Modern Social Work Theory [5th ed. 2021] 1352011085, 9781352011081

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Modern Social Work Theory

Also by Malcolm Payne:

How to Use Social Work Theory in Practice: An Essential Guide Internationalizing Social Work Education: Insights from Leading Figures Across the Globe (with Gurid Aga Askeland) Older Citizens and End-of-Life Care: Social Work Practice Strategies for Adults in Later Life Citizenship Social Work with Older People Social Work in End-of-Life and Palliative Care (with Margaret Reith) Humanistic Social Work: Core Principles in Practice Social Care Practice in Context Globalization and International Social Work: Postmodern Change and Challenge (with Gurid Aga Askeland) The Origins of Social Work: Continuity and Change Teamwork in Multi-Professional Care Anti-bureaucratic Social Work What is Professional Social Work? Social Work and Community Care Writing for Publication in Social Services Journals Linkages: Networking in Social Care Social Care in the Community Working in Teams Power, Authority and Responsibility in Social Services

Modern Social Work Theory Fifth edition

Malcolm Payne

BLOOMSBURY ACADEMIC Bloomsbury Publishing Plc 50 Bedford Square, London, WC1B 3DP, UK 1385 Broadway, New York, NY 10018, USA 29 Earlsfort Terrace, Dublin 2, Ireland BLOOMSBURY, BLOOMSBURY ACADEMIC and the Diana logo are trademarks of Bloomsbury Publishing Plc This edition published in 2021 by RED GLOBE PRESS Previous editions published under the imprint PALGRAVE Reprinted by Bloomsbury Academic, 2022 Copyright © Malcolm Payne, under exclusive licence to Macmillan Education Limited 2021 Malcolm Payne has asserted his right under the Copyright, Designs and Patents Act, 1988, to be identified as Author of this work. For legal purposes the Acknowledgements on p. XXV constitute an extension of this copyright page. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage or retrieval system, without prior permission in writing from the publishers. Bloomsbury Publishing Plc does not have any control over, or responsibility for, any third-party websites referred to or in this book. All internet addresses given in this book were correct at the time of going to press. The author and publisher regret any inconvenience caused if addresses have changed or sites have ceased to exist, but can accept no responsibility for any such changes. A catalogue record for this book is available from the British Library. A catalogue record for this book is available from the Library of Congress. ISBN: PB: 978-1-3520-1108-1 ePDF: 978-1-3520-1109-8 ePub: 978-1-3503-1383-5 To find out more about our authors and books visit www.bloomsbury.com and sign up for our newsletters.

Brief contents

List of figures

xix

Preface to the fifth edition

xxi

Acknowledgementsxxv About the author

xxvi

A note on terminology

xxvii

Part 1: Thinking about social work theory 1    The social construction of social work theory    3 2    Evaluating social work theory   32 3    Linking practice and theory   67

Part 2: Reviewing social cohesion theories 4   Psychodynamic relational practice  97 5    Psychodynamic attachment practice  131 6    Crisis, trauma and task-­centred practice  151 7   Cognitive behavioural practice  175 8   Motivational interviewing 210 9   Systems practice, complexity and chaos  225 10   Macro practice, social development and social pedagogy    251

Part 3: Reviewing empowerment theories 11  Social construction: strengths and solutions    285 12  Social construction: narrative practice    314 13  Humanistic practice, existentialism and spirituality    336 14  Social justice practice, empowerment and advocacy    361

v

vi  Brief contents

Part 4: Reviewing social change and development theories 15   Critical practice   399 16   Eco practice   428 17   Feminist practice   449 18   Anti-oppressive, Indigenist and multicultural sensitivity practice    477 Bibliography  508 Author index

548

Subject index

555

Contents

List of figures

xix

Preface to the fifth edition

xxi

Acknowledgementsxxv About the author

xxvi

A note on terminology

xxvii

Part 1: Thinking about social work theory 1

The social construction of social work theory    3 3 Main contribution 3 Main points Knowledge, theory and practice    4 Case example: An assessment raises the question of what practice 7 theory to use Case example: Using induction and deduction when working 9 with dying people Pause and reflect: Summarizing the claims for theory 10 Social work practice theory    12 Pause and reflect: A case example 14 Case example: A client’s pathway to the service is part of a shared 18 construction of social work practice The social construction of social work    18 Case example: Accepting social distancing in the Covid-19 crisis 20 Case example: A drug user’s life 23 Case example: Domestic violence 24 Case example: Mental illness 25 Arenas of social work construction    28 Case example: The impact of HIV/AIDS 29 Conclusion: using ideas about social work theory    29 Additional resources   30

2

Evaluating social work theory   32 32 Main contribution 32 Main points Major statements   33 The main groups of practice theory    33 vii

viii  Contents

Pause and reflect: Choosing theories as useful in your studies 36 and practice Using theory selectively and eclectically    41 Pause and reflect: How to use selection and eclectic practice 42 Case study: Selecting from theories to develop an eclectic 44 agency practice Theory in group, macro, residential care and family therapy practice    48 Direct use of social and psychological theory    51 Evidence-based practice (EBP)   52 Case example: Shouting at the children 53 Conclusion: how social workers can evaluate social work theory    64 Additional resources   65 3

Linking practice and theory   67 67 Main contribution 67 Main points 67 Practice ideas Major statements   68 Making theory useful   68 Pause and reflect: How might generalizations help us? 68 Pause and reflect: How are practising and thinking different? 69 Practical approaches to using theory    71 Case example: Maintaining coherence while using different theoretical 77 models at different stages Case example: Carrie’s fear of crying focuses her use of self 79 Pause and reflect: Repressing or expressing your emotions in practice 79 Reflection, reflexivity and critical thinking    80 Example: Knowledge and prevention in child welfare services 84 Case example: Chinese and Western views of mental illness 86 Case example: Hayley’s crisis questions led Soumen to defend 88 his family’s ‘moral adequacy’ Example: Reflexivity seen as rotating practitioners’ models 88 of the situation they are working with Case example: Henry’s death and his marriage 90 Case example: Josie discusses theory openly with her clients 91 Conclusion: using practice–theory links    93 Additional resources   94

Contents ix

Part 2: Reviewing social cohesion theories 4

Psychodynamic relational practice   97 Main contribution 97 Main points 97 Practice ideas 98 The debate summary 98 Debate about psychodynamic practice    99 Case example: Julia’s social work career 101 Major statements  103 Wider theoretical perspectives   103 Pause and reflect: Psychoanalytic ideas with cultural influence on social work 104 Case example: A young carer – 1. David’s unconscious feelings about his mother 107 Case example: Dealing with David’s anger – 2. The social work response 110 Connections  111 The politics of psychodynamic theory   112 Values issues  113 Applications  114 Pause and reflect: Looking at underlying factors in behaviour 114 Example text: Brandell (2004) on psychodynamic social work   116 Case example: Should Diana get her children back? 118 Case example: Gillian’s use of emotion in managing the relationship with her family 119 Case example: A single parent makes a new start 120 Important ideas in relational practice   121 Case example: Devina visits a suicidal young mother 122 Example text: Goldstein, Miehls and Ringel (2009) on relational principles and techniques   123 Case example: Encouraging Mosima to try out new relational experiences 127 Case example: Understanding and replacing unhelpful self-objectives127 Case example: Jemima assesses Joe and Peter as adoptive parents 128 Conclusion: using psychodynamic practice theory   129 Additional resources  129

x  Contents

5

Psychodynamic attachment practice  131 131 Main contribution 131 Main points 132 Practice ideas 132 The debate summary Debate about attachment   133 Major statements  137 Wider theoretical perspectives   139 Connections  139 The politics of attachment theory   140 Values issues  141 Applications  141 Case example: Attachment work with traveller families 143 Case example: Josie helps to make positive progress through Erica’s anger 143 Example text: Shemmings and Shemmings (2011) on attachment theory with children  144 Case example: Two single mothers’ approaches to their daughters 147 Case example: Mentalizing about removing a child from the mother’s care 147 Conclusion: using attachment theory   148 Additional resources  149

6

Crisis, trauma and task-­centred practice  151 151 Main contribution 151 Main points 152 Practice ideas 152 The debate summary Debate about crisis, trauma and task-centred practice   152 Major statements  155 Wider theoretical perspectives   156 Connections  158 The politics of crisis intervention and task-centred practice   159 Case example: Peter’s father’s divorce   159 Values issues  160 Applications  160 Example text: Thompson (2011) on crisis intervention   160 Case example: Ecological systems practice with Karina’s response 161 to her parents’ divorce Case example: Haroun Singh experiences his wife’s death 163 Pause and reflect: Jeanne debates whether to report a rape 164 Case example: Jeanne’s dilemma 164 Example text: Marsh and Doel (2005) on task-centred practice   167 Case example: Multiple definitions of problems – Joan’s job 169 Case example: Exploring Ethan’s drug problems 170

Contents xi

Conclusion: using crisis and task-centred theory   172 Additional resources  173 7

Cognitive behavioural practice  175 Main contribution 175 Main points 175 Practice ideas 176 The debate summary 176 Debate about CBT   176 Pause and reflect: Fabia’s life objectives 178 Case example: CBT to help Fabia 178 Major statements  180 Wider theoretical perspectives   180 Connections  183 The politics of CBT   184 Values issues  185 Applications  186 Case example: Getting muddy at the park 186 Case example: Feliks and the park again 186 Case example: Extinction process 187 Case example: Counterconditioning in enuresis 187 Case example: Davey’s homework: extinction in respondent conditioning188 Case example: The threat of unemployment 190 Example: The neuroscientific basis of drug abuse 192 Case example: Mrs Folwell’s arthritis 194 Example text: Kennerley et al. (2017) on cognitive behaviour therapy   195 Case example: Fred’s anxiety 196 Case example: Ferne is anxious about schoolwork 198 Case example: Socratic questions about Ferne’s teachers 198 Case example: Using distraction 200 Case example: Jane is ignored by her family 200 Case example: Faisal’s social activities 201 Pause and reflect: Freda’s school-related anxiety 201 Case example: Freda’s story 202 Conclusion: using CBT   208 Additional resources  209

8

Motivational interviewing  210 Main contribution 210 Main points 210 Practice ideas 211 The debate summary 211 Debate about motivational interviewing   211

xii  Contents

Major statements  213 Wider theoretical perspectives   213 Pause and reflect: TTM and intervening in change 214 Connections  216 The politics of MI   216 Values issues  217 Pause and reflect: Your belief in clients’ strengths and your capacity 218 to evoke them Applications  218 Example text: Hohman (2016) on motivational interviewing in social work practice  219 Case example: Rolling with the resistance of a smoker with COPD 220 Case example: Joanna expresses ‘sustain talk’ but increases ‘change talk’ 222 Conclusion  223 Additional resources  223 9

Systems practice, complexity and chaos  225 225 Main contribution 225 Main points 226 Practice ideas 226 The debate summary Debate about systems, chaos and complexity   226 Case example: Pete, a hyperactive child in the Marsalis family 228 Pause and reflect: Selecting levels and focuses 230 Case example: Kaspar’s interactions with young people in local clubs 231 Wider theoretical perspectives   232 Connections  234 The politics of systems theory   235 Values issues  235 Applications  236 Case example: Seeing practice in systems terms 237 Case example: Involvement with different aspects of a family’s needs 238 Case example: Context defines responsibilities with a disabled person 239 Example text: Gitterman and Germain’s (2008) life model of social work   242 Case example: Tyler’s drug abuse and Mrs Garrod’s housing 246 Conclusion: using systems theory   248 Additional resources  249

10 Macro practice, social development and social pedagogy    251 251 Main contribution 251 Main points 252 Practice ideas 252 The debate summary

Contents xiii

Debate on macro, social development and social pedagogy     252 Major statements    255 Wider theoretical perspectives    256 Case example: The social pedagogy pilot programme in UK children’s residential care 264 Case example: Kevin, a hyperactive child 266 Connections   267 The politics of social and community development    268 Values issues   269 Case example: A volunteering scheme for a housing project 270 Applications   271 Pause and reflect: Communities and shared interests 271 Example text: Desai (2015) on social development in Asia    273 Case example: Complex issues of social and economic well-being in Rwanda 275 Example text: Popple’s (2015) Analyzing community work   275 Conclusion: using macro, social development and social pedagogy ideas    279 Additional resources   280

Part 3: Reviewing empowerment theories 11 Social construction: strengths and solutions    285 Main contribution 285 Main points 285 Practice ideas 286 The debate summary 286 Debating social construction, strengths and solutions practice     286 Case example: Solution-focused questioned in child safeguarding 287 Case example: Putting the forms aside to get the story and find the strengths 289 Major statements    290 Wider theoretical perspectives    291 Case example: Strengths practice in UK adult social work 292 Pause and reflect: Criticizing social psychology’s contribution to social work 293 Case example: Grace caring for her mother 293 Pause and reflect: Underlying claims of constructions about social problems 296 Case example: Claims about divorce 296 Case example: Being old and vulnerable in the 2020 coronavirus pandemic 297 Case example: Talking to children about death 300

xiv  Contents

Connections   301 The politics of solution and strengths practice    302 Values issues   303 Case example: A disabled man’s allowance is withdrawn 304 Applications   305 Example text: Shennan’s (2014) solution-focused practice    305 Case example: Jacob after the divorce 308 Case example: Ted’s mental health aims 308 Conclusion: using strengths and solution ideas    311 Additional resources   312 12 Social construction: narrative practice    314 314 Main contribution 314 Main points 315 Practice ideas 315 The debate summary Debate on narrative practice    315 Case example: A case of Munchausen’s syndrome by proxy 316 Major statements    318 Wider theoretical perspectives    318 Case example: Diachronic narratives about a woman with dementia 321 Connections    321 The politics of narrative practice     322 Values issues   323 Case example: The daughter of a mother who died of cervical 323 cancer creates a diachronic narrative Case example: Tony recovers and values his work history after 324 a period of mental illness Applications   325 Case example: The questioning process 329 Pause and reflect: Josie and Maisie 330 Case example: Lacey externalizes, re-authors and re-members 332 her disability experiences Case example: Hidden but implied partner abuse emerging 333 in an assessment Conclusion: using narrative practice    334 Additional resources   335 13 Humanistic practice, existentialism and spirituality    336 336 Main contribution 336 Main points 336 Practice ideas 337 The debate summary

Contents xv

Debate about humanistic practice, existentialism and spirituality     337 Major statements    340 Wider theoretical perspectives    341 Connections    342 The politics of humanistic and related ideas    347 Values issues   350 Applications   350 Case example: Jabari’s unemployment 353 Example text: Glassman’s (2009) humanistic groupwork    354 Example text: Holloway and Moss (2010) on spirituality and social work    357 Conclusion: using humanistic social work    358 Additional resources   359 14 Social justice practice, empowerment and advocacy    361 Main contribution 361 Main points 361 Practice ideas 362 The debate summary 362 Debate about social justice, advocacy and empowerment     363 Major statements    366 Wider theoretical perspectives    366 Pause and reflect: The complexity of different kinds of justice 370 Case example: Deciding on a foster care placement 370 Connections   374 Pause and reflect: Barriers in Celia’s care decisions 378 Case example: Should Celia’s social worker advocate on her behalf? 378 The politics of empowerment and advocacy    379 Values issues   381 Pause and reflect: Conflicts of values in advocacy practice 382 Case example: Appeals against a healthcare funding decision 382 Applications   383 Example text: Dalrymple and Boylan (2013)    385 Pause and reflect: Think about an ‘understanding the issue’ statement 387 Case example: Moving into a mental health hostel 390 Example text: Lee’s (2001) empowerment approach    390 Case example: Choosing a new team leader 393 Conclusion: using advocacy and empowerment theory in social justice practice   393 Additional resources   394

xvi  Contents

Part 4: Reviewing social change and development theories 15 Critical practice   399 Main contribution 399 Main points 399 Practice ideas 400 The debate summary 400 Debate about critical practice    400 Case example: The housing project for mentally ill people 406 Major statements    406 Wider theoretical perspectives    407 Connections   410 The politics of critical theory    412 Values issues   413 Applications   414 Case example: How praxis works 414 Example text: Mullaly’s (2019) new structural social work    415 Case example: The disability and youth groups in a community centre 417 Pause and reflect: Structural challenge in your agency 420 Example text: Fook’s (2016) critical approach to practice    422 Conclusion: using critical social work    425 Additional resources   426 16 Eco practice   428 Main contribution 428 Main points 428 Practice ideas 429 The debate summary 429 Debate about eco practice    429 Case example: Youth unemployment in ecosystems and eco-critical practice 430 Case example: Pollution concerns for urban families 434 Case example: Joe’s work in the community farm 434 Case example: Housing repairs issues and the local environment 435 Major statements    436 Wider theoretical perspectives    436 Connections   437 The politics of eco practice    438 Values issues   438 Application   439 Case example: Traditional fostering for children ‘dropping out’ of families in social conflict 442

Contents xvii

Example text: Dominelli’s (2012) green social work    443 Pause and reflect: The impacts of the elements on each other 444 Pause and reflect: Shifting your approach towards green aims 444 Conclusion: using eco practice theory    448 Additional resources   448 17 Feminist practice   449 Main contribution 449 Main points 449 Practice ideas 450 The debate summary 450 Debate about feminist practice    450 Major statements    453 Wider theoretical perspectives    453 Connections    456 Case example: Money and power in a family relationship 457 Case example: The man who ‘tapped’ his wife 459 The politics of feminist social work    461 Case example: Rural older women in Uganda 462 Values issues   463 Case example: Dealing with all the issues in an assessment 464 Pause and reflect: Mr Jones’s attitudes 465 Case example: Hilda, Mr Jones, gratitude and caring labour 465 Applications   466 Case example: Feminist woman-centred practice with an older man and woman 470 Pause and reflect: Is Alice and Karina’s work a ‘feminist conspiracy’? 471 Conclusion: using feminist theory in practice    475 Additional resources   475 18 Anti-oppressive, Indigenist and multicultural sensitivity practice    477 Main contribution 477 Main points 477 Practice ideas 478 The debate summary 478 Debate on anti-oppressive, Indigenist and multicultural sensitivity practice     479 Case example: Confusion about the nature of Nia’s disability 481 Pause and reflect: Thinking about issues of culture and oppression 482 Case example: Gang fights in the social housing scheme 482 Case example: Celebrating cultural diversity in residential care 483 Major statements    485

xviii  Contents

Wider theoretical perspectives    485 Case example: Views of Muslim youth on integration and adaptation 491 Pause and reflect: Your life experience 493 Connections   493 The politics of anti-oppression and sensitivity    495 Values issues   497 Applications   497 Example text: Morgaine and Capous-Desyllas (2015) on anti-oppressive practice   499 Example text: Sisneros et al. (2008) on critical multicultural social work    502 Case example: Selma’s life develops from profound Deafness 504 Pause and reflect: Using the web of intersecting identities 505 Conclusion: using anti-oppressive and multicultural sensitivity approaches    505 Additional resources   506 Bibliography  508 Author index

548

Subject index

555

List of figures 1.1  Types of theory  8 1.2  Why use theory?  11 1.3  Approaches to practice. (a) Perspective. (b) Framework. (c) Model. (d) Explanatory theory  13 1.4  The role of social work theory  17 1.5  The social construction of social work  19 1.6  Three views of social work and their underlying political philosophies  22 1.7  The five shared principles of social work practice theories  27 1.8  Arenas of the social construction of social work  29 2.1  Groups of practice theories and their contribution to practice  35 2.2  Wide-ranging theory reviews  37 2.3  Selective theory reviews  40 2.4  EBP: six steps  56 2.5  CAIMeR conceptualization of social work  62 2.6  Positivist (EBP) and realist research compared  63 3.1a  Top-down (deductive) and bottom-up (inductive) theory development  72 3.1b  Theory development as a process of enquiry and debate  72 3.1c  Theory development as a process of accumulation  72 3.1d  Practice constraints as a degradation or limitation of theoretical development  73 3.2  Sheppard et al.’s process knowledge  78 3.3  The reflection process  82 3.4  Redmond’s model rotations  88 4.1  Historic and current types of psychodynamic theory  105 4.2  Psychodynamic social work ideas about the structure of the mind  106 4.3  Maroda’s psychodynamic techniques  115 4.4  Brandell’s four elements of psychodynamic social work  117

