Clinical Social Work at the Austen Riggs Center: Part 1 – What Has Changed and What is Unique?



by Aaron Beatty

At the Austen Riggs Center, a team of clinical professionals follow patients from admission to discharge. Social workers play a crucial role within the interdisciplinary treatment team and provide a number of essential services for both patients and their families throughout a patient’s stay.

This blog series will explore some roles social workers have, what has changed about social work and what the future holds for social work at Riggs. 

Part 1 – What Has Changed and What is Unique? 

Margaret Kortarba, LICSW is a clinical social worker at the Austen Riggs Center.Of her more than two decades as a clinical social worker at Riggs, Margaret Kotarba, LICSW, remarked “Things have changed certainly, but I can’t say that my practice as a social worker has changed drastically.” While the standard of care at Riggs and its underlying principles of the importance of relationships, understanding the meaning behind symptoms and patient authority have remained constant, what has changed, according to Kotarba, is the way in which social work and social workers have become more integrated into both the treatment and also Riggs itself; “systematically, we have really come a long way.” 

Originally there was only one social worker on staff. It was during the tenure of former Medical Director/CEO Edward R. Shapiro, MD, (1991-2011), that the social work department saw an expansion and the inclusion of social workers as part of the “Medical Staff.” The additional focus on patients’ psychosocial context that Dr. Shapiro brought to Riggs meant that, as part of the treatment, social workers would “hold” patients in context with their external world, including their family and provide a bridge from the internal to the external world. Kotarba said “Dr. Shapiro was a big part of bringing family work [to Riggs] … he was instrumental.” She learned about Riggs through hosted educational events and learned about the treatment model. “It was where things were happening that were more in depth … so I gravitated toward Riggs.” When a new position in the social work department opened up, she applied and joined the Riggs staff in 1996. 

When she began, Kotarba noted that at times she felt “alone with the families,” particularly in her role as a family liaison. Then, over time, she said, “we [social workers] started to bring more of our own experiences to the medical staff.” This, along with a shift in how family work was viewed at Riggs, helped to create an environment where, Kotarba says, “much more value now is placed on the family work.” There is more opportunity for social workers to explore issues that come up in their meetings with patients or families, often in patient-centered family meetings or family therapy sessions (both of which include a patient’s social worker and individual therapist as co-therapists). 

When asked about what she sees as unique about the way Riggs incorporates social work in the treatment, Kotarba referenced three particular, long-standing elements:

  1. The multi-generational family history – social workers take a three-generation family history on both sides for each Riggs patient, to better understand the psychosocial context of the patient in relation to his/her family system. 
  2. The interdisciplinary treatment team structure – social workers are part of an interdisciplinary team that meets twice weekly and follows patients from admission to discharge. 
  3. The co-therapist role – a patient’s social worker and individual therapist serve as co-therapists in all family meetings and ongoing family therapy.  

Through these elements, “You really get this amazing bird’s eye view into people lives … not only is it informative to the [individual] therapy, but it’s informative to the family therapy,” stated Kotarba. 

According to Kotarba, the benefits of practicing social work at Riggs are many, including the exposure to “wonderful clinical minds,” having “the opportunity to participate in a high caliber level of psychoanalytic, psychodynamic thinking” and enjoying the opportunity of being able to take the time to explore with other clinical staff members “how are we working together?”

Today, there are six full-time social workers at Riggs with the expectation of adding one more. As for what else the future holds for social work at Riggs, Kotarba sees continued institutional support for social workers and an effort to “expand offerings to families.” 

Check back next week to read Part 2 about the role social workers play in family work.