Clinical Social Workers, Gender, and Perceptions of Political Participation

Political participation to create social change is considered a professional and ethical imperative for social workers. Although researchers have examined overall political participation by social workers, little is known about how clinical social workers participate and the broader societal factors that influence their political participation. A critical phenomenological methodology was used with a sample of 23 clinical social workers from New England states to (1) identify how socio-political forces influenced their political activity; and, (2) understand how the concept of power affected individuals’ level of engagement or inclination toward the political process. This article describes one of the study’s major findings. Female participants described themselves as unqualified and/or unknowledgeable in the political sphere, with low levels of ambition and confidence to engage in political processes. Many female participants also described the challenges of achieving a work-life balance between their careers and traditional gender-based roles with little time left for political engagement. Social work education and policy advocacy can affect change that will increase the internal and external efficacy of social workers and create a policy environment that allows more options for all social workers in balancing the demands of professional and personal lives.

Social work has a rich history of helping marginalized and oppressed populations through social reform. One of the primary characteristics of the profession is its dual emphasis on the individual and the environment. The latter includes the social, political, and economic structures and actors that impact clients daily. Macro-oriented scholars, however, have accused the profession of neglecting its obligation to social justice and political participation and focusing its energies on micro practice (Harding, 2004;Haynes & Mickelson, 2009). In this article, we examine the ways in which female clinical social workers view their participation in politics within a professional practice context. This understanding can inform the educational standards of schools of social work, which could lead to more politicized practice and thus fidelity to the profession's defining principles of social justice (Fisher & Karger, 1997).
This article focuses specifically on the experiences of female clinical social workers for three reasons. First, while women as a group have received more attention as active members of the political process in recent years, the consequences of the historical exclusion of women from the political process in substantive ways are still being felt in the United States and most other industrialized democracies. We believe this historical exclusion justifies the focus on this population as the social work profession works to make our society, including our political process, more socially just. Second, clinical social workers are underrepresented in the literature about political participation among social workers, which makes it more important to hear their voices. Third, while interviewing the women in this study, it became apparent their experiences of political participation were firmly rooted in social identities connected to gender, specifically connected to identities as mothers, wives, and grandmothers, that it felt authentic to their voices to highlight these identities.

Literature Review
In order to address the experiences of female clinical social workers and the lessons learned from this group that can inform political social work and social work education, we will discuss literature that highlights both gender and political participation. First, we discuss issues of gender and inclusive democracy. Second, we conceptualize the term political participation as used in this paper. Finally, we look at ways that political participation and gender connect with political efficacy.

Gender and Democracy
The United Nations recognizes increased political participation by women worldwide as "the key to redress gender inequalities in societies" (Bari, 2005, p. 1). This argument is made for both intrinsic reasons (women make up half of the world's population and therefore should have an equivalent representation) and instrumentalist reasons (the argument that women's contributions to politics will be different from men's based on their sex and their gender-roles within families). However, across the world, we see women's "historic exclusion from political structures and processes is the result of multiple structural, functional and personal factors that vary in different social contexts across countries" (p. 2). Bari (2005) argues that democracy has fundamentally served men better than women throughout its history, and that the patriarchal structures of modern democracies continue to make it difficult for women to both enter the political arena and to be effective changemakers within it. This article positions female clinical social workers' participation in the political process within that patriarchal lens, and deliberately focuses on their experiences in order to see how these structural issues affect this population.