4.5  Development of ideas about relationship in social work thinking  124 5.1  Model of attachment theory  142 5.2  The strange situation procedure  145 6.1  The concept of crisis  162 6.2  Crisis intervention strategies and interventions 165 6.3  Crisis intervention assessment principles and skills  166 6.4  Kanel’s ABC skills model of crisis intervention 166 6.5  Roberts’s seven-stage crisis intervention model  167 6.6  Sequence of actions in task-centred practice 168 6.7  Exploring problems  170 6.8  Task planning and implementation sequence 172 7.1  Sources of current CBT  181 7.2  Cognitive behavioural models of practice 183 7.3  Farmer’s important areas of neuroscience knowledge  194 7.4  CBT assessment and formulation  197 7.5  Patterns of CBT ((a) The overall pattern of CBT sessions and (b) The agenda for a typical CBT session)  199 7.6  Issues in Freda’s family  202 7.7  Assessing the Four Ps  204 7.8  CBT intervention programme  207 8.1  Prochaska and DiClemente’s transtheoretical model of the stages of change  214 8.2  MI principles and skills  219 9.1  Some systems in the Marsalis family  229 9.2  Some more systems connecting with the Marsalis family  229 9.3  Systems concepts  232 9.4  The main social work systems  237 9.5  Ecological concepts in the life model  243 xix

xx  List of figures 9.6  The life model of social work practice  244 9.7  Main areas of life model practice intervention 247 10.1  The capabilities of the social entrepreneur   262 10.2  The diamond model of social pedagogy   264 10.3  Theories contributing to community work  276 10.4  Models of community work  278 10.5  Community work theoretical process  279 11.1  Personal and social constructs compared   295 11.2  Myers’s differences between solution-focused and traditional social work 303 11.3  Shennan’s solution-focused process  306 11.4  Useful solution-focused questions  307 11.5  Levels of tasks in solution-oriented practice 310 12.1  Stages of narrative intervention  325 12.2  Conversation map of a narrative  327 12.3  Baldwin’s seven features of narrative  328 12.4.  Béres’s (2014) account of conversational maps  331 13.1  Ideas contributing to humanistic social work  342 13.2  Developing the democratic mutual aid system 355 13.3  Helping groups establish and work on group goals  356 13.4  Religion, spirituality and social work  357

14.3  Dimensions of advocacy practice  384 14.4  Models of the advocacy process  386 14.5  Lee’s empowerment vision  392 14.6  Lee’s principles and practice of empowerment 392 15.1  Sources of critical practice theory  407 15.2  Neoliberal principles  408 15.3  Reconstructing socialism  416 15.4  Examples of privilege  418 15.5  Structural social work practice  421 15.6  Fook’s critical practice  424 16.1  Eco concerns in social work  431 16.2  Steps in local environmental transition 433 16.3  Basic ecological concepts and social work practice implications  437 16.4  Boetto’s eco practice strategies  441 16.5  The elements of green social work  443 16.6  Green social work practice approaches  445 16.7  Issues and objectives for green social work  447 17.1  Waves of development in feminist thinking  454 17.2  Feminist theoretical orientations  455 17.3  Traditional and developing feminist practice strategies  467

18.1  The development of theories and practices from racial conflicts  479 18.2  Anti-racist perspectives  487 18.3  Three concentric formulations of anti-oppressive practice  494 18.4  The social justice foundations of anti-oppressive practice  500 18.5  Anti-oppressive practice with 14.1  Social work approaches to individuals 501 social justice  372 14.2  Dominelli’s typology of empowerment  374 18.6  Web of intersecting identities  504

Preface to the fifth edition

 he aims of this book and its social construction T perspective My aim in Modern Social Work Theory, since its first publication in 1990, has been to present and review theories that at the time inform the practice of social work. Our professional imagination and our clients’ needs set an agenda for us in every piece of practice that we undertake. I want to show how theories can guide and enthuse us, enhancing that practice so that it achieves the outcomes that policy and law in our country set for us. This edition is restructured. After the initial section, which contains a general review of debate about social work theory, I have responded to comments by dividing the chapters reviewing practice theories into the three parts that are set out in the global definition of social work published by the international organizations representing social workers’ professional bodies and schools of social work (International Federation of Social Workers ([IFSW], 2014). The number of chapters has also increased to 18, from 14 in the 3rd and 4th editions. All the subjects of the new chapters were mentioned in the previous edition, and while I continue to recognize links between them, several practice theories needed more substantial treatment. The section on social justice is also substantially expanded, which I regard as a better representation of a renewal of social work’s values. In this fifth edition, I continue to try to make the text an easy read, while not compromising the complexity of the ideas contained in social work theory. I have continued to highlight case examples, diagrams and tables to help readers who find a visual presentation of ideas helpful. I am grateful to Emma Reith-Hall for providing two extended case studies in Chapters 2 and 6. These contributions help us understand the complex interaction between theory and practice in our agencies. I have also spread throughout the text opportunities for you to ‘pause and reflect’, applying your own thinking to crucial aspects of the argument. One illustration of the pace of theory development in social work is that, although this edition is being published only seven years after the previous edition, more than half of my accounts of example texts, which show how social work writers have used theories to present comprehensive accounts of practice, are new. I have continued to include the bare bones of how each group of theories developed, with historical citations that I hope will continue to provide a bibliographical resource, but mostly I refer to current sources, with more than half the citations referred to being published in the twenty-first century. About a third of the citations are new, and about a quarter were published after the previous edition. I have retained my social construction perspective because it makes clear that many different interests form our theory and practice. As accountable professionals, our theory and practice are produced in alliance with the experiences of our clients and their families and communities. They are also influenced by political and social ideas, our professional learning, skill and experience, and the partnership of our colleagues in other professions and services. xxi

xxii  Preface to the fifth edition

More than 30 years ago, when I was first writing Modern Social Work Theory in the late 1980s, we were coming to the end of what some (for example, Orme & Shemmings, 2010) have called the theory or paradigm ‘wars’. Theories were opposed to one another; people argued that some were better than others and would supplant them, but it has not turned out to be so. Instead, reviewing theory as it is currently used, I increasingly find that there are shared ideas present in most practice theories. In Figure 1.7, I extract these principles, which I call the shared principles of social work practice. They are present in the way in which most theory is used in practice, and you will find them recurring as you read social work theory and practice texts. I have sometimes highlighted them as I discuss a theory later in the book, but if you bear them in mind you will find them leaping out at you elsewhere in the text. This book is, therefore, an argument that, rather than being at war, social work theories are increasingly contributors to the rich range of enterprises that social work engages with. Therefore, each chapter begins by saying ‘this is the special contribution to your practice that this group of theories makes’. You could criticize my presentation of these shared principles as signs of agreement about practice theory: perhaps they assume too much of a consensus about social work. But no, I think there is still plenty of disagreement in social work even if we can see common ways of practising. Another emerging development is what, in Chapter 2, I call direct use of writers’ ideas from the social sciences and exploration of social science concepts, rather than interpreting these ideas and concepts through the creation of a practice theory. There may be a problem with this, because it often means that the focus is on theoretical ideas and writers, rather than on using them in a holistic practice. I also point to several writers who draw together ideas from different practice theories. Social work theory, therefore, is moving away both from theory wars and from dividing up practice theories because of their distinct theoretical sources. Nevertheless, I identify the distinct features of practice theories to help you disentangle the main sources of your practice models from a mix of ideas. This allows you, working with your team and agency, to construct a practice that is a coherent form of practice. If you are clear about the sources and the development of the practice ideas that you use, you can be more accountable for your practice. Your accountability is to your clients and the people around them, to the public and in the media as well as to the managers and policy-makers who implement the political and social mandate for the social work profession.

The structure of the book and its chapters The book is divided into four parts. Part 1 (Chapters 1–3) is different from the others. It summarizes general debates about social work theory and how to apply it. Parts 2, 3 and 4 (Chapters 4–18) review the main groups of social work theories, derived from my analysis of leading texts in Chapter 2. They are divided into three main categories of theory, organized according to the three main objectives of social work listed in the global definition of social work proposed by the international social work organizations.

Preface to the fifth edition xxiii

The structure of each chapter in Part 2 starts with summaries of the main elements of the chapter: ●●

●● ●●

●●

the theory’s distinctive features that make up its main contribution to social work practice; the main points that help us to understand that contribution; important practice ideas and concepts that this group of theories has contributed to social work; these cover only ideas used in practice, and this section is not a glossary of theoretical terms; a debate summary of the main points of contention about this theory.

Each summary leads on to a more detailed account of the theory, considering: ●● ●● ●● ●● ●● ●●

debate about the theory; major statements of this theory in current social work texts; wider theoretical perspectives that put the theory in context – where did it come from?; connections between this theory and other social work theories; the politics of the theory, showing how it is contested in social work debate; values issues: a brief comment on values issues raised by the theory.

Building on this account of the theory, I then provide an account of how it is put into action within social work, covering: ●● ●●

●●

applications: an overview of how the theory is applied in social work; example text(s) selected from book-length accounts of how this group of theories has been applied in a social work text. I account for the judgements that informed the selections in the ‘major statement’ section earlier in the chapter. Since the aim of the example texts is to show how the theory under review has been applied at length, I do not use edited collections as example texts, but I often include insights from edited books and articles as counterpoints to the main example text(s); conclusion: using the theory sums up the main points about how this group of theories is used in social work practice.

Each chapter ends with: ●●

additional resources, which include further reading and specialized journals, and suggestions of websites that provide good access to internet resources.

My accounts of each theory are only a starting point for a further exploration. That is why I suggest additional resources in each chapter. If you are committed to a particular theory or point of view, you might dispute my condensation of and selection from the materials I cover in this book. My aim is to give access to a range of ideas and encourage readers to progress from this introduction to the comprehensive accounts you can find in the books and articles to which I have referred. I find the social work literature full of stimulating ideas for practice and understanding. I am sure you will too.

xxiv  Preface to the fifth edition

I hope that new generations of practitioners and students will continue to find this review of social work practice theories useful in constructing their practice. Malcolm Payne Sutton, UK

Acknowledgements

The author acknowledges that a section of Chapter 13 on recovery ideas in mental health care is adapted from a previously published paper: Payne, M. (2017). Peer support in mental health: a narrative review of its relevance to social work. Egyptian Journal of Social Work. 1(4): 1–14. The publishers would like to express their gratitude to Oxford University Press for their permission to use Figures 10.1 and 14.6 and to Policy Press for Figure 1.6.

xxv

About the author

Malcolm Payne is Emeritus Professor, Manchester Metropolitan University; Honorary Professor in the Faculty of Health, Social Care and Education at Kingston University/St George’s University of London and Docent in social work at the University of Helsinki, Finland. From 2003 to 2012, he was Director of Psychosocial and Spiritual Care and Policy and Development Adviser, St Christopher’s Hospice, London. He is the widely translated best-selling author and editor of many books and articles, including What is professional social work? and The origins of social work: Continuity and change, which are companions to his account of social construction approaches to understanding social work in this book. Other books on social work theory include: How to use social work theory in practice: An essential guide and Humanistic social work: Core principles in practice. His recent books on practice include: Citizenship social work with older people, Older citizens and end-of-life care: Social work practice strategies for adults in later life and (with Margaret Reith) Social work in end-oflife and palliative care. He and Emma Reith-Hall recently edited the extensive Routledge handbook of social work theory (2019). He is an active contributor to social media, including Facebook (Malcolmpayne47) and Twitter (@malcolmpayne).

xxvi

A note on terminology

‘Clients’ and other words for the people we work with There are problems with putting people into categories. Many social workers dislike giving the people they work with category names such as ‘client’, ‘patient’, ‘resident’ and ‘user’. It sometimes leads to them being referred to as ‘the clients’ or ‘the users’ in a disrespectful way, and all these terms are unacceptable to some of the people to whom they are applied. Different countries have varying preferences. Since this book has an international circulation, I have often used the term ‘client’ as being the most inclusive and generally understandable term for its wide range of readers. I use other terms where the circumstances are appropriate, for example ‘patients’ when referring to healthcare situations, ‘residents’ when referring to residential care and ‘users’ when referring to people who are receiving packages of services or to people with intellectual disabilities who receive services, among whom this term has the widest currency.

Social development issues In literature about international issues, people argue over how to refer to the economic and social development of particular countries. Should we say that a country is developed, underdeveloped or developing, which hides an assumption that development is a desirable end result? The term ‘Third World’, referring to political allegiance, derives from the Cold War period (1960s–1990) and has appropriately fallen out of use. Should we say that a country is a Western country, meaning a country with an industrialized developed economy, whose culture originates from European and North American models? Some writers refer to the North (the northern hemisphere) and the South, implying that most countries in the North are economically developed and most in the South are not. Some countries in the Southern hemisphere, such as Australia, are ‘Northern’ and ‘Western’ in their social and economic development and culture. Some countries, however, do not fit into any such category. Examples might be countries such as China, which are experiencing rapid economic and social change and development alongside substantial poverty and inequality, or Eastern European ‘transition’ economies, which are moving from being part of the Soviet sphere of influence to participation in European economic markets. Bearing all this in mind, I have chosen in this book to refer to economically developed countries with a largely European or North American culture as Western countries. I refer to poorer nations with less industrially developed economies as ‘resource-poor’, a term that is current in the healthcare professions.

xxvii

PART 1

THINKING ABOUT SOCIAL WORK THEORY The three chapters in this part discuss general issues about social work theory. What is it? Can it be used in practice? How is it created? What kinds of social work theory exist? How can you evaluate it? Can practice and theory be linked? 1

The social construction of social work theory

3

2

Evaluating social work theory

32

3

Linking practice and theory

66

1

CHAPTER 1

The social construction of social work theory MAIN CONTRIBUTION This chapter aims to help social work practitioners feel confident in using theory in their practice. It discusses different kinds of social work theory and the arguments around them. Then it explains how all of this may be useful in practice. It shows how social work theory, and practice theory within it, is socially constructed. This means that both practice and theory are not given to us from on high, but that we build them through our experience in the real world. Social construction ideas also show that practice and theory are not separate, settled bodies of knowledge, but constantly evolve and influence each other. Change in social work, and in the lives of practitioners and clients, is possible if we engage in this process of evolution of ideas and practice.

MAIN POINTS ●● ●●

●● ●●

●●

●●

●●

●●

The main aim of the book is to review social work practice theories. Theories are generalized sets of ideas that describe and explain our knowledge of the world in an organized way. Theory is different from both knowledge and practice. Social work theory comprises formal and informal theories of what social work is, how to do social work and the social world in which our clients live. Theory helps us understand and contest ideas about social work and the world around us. It offers a framework for practice and helps us to be accountable, self-disciplined professionals. All social activities generate practice theory, which in social work may be perspectives, frameworks, models and explanatory theories. They often complement each other. Social construction ideas emphasize that change for social institutions and individuals is always possible, although it may be slow. Social experience often reinforces stability rather than change. The social construction of social work theory forms a politics. This means that groups within the profession contend to gain influence over practice by getting support for particular theories.

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Thinking about social work theory ●●

●●

●●

●●

Three views of social work objectives (social cohesion, empowerment and social change and development) are derived from the aims of social work and from political philosophies. They form the context in which practice theories are socially constructed. Five shared principles affect our use of all practice theories: alliance, aim, action sequence, critical practice and rights. Social work is socially constructed in three main arenas of debate and practice. These are the relationships between clients, workers and social agencies. Clients make an important contribution to the construction of social work through their reflexive interaction with practitioners in social work agencies. I explain reflexivity in Chapter 3.

Knowledge, theory and practice All over the world, at this moment, people are struggling into an office to see a social worker. Or perhaps they are meeting a social worker in their home or working with a social worker in a building such as a residential care home or a day centre. Or again, the social worker may be meeting them as part of a group and community activity, or in seeking policy change. How can people using the social worker’s services understand what is happening? How can the social worker decide what to do and explain it to them? You may have found that many statements about social work are generalized or idealistic and give you no clue about what is supposed to happen when social work takes place. Yet social workers must learn what to do and how to carry out what their agency and their profession expects of them. The main aim of this book is to review the practice theories that social workers use to inform their practice. This chapter aims to help you understand what theory is in general, what theories influence social work and, within that, what social work practice theories are. It also helps you to think through some of the debates about using theory in practice. In this first section, I look at ideas about the various kinds of knowledge and theory available in social work. This helps us to understand that knowledge and theory are connected, but different.

What kinds of knowledge are useful in practice? We start by looking at the kinds of knowledge that may inform what people do. Jacobs (2009) summarizes various philosophical accounts of knowledge in practice as follows: ●●

●●

●●

●●

‘Knowing how’ to do something is different from ‘knowing that’ something is true or ‘knowing about’ some aspect of the world. Technique is knowledge that is formulated in an organized way and is usually written down. Technique helps us to do something, but it is different from practical knowledge; that is, the unformulated knowledge of how to do something. Tacit knowledge is also unformulated and is different from express knowledge; that is, formulated knowledge of facts, procedures and values. Knowledge about the world used in academic study of the natural or social world is worked out by rational deductions from confirmed observations. This is different from

The social construction of social work theory

knowledge in practical fields such as social work. In practical fields where knowledge is used to do something, practitioners use theories to help them understand how knowledge can support their decision-making. Their aim is not just to know more, but also to use what they know. In practical fields of work, therefore, theory is about supporting reasonable judgements with thought-through arguments based on knowledge. The implication of these distinctions is that you can know a lot about facts, procedures and values, and possess techniques for doing things, but knowledge about how to act may not be so easily formulated. You can sometimes see this in professional guidance or agency procedures, which often leave it to you to decide how to apply their instructions in relationships with your clients. Social workers use skills and theory learned in their education and by personal experience to do this. Polanyi (cited by Jacobs, 2009) suggests that there are important facets of the professional use of knowledge in practice. The first is about priorities. A professional learns which issues to focus on in each situation, and which are subsidiary and don’t need to be dealt with in detail. Second, professionals use personal knowledge that comes from their interpretation, intuition and similar skills; for example, how well someone cares for the fabric of their house. In addition, they use impersonal knowledge, such as the number of rooms in a house, which we can learn in a mechanical way. Toulmin (cited by Jacobs, 2009) adds that knowledge in practical fields often involves clinical skills, which mean making timely decisions based on skills acquired through practice and honed and refined by repeated experience. This leads to a kind of practical wisdom. We develop this by a constant use of everyday practices, using local knowledge that allows for constant minor readjustments of formal rules by feel. The sociologist Garfinkel (1967; Roberts, 2006: 90) took this idea further, and showed that we all develop ‘practical theories’ about the world by building up with people around us a shared wisdom and a sense of what is reasonable and intelligible. These points lead us to consider what theory is, what that special kind of theory that we call ‘practice theory’ is and how it may help professionals to use knowledge in their work.

What is theory? One way to answer this question is to start from general ideas about theory. Sheldon and Macdonald (2009: 34) look at a dictionary definition of it, and suggest that there are both scientific and everyday uses of the word. To a scientist, a theory is a general principle or body of knowledge, reached through accepted scientific processes, that explains a phenomenon. The everyday use of the word ‘theory’ refers to abstract thoughts or speculations. In everyday talk, therefore, people may think that theory is disconnected from practical realities. Many social work writers (for example, Howe, 2009; Sheldon & Macdonald, 2009; Thompson, 2017) focus on explanation and structure: a theory should explain some aspect of the world in an organized form. Others accept less exacting understandings of theory. For example, Fook (2016: 50) argues that there are many different meanings of theory, and that the important thing is to be inclusive so that we do not cut ourselves off from useful ideas. When a mass of knowledge about a situation has been built up, one of the uses of theory is to help you rise above what you can immediately observe to find patterns that are not obvious in the tangle of everyday life. Howe (2009: 1) offers an analogy. He describes how the first people to fly in balloons saw the landscape in a new way. He is suggesting that patterns and

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Thinking about social work theory

order already exist, and that by looking more broadly than just at the situations you are faced with, you can identify aspects of them that are present but hidden from you. By providing you with organized descriptions of the world, a practice theory offers ideas about where to look. Bringing these points together, I define a theory as a generalized set of ideas that describes and explains our knowledge of the world around us in an organized way. A social work theory is one that helps us to understand and to do social work. A social work practice theory describes and explains what actions to take when doing social work.

Knowledge and theory To sum up these points, I argue that knowledge and theory are different but connected. In professional activities such as social work we use both, but we need a special kind of theory to practice. So: ●●

●●

●●

Theory is different from knowledge  – theory involves thinking about something, while knowledge is a description of reality. Reality is a picture of the world that is accepted as true. Theory is different from practice  – theory is thinking about something, while practice involves doing something. Practice needs theory to use knowledge – if we are going to do something, we need knowledge about the reality around us so that we can act upon it, but we need theory to help us interpret that reality.

Knowledge, practice and theory are connected, therefore, for two main reasons. First, the real world exists independently of theories and ideas about it, but evidence about that real world has to be obtained in ways that are accepted as valid through the accepted scientific processes that I mentioned earlier. If a theory is to explain the world, it must explain our knowledge of the world. The real is more than just being apparent; understanding a reality involves ensuring that the apparent is true, using some agreed process to check that what appears to be true actually is true. Second, social work is an activity, something that we do, so theories about it must be explanations of the real world that connect with how we act as practising social workers.

Practice theory Sociological research tells us that having theories about practice is not restricted to social work; it is universal. Practice theory is a kind of social theory that describes how a social group conceives of and organizes important aspects of its work (Nicolini, 2012). Practice theories create social structures that provide stability in the actions that a social group undertakes. They describe who acts in social situations, what they want to accomplish, the outcomes of the actions and what relationships those actions create. Also relevant is the interests of the people who participate, who manages and controls the actions and who exercises power within the relationships. A practice theory allows people to examine what knowledges are used in the actions and relationships, what understandings and discourses are relevant to the people involved in the practice and the sense they make of the process. So, as we have already seen in relation to social work, practice theory tells everyone about the connections between ideas and practice (Hui, Schatzki & Shove, 2017).

