disease-oriented model. The course explores several types of IMBS modalities, including meditation, body movement and manipulation, and energy therapies. See Raheim and Lu (2014) for a detailed discussion of course content and outcomes.

We use several means to promote praxis, critical pedagogy's methodology of ongoing critical reflection and action (Freire, 2000). Reading assignments, didactic presentations, IMBS guest speakers-practitioners, active classroom discussion, personal reflection journals, and other written assignments encourage exploration of the power dynamics that perpetuate dominance and perceptions of legitimacy of biomedicine while subjugating and undermining the credibility of the IMBS approach and related modalities. We examine how these dynamics influence our (instructors' and students') personal perceptions and choices, including our sense of freedom to discuss and explore IMBS modalities in professional and academic settings.

The course combines critical reflection with action, as students are invited to participate in experiential learning in the classroom that promotes greater awareness of the mind, body, and spirit, as well as the connection between these aspects of being. We encourage students to use these techniques for their self-care during the semester and write journal reflections. Although the course introduces a variety of mind-body-spirit techniques, mindfulness is used consistently for experiential learning (Raheim & Lu, 2014):

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 judgment. Variations were introduced, such as mindfully eating a raisin, which is used in MBSR [mindfulness-based stress reduction] training. After each exercise, students were invited to reflect on their experience in a brief discussion. (p. 292)

During the reflections that follow these exercises, most students express appreciation for the moments of stillness and the opportunity to mentally and physically slow their pace. Some students note that they experience difficulty with being still, whereas others report easily quieting their minds. As the semester progresses, students often report looking forward to the beginning of class and using these exercises in their self-care practice. As instructors, we feel grateful that students find these techniques useful, both inside and outside of the classroom. I (SR) am delighted to finally incorporate IMBS practice into the classroom after 3 0 years of feeling constrained from doing so.

Writing assignments ask students to analyze the perceived benefit of their self-care activities and compare and contrast these approaches to maintaining well-being with biomedical approaches they had experienced. Students are also invited to identify their level of comfort with revealing their use of these practices with those not in the class (e.g., family, friends, and coworkers) and reflect on the source(s) of their discomfort, if any.

A final paper further promotes critical reflection. Focused on an IMBS modality of the student's choice, this assignment requires students to examine the philosophical, metaphysical, and/or scientific foundations of the practice, including evidence of its efficacy; determine its acceptance within the biomedical health care systems and among insurance providers; identify the proponents and opponents of the practice; explore power and privilege dynamics that affect availability and accessibility to this practice; and analyze ways that the practice is consistent or in conflict with the student's personal conceptual framework and beliefs about how to maintain or achieve health and wellness.

Our commitment to critical pedagogy requires creating a safe, collaborative learning environment and engaging as co-learners with students and each other. Acknowledging and respecting the knowledges that all ofus bring to the learning experience are vital. Before the course began, we developed several strategies to create this quality of learning environment that we implement throughout the course. First, we model for students our respect for each other's knowledges and experience as co-instructors by expressing the importance of the unique perspective that the other brings to the class (e.g., Lu as a licensed clinical social worker with many years of experience with mindfulness and Family Constellations facilitation and Raheim as an IMBS practitioner at a local healing center with many years of experience with energy healing, meditation, and yoga). We made a conscious decision regarding how to address each other in class and selected first names to resist the hierarchical relationship that our institutional roles and titles would have constructed (e.g., dean/professor vs. doctoral student/instructor). For similar reasons, we invite students to call us by our first names as well. To convey respect for students' knowledges, we frequently ask them to share their prior and ongoing personal and practice experiences as related to topics being discussed in class.

We are deliberate in maintaining an accepting, nonjudgmental stance when responding to students' descriptions of their experiences, as well as their opinions about various modalities. When students make generalizations that are judgmental or disdainful of specific practice approaches, we use these opportunities to remind students that social work values require that critical analysis be done with respect and without oversimplification. These types of judgmental comments usually focus on biomedicine (e.g., “Allopathic doctors just want your money. They don't really want to help you get well.”). Although some didactic teaching methods are used, content presented is consistently framed as information for further exploration and critical analysis versus “knowledge” to be added to the data bank.

Finally, we meet as a teaching team before and after each class to share selfreflections, observations of each other's presentations and interactions during class, and other classroom dynamics. We discuss moments when each of us may have been less effective in our teaching efforts than we would have preferred or disclosed less about our IMBS practices and experiences than might have been useful. Our analysis of these sessions gives us opportunities to reflect on how we can be more effective and open in the classroom. We also share observations about lack of engagement ofparticular students and strategize about how to more effectively invite their participation. This ongoing focus on our individual and collective praxis is a valuable process for assessing our teaching effectiveness and strengthening our ability to maintain a safe, collaborative learning environment. These discussions also serve as re-membering conversations that support our identities as holistic, IMBS social work educators.

Participating in the design and implementation of the course is supporting our development as holistic educators. Prior to designing the course, we had only casually examined the sociopolitical-economic forces that advanced the dominant paradigm of biomedicine and constrained IMBS practice. Critically analyzing the history of biomedicine and the tactics it has used to discredit and undermine competing approaches to healing made clear how it became the dominant approach to health care and positioned other approaches as not credible.

These explorations helped me (SR) to develop a critical analysis of how my voice had been silenced on matters related to IMBS practice in social work education. My new critical understanding, my discovery of a growing body ofliterature that validated IMBS practices, and teaching with a co-instructor who uses IMBS approaches in his practice have helped me to move to a more empowered identity. The experience has enabled me to develop a critical consciousness and sense of agency that further supports my development as a holistic, IMBS educator.

As an experienced IMBS practitioner and clinical trainer, developing an identity as a holistic social work educator has been an easier journey for me (JJL) than for my co-author. Developing my professional identity in an environment and time period that is far more accepting than my co-author's experience is essential to recognize. Although my current doctoral education includes strong ideology from a post-positivist paradigm, there are also strong faculty and mentors who support my growth and development within critical and participatory frameworks, which spawned from a paradigm of social constructionism. Although there is much to be done, my path continues to bring new awareness and experience in developing my knowledge about IMBS.

 
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