Political Participation and Social Work
The first social work published author to analyze the political process was Reynolds in 1896 (Weismiller & Rome, 1995). Since then, a variety of studies in the social work literature have examined political participation by various subgroups of social workers, primarily using quantitative methods. Within this literature, nine studies used professional social workers as research participants and sampled only National Association of Social Workers (NASW) members. An additional eleven studies have used various other subgroupings, such as executive directors of NASW Chapters, administrators, state NASW Chapter members, child and family service workers, social work leaders in health care, undergraduate and graduate social work students, and social work educators (Ostrander, Lane, McClendon, Hayes, & Smith, 2017). Five additional studies contribute to the understanding of social workers' involvement in the political arena: Rocha, Poe, and Thomas (2010) explored the perceived barriers to social workers' professional advocacy, including legal issues; Rome, Hoechstetter, and Wolf-Branigin (2010) discussed empowering clients to participate in politics; Salcido (1984) examined social workers' participation in political campaigns, and Haynes and Mickelson (2009) and Lane and Humphreys (2011) studied social workers elected to public office. These studies identified several personal characteristics that correlate with high levels of political participation among social workers -such as age, income, and race/ethnicity. For a variety of reasons, macro social workers are frequently over-represented in these studies, except for Ritter (2007), who intentionally looked at licensed social workers, who are often micro practitioners.
Few social work studies have reported how female clinical social workers understand and/or participate in politics. Recently, Meehan (2018) found significant results supporting the finding that female MSW students doubted their qualifications, knowledge, and experience to engage in the political process. Since there are no written works on this specific topic in social work, the authors had to rely on the political science literature to help understand this phenomenon.
The present study is the first qualitative examination of the experiences and perceptions of female clinical social workers. It comes from a larger 2016 study of male and female clinical social workers. This group is relevant as women make up 81% of licensed social workers (NASW Center for Workforce Studies, 2005). In addition, the focus on women in this paper allows for a focused examination of the effects of patriarchy-a system of oppression-on this population. In a national study of political participation by social workers who are NASW members,  found that 62% of the sample worked in direct practice, nearly half of whom identified their place of employment as private/group practice, a mental health facility, or a hospital. Yet, inconsistencies exist in explaining the political participation of clinical social workers (Harris & White, 2013). Much of the literature demonstrates that social workers participate in politics at higher rates than the general public. The most frequently practiced form of political participation among social workers is voting (Ritter, 2007;Swank, 2012). Research shows that macro practitioners engage in higher levels of political participation than their micro counterparts (Ezell, 1993;Reeser & Epstein, 1990;Wolk, 1981). In a recent study by Mattocks (2018), social workers who self-identified as mezzo or macro level practitioners reported higher levels of political participation in the form of social action. Although clinical social workers can wear many hats and hold many roles, their primary work is as therapist or counselor (Harris & White, 2013). Understanding the experiences of clinicians and direct practitioners who are women is crucial to understanding large-scale political participation among social workers.

Political Participation Conceptualized
Political participation is discussed in a variety of ways in the social work literature, and there is no consensus on the form it should take for all types of social work practice. Concepts in this discussion to define political participation include activism (Swank, 2012), political action (Rome & Hoeschstetter, 2010), and advocacy (Bernklau Halvor, 2016). The most widely used and conceptualized model of political participation originates in Verba, Schlozman, and Brady's (1995) landmark political science study. They characterized political participation as an "activity that has the intent or effect of influencing government action-either directly by affecting the making or implementation of public policy or indirectly by influencing the selection of people who make those policies" (p. 38). Activities in their definition included voting, gaining and using political knowledge, being aware of political issues, protesting a policy issue or government decision, contributing money to and volunteering with campaigns or political committees, and, other politically-directed activities such as running for elected office. They separate political participation from awareness activities (e.g., watching the news) and civic engagement activities (e.g., volunteering for a community agency) that do not explicitly target elected officials. An inherent challenge to the adoption of Verba and colleagues' conceptualization, however, is that it makes no distinction between political participation. Whether there's a distinction between personal political action and engaging the political process on behalf of clients remains unresolved, but we hope to offer additional insight to this notion.