The social construction of social work theory

Applying these general sociological concepts to social work, we can see that practice theories are created, owned and operated by social work practitioners to organize and provide structure in doing their work. Social workers are practitioners in the social group that is using practice theory to conceive and structure what they do. But they are not the only people relevant: their clients and the people and communities that surround them, their managers and the organizations within which they do their work and the policy-makers and political processes that create the social mandate to do their work are included in how they structure their work. Thinking about practice theory calls us to examine the knowledge that we use to pursue a specific piece of practice, and also the knowledge that we do not use, together with how practitioners, clients and managers debate and make sense of the practice. Looking at practice enables us to examine the human beings involved, their bodies, their minds, their spirituality, their social relations and how every aspect of those human beings affects the practice that we undertake. The following case example applies this understanding of practice theory to social work. Case example: An assessment raises the question of what practice theory to use Aiko was a new social worker for a mental health agency. She was asked to assess Colin, a man living alone, who was recently discharged from psychiatric care and was attending her agency’s day centre. The community psychiatric nurse who was caring for Colin after discharge told Aiko that he planned to visit regularly to check on Colin’s medication and make sure he was eating properly and looking after himself. The nurse knew nothing about any of Colin’s friends or relatives. Colin told Aiko that he attended church regularly and had a ‘pastoral link’ who spoke to him each week at church and visited occasionally, and that he had a sister living nearby with a family, but there was very little active connection, although the sister thought he should do some volunteering with the aim of getting into work, and Colin liked this idea. The day centre operated on a recovery model of practice (see Chapter 13). One of the volunteers befriended Colin and encouraged him to make plans for taking

up some activities that he enjoyed there, which might have been inconsistent with the employment idea. Aiko discussed this with her team leader. One option was to build a relationship with Colin and to do some counselling to help him decide on his future direction; this would complement the nurse’s work. Alternatively, Aiko could build links with family and community supporters: this would add to what the day centre was doing. Or again, she could work with the day centre and its volunteer, coordinating their action. Or she could develop a combination of these approaches. There were lots of possibilities, and each had a practice theory to guide Aiko, and to help her to decide from her assessment what would be best for engaging Colin and what direction would be successful for him. Practice theories make it clear what she would need to know to use each of these approaches, and would help her to find out things to enable her to choose one option over the others.

Types of social work theory Practice theory is, therefore, one of the different types of theory that are used in social work. In Figure  1.1, I have collected several points that enlarge on Sibeon’s (1990) distinction between formal and informal theory. Formal theory is written down and debated in the profession and in academic work. Informal theory consists of wider ideas that exist in society or

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8

Thinking about social work theory Types of theory

‘Formal’ theory

‘Informal’ theory

Theories of what social work is

Formal written accounts defining the nature and purposes of welfare (e.g. personal pathology, liberal reform, Marxist, feminist)

Moral, political and cultural values drawn upon by practitioners for defining the ‘functions’ of social work

Theories of how to do social work

Formal written theories of practice (e.g. casework, family therapy, groupwork); applied deductively; general ideas may be applied to particular situations

Theories inductively derived from particular situations; can be tested to see if they apply to particular situations; also unwritten practice theories constructed from experience

Theories of the client world

Formal written social science theories; empirical data (e.g. on personality, marriage, the family, race, class, gender)

Practitioners’ use of experience and general cultural meanings (e.g. the family as an institution, ‘normal’ behaviour, good parenting)

Figure 1.1  Types of theory Sources: Sibeon (1990), Gilgun (1994) and Fook (2016).

that practitioners derive from experience. Sibeon (1990: 34) distinguishes between three different types of theory: ●●

●●

●●

Theories of what social work is are part of a discourse about the meaning of social work. Discourses are conversations between people, which you can see or hear in debates in articles and at conferences, but they are also reflected in the different ways people do social work. You can, therefore, take part in a discourse because of the way you do something, and not only in talk and writing. I consider theories about the meaning of social work briefly later in this chapter and more fully in Payne (2006). They offer different views of social work that, when you put them together, give you a fuller picture of what it is and what its aims are. I take up the issue of what social work is later in this chapter when, in the Section ‘The social construction of social work’, I examine how the discourses about social work and its practice create how we understand social work and its aims. This is important because the nature and aims of social work obviously have a bearing on how we do it. Theories of how to do social work are the practice theories that this book explores. They build on theories of what social work is by saying: ‘If social work is like this and these are its aims, here are some ideas about how to do that and achieve the aims.’ Theories of the social world are about the social realities that social workers deal with. Sibeon originally called it the ‘client world’ to emphasize that he is talking about the world that clients experience. I have expanded his word to point to the way social work explicitly uses ideas about the nature and structure of the societies we live in.

Theories of the social world are contested in the field where they came from. For example, ideas in child development, or the sociology of families and organizations, or the nature of power are vigorously debated. It is useful to know about them as we deal within social work agencies with children in their families. Using this material in social work, however, means that we must transfer it from its original discipline into social work practice. In doing this, we

The social construction of social work theory

must remember that it is not final knowledge; there will still be continuing disagreement over it and research into it. Moreover, social work uses these ideas in a different way from, say, doctors or teachers. The practice theories that I discuss in this book connect knowledge from different disciplines to social work practice. They say: ‘To practise in the way this theory proposes, you need these kinds of knowledge from other fields of study.’ In this way, practice theories help us practise by organizing how we transfer knowledge into social work. As you look at Figure 1.1, you may need an explanation of some of the words. Induction means making a general point from particular examples. It refers to bottom-up theorizing in which you start from a series of similar experiences and devise a theory that explains them. Deduction, on the other hand, means arriving at conclusions about a particular instance from a general theory; that is, top-down theorizing. Here, you look at a theory that someone has formulated and work out how a case you are working on fits into it. A case example may help to understand this distinction. Case example: Using induction and deduction when working with dying people This example considers people’s emotional reactions to dying. Perhaps you have worked with several dying people who at first got angry, and then became depressed, and then accepting about their approaching death. By a process of induction, you might create an informal model of the progression of emotional reactions to impending death using your experience. Imagine that you then meet a dying person who is depressed. As a deduction from your model, you might work on the assumption that they will shortly become accepting. In this way, induction allows you to take ideas from a case or a small number of cases and use them to create a general theory. Induction enables practitioners to transfer ideas observed from practice experiences into more general theories. We do this all the time to make sense of what is happening in our cases, often collaboratively as we talk things over with team members. It also allows us to contribute to theory from our own practice. We can feed patterns that we observe into writing about social work or into discussion about practice in our agency.

Deduction, on the other hand, allows you to use general theories in practice. For example, in this same area of work, KüblerRoss (1969) came up with a theory in an interview study of dying people that they went through five stages. First, they went through a stage of disbelieving their diagnosis; she called this the shock and denial stage. Second, they went through an anger stage – resentment that this was happening to them. Next, they went into bargaining behaviour; for example: ‘If I eat more healthily, I’ll be able to fight this illness and recover.’ The fourth stage was depression; and finally they became accepting of their fate. If you knew about Kübler-Ross’s work, you would not need to use induction to create your own theory. Instead, from day one in your job, if you came across a dying person who was angry, you would expect bargaining behaviour next. Knowing about her theory, therefore, allows you to hit the ground running in your work, rather than having to work without any guidelines until you have built up experience from lots of different situations.

The problem with both deduction and induction is that they can lead you astray. Suppose, for instance, you did not see enough examples. You might assume that something was a pattern, but if you looked at more examples you would find that there were many exceptions to your initial assumption. The answer to this problem is to treat all your inductive theories

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Thinking about social work theory

cautiously, testing them out with new experience. In this way, you build up better evidence to support your work. Deduction may also be unreliable, because you might also be led astray by the research that led to the theories from which you are making deductions. Indeed, Kübler-Ross’s theory has been refined to suggest that these reactions are quite common, but people do not go through all the stages in order. If a client misses one out, practitioners do not have to worry that they are not adjusting properly to their situation. Because we build up evidence all the time as we practise, when we find aspects of a theory that are not true, we may need to adjust our deductions and contribute that experience to the literature to refine the theory. All professions build up knowledge to support their work in this kind of way. In addition, they need to keep an eye on new research that tells them when a theory has been modified. Whether working inductively or deductively, therefore, practitioners have to keep on learning and checking the evidence. Induction and deduction therefore go together and interact with each other: practitioners deduce how to practise from general theories and induce ideas from experience to contribute to the theory.

Why use theory in social work practice? We have seen that knowledge, practice and theory are connected ideas, and social work has various types of theory including practice theory. But social workers have gone on to ask why abstract ideas should connect with what a social worker does in real life. Some feel uncomfortable about using theory in practice. This might be because social workers see themselves as practical people, doing rather than theorizing. Or maybe they have found theory difficult to digest or to connect with practice. So why do practitioners use theory in social work? Figure 1.2 lists some of the advantages of doing so that have been identified by social work writers. These points are not exhaustive, some of them overlap and not everyone accepts all of them. However, simply listing the potential advantages of using theory in social work practice shows that people make a big claim for the value of theory in practice.

PAUSE AND REFLECT  Summarizing the claims for theory Look through the list in Figure 1.2. Why might it be important to get help with these areas of practice by looking at theory?

Some suggestions: the four main uses of theory The list in Figure 1.2 contains several different ideas about the usefulness of theory in practice, but these may be summarized and grouped into four main points as follows: ●●

Theory helps us understand and contest ideas. This is important because theory can be revelatory: it reveals and makes clear things that might not be obvious.

The social construction of social work theory ●●

●●

●●

Theory offers explanation and understanding. This is important because it orders complexity. Social workers deal with complex human behaviour and social phenomena and need to think about what to focus on when they take action. Theory offers a practice framework. This is important because it organizes ideas and research that offer guidance about what to do in these complicated situations. Theory helps us to be accountable, self-disciplined professionals. This is important because clients, colleagues and agencies are entitled to expect that practitioners can justify and explain what they are doing and why.

Reason

Theory helps you to

Four uses of theory

Accountability

... be accountable to agencies, clients and colleagues

Professional

Boundaries

... locate the limits of permitted and required practice

Professional

Causation

... understand causation

Explanation

Control

... control situations you are involved with

Practice framework

Critical

... be critical of and contest assumptions and ideas

Ideas

Cultural understanding

... understand how general cultural differences affect us

Explanation

Cumulation

... build experience from one situation to another

Explanation

Discourses

... identify debates about meaning in our lives

Ideas

Effectiveness

... decide what is most likely to be effective

Practice framework

Explanation

... explain human development and social phenomena

Explanation

Focus

... identify relevant and irrelevant factors

Practice framework

Framework

... organize practice consistently

Practice framework

Guide

... guide actions

Practice framework

Identification

... identify concepts and theoretical traditions

Ideas

Ideologies

... understand the impact of organized systems of thought

Ideas

Intervention

... identify potential interventions

Practice framework

Knowledge base

... use knowledge to inform your actions

Explanation

Mobilization

... get support for potential objectives

Professional

Neutrality

... avoid bias in making decisions

Ideas

Outcomes

... select intervention outcomes

Practice framework

Prediction

... predict outcomes

Practice framework

Professional

... behave professionally rather than as an amateur

Professional

Self-discipline

... avoid irrational responses

Professional

Simplification

... simplify complex phenomena

Explanation

Understanding

... understand behaviour and social

Explanation

Value positions

... avoid taking dogmatic value positions

Ideas

Figure 1.2  Why use theory? Sources: Healy (2014), Fraser and Matthews (2008), Greene (2008: 4–8), Gray and Webb (2009), Walsh (2010), and Hardiker and Barker (2015 [1991]).

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Thinking about social work theory

Like many writers, Munford and O’Donoghue (2019) assert that we need practice theory because social work is contextual, responding to the needs of each local place. Social work must therefore respond to diverse social settings and the enduring issues faced there, and also to new social challenges, such as the digital world, disaster work and environmental change. Social work theory increasingly links individual and macro perspectives and incorporates an ethical dimension. To them, therefore, social work requires specific applications of theoretical ideas. D’Cruz (2009) argues that social work is not interested in knowledge or theory that has no practical use. The alternative view is that ideas raise new possibilities and stimulate new action, but don’t need interpreting into practice theories. Social work can pick up general social science theory directly to think about the nature of social work and how to practise it, rather than relying on practice theory specifically created in the social work field. Examples are books by Hodgson and Watts (2017) and Parrott with MacGuiness (2017), which apply concepts to social work from a range of humanities, philosophy and the social sciences. They cover issues such as difference, dignity, disadvantage, empathy, globalization, human rights, power, poverty, reflexivity, respect, risk, social justice, spirituality and stigma. Garrett (2018a) and Gray and Webb (2013a) also want to make connections between general social science ideas and practice. Both summarize the social work interest in the ideas of social thinkers such as Pierre Bourdieu, Judith Butler, Michel Foucault, Nancy Fraser, Antonio Gramsci, Jürgen Habermas and Axel Honneth. I discuss some of these ideas and writers later in the book as their ideas come up. But we have seen that all people undertaking all activities such as social work have practice theories that organize their thinking about their actions. So I argue that it is most useful for social workers to start from the practice theory and see how theoretical ideas and theoreticians have influenced that practice, rather than starting from interesting theory and having to make a jump towards practice. In the next main section, therefore, I move on to identify different kinds of social work practice theory, and discuss how we can use it.

Social work practice theory Types of practice theory Practice theory in social work offers four different approaches to thinking about how to practise, which I illustrate in Figure 1.3. Opinion differs about whether all these approaches are equally useful, and after introducing them I will discuss some of the debates. Perspectives allow practitioners to make decisions according to general guiding principles. Lying behind a preference for using perspectives is a philosophy that human beings are immensely diverse and that precise rules about how to act do not allow you to respect that diversity. Instead, you deduce from your perspective how to act in the situation that you are facing. Preferring to use perspectives also has the advantage of integrity: your perspective and your actions fit your personal value systems. Frameworks are more concrete and less value-­based than perspectives, although there are usually some implied values that can be teased out from how they work. They can help us by setting out the range of situations that we typically have to deal with, and by identifying the range of methods available for us to select from, perhaps giving us

The social construction of social work theory

1.2a Perspectives express ways of thinking about the world based on consistent values and principles. Perspectives help you to apply a coherent set of ideas to what is happening. Applying different perspectives can help you see situations from different points of view. Examples of perspectives are humanistic (Chapter 9) or feminist (Chapter 17) theories.

Perspective: how to look at a situation

Methods available

Situation 1.2b Frameworks organize bodies of knowledge in a systematic way so that you can focus on and select useful knowledge required to practise in different situations. Systems theories (Chapter 7) are a good example. Situations dealt with in social work

situations. Models help you to structure and organize how you approach a complicated situation. A good example is task-centred practice (Chapter 5).

1.2c Models extract patterns of activity from practice and describe what happens during practice in a structured form. This helps to give our practice consistency in a wide range of Situation

Action 1

Action 2

Situation

Evidence about actions to take

Action 1

Outcome

for ideas that offer this causal explanation. To them, theories have to tell you ‘what works’ and why it works. Cognitive behavioural theory (Chapter 6) is an example.

1.2d Explanatory theory accounts for why an action results in or causes particular consequences and identifies the circumstances in which it does so. Some writers reserve the word ‘theory’ Evidence about the situation

Action 3

Evidence about actions to take

Action 2

Evidence about likely outcomes

Action 3

Outcome

Figure 1.3  Approaches to practice. (a) Perspective. (b) Framework. (c) Model. (d) Explanatory theory

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Thinking about social work theory

some basis for making our selection. Models are frameworks that set out a clear sequence of actions to take in the situation we are facing. Explanatory theories are models that are based on well-researched explanations of human and social behaviour. Here, the sequence of actions that you take is informed by knowledge about the reasons why this situation occurs and is backed up by evidence about the right actions to take to achieve the required outcome. Thinking about the debates about these approaches, people prefer frameworks, models and particularly explanatory theories because they think it is wrong for their own personal values and preferences to intrude into decisions about professional actions. They think it is more ethical to concentrate on evidence that tells you what will be most effective in dealing with people and the problems they are facing. In that way, you may have a better chance of achieving what your agency or client wants. Such approaches see social work as a technical matter of applying knowledge in a neutral way. People who use perspectives say that since social work is a human, interpersonal process, using ideas to think through what is right for the human beings involved is more likely to be effective than using a non-human technical process. One answer to these uncertainties is that, to some degree, these different types of theory may be used together. For example, you might use a framework or perspective to select models or explanatory theories from the options available, depending on the situation you have encountered. In the other direction, you might prefer to use an explanatory theory, but find, perhaps because there is no relevant evidence, that it does not fit the situation you are working with, so you use an appropriate perspective to guide you through this unknown or complex picture.

Using practice theory How do we use practice theory? In the next Pause and Reflect question, I look at the different kinds of knowledge that are useful in a case example, and argue that practice theories allow practitioners to bring all these resources together in taking action.

PAUSE AND REFLECT:  A case example Using practice theory in working with a bereaved son

At the hospice where I worked, Graham came to see me about his mother. She had died unexpectedly while he was abroad with his father, who was divorced from his mother; she had since remarried. He spoke calmly, but said he was

upset that this had happened while he had been away. I asked how I could help him. He had two main requests: he wanted help in finding out what had happened and he wanted to know what he should do. What would you do?

Some suggestions: theory is a useful framework As you can see, my starting point was to ask an open-ended question, letting Graham take the lead and expressing my willingness to try to help with whatever he needed. In this situation, it is usual to appear sympathetic and express how sorry you are for the bereaved person’s loss, but this does not come naturally to everyone. This is because many people fear they may not be able to handle strong emotion, if it is expressed, but working in a hospice this is everyday

The social construction of social work theory

for me. I’m cautious about saying ‘I’m sorry for your loss’, however, because some people may not see a particular death as a loss, and his opening statements did not clarify how he felt, so I did not make assumptions. For example, Graham might have had mixed feelings, having seen his mother’s death as a relief from a long illness, or been pleased because he saw her as critical or demanding. Looking at this, some skills training in the right way to begin interviews, and experience and confidence that you can respond appropriately to whatever situation arises would be a good basis for starting social work. These skills are based on psychological and sociological communication theory, but they are also practical human behaviour that many people will have acquired through social experience. No absolute need for a practice theory here, then, although it might help you to organize your thinking about the social work approach to engaging with people (Payne, 2020b). Graham’s requests presented a legal and administrative problem. Information about his mother’s medical care was private, so I had to get his stepfather’s permission to allow him access. I then arranged for him to meet a nurse who had cared for his mother so that he could hear person-to-person the story of her last few hours. Doing this required legal knowledge about his rights to have access to confidential information, and administrative knowledge and organizational skills to know whom to contact and how to set up a meeting. Finally, I needed to ask myself what he should do next. We talked over his memories of his mother, and he completed a salt sculpture of his mother, a commonly used technique for making a physical memorial to someone (see Reith and Payne, 2009: 151 for a description of what to do). In another session, we discussed how he could help his stepfather with some practical tasks, including sorting out his mother’s finances and property and keeping some items of hers that were important to him. After this, we talked about his feelings about losing his mother, and I gave him the telephone number of our bereavement service, also asking him whether we could call him every so often to offer further help. I needed a sound knowledge of practical technique and of theory about bereavement and loss here. It was clear that it would be some time before Graham wanted to tackle his feelings about his mother, and that the repeated offer of a service would empower him to seek help if he needed it. Most people, however, manage bereavement without professional help. This case example illustrates some of the reasons why people often feel that using social work theory is not relevant to them, since: ●●

●●

●●

●●

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practitioners can rely on skills learned in ordinary human interaction (e.g. being warm and welcoming); practice relies on learned communication and interview skills (e.g. open-ended questions); practice is often guided by legal and administrative requirements (e.g. access to records and arrangements for referral to other professionals); practice is often informed by practical techniques built up in agencies and learned by their staff (e.g. the salt sculpture); practice is informed by theory about problems (e.g. bereavement and loss) rather than social work theory.

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So why would we need a social work practice theory? Let’s stand back and look at the whole process with this client. There is a framework that guided the events that took place, and this consisted of several elements: ●●

●●

●●

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The agency (the hospice) had decided to employ social workers and defined their roles and responsibilities, which came from some generalized view of what social workers might offer as part of a hospice service. In using my skills, I addressed issues that reflected the client’s wishes as well as my own view about what it was important for me to deal with. That view came partly from the agency mandate (what social workers are expected to do in the hospice) and also from broader policy and social expectations (the expectations of social policy and the general public about what social workers do and what an agency like a hospice should do when bereaved people present themselves). My focus was on a combination of the client’s personal emotional responses, practical tasks and social relationships. Combining work on different issues is characteristic of social work. I drew together a range of knowledge about psychological reactions and social relationships in bereavement and loss, legal, administrative and practical issues and interpersonal skills, which is again characteristic of social work.

The framework of a social worker’s practice in this instance is underpinned by knowledge and ideas about what social workers representing their profession, as opposed to, for example, doctors, should do for the best when faced with a situation like this. My medical colleagues, when asked to see someone like this, would check for physical and psychiatric symptoms and pass the client straight on to a social worker. Our agency and society in general say that someone with combined emotional, practical and relationship concerns coming from an event in their lives needs a social worker. And this was not a big part of my week. I often dealt with three or four such situations each day, all with different concerns. Therefore, questions such as ‘what is my responsibility?’, ‘what skills do I need to act?’, ‘what should I focus on?’ and ‘what knowledge do I need?’ come up repeatedly. Practice theory means that practitioners do not need to rethink social work every time they see a client: a set of ideas about social work describe and explain in an organized way the events in the world around them and provide general guidance on how to react. Practitioners may then adapt them to different scenarios. As you look at the theories discussed in this book, you might identify some of the sources for my approach with Graham. For example, ideas about attachment (Chapter 4) inform bereavement practice, and crisis intervention theory (Chapter 5) suggests an initial focus on feelings. Although both of these theories influence theory about bereavement, bereavement theories do not in general tell you how to approach and work with people in a social work agency and then bring to the surface and respond to the issues that bereavement theory tells us are important. Figure 1.4 shows my analysis of the role of social work theory as a framework for deciding on and planning intervention in a social work agency. Practitioners gain information about clients and their feelings and attitudes, and about the social situations that clients experience. The practice theory framework enables practitioners to create interventions that bring the specific information about this client in this situation together with generalized social work

The social construction of social work theory

Social work agency

General and social work skills

Information from and about clients Social work theory framework

Social work intervention

Information about the social situation

General and social work knowledge

Figure 1.4  The role of social work theory

skills and knowledge. You can see from the social work agency boundary here that although all this is brought together in the agency, some knowledge and skills come from outside it, and the intervention itself also has effects outside the agency. The knowledge and skills from outside the agency emerge from expectations taken up from the society that has created this agency and given it a mandate to operate. A society is the whole pattern of relationships between people, which form into social institutions that provide an organized and understood structure for people to manage the relationships between themselves. Social work and social work agencies are examples of those patterns of relationships and the institutions in which they take shape. People form or construct social work and its agencies, therefore, by their demands and expectations, and social workers and their agencies are influenced to change by their experiences with the people they serve. In addition, practitioners, clients and agencies contribute to some extent to society’s expectations and its political and social processes by their own thinking and doing. That is a process of social construction in which people who do things together and as part of the same social organizations come to share common views of the world that they see as a social reality. In this way, it is a circular process, with each element – agency, client, social worker – influencing the others, and all this occurring in the context of the social expectations that come from their wider social relations and the practical realities they face. I will explain more about social construction as a way of thinking about practice in Chapter 8.

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In the following case example, Angus had first gone to the people he saw regularly  – healthcare workers. They defined his problem as a housing issue, but when he went to the housing department, they saw it as a financial problem and sent him to the social worker. The social worker gave advice about social security and charitable grants, but also picked up the emotional elements of end-of-life care. Each stage of this pathway to the social worker had defined the problem differently, constructing for Angus a picture of the role of the next official he saw. He came to the social worker seeing her as a problem-solver, mainly with financial difficulties, and she expanded the role, building on these initial expectations. Later, her identification of an end-of-life care situation and subsequent discussion with the healthcare workers might have reconstructed their assumptions about what else social workers can do. Doing this as you go along helps to change other professions’ views of what social workers can do, and in the long run doing this consistently enables social workers to begin to change society’s views of them. Case example: A client’s pathway to the service is part of a shared construction of social work practice Angus, a man in his 70s, was sent by a housing welfare officer from the local government housing office to a social services agency. He had arrears in payments for gas and electricity for his home. His wife had been ill and he had been using the heating more, but the house was also damp, and the housing welfare officer advised him that he needed better heating to prevent mould growing on the apartment walls. Angus’s doctor and the district nurse who helped his wife had also advised

him that he needed to make sure the house was suitable for caring for his wife. The social worker advised him about his social security entitlements, and also talked through the management of his income and the costs of his wife’s illness. She agreed to apply for a charitable grant to help him. Visiting to complete the application form, she also discussed the pressures on him as a carer for his increasingly sick wife, and his fears that she was coming towards the end of her life.

To summarize what I have covered so far, I have argued that perspective, framework, model and explanatory theory can be used together. Going further, I have argued that for a social work practice theory to be useful, you need all these elements. Because social work is practical action, practice theory must include a model of explicit guidance. Yet action is not entirely pragmatic, because social work acts must be based on evidence about what is valid and effective, so any models should be backed up by explanatory theory and we need to evaluate the different kinds of knowledge that support it. Model and explanatory theory can only gain consistency over a wide range of social work and offer general usefulness if they offer a perspective that allows us to transfer ideas between one situation and another and be consistent in our work.

The social construction of social work This section picks up again on theories of what social work is (see Figure 1.1) and shows how social work is socially constructed by our practice, the people and organizations involved with us and the theories that inform our practice. The process is set out in Figure  1.5. In the

The social construction of social work theory

The nature of social work

Ideas and debates about social work

Practice theories

Social work practices

Figure 1.5  The social construction of social work

previous section, I argued that how we see the nature and aims of social work affects how we choose and use practice theories, whether they are formal written or informal unformulated theories. If we practise according to these theories, they will influence what we do. What we do then becomes a contribution to ideas and theories about social work, either through professional or social debate or more directly because people see and experience what we do, and this influences their understanding of social work. Practice theories are also part of the debate about what social work is because they give you an idea about what social workers are supposed to be doing, so there is a two-way interchange between practice theories and the nature of social work.

Social construction Exploring ideas about social construction helps to explain how this works. The idea of social construction comes from the work of the sociologists Berger and Luckmann (1971). They say that, in social affairs (they are not talking about the natural world), people having a shared view about how things work helps us to live life. What we call ‘reality’ is social knowledge that has been agreed between people. For example, I always drink beer from a glass because my mother taught me that this was polite and that the tops of bottles often had broken glass that might cut my mouth. We all have slightly different views of that social reality, however, because we see and interpret what happens around us in slightly different ways, and this varies according to our life experience. Continuing the example, when I go into a bar with my son, he is always given the bottle, while the bartender looks at my greying hair and offers me a

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glass. This is evidence that a social change has taken place that the bartender and I share awareness of: people often drink from the bottle nowadays, but older people like me have the habit of using a glass ingrained in us from longer ago. We arrive at agreed views of social reality and the circumstances affecting what people think is appropriate behaviour by sharing our knowledge with other people through various social processes that organize it and make it objective. How to go about shopping might be something we learn by example from our parents, while we might learn how a church service goes and how to behave there by watching other people at the service who seem to know what they are doing. Social activity becomes habitual, so our assumptions about how things should be come to be accepted as true. In addition, we behave according to social conventions based on that shared knowledge of what we have accepted as true. So these conventions become institutionalized; that is, we turn them into rules of behaviour because most people agree about the accepted way of understanding that aspect of society. These understandings also become legitimized, accepted as morally right and appropriate, by a process that attaches ‘meanings’, integrating these ideas about reality into an organized and plausible system. Social understanding is, in this way, the product of many shared human understandings. Case example: Accepting social distancing in the Covid-19 crisis During 2020, a global pandemic caused a widespread illness (Covid-19) because a new type of virus affected most countries in the world. In most places, governments reacted by closing inessential activities and shops and asking people to avoid infecting others by staying at home This was called social distancing. Different governments introduced slightly different rules, and while most people complied because of public explanations about how infection worked, some people did not. In the UK, for example, when the weather was good, people living in small apart-

ments went out to use the parks and beaches, and younger people more used to an active social life in bars and clubs than people in older age groups carried on socializing. This led the government to publicize and enforce very specific rules of behaviour. Some groups of people who thought that it was wrong for governments to impose behavioural rules on their populations in this way resisted it. We can see here how, faced with a new situation, people have no agreed guidelines for behaviour and explicit regulation must be developed.

The social understandings of the humans involved are also objective because the knowledge of reality is widely shared. Since everyone grows up within those social understandings to accept that they are a reality, people are in a sense the product of society. So there is a circular process in which individuals contribute through institutionalization and legitimization to the creation of social meaning within the social structure of societies, and in turn, societies, through individuals’ participation in their structures, create the conventions by which people behave. We can see a spiral of constantly shifting influence, creating and recreating structures, and these changing structures recreate the conventions by which people live within them. Looking back at the case example of Angus, his pathway to practice may have reconstructed a different reality of social work for him, his family and the healthcare professionals he worked with. It is this same circular process that you can see creating social work in Figure 1.5.

The social construction of social work theory

Social construction ideas have been widely used in social psychology to criticize traditional psychology. Influential proponents of this view are Gergen (Gergen, 1994, 1999; Gergen & Gergen, 2003) and, in Britain, Parker (1998). To give you a flavour of what this might mean for social work, you might think that in the real world we all have a personality, which is basic to our individual identity. Constructionist psychology casts doubt on this because we all have the possibility of making changes, and then we become a different person. Traditional psychology emphasizes the continuity of personal identity, so it might lead you to say that it is difficult or impossible to change someone’s basic beliefs. Constructionist psychology emphasizes the possibility of change, and might lead you to be optimistic about changing people’s personalities. For a social worker, which of these views of personality that you accept matters. If you take the traditional view of personality as fixed and difficult to change, you might focus on practical help rather than trying to change personal attitudes or behaviour. If you take a constructionist view, you might look to making changes in the social surroundings and in how your clients think to help them change their personalities. A good reason for using social construction ideas in social work is this idea that social arrangements are not set in stone. The nature of social work, and any other social construction, changes as events in history or relationships in various social contexts alter. So you cannot define social work in one way for all time and across the whole world; it changes according to how societies, clients and practitioners use it. This is a cause for optimism as it tells us that everybody can make a difference to any social institution or social relationship – because by doing it or debating it, we can contribute to changing it. All social work practice, yours and mine, plays a part in creating social work. This is also a positive idea for practice, since social construction tells us that people can reconstruct their lives and behaviour; we should not be gloomy about whether people can change. A criticism of social construction identifies a consequence of this idea that the nature of social realities is always changing. The criticism claims that this leads to a position where there are no certainties and we can have no security, because everything is always changing; this is called relativism. There are two answers to this criticism (Archer, 1995). First, this process of social construction is a gradual one: things change slowly, morphing in a series of small changes until we become aware that a large change has occurred under the radar. We can keep up with this, and understanding changes that we can see around us helps us to adjust to wider social change. Look back at the case example about social distancing during the Covid-19 crisis for an instance in which understanding of changes in social rules helped people adjust. Social workers keep an eye on social research and official information so that they can stay up to date with how society is changing. Second, many things do not change, and much social experience reinforces current social constructions, so social construction often supports stability and security; it is wrong to claim that social construction says that everything is insubstantial.

The politics of theory Social construction creates what I call a politics of theory (Payne, 1992, 1996a, 1998, 2002) in which political debate and conflicts create change within a profession about the theory that profession uses. I call it political debate because groups of people gain an interest in a theory

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and support it in arguments with groups who support other theories. These groups are like the political parties supporting one policy or another in Parliament. This goes on in professions in the same way as in ordinary social life, as part of the constant interaction about what reality is. The aim of each group is to gain wider acceptance within social work of the theory that they support. If they can achieve this, the support groups for particular theories shift our understanding of the nature and practice of social work. In this way, proponents and supporters of a theoretical point of view struggle to have it accepted, and they use practice theories that support their premises to ensure that it contributes more to the overall construction of social work and that it has a greater impact on practitioners’ actions. So when, as a practitioner, you use a theory, you are contributing to the politics of theory, because what you do in social work is or becomes social work through the process of social construction.

Three views of social work objectives A widely discussed construction of social work is contained in the Global Definition of Social Work (International Federation of Social Workers [IFSW], 2014); this is a good example of how social work is constructed from the variety of views of it. The first sentence of the definition proposes that social work has three main objectives: ‘Social work is a practice-based profession and an academic discipline that promotes social change and development, social cohesion, and the empowerment and liberation of people.’ I present these objectives in Figure 1.6 as the corners of a triangle; the space within the sides of the triangle represents the discourse between them. We have seen already that discourses are interactions between what people or groups say and do that indicate important differences between them in the meanings they give to something. The important differences between these views of social work

IFSW (2014): Empowerment and liberation IFSW (2000): Empowerment Payne (2006): Social democratic

A

B

C

D IFSW (2014): Social cohesion IFSW (2000): Problem-solving Payne (2006): Liberal/neoliberal

IFSW (2014): Social change and development IFSW (2000): Social change Payne (2006): Socialist

Figure 1.6  Three views of social work and their underlying political philosophies Source: Adapted from Payne (2006).

The social construction of social work theory

connect with different political views about how welfare should be provided. We can therefore see that each view represents a political position in social work, connected with a political philosophy that would be recognized more widely in society, socialist philosophies, liberal or neoliberal philosophies and social democratic political philosophies (Payne, 2006). These philosophies also influenced alternative views of social justice, and I look at this in Chapter 14. The changes that have taken place in the IFSW definition and my own account of these three objectives have changed over the years since I first wrote about this (in Payne 1996b). Earlier editions of Modern Social Work Theory used the terminology of the previous IFSW Global Definition (IFSW, 2000). To make the connections across the years, Figure 1.6 identifies the previous IFSW terminology and the related political philosophies, as well as the current terms. We can see that the meanings attached to each of these broad objectives of social work has developed in the past 20 years, and will undoubtedly continue to develop, responding to social and political change. Empowerment and liberation views These views see social work as seeking the best possible well-being for individuals, groups and communities in society by promoting and facilitating growth and self-fulfilment. In this view of social work, practitioners help clients to gain power over their own feelings and their way of life. Through this personal power, they are enabled to overcome or rise above suffering and disadvantage. This view expresses in social work the social democratic political philosophy; that is, that economic and social development should go hand in hand to achieve individual and social improvement. Dominelli (2009) calls these therapeutic helping approaches. Case example: A drug user’s life Karim was a young man who had become a drug user from an early age, being offered drugs at school, becoming part of a gang of young men and earning money by supplying drugs to others. Several years on, a new practitioner, Ken, became Karim’s social worker as part of a drug rehabilitation project. Ken was shocked that Karim lived in derelict houses in poor and unhealthy conditions. Although he knew a lot of theory about the effects of drugs and possible treatment methods, he had not appreciated until he spent time with his client the urgency of Karim’s need to get a

regular fix, his lack of drive to make progress with his rehabilitation in spite of his unpleasant lifestyle and the influence of friends from his gang life, which meant that Karim could not keep to a daily routine involving activities not centred around drugs. When Karim failed to avoid drugs in a hostel placement, Ken was dispirited by his return to his old life and the failure of his treatment methods. He realized the importance of building a relationship with Karim, helping him to develop skills in social relationships and trying to provide a new social environment for him.

This case example illustrates how clients contribute to constructing social work: as practitioners gain experience of clients’ lives, their practice changes as their understanding of what is possible and desirable shifts. Empowerment and liberation views of social work emphasize the importance of helping people lead a more fulfilling life by developing their skills and personal relationships. Humanistic and strengths theories are good examples of empowerment

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views. These views are basic to many ideas of the nature of social work, but the two other views modify and dispute it. Social change and development views These see social work as seeking cooperation and mutual support in society so that the most oppressed and disadvantaged people can gain power over their own lives. Social work facilitates this by enabling people to take part in a process of learning and cooperation that creates institutions that everyone can own and participate in. Elites accumulate and perpetuate power and resources in society for their own benefit. By doing so, they create oppression and disadvantage, which social work tries to supplant with more egalitarian relationships in society. Dominelli (2009) calls these emancipatory approaches because they free people from oppression. Others (for example, Pease & Fook, 1999) call them transformational because they seek to transform societies for the benefit of the poorest and most oppressed. They imply that disadvantaged and oppressed people will never gain personal or social empowerment unless society makes these transformations. The shift in IFSW’s terminology from ‘social change’ in 2000 to ‘social change and development’ in 2014 reflects the stronger global influence of social development as an objective and model of practice in social work professions in Africa, Asia and Latin America.

Case example: Domestic violence Ushi, the daughter of a Chinese family, married a violent man who often beat her. She accepted this as part of her husband’s personality until he also began hurting their two daughters. Child protection concerns were reported by the girls’ school, and the social worker helping the family picked up Ushi’s increasing distress at the pattern of her husband’s behaviour. The practitioner referred her

to a woman’s refuge, and the social worker there helped her to live in safety until legal action against her husband made it safe for her to return home with her daughters. In the process, Ushi became aware of her right to have positive expectations of her relationships with men, and her husband was forced to shift his perceptions of acceptable behaviour by a men’s violence project.

Value statements about social work, such as codes of ethics, represent this objective by proposing social justice as an important value of all social work; this appears in the IFSW account of the values influencing social work. This view expresses socialist political philosophy; that is, that planned economies and social provision promote equality and social justice. Examples of social change views are anti-discriminatory or critical practice. Social cohesion views These see social work as an aspect of social provision that aims to create social cohesion and social order in society. It does this by meeting individuals’ needs by providing personal practical help and services to them. Such views see social work as maintaining the social fabric of society by supporting people through difficult periods in their lives so that they can recover

The social construction of social work theory

their stability. This view expresses the liberal or neoliberal political philosophy that says societies should support personal freedom in economic markets, underpinned by the rule of law. Such political philosophies say that people should be free to make decisions about their lives, but if they have problems, they should suffer the consequences of those problems. The role of social work is to help people adjust to this way of organizing society, smoothing the way through problems that people cannot handle. A good example of social cohesion views is task-centred practice. Case example: Mental illness Bernard experienced considerable stress at work, which led to several periods of depression, and he eventually lost his job. After a period of hospitalization, a community mental health project involved him in a drop-in day centre, which reduced the sense of isolation he felt living in a small shared house.

The project staff made sure Bernard’s medication was continued and arranged for him to get help in applying for jobs, including putting him on a course to improve his job interview skills. They also persuaded him to take additional qualifications so that he could increase his job prospects.

Each of the views discussed here says something about the activities and purposes of social work in welfare provision in any society. Each criticizes or seeks to modify the others. For example, seeking personal and social fulfilment, as in empowerment and liberation views, is impossible for social change and development theorists because the interests of elites obstruct many possibilities for oppressed peoples unless we achieve significant social change. Social change and development theorists argue that merely accepting the social order, as empowerment and social cohesion views do, supports and enhances the interests of elites. Karim and Bernard might have been helped personally by engagement with their practitioners or by practical services, but the social pressures that make it hard for vulnerable youngsters to make their way in life still remain, so there will be a continuing flow of young men involved in cultures of drug misuse or suffering from exploitation, leading to mental ill-health. To social change and development theories, therefore, empowerment and social cohesion views do not remove the barriers that obstruct opportunities for people who should be the main beneficiaries of social work. To take another example, social cohesion theorists say that trying to change societies on a large scale to make them more equal or to enable personal and social fulfilment through individual and community growth is unrealistic in everyday practice. Chapter 10 includes an example of this argument in relation to social development. Midgley and Conley (2010a) assert that steps forward are made through more practical measures to empower people to solve their problems. They, and others, argue that social change and development philosophies are unrealistic because most social work activity deals in small-scale improvements, which cannot lead to major social changes. In addition, stakeholders in social care services who finance and give social approval to social work activities mainly want to achieve a better fit between society and individuals rather than effect major changes. These different views, however, have affinities with each other. For example, both the empowerment and liberation and the social change and development views largely concern

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change and development, as we see in the cases of Karim and Ushi. In addition, empowerment and liberation and social cohesion views are about individual work rather than broader social objectives. Indeed, many practitioners find these two perspectives complementary. Most conceptions of social work include elements of each of these views, or they acknowledge the validity of elements of the others. Social change and development views criticize unthinking acceptance of the present social order, which is often taken for granted in empowerment and social cohesion views. Nevertheless, most social change and development practice theories include helping individuals to fulfil their potential within current social systems. Such theories often see this as a stepping stone to a changed society by promoting a series of small changes aiming towards bigger ones. Looking at Figure 1.6, if you or your agency were positioned at A (which is very common, especially for social workers at the start of their careers), you might be providing assistance and therapeutic services as a care or case manager, or in child protection. You might do very little in the way of seeking to change society, and by being part of an official or service system you are implicitly accepting the current pattern of welfare services. In your daily work, however, what you do may well be guided by your personal aim to change society for the better in the future. For example, if you believe that relationships between women and men should be more equal, your work in families will probably reflect your views. Position B might represent a practitioner working in a refuge for women who have experienced domestic violence. Much of the work is concerned with helping the women personally and practically, but the reason for the existence of their agency is to change attitudes towards women, and you might do some campaigning work as part of your role there. Position C is equally balanced – some change, some service provision, some therapeutic helping. My hospice job was like that: one aspect was to promote community development so that communities respond better to people who are dying or bereaved, but I also organized and provided help and support for individuals, and was responsible for liaison with other services so that our service system became more effective. Position D is mainly about social change but partly about social cohesion too. This reflects the reality that seeking social change is not, in social provision, about creating a revolution, but aims to make the service system more effective. Many community workers, for example, are seeking big changes in the lives of the people they serve by improving cooperation and sharing the preferred way of organizing society. As they do this, however, they may well help local groups make their area safe from crime, provide welfare rights advocacy or organize self-­help playgroups in the school holidays. Working on such issues allows people to gain the skills to achieve wider social change in their community (see Chapter 10). Political aims in welfare, views of social work and practice theories link in complex ways. The links between, say, liberal political theory and social work that aims for social cohesion are clear, but the devisors of task-centred practice (Chapter 6) did not say to everyone ‘we are neoliberal theorists’ and follow this up by devising a theory that expressed their political ideas. They did research, came up with an approach that seemed to work and presented it to social workers to use. When we set this alongside other theories, we can see that it meets some of social work’s aims but not others. In the three reviewing sections of this book (Parts 2–4), each chapter has sections on wider theoretical perspectives and connections. These draw attention to some of the links and disagreements between theories that express these philosophies of welfare and views of social work.