Political Participation, Gender Roles, and Political Efficacy
Clinical social workers have an important role to play in the political context of the social work profession. They have direct contact with clients and can see how policies are affecting individuals. One potential barrier to political engagement by clinical social workers is gender. As noted previously, women comprise the majority of clinical social workers. Although the social work profession has an ethical obligation to promote social change, it is also influenced by broader societal and cultural beliefs. Fox and Lawless (2011) explored how gender socialization and traditional gender roles impacted women's engagement in electoral politics. They found that men are socialized to be "confident, assertive, and self-promoting" (p. 60), and when women demonstrate similar characteristics it is often perceived as "inappropriate or undesirable [for them] to possess these characteristics" (p. 60). This has resulted in women exhibiting a decrease in political ambition due to lower confidence in their leadership capacities, while men demonstrate a higher level of confidence Meehan, 2018). Burns, Schlozman, and Verba (2001) found that women who are employed have a decrease in political participation due to a lack of leisure time. This disparity is magnified for women who are married with children because of traditional views of men's and women's gender roles regarding family responsibilities. Fox and Lawless (2012) found statistically significant differences between 4,000 men and women surveyed between 2001 and 2011, including women doing most household tasks and child rearing. As women's hours spent working increases, their political participation drops. This is not the case for men. Essentially, women are more likely to trade leisure time for child-and family-related responsibilities than men (Burns et al., 2001;Fox & Lawless, 2012;Silbermann, 2015). Further, as women spend more hours at work focusing on their career, they tend to participate in less visible and formal political activities (Lister, 2007). Although attitudes about gender roles may be shifting, these stereotypical norms and attitudes continue to impact engagement in politics (Fox & Lawless, 2012). When women report having children living in their home, they score lower on measures of political ambition . Thus, access to the political arena, both in terms of perceived ability and available time, is different for men and women (Enloe, 2004;Freedman, 2002).
Scholars have consistently reported a gender gap in political knowledge as well (Dolan, 2010;Schlozman, Verba, & Brady, 1997). When women are surveyed about political issues, they answer fewer questions correctly than men (Burns et al., 2001;Dolan, 2010) and more often answer with "don't know" (Lizotte & Sidman, 2009). This last finding may be explained by a recent study by Ondercin and Jones-White (2011), which found women have a self-imposed requirement to have higher levels of political knowledge prior to participating in political activities. Additionally, women hold themselves to a higher standard than men when deciding whether to run for elected office (Fulton, Maestas, Maisel, & Stone, 2006). Essentially, women view themselves as lacking the confidence and qualifications to offer political opinions and to discuss politics, even when objective measures of their qualifications are equivalent to men's (Mendelberg, Karpowitz, & Goedert, 2014;Nir & McClurg, 2015).

Political Efficacy
Political knowledge, confidence, and competency contribute to one's sense of political efficacy, or that "a combination of one's sense of competence in the political sphere and one's assessment of the responsiveness of the system" (Campbell, Gurin, & Miller, 1954, p. 187). Beginning with the work of Lane (1959), political efficacy has been used to help explain political participation, and more than a dozen studies have differentiated two types of political efficacy: internal efficacy and external efficacy (Beaumont, 2011). A person with high internal political efficacy believes they understand how to take part in the political process and are not intimidated by obstacles that may be encountered. A person with high political efficacy views the political system and leaders as responsive and accessible to the general public (Caprara, Vecchione, Capanna, & Mebane, 2009).

Research Design
Using a critical phenomenological approach, this exploratory study sought to understand the lived experiences of clinical social workers and the various factors that contributed to their thoughts and decisions about political participation. Through delineating power differentials and the social, political, and economic forces impacting clinical social workers' daily lives and experiences, this study sought to contextualize the decisions they are obliged to make between meeting the profession's mission and ethics and fulfilling their daily job and life responsibilities. This analysis focused on clinical social workers' perception of how their identity as women impacted their political participation. This study was designed to be nonpartisan, and therefore topics that had partisan implications were only discussed when raised by participants.

Data Collection
Human subject approval was obtained from the Institutional Review Board at the primary researcher's institution. Data was collected using in person (n=17) and Skype (n=6) interviews. Prior to conducting each interview, potential participants were verbally screened for eligibility, and informed consent was obtained. In order to participate in this study, participants needed a master's degree in Social Work; two years post-education clinical practice experience; and, experience providing direct clinical therapeutic services to clients. A semi-structured interview guide was used during all formal interviews, which lasted 75-120 minutes. Second interviews were conducted with five participants to gain further clarification. A demographic survey was also administered.
All interviews were digitally recorded, and thorough field notes and memos were written after each interview. Each participant was assigned a unique identifier, and all personal information was removed to protect the confidentiality of the participants. After all data had been collected, the master list connecting the participants' identity and his/her unique identifiers was destroyed. Interviews were transcribed, reviewed, and coded using NVivo 11 for Mac. Demographic survey data was downloaded and entered into SPSS version 23 for Mac.