The social construction of social work theory

Taking part in social work means that you will always, by the way you practise, express a view about your particular balance between these various aims – you will construct your own version of social work that will guide the actions you take. Thinking about the three views of social work objectives helps you to clarify your own view.

Five shared principles in social work theory I argued in the previous section that all social work actions express a balance between the three views of social work’s objectives. Agency policies also mean that agencies represent a balance between these views, as does the wider political debate about the objectives of social work within any society when it leads to new social laws and innovation in social services. This balancing of objectives is part of the social construction process through which social work constantly evolves, influenced by our clients and their social experiences and professional and academic knowledge about our societies. If we see social work as a constantly changing balance of these objectives, how does this affect the diversity of practice theories? If the overriding broad objectives interact, so must the practice theories, because they are specific formulations of practice that meet those objectives. Thus, there is not only a politics in which different objectives vie to influence our view of social work, but there are also constructions that make connections between theories. This is why each chapter dealing with a specific practice theory identifies the politics of that theory in social work debate, and also the connections between that theory and other ideas in social work. Each practice theory influences the others, contributing to social work practice ideas as a whole. I explore this process further in Chapter 2 (see particularly Figure 2.1). The process of mutual influence has been continuing for some decades, to the point where it is possible to identify in the diverse formulations of social work theory some clear shared theoretical value principles that inform all social work practice theories. I set these out in Figure 1.7. The shared principles of social work practice theories represent accepted ideas informing most social work practice. The first of these shared principles is the concept of alliance between practitioner and client. Most theories aim for equality within this relationship, in which the client gives informed consent to the practice, influences the setting of the intervention’s aims and engages in dialogue to arrive at a shared understanding of the situation and the actions taken. Because of this, interventions focus on clearly specified outcomes, the second principle, partly because this is most effective in gaining commitment from both the client and the

Element

Examples

Alliance

Informed consent, relationship, therapeutic alliance, dialogic relationship

Aims

Clearly specified and positive outcomes

Action sequences

Specified sequences of actions

Critical practice

Disruption, critique of current social assumptions

Rights

Human rights, cultural respect, equality, sustainability

Figure 1.7  The five shared principles of social work practice theories

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Thinking about social work theory

practitioner to get working on their aims. It also means that the agreement between agency, practitioner and client is transparent. These aims are now stated in positive terms, rather than as deficits in the client or as problems to be solved. This is why the IFSW Global Definition of 2000 (IFSW, 2000) was inaccurate in presenting problem-solving as one of the objectives of social work: social work is now more about positive outcomes than the definition and solution of problems. This development also challenges cognitive behavioural and task-centred practice, which emphasize a detailed specification of problems, as we shall see in Chapters 6 and 7. Theories increasingly present clear sequences of action for practitioners and clients to work on, the third principle. Again, this means that what social workers do is more openly and equally shared with clients, their families and communities than in the past. This is a balancing factor that supports cognitive behavioural and task-centred practice despite their social cohesion impetus, since these theories also emphasize clear action sequences. Exploring the shared principles in this way can help to produce criteria for evaluating the contribution of theories to social work practice. By looking at the important elements in a theory, we can see how it might be especially relevant to social work within the social care system of a country. At the same time, all practice theories are concerned with being critical, the fourth principle, in the sense that individual practice often seeks to disrupt people’s assumptions or expectations about behaviour. Critical practice also requires practitioners to question the social structures that contribute to clients’ problems. Finally, the fifth principle of explicit concern for equality, respect for cultural diversity, social justice and human rights is increasingly integral to all theory of social work practice. All practice theory incorporates these five elements as shared practice values more clearly than was the case when the different practice theories reviewed in this book first began to build separate theoretical identities. Because these shared elements are present, social work practice theories are more able to influence each other and make progress jointly. Practice theories become questionable when they deviate from these shared principles. You can see how deviation from the shared theoretical values leads to the questioning and rebalancing of views about the contribution of theories in my discussion of the role of cognitive behavioural and task-centred practice in social work in the next section.

Arenas of social work construction The final element to consider in the social construction of social work is how the politics of social work theory takes place across society. Three arenas of social construction are important for social work, as set out in Figure 1.8 (Payne, 1999a), and each arena influences the others. One is the political–social–ideological arena, in which social and political debate forms the policy that guides agencies and their purposes. Social workers engage in this through professional associations and other organizations and their involvement in social issues as activists, voters or writers. Another is the agency–professional arena, in which employers and collective organizations of employees, such as trade unions and professional associations, influence each other over the more specific elements of how social work operates. The third is the client–worker–agency arena. This is the most important arena for the focus of this book on practice theory, since, as we saw in the case examples in this chapter,

The social construction of social work theory Client–worker–agency arena

Political–social–ideological arena

Agency–professional arena

Figure 1.8  Arenas of the social construction of social work

clients influence how social work practice is constructed through their relationships with practitioners in the agency. Clients can influence the political–social–ideological arena by, for example, their votes, by rioting and in many other ways. They can affect the agency–professional arena through their reaction to social work practice, influenced by their community and other agencies, as they follow the pathway to service. For example, they can change policy and practice by arriving at agencies in large numbers asking for service. Changes are negotiated in many different places, and these three arenas are only a limited selection, indicating important centres of influence. Case example: The impact of HIV/AIDS In the 1980s, when HIV/AIDS first became evident, pressure groups and specialist agencies started to appear to influence government and social debate; this is influence in the political–social–ideological arena. People with problems arising from HIV/AIDS came to social agencies and caused them to change their ­practice; this was change in the agency–

professional and client–worker–agency arenas. The appearance of clear need arising from a new condition forced agencies and professionals to adapt their practice and provide new kinds of service. One example of this professional change was the idea of volunteer buddies, enabling people with the condition to support each other.

Conclusion: using ideas about social work theory This chapter shows how social work theory connects with the real world in which social workers practise; it is not abstract or irrelevant. Social construction ideas show how theory is created in a variety of social arenas and how clients’ interactions with practitioners in their

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agencies form an important arena in the construction. What you do in your practice is therefore important to theory. It is also important to the different groups engaged in the politics of theory. Debate about using theory is part of the political process by which people with commitments to different views of social work gain influence and seek to change social work in their preferred direction. It works the other way around too, because theory provides a framework for action. All actions are based on theory, some of it informal and unformulated. Using theory in practice therefore relies on understanding different types of theory and how they connect. The social construction of social work suggests that its theory is constructed by the same social forces that construct the profession and its agencies. Theory for practice inevitably responds to current social realities, so that it is shaped by current interests and concerns. Yet it also reflects the histories of theoretical, occupational and service context. The social construction view is that social work theory is a representation of agreed understandings about social work within various social groupings. The struggle between competing understandings and constructions of social work is manifested in the differing theories discussed in this book. Social work theory is a construction, interacting with a real world of social relations, but because it is a construction, we can adapt and develop it as we practise, just as we can help clients to develop and adapt by our practice. To do so, we need to have ideas to direct, manage and inform what we do. These ideas are the social work practice theories reviewed in Chapters 4–18 of this book. However, to use them, we must be able to make decisions about which theories to use, evaluate which will be most useful for different purposes and integrate our practice with those ideas. The next two chapters focus, then, on putting theory into practice.

Additional resources Further reading Burr, V. (2015). Social constructionism (3rd Ed.). London: Routledge. An accessible account of social construction theory in social psychology. Jokinen, A., Juhila, K. & Pösö, T. (1999). Constructing social work practices. Aldershot: Ashgate. A useful collection of papers, many of them research-based, demonstrating how social construction ideas may be applied to social work, and how effective social construction research may be in researching practice. Payne, M. (2005). The origins of social work: Change and continuity. London: Red Globe Press. This book examines the development of social work and continuing themes in its social construction as a profession within different welfare regimes. Payne, M. (2006) What is professional social work? (2nd Ed). Bristol: Policy Press. An extended discussion of the points summarized in this chapter about the social construction of social work within the three perspectives. It also examines the construction of practice from ideas about social work, its values and its organizational setting, and deals with issues such as globalization, power and professionalization.

The social construction of social work theory

What is professional social work? and The origins of social work: Change and continuity are related to the present book and its account of how practice theory constructs social work. Together, they give an extended account of the social construction of social work as a social phenomenon, a practice activity and a profession.

Websites http://ifp.nyu.edu/ Information for Practice is a regularly updated website with extensive resources about all forms of social work. http://www.ifsw.org/ The IFSW website provides access to national associations of social workers and codes of ethics across the world, many of which have useful resources. It also contains the International Definition of Social Work and international codes of ethics. https://www.scie.org.uk The Social Care Institute for Excellence is a useful information resource, and gives access to Social Care Online, a searchable database of information about social work and social care. https://player.fm/podcasts/Social%2520Work A useful listing of social work podcasts.

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CHAPTER 2

Evaluating social work theory MAIN CONTRIBUTION Practitioners benefit from thinking about how to evaluate the range and usefulness of the practice theories available in social work.

MAIN POINTS ●●

●●

●●

●●

●●

●●

●●

32

A developing range of theories contribute to social work practice. These can be divided into 15 groups, each informed by distinctive theoretical ideas. There are two main approaches to choosing which theories to use: selection and eclecticism. Most social work practice uses managed eclecticism  – theories are combined by agreement in agencies and teams. Two alternatives to using practice theory are the direct use of important theoretical ideas and a concern with evidence of effectiveness in achieving outcomes desired by clients or agency policies. The direct theory position identifies important social thought and psychological ideas from so-called brand-name psychotherapies that can offer useful guidance to influence social work practice. Evidence-based practice (EBP) is the main effectiveness position. It proposes that practice should be based on objective knowledge from the social sciences, mainly psychology, of what is effective in practice in achieving desired outcomes. EBP accepts that such objectivity is possible. Social construction, empowerment and critical realist views of knowledge are important interpretivist positions, which contest the validity of objective knowledge of psychology and social relations guiding practice. Decisions about using practice theory are influenced not only by evidence and theoretical ideas, but also by wider policy and the agency’s decision-making processes.

Evaluating social work theory

Major statements The major recent textbook reviews of social work indicate the range of social work practice theories that are available for practitioners to use. These reviews are presented alongside each other in Figures 2.2 and 2.3, later in the chapter. Using practice theory is an important way of evaluating theoretical positions to see how they can be used in practice. Practitioners need to consider alternative views about using theory in practice: the effectiveness and theoretical positions. An authoritative and complex account of how to operate in accordance with evidence-based principles is in Gambrill’s US texts, most recently in Gambrill (2019). Sheldon and Macdonald (2009) offer a wide-ranging UK text with a similar approach. Gray, Plath and Webb (2009) is the major account of the critical position, providing a thoughtful, but not wholly negative, critique. There are several collections of essays that present various positions and arguments about the debate. Otto, Polutta and Ziegler (2009) is the best, containing contributions from many American protagonists in the debate, as well as more philosophical and critical comment from European writers. Books by Garrett (2018a), Gray and Webb (2013a, b) and Hodgson and Watts (2017) offer insights into what the direct use theoretical position, mentioned in Chapter 1, offers.

The main groups of practice theory Social work practitioners can choose to work using a wide range of practice theories. In this chapter, I aim to help you choose the ideas you want to use. My starting point is to classify the theories into groups. This classification divides the ideas into categories, relying on important differences between the theoretical ideas that underlie the different groupings. Most practitioners do not separate theories completely in practice. Therefore, later in the chapter, I move on to look at two important options: selecting from among the theories and combining aspects of different theories eclectically. To help you decide on selecting or combining theories, I also look at the value of the direct use and evidence-based approaches to practice, which intersect with the categories of practice theory. As a result, we look for and use social science scholarship and empirical research to show how each group of theories helps us achieve effective social work practice.

 lassifying practice theories: comparative reviews of social work C practice theory This section deals with the first of these tasks, identifying the main groups of theories available. Until the 1970s, most theoretical debate in social work focused on various forms of psychodynamic theory (see Chapters 4 and 5). Roberts and Nee’s (1970) review of social work theory, for example, looks mainly at alternative psychodynamic theories. From the 1970s onwards, other theoretical positions emerged, mainly in criticism of psychodynamic theory (Payne, 2005: Ch. 9). These alternatives became divided up to form groups of practice theories, each incorporating new ideas as it developed. In each edition of this book, I have compared books that review practice theories to identify the theories covered in the literature, and Payne (2020a) collects these comparisons in a

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table. You can look at this table on the Internet to get a historical view from 1970 to date. It shows that, while the range of practice theories used in social work has remained stable for several decades, there are innovations. I carried out this exercise again for this edition of the book, and the results are summarized in Figure 2.1. It shows that recent reviews of theory mainly discuss 15 groups of theories. These form the basis of the theory chapters (4–18) in Parts 2–4 in this book. Two groups of theories cover a big range, psychodynamic theory and social construction. I have, therefore, divided different aspects of the theory and dealt with them in separate chapters. Each column in Figure 2.1 says something about the usefulness of these practice theories. In the first column, I list the 15 groups of social work theory. Different countries, agencies and practitioners use some more than others. The second column classifies these groupings according to the global definition of social work’s three main objectives, which I discussed in Chapter 1 (see Figure 1.6). I have categorized theories according to whether they mainly seek social cohesion, empowerment and liberation or social change and development objectives. These objectives form Parts 2–4 in the later part of the book. Two groupings of theory, macro practice/social development/social pedagogy (Chapter 10), and empowerment/advocacy (Chapter 14) contain a balance of two social work objectives. The second column, therefore, mentions both relevant objectives for these groups of theory. I have placed these chapters in the section that I think most accurately describes them: Chapter 10, on macro practice/social development/social pedagogy, in the social cohesion section and Chapter 14 on advocacy/empowerment in the empowerment and liberation section. In the third column, I set out that practice theory’s ‘claim to fame’ – the distinctive contribution it makes to the range of social work practice ideas available to us. I expand these statements at the beginning of each theory chapter. The theories’ different objectives and their different contributions to practice overall are what make each group of theories different from the others. In the next subsection, I look in more detail at how I arrived at my comparison between reviews of practice theory.

Reviews of practice theory Several writers and editors have reviewed and compared a range of social work theories. Figures 2.2 and 2.3 summarize the coverage of some of these published since 2012, when the previous edition of this book was prepared. Column one of each table lists the coverage in this edition, so that you can compare other books with this one. Both tables list the main categories of theory covered by reviews of social work practice theories, excluding material that is not about specific practice theories. It also gives the national location of the authors or editors at the time of publication. By comparing them, you can see what theories different authors and editors select and how they classify them. This allows you to test out the judgements I have made in setting out 15 main areas of theory. Figure 2.2 contains listings of the theories in books that distinguish many different theories and hence provide a broader perspective (for example, Teater, 2014), while Figure  2.3, later in the chapter, covers books that take a more selective approach with more detailed reviews of particular theories (for example, Musson, 2017). Both are set out across two pages.

Evaluating social work theory Chapter Theory group

Social work objectives

Contribution to practice

4

Psychodynamic: relational practice

Emphasizes the importance of people’s internal feelings and conflicts expressed in their relationships in generating and resolving the problems that they face.

5

Psychodynamic: attachment practice

Focuses on caregiving by providing a ‘safe haven’ for people, ‘a secure base’ to explore the world. Regulates emotions through close relationships, helping people deal with stresses and traumas.

6

Crisis-, trauma- and taskcentred practice

Focuses on brief structured models of intervention with clearly defined problems that may have traumatic mental health consequences, and will respond to active efforts to resolve them.

7

Cognitive behavioural practice

Emphasizes the importance of rational management of behaviour in understanding the source of and managing people’s problems.

8

Motivational interviewing

Defines stages of movement through personal change and builds alliances between worker and client to generate motivation towards change.

9

Systems, complexity, chaos

Aims at social integration, resolving chaos, complexity and uncertainty by combining work with individuals and with families, communities and social agencies.

10

Macro practice, social development, social pedagogy

11

Social construction: strengths and solutions

Forward-looking social constructions help recast apparent problems, looking for strengths, positive solutions and resilience.

12

Social construction: narrative practice

Enables people to express and work on issues in their lives through exploring and shaping understanding of their personal and social impact.

Social cohesion

Social cohesion/ empowerment

Empowerment 13

Humanistic, existential, spirituality

Gives priority to the social and educational, engaging people with shared interests and concerns to work jointly to overcome them.

Emphasizes personal development through shared experience as a source of individual and group empowerment.

Figure 2.1  Groups of practice theories and their contribution to practice

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Thinking about social work theory Chapter Theory group

Social work objectives

14

Social justice, advocacy, empowerment

Empowerment/ Social justice practice, advocacy and social change and empowerment aims for personal fairness, development recognition and social justice and to represent disempowered people to overcome barriers and gain powers of decision and action over their lives.

15

Critical practice

Offers critiques to the present social order, analysing and dealing with the social and practice factors that underlie problems and social barriers.

16

Eco practice

Confronts environmental injustice by strengthening people’s capacity to respond to environmental change, working around ecological crises and connecting the natural and social worlds.

17

Feminist practice

18

Anti-oppressive, Indigenist and cultural sensitivity practice

Social change and development

Contribution to practice

Explains and responds to the oppressed position of women in societies through collaborative dialogue and groupwork to achieve consciousness of issues that affect women’s social relations. Focuses on cultural and ethnic barriers, conflicts and differences in societies, respecting people’s identities and responding to oppression because of cultural and ethnic difference.

Figure 2.1 (continued)

PAUSE AND REFLECT  Choosing theories as useful in your studies and practice Looking at Figures 2.2 and 2.3 allows you to think about how different authors and editors have classified and selected theories for coverage. What conclusions do you reach about choosing theories to focus on in your studies and in social work practice?

Some suggestions Comparing the tables as part of this reflection task raises a variety of issues. First, what theories are most commonly covered in reviews of theory? Only cognitive behavioural and related theories and some form of humanistic ideas appear in every review. Other theories that recur in most of the books are: psychodynamic, crisis, task-centred, systems, strengths, solution-­ focused and empowerment ideas. From this, I conclude that understanding these theories offers practitioners a good awareness of the theories most widely discussed in the practice theory literature and most likely to be used in their agency. A well-educated practitioner should be able to understand the contribution of at least these theory groups.

Payne (this book) – UK

Stepney & Ford (2012) – UK

Trevithick (2012) – UK

Thyer, Dulmus & Sowers (2012) – US

Psychodynamic

Psychodynamic

Psychosocial

Psychosocial

Teater (2014) – UK

Langer & Lietz (2015) – US

Individual & family development

–relational –attachment Crisis

Cognitive behavioural

Task-centred Task-centred Cognitive behavioural Behaviourist Cognitive

Motivational interviewing Systems, complexity and chaos Ecological systems

Crisis intervention

Crisis intervention Task-centred Cognitive behavioural Cognitive behavioural Respondent learning Operant learning Genetic

Motivational interviewing Stages of change Ecological

Task-centred Cognitive Behavioural

Ecosystems

Systems

Ecological, systems

Social constructivist

– strengths, solutions

Strengths

Counselling Existentialist

Community social work Groupwork

Figure 2.2  Wide-ranging theory reviews

Person-centred

Task-centred Cognitive behavioural

Strengths Solution-focused Person-centred

Person-centred

Community work Small group

Groupwork

Ecological systems Collaborative

Strengths Solution-focused Narrative Humanism, clientcentred

Strengths Solution-focused Narrative Client-centred Existential Emotion-focused

Evaluating social work theory

Macro practice, social development, social pedagogy

Crisis

Attachment Self-psychology Crisis intervention

Motivational interviewing Transtheoretical

Social construction

– narrative Humanistic, existential, spiritual

Problem-solving Relational

Attachment

Crisis, task-centred

Coady & Lehman (2016) – US/Canadian

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38

Advocacy, empowerment

Radical, activist

Conflict

Feminist

Empowerment

Family systems Organizational

Payne (this book) – UK

Deacon & Macdonald (2017) – UK

Psychodynamic

Psychoanalytic Psychodynamic Human growth & development Psychosocial Functional Problem-solving Relational social work Relational theory Attachment

– relational – attachment Crisis, task-centred Cognitive behavioural

Cognitive Behavioural

Systems, complexity, chaos

General systems, ecological

Social construction

Social constructionism

– narrative

Crisis, disaster, trauma Trauma informed Task-centred Cognitive behaviour Cognitive Neuroscience Social learning Mindfulness

Motivational interviewing

– strengths, solutions

Turner (2017) – Canadian

Feminist

Feminist & critical

Feminist

Empowerment

Empowerment

Empowerment

Lishman, Yuill, Brannen Thompson & & Gibson (2018) – UK Stepney (2018) – UK

Payne & Reith-Hall (2019) – UK

Psychodynamic

Relationship-based

Relational Attachment

Crisis intervention

Crisis intervention

Task-centred Cognitive behavioural

Task-centred Cognitive behavioural

Motivational interviewing

Task-centred Cognitive behavioural

Motivational interviewing

General systems

Systems, complexity, chaos

Chaos Constructivism Social construction Solution-focused Role

Solution-focused Narrative

Solution-focused Narrative

Strengths Solution-focused Narrative

Thinking about social work theory

Critical Critical Eco Feminist Anti-oppressive,indigenist, Anti-racism cultural sensitivity

Humanistic, existential, spiritual

Humanistic

Person-centred Existential Four forces Gestalt Hope Hypnosis Meditation Neurolinguistic programming

Social/community development, pedagogy

Social networks

Person-centred planning Counselling

Community practice Life space

Critical Eco Feminist Anti-oppressive, indigenist cultural sensitivity Advocacy, empowerment

Radical Feminism Anti-discriminatory Models of disability

Ecopsychology Feminist

Mindfulness Macro Community social work Local social development Group work Mediation Social pedagogy Ecological

Oppression Empowerment Resilience Electronic exchanges

Social pedagogy Critical Ecocentric Feminist Anti-oppressive Indigenist

Activism & advocacy

Family therapy

Empowerment Advocacy

Evaluating social work theory

Figure 2.2 (continued)

Existentialism

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40

Thinking about social work theory Payne (this book) – UK

Gray & Webb (2013) – Musson (2017) – UK Australian

Psychodynamic – relational attachment

Psychodynamic Psychoanalytic Attachment

Attachment Grief and loss Problem-solving

Cognitive-behavioural

Behavioural Classical conditioning Operant conditioning Social learning Cognitive-behavioural

Crisis, task-centred

Cognitive-behavioural

Motivational interviewing Systems, complexity, chaos

Harms & Connolly (2019) – Australia Psychodynamic Person-centred

Cognitive-behavioural Behavioural

Systems Biological Ecological

Social construction – strengths, solutions – narrative

Humanistic, existential, spiritual Social/community development, pedagogy Ecocritical, ecocentric Critical

Feminist Anti-discriminatory, cultural sensitivity

Ecological Critical Structural Feminist Multiculturalism

Strengths Solutions-focused

Strengths-based Solution-focused Narrative

Humanistic Existential

Mindfulness

Radical, structural Marxism Feminism

Feminist Indigenous Anti-oppressive

Advocacy, empowerment Neo liberalism

Figure 2.3  Selective theory reviews

Second, is there an accepted way of grouping theories? There is no universally accepted method of grouping ideas together. Theories that some writers and editors group together are sometimes disaggregated. The most disaggregated presentation is by Turner (2017), who covers 38 theories. Most reviews collect theories into between 10 and 12 groups. Among the theories most commonly disaggregated are psychodynamic, social construction and humanistic groupings and, less frequently, cognitive and behavioural theories. Third, have the theories covered changed over time? While there is little obvious variation over time, one area of theory, eco practice, is differentiated only in books published in 2017

Evaluating social work theory

and later, so this represents a new perspective. This must be distinguished from ecological systems theory, a form of systems theory that has a longer provenance. Another variation over time is a shift since 2010 from covering a broad psychodynamic or psychosocial perspective. Now it is more common to distinguish relational and attachment theory as separate derivations from psychodynamic theory. This represents a further innovation in the last ten years. Fourth, are there any differences in emphasis? Different writers and editors emphasize different aspects of theory, and you can evaluate their approach and political concerns by examining their choices. These reflect a theoretical perspective (that a theory is important from their point of view) or editorial judgements (that a theory is relevant to a particular country or group of readers). For example, Gray and Webb (2013a) focus mainly on critical sociological theories, and Thyer et  al. (2012) and Musson (2017) disaggregate cognitive ­behavioural ideas more fully than other writers and editors. A final point on different emphases is about the different aims of social work, according to the IFSW Global Definition, which I considered in Chapter 1. Much of the coverage emphasizes psychological theories with a social cohesion objective, rather than empowerment or social change theories. In addition, except for feminism and empowerment, social change theories do not usually appear in books from North American sources. I conclude from this and the previous point that there is disagreement over whether some theories are useful in some national contexts or services. For example, social change theory is not considered central in the North American social work literature, but is debated (hotly and extensively) elsewhere. Moreover, practice theory focuses on psychological theory for social cohesion objectives, although some empowerment theories are also valued. On the other hand, practice debate about social change is shifting towards applying ideas about social relations and structures directly, rather than devising practice theories to implement social change objectives. As a result, many writers encourage practitioners to develop and apply useful skills alongside theoretical awareness, rather than developing the sort of practice theory reviewed in this book that draws specific practice prescriptions from theoretical positions. Given the extensive range of different social work practice theories, how do students and practitioners make decisions about which theories they will study and use in practice? The rest of this chapter explores ways of evaluating theories for practice, and Chapter 3 moves on to look at how you make the links between the theories and ideas that you find useful and the decisions and actions you take in practice.

Using theory selectively and eclectically There are two main approaches to dealing with the problem that there are so many theories potentially available: selection and eclecticism. To use theory selectively, you review the theories and then select one group of theories to use as the basis of practice. To do this, you use evidence from research and scholarship about how a theory might help you achieve the outcomes you and your clients are aiming for. Selectivity is common in specialized agencies, where the theory works well for the specialism. For example, although you can theoretically use crisis intervention (see Chapter 6) in a variety of situations, it is mainly used explicitly in agencies dealing with mental health emergencies, often involving psychiatrists, psychiatric nurses and others as well as social workers. This

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theory originated in mental health settings and so it may be particularly relevant in them. In the USA, other emergency services, such as the police, use it when dealing with disasters and emergency situations. Services dealing with emergencies with a strong emotional component, such as rape and domestic violence, also employ it. Selecting crisis intervention as your main theory means that workers coming from different professional backgrounds can share the same ideas in their different roles, speak the same theoretical language and understand each other’s actions. Selectivity, therefore, often works well in multiprofessional work. Eclecticism means taking ideas from several theories and combining them to produce a style of work that suits the agency and the capabilities and preferences of the individual practitioners. Research and debate in social work has led to a wide acceptance that everyday practice is usually eclectic (Coady & Lehmann, 2016). In clinical psychology, eclectic practice is a model of practice, and Coady and Lehmann use the theoretical discussion and research underlying its use there as part of their argument for eclecticism in social work. It is quite common, too, for writers of theory to combine elements of different theories. A good example is Blood and Guthrie’s (2018) book in working with older people using attachment and strengths theories (see Chapters 5 and 11). A caution, however: theoretical eclecticism that works in counselling or clinical psychology practice might not transfer fully to the different context of social work. Critics of an eclectic use of theory worry that it leads to practitioners making personal choices so that they feel comfortable with the ideas they practise with, when evidence might suggest that other alternatives might be better (Sheldon & Macdonald, 2009: 46). Theoretical inconsistency is another potential problem: practitioners might use theories in ways that are internally inconsistent or debase the full theory. This is because it is difficult to keep in mind the possible implications of all social work theories and to use them with credibility. It is also not practical to use many theories in depth without going into them in considerable detail. This requires considerable supervision and support in their application, which not every agency can provide. In many agencies, therefore, it makes sense for practitioners, managers and policy-makers to come to an agreement about combining points that are relevant to practice in that setting. Being eclectic is thus something that that we should do consistently, in a planned way. Testing out our decisions against agency policy and with a team of people working together is better than being eclectic on a casual or an individual basis (Epstein & Brown, 2002: 268–9).

PAUSE AND REFLECT  How to use selection and eclectic practice From this discussion, look at your present work setting or, if you are a student, a setting you want to work in. Make notes about any preferred main group of theories that are relevant to it and other ideas that you might use eclectically alongside that group of theories.

This book aims to provide a starting point, allowing you to move thoughtfully on to literature on theories that are relevant to the clients that you practise with. Each chapter starts with a section on the main contribution that each theory makes to practice. This should help you

Evaluating social work theory 43

compare and choose within the range of theories. Each chapter lists the major practice ideas and concepts relevant to each theory near the start of each chapter. This should help you to identify useful concepts to transfer into an eclectic practice. Next, there is a brief summary of the debates about that theory, so that you can pick up quickly what people argue about. I expand on these debating points later in the chapter. A more detailed account of the theory appears in the main part of each chapter, and additional resources listed at the end of the chapters help you to explore the idea in greater detail if you, your agency and your team want to do so.

Some suggestions To sum up this discussion, my suggestions for a reasonable approach to selecting theories and eclecticism are as follows: ●● ●● ●●

●●

●●

●●

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Start from the agency’s and professional expectations and preferences. Connect these to the needs and preferences expressed by your clients. Build on these expectations, needs and preferences, in debate with team colleagues, adapting to new ideas as they become available and you have tested them out. Try to identify theoretical models whose main contributions to social work are relevant to your setting. Identify practice ideas and concepts from different theories relevant to your setting that are used in or available for your setting. Specialist settings might use a realm of theory; for example, a women’s refuge might explicitly use feminist theory. The agency might attract workers already committed to feminism, or workers might go there to develop this theoretical emphasis in their repertoire. Within general agencies, workers might decide to use one theory in greater depth with appropriate people. This would be backed up by team decisions, supervision, peer support and training. As many social workers now work in multiprofessional settings, you may need to use or at least understand the theories used by your colleagues. This also makes it important to be explicit about the theories you are using.

Throughout such a process, you need to evaluate the evidence for effectiveness in the practice you are concerned with, as well as looking at your own perceptions and feelings. It is also important to test your ideas against the needs and wishes of clients, their families and carers, because you are selecting ways of working with them and incorporating their objectives in what you are doing. It would be wrong to use theories that seem congenial to you if they are unacceptable to clients. The following case study of how a four-tier model of children’s mental health services in the UK builds on an NHS Health Advisory Service Report (1995), and shows how different tiers call for varying theories. Tier 1, universal services, deals with low-level emotional and behavioural difficulties. The case study writer works in Tier 2, community Child and Adolescent Mental Health Services (CAMHS), with mild to moderate mental health problems. Tier 3, specialist CAMHS, addresses more severe, complex or enduring disorders. Tier 4 includes specialist day units, hospital outpatient teams and inpatient units.

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Case study: Selecting from theories to develop an eclectic agency practice (The case study and associated text have been written especially for this book by Emma Reith-Hall) The case study that follows is more extensive than the case examples used in many parts of the book. It explores in some detail how an agency arrived at its selection of theory, and the way in which different uses of theory are combined within the agency’s organization to provide a comprehensive service using a range of theories

of practice. It describes the theoretical organization of practice in a community CAMHS in a medium-sized city. It starts from the significance of attachment theory (see Chapter 4) as a basis for the service’s practice and then goes on to explore possibilities for using other theories. The service deals with the mild to moderate mental health problems and emotional and behavioural difficulties of children and young people from infancy to the age of 18 years.

Throughout the 1970s and 1980s, literature on attachment theory centred on work with babies and toddlers, revolutionizing Tier 4 services; that is, children’s hospital and day-care provision (Belsky & Rovine, 1988). This did not, however, address the challenge of working with older children who present with attachment difficulties – the children typically referred to community CAMHS. Recent research and literature on attachment does address working with older children and adolescents, yet it focuses on fostered or adopted children, understandably so given that attachment difficulties in children are closely related to ineffective, neglectful or even abusive parenting practices. In our city, this client group falls within the remit of our Tier 3 Specialist CAMHS Looked After Children Team, which provides consultation to professionals and carers around the mental health of children and young people in foster or adoptive care. Similarly, the more severe cases of attachment difficulties (a disordered or disorientated attachment pattern, no attachment pattern or the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) diagnosis of ‘Reactive attachment disorder’ [American Psychiatric Association, 2013]) would fall within the remit of the Tier 3 Specialist CAMHS Emotional Disorders Team. However, I do not work with fostered or adopted children. Typically, the cases seen by Tier 2 Community CAMHS involve low to moderate attachment difficulties, and the children often remain with their birth parents or families. This is sometimes the context within which attachment difficulties have occurred. The prevalence of these cases is high, although exact numbers are hard to establish because referrals usually cite the behavioural or emotional presentation displayed by the child rather than the cause of the difficulties, which is often attachment-­related. From clinical practice, I would estimate that one-fifth of the Tier 2 Community CAMHS cases involve attachment difficulties. Although attachment difficulties often appear in children who remain with their birth parents, there is a dearth of research and literature on working with attachment difficulties within the birth family context. Hughes (2009), writing about the importance of attachment-­ focused work for all families, is one notable exception. Attachment is one of the complex influences on children’s development and the emotional, behavioural and social difficulties that are typical of those referred to Tier 2 Community CAMHS. Attachment difficulties can manifest in an internalized way, whereby children present with anxious or depressive symptoms and indulge in soothing behaviours such as

Evaluating social work theory

rocking, biting or picking at their skin. Alternatively, these difficulties can manifest in externalized ways, with the children displaying anger, aggression and poor impulse control. ‘Attachment theory provides a framework within which we can understand the children and the behaviours they are displaying’ (Golding, 2008: 71). The Tier 2 service uses three levels of intervention, which will all be considered here. These include direct work with the child, direct work with the parent and consultation. Direct work with the child is the intervention most often requested by referrers. Parents, carers and professionals often refer children assuming that they need direct work to ‘fix’ their emotional and behavioural problems. However, all types of direct work with the child alone have limited use where there are attachment difficulties, as supported by the literature on the subject. The idea that therapy can ‘cure’ children comes from a medical model, setting up the expectation that treatment can be used to make the child better. Therapies aimed at helping children to modify their behaviour ‘do not take into account core deficits they have in managing their emotion or in living within relationships’ (Golding, 2008: 79–80). Attachment theory tells us that attachment difficulties lie within the parent–child relationship rather than within the child in isolation. Thus, working with the child alone, whatever intervention is used, is not only counterintuitive, but may also serve to compound the child’s difficulties further. Locating the relational problem of attachment difficulties within the child further pathologizes them, and might have a detrimental impact on their already negative self-view. Until issues within the family environment are addressed and caregivers can provide emotional support, direct work with the child alone is not appropriate. Services therefore increasingly recognize that therapeutic work should only take place when the child is in a safe, secure and contained environment (Golding et  al., 2006). Harrington (2003: 51) argues that ‘no treatment for the child is likely to succeed if basic needs such as security of family placement are not met’. Providing children with the message that their distress can only be managed by a therapist can be unhelpful, as it suggests that their caregivers cannot bear or contain their hurt (Hunter, 2001). In addition, if a child has an anxious-avoidant pattern of attachment (see Chapter 5 for further information), it reinforces the child’s existing view. With attachment difficulties, then, cognitive behavioural therapy (CBT) and other behavioural approaches, which seek to ‘change’ the child, present difficulties. CBT works on the premise that it is not a given situation that is problematic, but the child’s response to it that causes difficulties. Yet for children with insecure attachments, the behaviours they display help them adapt to the environments in which they live; thus, it is the situation that needs to change, not the child’s response to it. Using CBT to challenge the child’s core belief will be ineffective and inappropriate while the relationship with the caregiver is uncertain and insecure, as the child’s belief is adaptive to the situation. Play therapy is another alternative approach, in which children are enabled to make sense of their situations through play. Golding et al. (2006) describe role-play scenarios from which ‘children are able to explore simultaneously the feelings and actions of the adult, hear the child’s responses from the therapist, and gain some mastery over a painful situation, perhaps by changing the outcomes of expressing their own story and previously hidden feelings’ (Golding et al., 2006: 310). This might help ‘looked-after children’ (the UK term for children in the care of the local council), but children who remain in the same family relationships

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from which their attachment difficulties have arisen find it difficult to make sense of the past when the difficulties remain in the present. In the light of these difficulties, therapeutic approaches that address attachment difficulties within the context of the child–parent relationship may be more beneficial. Family therapy provides one such approach. The family is supported to view itself from a different perspective, to move away from entrenched behaviours and patterns of interaction towards identifying alternative solutions (Herbert, 1999). However, many of the children seen by the Tier 2 Community CAMHS do not meet the threshold of experiencing a ‘severe and enduring mental health problem’ that is required for working with the Tier 3 specialist family therapy team. Interventions that focus on increasing the responsiveness and sensitivity of the caregiver are a key treatment approach for children with attachment difficulties (Bowlby, 1988; Hughes, 2006, 2009; Golding, 2008). They can also be implemented even when the child does not want any therapeutic input (Hunter, 2001). Community CAMHS provide attachment-based sessions to parents that are based on the Solihull Approach and House Model of Parenting. These, alongside parenting programmes (for example, Webster-Stratton, Triple P, Strengthening Families and 1-2-3 Magic), aim to teach parents how to manage the emotional and behavioural difficulties that children and young people display. Parenting interventions take time, patience and support. The literature on attachment difficulties suggests that the child must experience a secure and safe relationship with the caregiver before behaviour management techniques can be effective (Douglas and Brennan, 2004; Hughes, 2009). In fact, parents need to demonstrate availability and nurturing care despite any difficult behaviour displayed by the child if attachment difficulties are to be addressed. Therefore, parents need support to meet their children’s emotional needs before attempting to address behavioural difficulties. The Solihull Approach, developed in 1996, is a brief early intervention model that provides professionals with a framework for supporting parents in thinking about their children’s emotional and behavioural difficulties within the context of the parent–child relationship. Parental emotions and anxieties are processed through containment, allowing problem-­ solving abilities to be restored. Reciprocity focuses attention on the attunement between parent and child, helping to foster a better emotional connection. The Solihull Approach uses these key concepts underpinning attachment to provide a theoretical focus for practical interventions in behaviour management, providing a resource pack for addressing this. In a small-scale study with health visitors, the Solihull Approach was found to decrease parental anxiety by 66 per cent and reduce the severity of children’s difficulties after three sessions (Douglas and Brennan, 2004). The Solihull Approach has now been developed for use by other professionals and has been endorsed by our service. The training is being rolled out and the concepts integrated into our work. For example, our CAMHS mental health assessments now incorporate the Solihull Approach Assessment, enabling us to identify attachment difficulties from the outset, and influencing the treatment plan. The House Model of Parenting (Golding, 2008) aims to help older children and caregivers build more secure attachments. It consists of: ●● ●●

●●

the ground floor – a secure base; the upper floor – parenting with playfulness, acceptance, curiosity and empathy (PACE; see later in the chapter); the roof – behaviour management.

Evaluating social work theory

For the ground floor, Golding (2008) describes five features conducive to building a secure base, which enables a balance to be attained between the child’s attachment and exploratory systems. First, the parent will need to provide empathy for the feelings behind the child’s behaviour. Conveying this back to the child ensures that their internal experience is accepted, even when their behaviour is not. Second, ‘the experience of attunement with a responsive, sensitive parent is a pre-requisite for a secure attachment’ (Golding, 2008: 115). Attunement is the emotional connection between child and parent, whereby enjoyable experiences are amplified and stressful experiences are contained. At times when children are disciplined, attunement will be broken, hence the emotional connection must be repaired. Parental reassurance shows the child that the relationship has not been damaged. Third, the adults in the household need to maintain a positive family atmosphere with consistent attitudes, values, rules and norms. Golding (2008: 128) suggests that ‘living in a calm accepting atmosphere with a high level of empathy and support will gradually help the child to learn about the emotions she experiences and manage these in a self-regulating way’. Fourth, as parents control the emotional rhythm of the house, the child experiences a sense of belonging. Fifth, the importance of parental self-care, through rest, relaxation and support, is highlighted. The upper floor of the house focuses on building a deeper relationship with the child. Parents are encouraged to adopt the PACE attitude (Hughes, 2009; Golding & Hughes, 2012). Playfulness emphasizes the importance of the parent and child enjoying each other’s company and spending quality time together. Curiosity encourages parents to understand the child, to wonder about the meaning behind the behaviour displayed. Acceptance involves demonstrating to the child that their inner feelings are acknowledged and valued. The parent expresses empathy for the child’s thoughts and feelings before implementing guidance and boundaries. The roof of the house represents managing difficult behaviour. Different strategies are required for different problems and must take into account the age and stage of the child’s development. Regardless of the strategies used, parents need to be interested, attentive and empathic to manage the child’s behaviour difficulties. From this, parents need to provide routine, structure, and firm and consistent guidance and boundaries. Consultation is a method of engaging the network around a child, and is increasingly receiving support from research into its effectiveness and flexibility (Golding, 2004). Consultation benefits consultees by providing them with a space to reflect on a child’s difficulties and how to address these, and to consider the impact the child has on them both personally and professionally. Consultation benefits CAMHS practitioners as it helps to contain the anxieties of professionals within the network, builds the capacity and skills of other professionals, moves away from seeing the CAMHS staff as having an ‘expert’ role, supports multiagency working and informs the intervention plan. Consultation is an effective intervention for children with attachment difficulties, and it has therefore become a primary intervention used with looked-after children. ‘The most effective way to change a child’s behaviour in the short term is to change the context. This can be accomplished in various ways, such as parent training programmes, but for children who are looked after, consultation has emerged as a particularly effective way of making changes in the network’ (Dent & Golding, 2006: 170). Consultation recognizes the importance of strengthening the relationships between the child and the people already involved in their lives, rather than expecting children with relationship struggles to develop a new relationship with a therapist.