Sampling
Nonprobability purposive and snowball sampling methods were employed due to the survey's exploratory nature. For the purposes of this study, the sampling frame was designed in order to access clinical social workers, defined as Masters-level practitioners who provide direct services to "individuals, couples, families, and groups with a focus on intra-personal and interpersonal problems" (Harris & White, 2013, p. 89). Specific agencies that employ clinical social workers who reside in Connecticut, Rhode Island, Massachusetts, Vermont, New Hampshire, and Maine were contacted to develop the original list of participants. This region was selected to allow the researcher to conduct most interviews in person. At the conclusion of each interview, participants were asked to share the interviewer's contact information with other potential participants. The goal of this sampling strategy and study design was to capture the phenomenon.

Participants
Twenty-three participants were interviewed for this study, and only one participant did not complete the demographic survey, resulting in a 96% response rate. The mean age of the sample was 43 years old, and ages ranged from 28-66 years. Regarding gender, 77% of participants identified as female and 18% as male; one participant identified as a transgender male. Almost 70% of the sample identified as Non-Hispanic White, 14% were Black or African-American, 9% identified as Hispanic/Latino, and 4.5% identified as Afro-Caribbean and Bi-or Multi-Racial. Thus, the sample for this study is primarily White and female, which is reflective of the demographic breakdown of the social work profession. Two respondents (9%) identified as Republicans, two (9%) were unaffiliated with a political party, and the remainder (82%) identified as Democrats. All participants identified their sexual orientation as heterosexual, more than half (54%) were married, 91% of participants had one child or more, and slightly more than one-third (32%) were affiliated with a religion. This article will focus on the experiences of the participants identifying as women, regardless of other social identities.

Data Analysis Coding
After transcription and uploading of interviews into NVivo, an initial codebook was created, followed by a first and second cycle coding methodology (Saldaña, 2013). In order to further increase the rigor and trustworthiness of the coding process, a trained co-coder was employed to code independently using the initial codebook. Once both coders were finished, they met to discuss and reach consensus on all discrepancies. Thematic analysis was conducted by both coders to identify meaning for the larger themes using the interview data, member checking, analytic memos, and peer debriefing. This article discusses one of the two primary themes identified: gender identity as a woman and its impact on political participation. Validity and trustworthiness were addressed in a variety of ways, including use of an audit trail throughout the collection and analysis of the data, peer debriefing, prolonged engagement over one year-working with participants from the initial interview through reporting the findings, member checking, and awareness of researcher bias.

Limitations
The researcher was cognizant of the stark demographic differences between himself and his interviewees. Identifying as a white, heterosexual, cisgender, male political social worker, the researcher remained mindful of potential bias through constantly assessing and being aware of his position (Padgett, 2016). As this study's findings are based on a nonprobability convenience and snowball sample of 23 participants, these findings are not generalizable to all clinical social workers. Like all qualitative research, the interviews represent a point in time. The first interviews occurred April to June 2015, and the second interviews were conducted in January 2016. Contemporary social, economic, and political events likely impacted the interviewees' perspectives on political participation. The results of this study need to be examined within the context of the 2016 United States presidential election, which proved to be one of the most contentious election seasons in modern history.

Findings
In the social work literature on political participation to date, no scholars have investigated gender differences among clinical social workers' engagement in the political process. However, in this study the participants' identity as women seemed to influence their understanding of and engagement in political participation with four sub-categories: identity as a woman, the impact of their family on political participation; marriage/partnership with men; and, having children and/or grandchildren.