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Consultation is also being adopted as the model of choice for mental health practitioners working in school settings (Dickinson, 2000). It can help networks around the child, including family members, social workers and school staff, to consider the child’s behavioural difficulties in the context of their attachment relationships. This helps the adults to understand the child’s feelings that underpin their challenging behaviour. In turn, this can foster helpful changes within the network. Supporting school staff is crucial for CAMHS work, since the school context plays a key role in children’s emotional health and well-being. For example, a school teacher who recognizes and implements aspects of PACE within the school context, such as expressing empathy for the child’s feelings before implementing school rules, can make a big difference. ‘Feeling understood and experiencing empathy is the starting point from which children develop trust and new ways of relating to people’ (Golding, 2008: 71). Consultation can help professionals to build more positive relationships with a child who is struggling with trusting and relating to adults, and to gain an understanding of how these children can be helped to overcome attachment difficulties. One model of consultation used in Tier 2 CAMHS teams is a solution-focused consultation. This invites the network to identify their goals by identifying what a preferred future would look like. Scaling questions and tools are used ‘to establish progress already achieved, to allow for the exploration of what the consultee has done that is useful and to establish detailed pictures of the way forward’ (George, 2005: 60). A solution-focused consultation is particularly suited to large professional networks, helping them to consider the past, present and future implications of complex decision-making (Bremble & Hill, 2004). This case study shows how local managers adopted locally the structure for this service, which had been presented in a national report, and then selected theories relevant to their practice from each part of the structure. A new practitioner appointed to a job in the service might see this as a given, but it is always possible to see where the structure and theoretical decisions came from. Over a period, practitioners can see theoretical ideas being picked up and adapted by managers and colleagues to be used in the local context.

 heory in group, macro, residential care and family T therapy practice The case study just presented is an example of how managed eclecticism in the use of practice theory emerges in a social work service. Another aspect of eclecticism arises when theory is adapted so that it is relevant to different forms of practice. Many writers distinguish three forms of social work, called modalities in the USA: work with individuals and families, usually called casework until the 1970s, groupwork and community work, now sometimes called macro practice. In most practice settings, as in the case study of CAMHS, work with individuals and families is the main form of practice, other forms of practice sometimes being added to it. In the USA, using more than one modality together is called integrated practice. This means something different to service integration in the UK, which refers to professions working in separate agencies cooperating to provide a holistic response to clients and families. Another issue of terminology is the meaning of clinical social work. In the USA, this refers to a psychotherapeutic practice, using social cohesion practice theories, and many

Evaluating social work theory

practitioners work alone, or are employed in fee-charging private practice agencies and in elite charitable agencies. Being able to practise clinical social work is mainly limited in the USA to practitioners with a master’s qualification with relevant specialisms. In other countries that do not follow the US system, the term ‘clinical social work’, if it is used at all, sometimes refers to social workers in healthcare settings. In addition to the three modalities, many practitioners work in residential care, and some do specialist kinds of work such as family therapy, counselling or psychotherapy. Others work in settings such as education or school social work, or practise using ideas built up in particular countries, such as in social pedagogy or social development. In the USA, organizing and managing agencies is also often treated as a form of practice (for example, by Thyer et al., 2012). In other countries, management is seen less as a social work practice and more as a responsibility of people in promoted posts, requiring separate training and education that is often based on business school or public administration education. The existence of these different forms of practice raises the question of whether there are theories designed to be used in these forms of practice, and of how social work and its theories connect with them. Most analyses of groupwork start from Papell and Rothman’s (1966) ground-breaking article. This offers three approaches, depending on the groups’ aims: ●●

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In the remedial model, groups bring together individuals who have problems, often in how they function in social roles, aiming to help them change their undesired patterns of behaviour. Any groupwork that aims to change behaviour is remedial in approach, for example, implementing solution-focused therapy in groups (Sharry, 2007). Encounter groups are normally regarded as a separate humanist and gestalt form of groupwork concerned with personal growth. Glassman (2009) developed a broader humanistic approach to groupwork (see Chapter 10). Groupwork is also possible using CBT methods. The reciprocal model emphasizes self-help and mutual support according to a programme devised by group members alongside practitioners. For example, hospices run groups for people who are bereaved (Finley & Payne, 2010) and care for family members who are dying (Reith, 2011). The social goals model, associated with social pedagogy or youth and community work, uses groupwork to pursue external goals, such as arts, community or education activities. For example, many agencies use arts activities to encourage educational, personal and social development and to stimulate family and social interaction (Hartley & Payne, 2008; Huss & Bos, 2020).

Recent developments in groupwork are more pragmatic (Trevithick, 2012b; Lindsay & Orton, 2014). Examples are time-limited groups aimed at meeting agency objectives to achieve individual change in clients, using shared activities and discussion focused on issues that the group members have in common; for example, young carers responsible for disabled or sick relatives (Richardson, Jinks & Roberts, 2009). These may involve elements of remedial, reciprocal and social goals objectives. A variety of theoretical perspectives can inform our understanding of what is going on in groups and devise helpful interventions (Crawford, Price & Price, 2016). These include cognitive behavioural, empowerment, humanistic and psychodynamic ideas, and I have drawn on these in the relevant chapters. Similarly, ­task-­centred practice has also been used and researched in group and family practice

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(Fortune, 1985; Epstein & Brown, 2002; Tolson, Reid & Garvin, 2003). Many practitioners therefore transfer and adapt ideas that they are confident in applying in one part of their practice to other aspects of their work. Heap (1992) argues that groupwork became more multidisciplinary and less central to social work practice; this is a worldwide trend. He also points out the growing importance of self-help and mutual-support groups in healthcare work with people with mental illness and long-term conditions. Supporting and stimulating such groups has become a major focus of groupwork development, often as part of community work and empowerment practice. One of the traditional modalities, community work, may be subsumed in ideas of social development and macro practice (see Chapter 10). Like groupwork, it is often practised in separate agencies and settings from the mainly psychological practice aiming at social cohesion. While it may connect with both empowerment and social change objectives, and critical practice, it can be used in social work agencies to achieve social change and empowerment as part of their range of services. Thus, it may be relevant to all three social work objectives, although its different timescale and focus may make it difficult to use alongside psychological interventions. Some writers include family therapy within social work theory (see Figure 2.2). In this practice, all or several members of the family are treated together on the assumption that their problems arise from interactions among them all. Family therapy is a multidisciplinary area of practice to which several professions, including social work, have made contributions. Some social workers use or borrow from family therapy and contribute to the development of family therapy theory and practice. Many social workers see themselves as practising social work with special relevance to families, and taking into account the family context as part of working with clients in their situation or social environment. In doing so, they often use systems ideas, which is the source of much family therapy. Similar points might be made about counselling and psychotherapy. These are, alongside clinical psychology, separate professions whose role overlaps with that of social work, particularly in healthcare or similar clinical roles. Some social work practice theories have been adapted from clinical psychology, counselling, psychiatry and psychotherapy, and social work overlaps with work in these fields, particularly in the USA, where social workers are involved in private clinical and counselling practice. Since this book focuses on theory that is formulated as part of social work practice, I do not differentiate the many counselling and psychological theories directly used in US social work that sometimes appear in North American texts. Counselling and psychotherapeutic knowledge also influence social work skills, in particular, communication skills (Bellinger & Fleet, 2012). Residential care is mainly a setting in which other treatment theories are used, rather than being a distinct form of social work activity justifying theories of its own. Clough’s (2000) typology of theory in residential care is as follows: ●● ●●

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Theories of the resident world are like theories of the social world. Theories of function and task in residential care are like theories of the nature of social work. Theories of intervention are like social work practice theories, and often use similar concepts.

Evaluating social work theory ●●

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Theories of residential homes as systems refer to the specific characteristic of residential social work practice that it needs so it can take account of the social organization of the location in which it operates. It would, and perhaps should, be worthwhile for practitioners in other settings to think more about the influence on their practice of the social organization of their location.

Social pedagogy is a key European perspective that has important relationships with groupwork, especially with children and with residential work. This is a general theory of social work that concentrates on social work as an educational and developmental process (see Chapter 10).

Direct use of social and psychological theory So far, I have been looking at how practice theories are divided up in reviews of social work theory. We saw in Chapter 1, however, that other knowledge and ideas are directly used in social work, and doing this intersects with practice theory. You either incorporate some of the direct use theory as you use a practice theory, or as you follow your skills training and agency requirements. Recent writing on social work theory (Sheedy, 2013; Ingram, 2015; Parrott with MacGuiness, 2017; Deacon & Macdonald, 2017) starts from important psychological, social and value themes that affect how we practise. Examples are emotion, poverty, power, risk, spirituality and stigma. Other direct use theories include understanding of important political movements that affect social policy and agency management. These include anti-­ discrimination, disability models, globalization, managerialism or new public management, neoliberalism and markets, and organization theories. Some direct use theory builds on ideas developed by important social thinkers such as Bourdieu, Butler, Habermas, Giddens and Foucault. To use these directly in practice, you follow agency and policy requirements and use your training in practice skills. Direct use involves being responsive to your understanding of the themes in what you do. Some approaches make connections with the main roles of social workers in agencies, treating practice theories as a secondary consideration in agency requirements. For example, Heslop and Meredith (2019) present different aspects of assessment as the main role of social work, buttressing this by a small number of practice theory perspectives on intervention. Lishman et al. (2018) also make assessment an important plank of practice, before exploring practice theories. Another influence is from brand-name psychotherapies, combining elements of person-­ centred, psychoanalytic, cognitive, systemic and behaviourist therapies (Holmes, 2001: 144). These are off-the-shelf practical guides to intervention in relevant situations. They are identified by memorable abbreviations or acronyms, pulling in elements of well-evidenced practice models and providing well-structured programmes of intervention. Examples are Acceptance and Commitment Therapy (ACT), Brief Attachment-Based Intervention (BABI), Dialectical Behaviour Therapy (DBT) and Mindfulness-based Stress Reduction Therapy (MBSR). We saw some examples of this in the case study on child and adolescent mental health services in this chapter. Some social work practice theories, such as motivational interviewing,

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solution-­focused and narrative practice (see Chapters 8, 11 and 12 respectively), are successful transfers of such brand-name psychotherapies into social work.

Evidence-based practice (EBP) EBP argues that we should base our practice on knowledge that comes from empirical evidence about what is effective in achieving our objectives. A group of social workers has been pushing for this EBP to be the normal mode of practice, but other groups contest it strongly. The debate is, therefore, an example of what I called in Chapter 1 a politics, people forming groups to influence what social work should be like. Similar debates are also taking place in medicine, nursing, clinical psychology and other professions, so EBP is an interdisciplinary movement of professional politics. I review the arguments in the subsection ‘The politics of EBP’ later in this chapter. Some arguments for EBP reject theory as being useful in social work, saying that much theory is simply ideas, not knowledge that comes from evidence. An example is the work of Thyer (2012a). This is a special case of the arguments that we met in Chapter 1 – first, that the term ‘theory’ often means insubstantial ideas about issues such as social justice and social change unrelated to reality, and second, that it should be reserved for explanatory theory rather than being used more broadly. In this way, some views of EBP want to exclude theoretical scholarship and debate from influencing social work practice.

Underlying EBP: positivism and interpretivism Webb (2001) points out that this is a long-standing philosophical debate. The debate is between positivism and interpretivism (Brechin & Sidell, 2000): ●●

●●

Positivists, among them many supporters of EBP, believe that the world is orderly and that it follows natural rules that we can come to understand. The world exists independently of human beings, and we can stand outside it and observe it objectively. Being objective means our observations are independent of our own feelings and beliefs and we can check our beliefs against the observations. Other people can also observe it, and we can compare observations to make sure that we are all seeing reality in the same way. Human beings are like objects to an objective positivist. They are animals in a natural world and behave according to rules that apply to objects of the human kind. If we observe them systematically, we can understand the rules that affect the inhabitants of the human world, just as we can understand the natural world. We can then apply that knowledge to create the desired changes. In doing so, we can be effective, because we can explain how one action causes another. Human beings are complicated, so it will be difficult, but positivists believe that it is possible. Interpretivists, who contest EBP, believe that human beings are independent, free to follow their will as part of the world, in relationships with other human beings, so they cannot be objective. Because we participate in human relationships, we inevitably influence the world we are studying, and in turn our understandings about the world will influence how we behave; that is, we are subjective. Interpretivists believe that human beings are subjects, meaning that they can freely take command of their thinking and their actions. Although

Evaluating social work theory

their actions affect others, in acting they also change themselves. This is so even though they may be constrained by the natural and social order of the environment around us. This view says that it is just not possible to collect all the necessary information to understand the rules of human life, so it is better to think about the world in a more flexible way. An example might help to explain these distinctions as they apply to everyday life. Case example: Shouting at the children Baz shouted at his children because they ran away from him and he was frightened they would get onto the road and be involved in an accident. They were upset because they thought he was being angry with them. Seeing this, he was angry with himself for

seeming aggressive rather than helping them to understand his concern. When they got home, he explained why it was important to be careful. The next time they went out, he reminded them that it was sensible to stay together and keep away from the traffic.

The positivist observes the behaviour and the reaction: does Baz keep the children out of danger? Yes, so his behaviour is effective. But interpretivists do not accept that people can be objective, that is, stand outside their actions. Baz is doing more than standing outside himself and looking at his behaviour objectively, because he does not just take for granted what happened; instead, he questions it. In questioning what happened, he shows that how people act and how others react to their actions will always affect each other in a circle of interactions. This is called reflexivity, and I discuss it further in Chapter 3. The interpretivist notes that whether the behaviour is effective depends on the question you ask. Yes, it is effective at keeping the children out of danger this time. But ask a different question: does this behaviour mean that Baz develops his relationship with his children so that they love and trust him, and as a result he can influence them successfully to keep safe in the long term? Doubtful. If we look at the later behaviour, the evidence might be that reasoning and advance reminders are more effective than shouting. The interpretivist view is, therefore, that social workers engage in relationships with people and explore together what is happening to gain a full and complex appreciation of the situation. People’s social objectives and values in their relationships are always a factor. Baz was affected by his children’s reaction: he did not want to be the kind of father who made his children fearful. So he adapted his behaviour. His behaviour was influenced by values and predispositions. Baz had ideas, drawn from experience of past relationships in his life and influenced by his wife’s views, about how a ‘good’ father should behave. In his marriage, he and his wife had agreed about ways of fathering that would be helpful or unhelpful in realizing that vision. In contrast, another father may think differently. Someone else may believe that it is all right to use his size, loud voice and status as a father to manage his children’s behaviour by dominating them. Since this father’s starting point would be different, he might consider the upset reactions of Baz’s children to be a satisfactory and appropriate response: perhaps they would remember to behave next time. We can see, therefore, that assumptions, perceptions and interpretations  – not only behaviour  – are important in understanding what happened.

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The development of EBP How do these ideas affect discussions of theory? To start with, why is this an issue for social work and its practitioners? Pragmatically, many practitioners in general social work settings have picked up ideas according to their interest or use. But, apart from your own feeling that some ideas are valuable, how can you tell whether one is more useful than another? Social work is used across the planet for a widening range of social purposes. Positivists would say we can find the rules that will tell us what treatment is effective to achieve our aims, while interpretivists ask instead how we can understand and work within a complex of human interactions and a variety of potential aims. Early evaluations of social work in the 1950s and 1960s took the positivist route. They found that it did not achieve its aims or that it produced uncertain results (Mullen & Dumpson, 1972; Fischer, 1973, 1976; Reid, Kenaley & Colvin, 2004: 72). It seemed that nothing worked. Consequently, researchers in the ‘empirical practice movement’ tried to find practice that would work. The most important developments from this were task-centred practice and accumulating evidence of the effectiveness of cognitive behavioural methods. Using behavioural models, practitioners were encouraged to use single-case or single-system research designs (Kazi, 1998; McLaughlin & Teater, 2017: 115–17) as they practised. These start from a baseline at the beginning of a piece of intervention, and check for improvement in the intended directions during and after the intervention. This is a practical way for individual social workers or teams to examine whether their practice is successful. There are problems, though, because many problems resolve themselves without help and practitioners’ and clients’ views about improvement may be biased, because they valued the relationship they built up, for example (Gambrill, 2019: 115). You might still do it, but such studies must be carefully designed. As a result of these developments in theory and how we thought about practice, several advances were made. Practitioners sought to make social work less idealistic: we cannot make everything in people’s lives good. One way of doing this is to be less vague about what you are trying to achieve. Social work objectives in individual cases became more highly specified and testable; goals were more limited; assessment was more thorough; evaluation gave better feedback to practitioners; intensive and focused activities were used; clients rehearsed behaviour instead of just being counselled and supported; special projects and developments were tested in situations that avoided conditions limiting their effectiveness; and services were located to encourage clients to come early for help (Sheldon, 1987). All these led to clear evidence, mostly from the USA, of success in well-designed agency programmes or individual work (Reid & Hanrahan, 1982; Thomlison, 1984; Rubin, 1985; Videka-Sherman, 1988; Macdonald & Sheldon, 1992; Gorey, 1996). This led to an emergence of the aims and action sequence elements of the shared principles that I discussed in Chapter 1 (see Figure 1.7). The first states that we should be clear about our objectives as we practise, and the second that we should follow clearly identified and transparent procedures in what we do. Most interventions in this research were cognitive behavioural, but about half the investigations of ordinary casework, non-behavioural groupwork and much family therapy were also successful (Macdonald & Sheldon, 1992). Several studies have shown that service developments including or focusing on social work have been successful (Goldberg, 1987). Many

Evaluating social work theory

studies looking at specific aspects of service or practice with particular client groups have been published and collected into accounts of practice that are supported in some way by research. Reid et al. (2004) have examined a range of small-scale experiments and evaluations that compared different interventions or looked at the contribution of different elements of an intervention, finding that there was evidence of their effectiveness. Reviewing effectiveness research, Coady and Lehmann (2016) judge that the research into many models of interpersonal work in counselling, psychotherapy and social work confirms the impression that well-­ designed and rigorously implemented interventions according to a wide range of theoretical models, including psychodynamic practice and solution-focused practice, have been shown to be effective. It is not that ‘everything works’, but rather that research has identified important ‘common factors’ (Reid et al., 2004: 72) other than the theoretical model used in helping people. Important examples are the quality of the relationship between practitioners and clients and the organization of the agency service in which practitioners work. Zimmerman et al. (2003) similarly find that social engagement is an important factor in successful service provision in residential care and assisted living in the USA. These points emphasize another of the shared elements of all social work theories that I identified in Chapter 1: the alliance between practitioner and client.

Two types of EBP Arising from these developments, an EBP movement emerged in the USA and elsewhere (Gray et  al., 2009). It has promoted a policy of following empirical evidence to decide on practice actions. There are two approaches to EBP: ●●

●●

The first is the principle that evidence should determine how social work should be provided and organized. This is a top-down approach. It looks in general at what kinds of practice have been found to be effective with particular client groups, and it organizes services to practise in that way. The second is a system of practice in which individual practitioners, together with their clients, evaluate the most effective methods to help with the problems faced by their clients.

The first approach suggests that services should reflect the best research in existence, so that the agencies are providing services that will achieve the best outcomes possible in meeting their own and their clients’ objectives. This is most relevant where services derive from government policy or accepted professional practice guidelines. To support this, research information is disseminated to practitioners and agencies and combined with legal and professional knowledge to achieve an agreed best practice (Jones, Cooper & Ferguson, 2007). This is done by collecting: ●● ●● ●●

systematic reviews of research about particular problems or interventions; information about effective agency services or intervention programmes; practice guidelines setting out intervention protocols (Jenson, 2005).

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Convert information needs into an answerable question Find the best evidence to answer the question Appraise critically the evidence for its validity, impact and applicability

Integrate the appraisal with practice experience and the client’s strengths, values and circumstances Evaluate effectiveness and efficiency and seek ways to improve next time Teach others to follow the same process Figure 2.4  EBP: six steps Source: Bellamy et al. (2009).