Identity as a Woman
The majority of the female participants, without being prompted, personally identified based on their gender, often connecting other intersecting identities around race, ethnicity, or family roles. These identities included being women, feminists, mothers, grandmothers, wives, and spouses. The participants discussed how these identities interplayed with their political participation. Unlike the female participants, not one of the male clinical social workers mentioned their gender in any context of their interviews unless they were asked about it directly.
One of the first participants interviewed was born in Puerto Rico and moved to the continental United States later in life. She eventually married and worked as a school social worker. Discussions about political participation frequently came back to her identity: She felt that as a woman and clinical social worker in the medical field, her colleagues and administration did not view her position as a valuable component of the treatment team. She felt their assumptions that she "should just be happy with what [social workers] get," and that she was "just going to roll over and give in" when she was challenged by a doctor or nurse. Her identity as a "strong woman" helped her combat the injustices she encountered at work.
One participant worked for many years in a clinical setting, but decided she wanted to have a greater influence on the low-income individuals and families she worked with in her rural community mental health practice. She decided to run for elected office. While going door-to-door to introduce herself to voters, this participant encountered many people who needed social services. She felt as a social worker and as a woman she needed to help them, so she brought Medicaid applications and pamphlets for area social service agencies to distribute to people who needed services.
Impacted by the many experiences she had throughout her life personally and professionally, another participant spoke about how she identified as a "strong feminist, liberal, mother and wife. Oh, grandmother, mother, wife." Over the course of the participant's career, she began to believe the best way for her to bring about broader change was through the political process. This led her to work in a macro setting as an advocate, organizer, and a politically engaged social worker. After reflecting, the participant explained how her different identities impacted her career as a social worker employed in the macro sphere: I have devoted my career to mostly helping women. I mean, I have male clients now, but they're…honorary women. They're good on women's issues, they're usually men of color, they're usually gay men of color. I feel like I've devoted my whole career to helping women and children.
A participant who worked in a community mental health agency also identified as a feminist and described what being a woman meant to her. Interestingly, she acknowledged a conflict she experienced as a mother and woman who is impacted by greater society:

Family of Origin
Most of the women interviewed discussed how their beliefs, values, and ethics were influenced by their families, often through deliberate messaging about traditional gender roles. Participants who came from civically and politically engaged families eventually participated in activities to help impact their communities and the broader society. A participant working in private practice and consulting with a substance abuse agency discussed her socially and politically active family members. She described her family with pleasure and pride:

Both of my parents were very politically and socially active people…Even predating that, my grandfather wrote a book about the first African-American Merchant Marine captain of a Merchant Marine ship. Harriet Beecher Stowe is a part of my family lineage. My father's side of the family was very politically active, socially active.
Her family history was the catalyst for social awareness and curiosity about how people relate to each other. On multiple occasions, this participant discussed trying to understand and develop opinions on how people who are different (e.g., gender, race, ethnicity) are allowed to be disadvantaged economically or marginalized. She reflected, "it's one thing to have strong feelings about social issues, [but] it's another thing to take action and take risks to speak out." Another participant grew up in a very politically active home and had socially conscious and engaged family members. Her grandfather was a state representative, which she acknowledged had a direct impact on her father. After her grandfather died, her parents moved to where "no Democrat had been elected." She related a story about her parents' political involvement and the impact her parents had on her:

Husband or Male Partner
During the interviews, multiple female participants stated they would "ask [their] husband" whenever they had a concern or question about politics, current events, and/or civically oriented topics. After asking one participant to explain how politics or political participation impacts the work she does with physically and sexual abused children, she quickly minimized her competence and her impact on political systems. She then outlined why her husband was more knowledgeable on the topics:

My husband really is involved in a lot of that stuff. He keeps up on a lot of the news. All of my political talk at home is him talking at me about things. But as far as any sort of funding for what we do from the government, I always feel like there could be more.
One participant has been out of her graduate program for two years, recently married and has an 18-month old son. The participant repeatedly told me she could not lend her voice to a conversation she had with her husband on politics. Like other participants, she also viewed herself as not having enough information to have an opinion. When she was asked why she so readily asked her husband about politics, she responded:

I'll ask him questions, what does this mean? Or, what does that mean? Or, what are they negotiating in Congress? Because I might not even know. Then I have him explain to me, this is what this [bill] means, or this is what that [political issue is about]. This is why the Iranian deal is happening or this. I think a lack of knowledge really.
Like the other participants, she then began to talk about her lack of knowledge and capabilities to discuss political and civic issues with her husband:

Because of my lack of knowledge, I can't really engage…[my husband] in [political related] conversations. It's more I'm asking and he's providing information. I think sometimes it's probably frustrating for him because those conversations aren't happening and he's super intelligent…. This is the first time that…[I have] ever really…[thought about this topic] and…how disengaged I am from the whole process.
Further clarification was required to better understand the participants' answers and comments about their husbands. An important dimension in the lives of these women was the low priority they held for politics, current events, and civic-oriented activities. When these participants were asked what items ranked highest on their priority lists, responses about family were most prominent: "my family will always be the most important priority in my life," said one. After follow-up questions, one participant stated, "my children are first and then the remaining members of my family come somewhere after. My children are always most important to me." Events involving the participants' paid work and community involvement appeared at different places on their individual priority lists. The participants' most frequent community involvement was directly connected to their children's activities.
When questioned about how their husbands viewed their wife's role within the family, one participant responded concisely and captured the consensus: "[their wife] is responsible for nurturing and caring for the family." Although the participants did not view their husbands' role as one of nurturing, the participants did expect their husbands to split home and family responsibilities. Thus, the participants believed their husbands cared for their families deeply, but it was understood and demonstrated differently. Many believed their husbands viewed their role as being able to financially support their families because they earned higher annual salaries. This allowed these men to pay for the majority of the "family's expenses," to have money "to take family vacations together," and give their children "a jump on life" by providing opportunities to be successful, such as an excellent education. All spoke of their husbands' interests in being engaged with attending their children's events and being present for important school functions. Participants clearly stated they did not believe their husbands "understood all that was required" and the "time commitment" required to care for children.

Children and Grandchildren
Many of the women in this study shared a story or an explanation of their limited availability to engage in politics due to their work and family time commitments with their children or grandchildren. One recently retired participant had three grown children who each had families of their own. Her eldest daughter was struggling to care for her own teenage daughter and the participant agreed to help care for her granddaughter. She said it was "almost impossible to handle anything else because my daughter and granddaughter need me." Regarding political participation, she said she was "focused on being a grandma." Another participant frequently reflected on her life as a mother and now as a grandmother. She discussed the enormous amount of time it took to raise her children: Everyone says [having children is] the greatest thing [they] ever did. I'm not sure it's the greatest thing I ever did-it's the hardest thing I ever did. My heart breaks for women now who are trying to juggle work, school, babies, and diapers. Then I look back and say I did all of that: I worked full-time, went to graduate school, had a baby, and then had [a second] baby….
The participant reflected fondly on the relationship she had with her parents and gave credit to them and her husband for the support she received to accomplish her goals. During that time, she had to move political engagement to the bottom of her priority list and focus on her young daughter and critically ill son. Although she is actively engaged politically today, she still faces the struggle of being present in her family's life. The participant smiled, and became soft-spoken when she described her children's relationship with their grandparents: My parents lived three miles away and their house was utopia for my children and my children were very close to them. I didn't have grandparents and my husband really only had a grandmother and she was wonderful, we have great, fond memories of her. I'm trying to be a very patient [and] engaged on an almost daily basis.

Political Efficacy
As discussed previously in the literature review, political efficacy strongly determines political engagement. For this study, political efficacy seemed to be influenced by two subcategories: distrust of the political system and participants' self-image as knowledgeable and qualified to impact political systems. Statements expressing distrust of the political system, or that the system is unresponsive to their needs, are indicative of low external political efficacy, while high external political efficacy is indicated by confidence in and perceived responsiveness of the political system. Low internal efficacy is indicated by statements expressing participants' belief that they lack the knowledge and qualifications to impact political systems, while high internal efficacy is indicated by participants' selfperception that they are knowledgeable and qualified to engage politically. Each of these sub-categories seemed to be influenced by the participant's identity and socialization as women.

Distrust of Political System
The clinical social workers who participated in this study expressed cynicism and distrust of the political system. They shared feelings of not being heard, distrust of politicians, and that involvement in the political system was a waste of time and effort. One female participant noted: A middle-aged female participant from Maine who had been very politically engaged further emphasized how a lack of trust in elected officials led to a reduction in her political activity:

I feel very cynical about the effect…of my voice in a political forum. I feel like voting has so little effect. And I don't trust…what is being said is actually
Believing you can actually make change and…[then witnessing] how our governor just chopped, chopped, chopped up services for the mentally disabled and handicapped. He stood on stage and said, 'I know cutting these services are going to hurt the Mainers who need them the most,' and he still cut [the] services. That [experience] made me take a step back and say, 'I can't do this anymore.' Participants' self-image as knowledgeable and qualified. Many of the quotes from female participants demonstrate their belief that they lack adequate knowledge to participate in the political process and rationalizations as to why they were not qualified for politics. As one female participant in her late 20s described: There were only three female participants (out of 18) who believed they were knowledgeable enough and qualified to run for elected office. In each case, these participants had previously run or served as an elected official. One of these women, an administrator of a non-profit, described how she became frustrated with the decisions her local town board was making and with hearing from her family, friends, and clients about the consequence of the board's decisions.

Discussion
The study's findings suggest female clinical social workers' perspectives of political participation and their own potential for political involvement align with the extant literature on women's political participation (e.g., Barabas, Jerit, Pollock, & Rainey, 2014;Dolan, 2010;Fox, 2011;Hannagan, Littvay, & Popa 2014;Thomas, 2012). The participants described their own expectations and their families' expectations that they would focus on family caretaking to the exclusion of political involvement. They also described themselves as lacking knowledge about the political process and policy, and looking to others, generally husbands, to provide that knowledge. Female participants described the challenges of their work-life balance, balancing the work they do as graduate-educated professionals and traditional gender roles as wives, mothers, and grandmothers. These women explained that when they returned home from work, their primary concern was caring for their children; other time commitments were less of a priority.
Most of the female participants exhibited low levels of internal political efficacy, viewing themselves as politically unqualified and un-knowledgeable, and possessing low levels of political ambition and political confidence to engage in politics. The finding that many women reported asking their husbands to explain politics and policy decisions to them was unexpected in light of the women's professional status and the amount of policy content that is expected to be provided in social work education programs in order to meet the Council on Social Work Education (CSWE) competency regarding policy practice. More research is needed to determine whether the participants in this study are outliers in this regard, or whether this is a larger issue that needs to be addressed by social work education.
Further complicating the female participants' political participation were their low levels of external political efficacy-a distrust in political structures. Many of the participants felt that government was present in their lives, but only when something was required of them, such as when they had to take their social work license exam. The exception to this were the four participants with household incomes greater than $160,000 per year, who found government both responsive and able to meet their personal needs, describing, for example, their ability to receive high-quality health insurance through the Affordable Care Act. Women in this study who described low internal political efficacy (feeling that they could not make a difference in the political realm) and low external political efficacy (trust of political systems) showed low levels of political involvement, as previous research in this area has uncovered (e.g., McClendon, Lane, Ostrander & Smith, in press;Ostrander, 2017;Ostrander et al., 2017).

Implications
The implications for this study must be considered within the light of the small sample size and qualitative methods. They must also be considered within the patriarchal framework of modern democracies. The findings highlight two significant implications regarding this framework. First, they show that the population studied here is hindered from political involvement by many of the socio-cultural and functional constraints that limit women's political participation around the world, such as gender roles that conceptualize women's roles as primarily in the private sphere, while men's gender roles are in the public sphere (Bari, 2005). Second, they show that the women in this study have rich positionality and life experiences that, because of these constraints, are not represented in political participation. We believe this is a disadvantage to both the political process and the outcomes of policy, as their participation could inform a different set of policy norms and priorities than exist in the current system. Beyond these structural considerations, we suggest three overarching areas of implications: suggestions for social work education, suggestions for clinical social workers who wish to increase their political participation, and future research directions.
Social Work Education. The Educational Policy and Accreditation Standards (EPAS) of the CSWE outline social work's important role in political advocacy and political participation (CSWE, 2015). As currently written, these standards outline an expectation that through social work education, social work students should learn to advocate for effective policies that help lift people out of poverty and remove barriers and oppressive forces. In order to achieve this, CSWE asserts that students should engage in collaborative action within the profession and in tandem with clients to bring about effective policies if those who control the levers of power are not willing to bring about change (CSWE, 2015). Social workers facilitating the political engagement of their marginalized clients cannot only affect clients' lives immediately but potentially have positive ramifications for future generations of these vulnerable families.
In 2013, a report sponsored by Association for Community Organization and Social Administration was critical of social work education's lack of attention to the importance of macro practice (Rothman, 2013). The findings of this research, while small, are consistent with the findings in this report. Combined, these findings suggest that one option for improvement within social work education is for CSWE to modify EPAS Competency 5 (Engage in Policy Practice) and emphasize the ways in which policy affects the other eight competencies. For instance, female participants' consistent reference to their spouses' keeping up with news and current political events, points to the necessity of including political awareness activities in a model of political participation. If these women are typical of other social work students, social work education can serve them well by increasing political awareness. The Specialized Practice Curricular Guide to Macro Social Work Practice addresses these issues (personal communication, Suzanne Pritzker & Sunny Harris Rome, June 1, 2018), and should be used regularly by social work programs across the country. Based on our research, the Rothman Report, and other related research, we also recommend an increase in policy-related field placements. The research in this area suggests that policy and politically-related field placements are rare, particularly for generalist and micro students (Hill et al., 2017;Pritzker & Lane, 2014). The work of the social work programs who have received grants from the CSWE Policy Practice in Field Education Initiative highlight the opportunities for this work to occur with micro, macro, and generalist students, in a variety of programs and settings (CSWE, n.d.).

Clinical Social Workers and Policy.
Lawmakers' and corporations' continual push for greater efficiencies with a focus on increased profits comes at the risk of eroding the social work profession's mandate and the betterment of some of the most vulnerable populations. We believe those who participated in this study may be typical of other clinical social workers who can be part of the efforts to reverse these trends by engaging in the electoral process and encouraging their clients to participate in changing the policies that further marginalize and oppress them. The participant from Puerto Rico's perspective on the way that residents of the US territory "trust their people" highlights the importance of engaging with local politics, which are often more accessible and less time-consuming than national politics. Clinical social workers who work with marginalized groups can look for opportunities to engage agencies, clients, and communities with local leaders to build knowledge and trust in the political system, which can potentially increase external political efficacy of groups most impacted by social inequities. Like the participant who "was tired" of what she saw in the political arena, one strategy for cultivating such leadership lies in social workers' interventions with clients to help them recognize areas of strength, resilience, and expertise that they can contribute at the local/community level. This can contribute to the development of internal political efficacy of these community members.
Future Research. This study highlights several areas where further research should be conducted. As discussed in the limitations section, this group was a small sample from one area of the country. Future qualitative research can help us better understand how people who identify as queer, people of color, geographic differences, political ideologies, and other subsets of social workers interpret political participation. Although this study seems to identify new areas of research to explore among social workers, different subpopulations may be influenced differently by broader gender socialization, thus warranting further exploratory study. Future quantitative research among larger groups of clinical social workers would allow researchers to determine whether this study's results are reflective of other clinical social workers. The results of such a study would provide strong empirical evidence to help impact policies at NASW, CSWE, and social work educators and practitioners around the country. In addition, this study took place within a contentious and divisive national election process. There have been massive demonstrations in opposition to many of the administration's policy positions and decisions, such as The Women's March, and there has been an influx of female political candidates for local, state and federal office. Consequently, a potential area of future research could be identifying the extent to which clinical social workers' political awareness and involvement have been impacted as a result of these events and activities. Finally, further research guided by radical feminism, socialist feminism, or Black feminist theory may more accurately portray the lived experiences of female social workers who hold non-White, non-middle-class, and other marginalized identities.

Conclusion
Although professional organizations and leaders continue to highlight the ethical and professional responsibilities of all social workers to participate in the political process, clinical social workers, particularly women, face a variety of challenges in reaching these aspirational goals. The negative impressions of the political process and gender gap in political participation described here have roots in socialization and expectations. Social work education and policy advocacy can affect change that will increase the internal and external efficacy of social workers and create a policy environment that allows more options for all social workers in balancing the demands of professional and personal lives and in advocating on behalf of disempowered groups.