The second approach puts the responsibility on practitioners to work with clients, groups or community organizations, to identify the aims of their intervention and to review possible options for achieving these aims and the research supporting each option. This is most relevant where there is a ‘personal practice’ model, where individual practitioners devise their own interventions in personal relationships with clients. The practitioners would decide what they do according to the research evidence. Bellamy, Bledsoe and Mullen (2009) propose six practice steps, set out in Figure 2.4. For a practice critique of this process, see McCracken and Marsh (2008). In practice, there are short cuts. For example, as we saw in the case study on CAMHS earlier in this chapter, most practitioners work within agencies or in private practices that deal with specific problems, and, as a result, similar problems recur. Practitioners therefore develop standard patterns of service and guidelines for practice that reflect the best evidence. In addition, the accumulation of evidence suggests approaches that are typically successful for the main objectives of social work, so these gain wide currency. Less successful approaches, or approaches that did not gain research support, fall out of use.

Arguments for EBP Arguments for EBP as the main form of practice are as follows: ●● ●●

It provides for a planned and systematic form of practice. It is ethical to use methods that have been proved effective and to avoid other methods.

Evaluating social work theory ●●

●●

●●

It is unethical to prefer methods on the grounds of practitioners’ personal preferences or personal and professional theories and values, rather than methods that have been proved effective. EBP is accountable to clients. This is because clients are involved in the decision-making process and can influence the problems tackled, and the choice of outcomes and methods. EBP is accountable to agencies and more broadly to the mandate of social work, because it sets clear objectives, prescribes methods that have been demonstrated to be most likely to achieve those objectives and focuses on measuring the outcomes of the work, rather than on ideological or theoretical preferences.

Arguments against EBP The arguments against EBP fall into four main areas. I have adapted these points to a social work context from House and Loewenthal’s (2008) discussion of CBT in psychology, which succinctly summarizes the main aspects of the debate. Most critiques of EBP expand on these points. ●●

●●

●●

●●

Paradigmatic. EBP relies on a positivist world view that cannot be integrated with the alternative interpretivist world view. Promoting EBP therefore leads to division and sterile argument that can never be reconciled. Practical. The aims and practices of social work are broad. Often, they cannot be defined in ways that will allow research to provide enough guidance to make decisions that respond to the diversity and complexity of behaviour, personality and social relations that practitioners deal with. In addition, that complexity interacts with the equally unresearchable personality and skills of diverse practitioners. Moreover, it assumes that practice will be mainly about behavioural change rather than broader social issues. Epistemology and research. EBP gives priority to certain kinds of knowledge produced by certain kinds of research, and disparages other knowledge. EBP prefers research showing evidence that practitioners’ interventions have made a difference to a pre-existing state and research that controls external factors that might interfere with the clarity of findings. Thus, random controlled trials are preferred, especially those that compare one intervention with another and find which is more successful (Reid et al., 2004). Circumstances like this are rare, so the findings of such studies do not help much in practice. Cultural and political. In its research, EBP explores, and therefore by implication accepts, the present social order, including its existing political and cultural assumptions, and therefore prescribes practice that encourages behaviour change so that people adapt to a society in which there are widespread inequalities and injustices. It may, therefore, ‘blame the victim’ by seeking to change individuals, families and communities, rather than working to change inequalities in society. In this view, EBP accepts Western cultural assumptions rather than the alternatives available in diverse cultures and ethnicities. Feminists argue similarly that EBP promotes male ways of thinking about reality as a set of certainties, rather than female preferences for exploring and accepting diverse ways of thinking and acting. Moreover, social work is often part of government, or is otherwise used on behalf of existing social structures in which most clients are relatively powerless. A model

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of practice that accepts those structures is inappropriate to the values and objectives of social work. In reality, the aims of social work agencies are set by economic and political factors rather than by decisions about practice that are made by practitioners, so EBP makes false assumptions about how practice works. These arguments are connected. If you take an interpretivist view of knowledge, you are also likely to accept that the diversity and complexity of behaviour and practice raise barriers to EBP. Similarly, an interpretivist is also likely to value a diverse epistemology and a wide range of research methods, to acknowledge the importance of cultural and political influences on decision-making and to value broad contextual understanding of what is happening to clients.

The politics of EBP The politics of EBP pit an international group of supporters against other groups who are critical of the research priorities implied by EBP and the possibility of implementing it in practice or through social work education. In addition, other important players are interest groups concerned with using evidence to support policy innovations in social services, including politicians and civil servants, and managers seeking greater effectiveness in practice. Gray et al. (2009) review the international development of the EBP movement and its opponents. These arguments about EBP have been played out in social work debate in three phases. The first was early articles seeking to establish empirical research evidence as a basis for practice, contested by writers supporting interpretivist understandings of knowledge development, who were often described as constructionist (Witkin, 1992; Atherton, 1993, 1994; Thyer, 1994). The second was a phase of debate about the validity of EBP.  Two important articles, the second replying to the first, express this debate very fully (Webb, 2001; Gibbs & Gambrill, 2002). The third phase has been a body of work concerned with introducing EBP into the social work curriculum, particularly in the USA, where using EBP to achieve wider change in the rigour of social work education has been an important trend since 2005 (Jenson, 2007). It connects to political trends towards managerialism or the new public management, which emphasize the managerial and political control of professional discretion in practice. A positivist stance that emphasizes evidence similarly questions professional judgement as the basis of practitioners making practice decisions. There is, consequently, also a significant move to incorporate EBP into the regulation of social work agencies in Europe, where governments have sought to identify and disseminate effective practice methods. There are also practical difficulties in implementing EBP in agencies. Some of the issues identified by Webb (2001) arise from the fact that social work is: ●●

●● ●● ●●

mediated by organizations, the availability of resources, communication and social relations between individuals within and outside agencies; situated in complex decision-making environments; provisional, since most social situations cannot be fully understood; pragmatic, arising from an interaction between clients’, agencies’ and social workers’ understandings of particular situations rather than being concerned with formal, therapeutic decision-making.

Evaluating social work theory

Consequently, while the research may be relevant to your services, it may not tell you enough about how you can practise in the situations your agency is responsible for. These debates have stimulated interest in different research methods that can appropriately and successfully provide guidance in undertaking social work practice. There are many other methods of research that can deal with complexity more effectively than EBP does, such as decision trees (Hudson, 2009) or naturalistic decision-making through ideas, such as ‘recognition-­primed decision-making’ (van de Luitgaarden, 2009). ‘Soft’ evidence, such as clients’ accounts, explanations and interpretations of their lives, arguments between people and non-verbal communication, can all be evaluated in rigorous ways and contribute helpful knowledge to practitioners (Murdach, 2010). These doubts have led many writers to refer to being aware, informed or enriched by research evidence (Lawler & Bilson, 2004; Nevo & Slonim-Nevo, 2011; McLaughlin & Teater, 2017; Stepney & Thompson, 2018: 31) or discussing ‘research based practice’ exploring wider models of research practice (Orme & Shemmings, 2010). Cooper (2018b) talks about ‘practice near’ research, arguing that social work research, by being close to people working actively in relationships with troubled people and social situations, inevitably involves research that differs from traditional ‘objective’ research models. The ethical arguments for EBP are also disputed by arguments that social work research, as well as social work practice, should aim to support social justice rather than psychological and small group change that furthers the present social order (Humphries, 2008). This argument follows social change and development views of social work (see Chapter 1). Furman (2009) points out that privileging some research methods is a value decision to focus on knowledge about outcomes rather than the value of relationships and effective interpersonal skills. He also proposes that it is a value decision to focus on developing quantitatively measurable methods of practice over improved practitioner education and a focus on broad social change or qualitative improvements in people’s lives. For example, Manthorpe et al. (2008) report a study of older people’s views about social workers in which older people, while recognizing the value of fair assessment and an efficient delivery of services, expressed regret that this was given priority over building a relationship that acknowledged their feelings about the changes occurring in their lives.

Interpretivist and realist evidence There are three main research approaches that use evidence in different ways from the EBP approach, and these put forward additional ways of using evidence. They are social construction, empowerment and realist views. Social construction views argue for an interpretivist view of knowledge and theory in social work. I take this position and argue for it in my account of the social construction of social work theory in Chapter 1; here, we are meeting it applied to social work knowledge more broadly. Empowerment views argue that clients’ needs and preferences should be the main source of our decisions. Realist views emphasize the need to use research in ways that reflect the different social contexts in which it is used. Social construction is an interpretivist, postmodernist set of ideas proposing that understandings about the world come from interactions between people as part of many

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interchanges in a social, cultural and historical context. Knowledge is therefore constructed within cultural, historical and local contexts through the language used to interpret social experiences. This comes to form and represent how people understand their social experiences. In social work, this position is represented most directly in the work of a group of Finnish researchers (Jokinen, Juhila & Pösö, 1999; Karvinen, Pösö & Satka, 1999; Hall, Juhila, Parton & Pösö, 2003; Hall, Juhila, Matarese & van Nijnatten, 2014) and Parton (1996; Parton and O’Byrne, 2000). Their work has been increasingly influential since the 1990s, particularly in ideas such as solution, narrative and strengths-based practices (see Chapters 11 and 12). The social and historical context in which situations develop and knowledge is researched has an important impact on our understandings of individuals, society and research as a source of knowledge. Social construction therefore has a distinctive approach to research, which tries to engage people who are the subjects of research in an equal relationship with researchers. As a result, complex human understandings about the situation are explored from different points of view, and the outcomes represent a full picture of intricate human situations. Social construction research often uses detailed analysis of human interaction, particularly conversation analysis, relying on video- and audio-taped records of interactions, so it is particularly relevant to social work practice. These taped records are systematically analysed to reveal patterns of communication and behaviour that may be hidden. These patterns also often show the covert exercise of power and provide research support for empowerment practice. Social constructionists argue that the results of EBP do not reflect this rich, complex reality. EBP’s narrow research base is naive, and a wider range of methods that examine how people make sense of the social situations they face is more helpful (White, 1997). Social construction ideas therefore not only propose an alternative world view, but also make it clear that there are alternative, valid ways of researching social work practice. Empowerment views argue that knowledge primarily comes from clients and that, to be ethical, social workers should use knowledge according to clients’ wishes in order to empower them further. In social work, these ideas are most clearly represented in Beresford’s work (Beresford & Croft, 2001; Beresford, 1999, 2000, 2002; Glasby & Beresford, 2006) and are particularly associated with social and community development, empowerment and advocacy theories (see Chapters 10 and 14). Empowerment views of knowledge argue two things: ●●

●●

The purposes of social work require practitioners to seek social justice, and therefore to empower people by responding to their knowledge and understanding of the world. Clients (in this view often called consumers or service users) often have the best knowledge about their circumstances and objectives, which should therefore be followed. They are expert carers, clients, patients or users whose expertise should direct practice, rather than ideas held by the practitioner doing this.

Since service users are often oppressed, disadvantaged and marginalized, empowerment views of knowledge argue that understanding their situation should guide social work practice. Such views partly rely on epistemic privilege, the view that the person or social group that creates knowledge or experiences aspects of life has an advantage in understanding and describing their knowledge or experience. This view is also espoused in relation to people

Evaluating social work theory

from minority groups; it is claimed that only they have the experience of oppression that gives them the full understanding of it. Empathy from professionals is not enough. Another relevant factor is that, in democratic societies, professionals and governments should respond to the social demands of the citizens. Empowerment views suggest that it is neither ethical nor practical to pursue activities contrary to service users’ wishes. Many approaches to knowledge, including EBP, emphasize the social worker as an expert whose knowledge of research results should set the direction of work, and this diminishes their valuation of their client’s knowledge. A better way of using research is through working in a dialogue that incorporates service users’ views as a critique of professional knowledge (Sellick, Delaney & Brownlee, 2002). Feminist social workers argue that social workers reinforce the oppression of women through the role of social work in the surveillance and enforcement of conventional patriarchal relationships (Dominelli, 2002a). This approach also produces a useful research perspective. Action research proposes a technique for evaluating social projects as they develop, the results influencing how the project progresses as it goes along. Because of its interpretivist view, this can be criticized for its lack of rigour by positivists, although it has proved practically useful in evaluating experimental projects. It was also criticized by empowerment writers for viewing projects from the point of view of the funders or professionals involved in the projects. This led to the development of participative action research in resource-poor countries (Whyte, 1991). More individual work also produced alternative research approaches. De Shazer and Berg (1997), for example, emphasize the importance of whether solution-focused therapy meets clients’ objectives rather than the agency’s purposes. Realist views argue that evidence of reality is not always available to empirical observation, so that knowledge emerges or is generated from human interpretations of successions of events that can be captured empirically. In social work, these ideas are represented in the work of Houston (2001), Morén and Blom (2003) and Kazi (2003). Although this view is often described as realist for convenience, many writers prefer to talk about critical realism, because this particular view of realism seeks to question taken-for-granted assumptions about theory and research, and this connects the ideas to critical social science theory, which tries to achieve this critical position. This research approach contributed another of the shared elements of practice theory that I identified in Chapter 1: critical practice. EBP is realist in another way, because it assumes that there is a reality that we can research. Realist views argue that it is true that social phenomena exist beyond social constructions (Houston, 2002), but that it is nevertheless important to understand those constructions. Their current importance originates from the work of contemporary social scientists, in particular, Bhaskar (1979, 1989) and Archer (1995) and researchers such as Pawson and Tilley (1997). Realist researchers say that finding extensive evidence of social structures is difficult, so a positivist approach is not helpful. An important account (Blom & Morén, 2010, 2019) proposes that adequate research on and accounts of social work require a complex range of understanding, described by the acronym CAIMeR. I set out a much simplified version of the elements of this in Figure  2.5. What it illustrates is the complexity of the factors that are required to understand fully what takes place in a social work intervention. For example,

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looking at the social worker’s output tells you nothing about the outcomes, but outcomes may include both target behaviour changes and also processes and more in-depth issues in clients’ lives. Social work research, therefore, relies on many human judgements about the kinds of information and understanding that is relevant. Houston (2001) points out that all human activity takes place in open systems, which are constantly changing and depend on human beings’ decisions, which are not fully determined by their own psychology or social circumstances. Expecting to use evidence to predict human activity is therefore impossible. We should refer more to events containing tendencies and being influenced by psychological and social mechanisms. By examining these tendencies and influences, we can see the underlying mechanisms at work.

C

Concept

Elements of concept

Explanation

Contexts

Social and cultural contexts

May be enabling or disabling

Clients’ lifeworld

Primary (close) and secondary (other) relationships; both may be ‘troubling’

Intervention contexts

Direct (physical environment) or indirect

Primary intervention actors

Personnel (e.g. social worker) and attitudes

Clients

Adult, child etc. human attitudes

Other intervention actors

Formal (professionals, agencies) and

(policy, intervention programme, resources)

A

Actors

informal (neighbours, friends)

I

Me

Interventions

Mechanisms

Social workers’ interventions

Methods, ideas, resources

Informal interventions

Other people involved

Clients’ interventions

Efforts, choices

Other interventions

Formal and informal

Social intervention mechanisms

Responses, challenge, risk-taking

Social psychological

Internalizing and externalizing

intervention mechanisms

R

Results

Psychological intervention

Altruism, passion, vengefulness,

mechanisms

identification

Outputs

Actions taken, support given

Outcomes

Early, intermediate, long-term; surface, processes, depth, e.g. changed self-image

Figure 2.5  CAIMeR conceptualization of social work Source: Blom and Morén (2019: 44–54).

Evaluating social work theory

The concept of emergence is important in understanding the realist critique of EBP, which often ignores emergent properties. EBP assumes either that we can observe everything that exists or that what actually happens is all that might happen. However, we cannot empirically observe every aspect of a social work agency and the other social structures that affect our work. Archer (2000) proposes, moreover, that although language and interaction are important, it is our practical experience of the world that allows our humanity to emerge and become our personal identity. So what we do in relation to other people is what mainly gives us an identity. In turn, this emphasizes that practice, rather than what we think or theorize about, is what produces reality. Figure 2.6 compares the assumptions of realist and positivist research. Pawson and Tilley (1997) describe research on and the evaluation of projects to prevent and reduce crime. Each project is in a different geographical area and social context, so the initial social structures and the outcomes of similar project activities vary. However, by examining several projects, researchers can identify the different factors that affect how projects work. The more studies you have, the better you can understand the range of factors explaining the variations that these different social factors cause, and the more social factors you can identify that are relevant to this field of study. In positivist research, on the other hand, the assumption is that the outcomes of the different studies can be combined. The more studies you have, the closer you can get to saying what the outcomes might be in all similar circumstances. To the critical realist, there is no right answer, but you can understand better the factors you have to take into account. If you carry out studies over time, the critical realist would expect to identify trends as social circumstances change, while the positivist would expect to get closer to a full understanding of what will happen, whatever the social circumstances. Therefore, for the realist, it is impossible to meet the EBP assumption that we can identify interventions that

Variations in study outcomes explain different factors that affect actions in this field at this time

The accumulation of study outcomes refines understanding, so that knowledge may be generalized to all other settings

Study 4 Study 3

Study 1

Study 2

Study 3

Study 2 Study 1

Field of research e.g. crime prevention

Field of research e.g. crime prevention

Positivist (EBP) research

(Critical) realist research

Figure 2.6  Positivist (EBP) and realist research compared

Study 4

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will always have the same effects. Moreover, social change means that what will be needed is always on the move towards different patterns. But, for a limited period, we should be able to identify relevant factors that might be helpful in setting up, as in this case, a crime prevention project. Many people argue that this is a reasonable approach to take to the knowledge requirements of social work. We have some knowledge and information to guide us, but we have to apply it with an awareness of the change that is going on all around us. Therefore, flexibility and following the principles and guidelines of practice theories are more practical than expecting clear statements from research that we can apply to the variety of human situations we are likely to meet. Following this principle, a social work researcher can see how a social work technique works in several different settings. It might work well in some circumstances but not others. As you accumulate information, you can identify the circumstances that affect how it works. This would then tell you how using the technique is likely to change as social change affects the context in which we use the technique. EBP, empowerment, social construction and realist ideas are alternative ways of looking at evidence, each exploring different cultural and social forces that influence our practice actions. The political, cultural and social expectations of social work, and the needs and demands of clients, contribute pressures that affect what practitioners are required to do. Pre-­ existing social constructions also affect us. Social constructions change over time, and you can trace these changes through research, but they show a good deal of stability and are the basis on which many people carry out their social interactions. Provided it is constantly updated to respond to social changes, social research can provide evidence to guide practitioners. As we saw in Chapter 1, Berger and Luckmann (1971) originally described social construction as a process in which current reality is determined, for the participants in any social environment, by their own social constructions. Research can provide evidence about that reality, but we must recognize that it is determined in social relationships and forms a constantly changing reality.

 onclusion: how social workers can evaluate social work C theory Chapter 1 set out the arguments for using practice theories to guide social work practice. They are also a way of including different views in our work about the objectives of social work. I argued, at the outset of this chapter, that practitioners need to be aware of the range of social work practice theories available and what they might contribute to our social work practice. Practitioners may be able to select a practice theory to use that is appropriate to their setting, or they may develop an eclectic practice drawing on a combination of theories in the context of their agency, team and personal requirements. There are other ways of looking at practice theory. The direct use approach builds influence for important social and psychological ideas and brand-name psychotherapies in social work practice. This can help us understand more deeply the ideas we are using, so that we can be more flexible and responsive. If we take a practice theory approach to social work, we can improve our understanding of the elements that go into a practice theory, and perhaps create a more planned structure for our work by using these alternative approaches.

Evaluating social work theory

Evidence-based practice argues for the role of empirical research evidence in evaluating practice. Strong contending groups in the politics of EBP are ranged against each other. While most people would agree that the available evidence should influence how services and agencies develop and manage their services through guidance, research dissemination and professional debate, there are serious questions about whether social research can ever be adequate or appropriate to guide practitioners’ decision-making and actions in everyday situations. It is unrealistic to review the evidence relevant to every case every time a practice decision must be made. Equally unrealistic is expecting research to clarify how a service should be organized to provide effective social work: what social workers do day to day is more important. Not enough research is yet available to help in many areas of practice. Many factors affect whether a practitioner’s actions are effective in achieving their desired outcomes, and many of those factors are based on the social context and the personality, skills and interactions of the people involved, both practitioners and clients, rather than on researched intervention techniques or services. Therefore, it is unlikely that we can make generalized deductions from research to inform everyday practice decisions. Politicians and policy-makers make demands on social work practice to help manage crime and community problems that research does not or perhaps cannot help us with. The centuries-long debate between the interpretivist and positivist views of knowledge suggests that these questions raise fundamental issues about the nature and possibilities of human knowledge that may never be resolved. Social workers must still provide services and take action. Scholarship and research evidence will contribute to their service, and must influence social workers’ thinking, but it is not the final answer. It is the process by which practitioners interact with their evidence and knowledge, in cooperation with their colleagues in teams and agencies, that will enable them to use the framework of practice theory to make practice decisions. Chapter 3 examines our current understanding of the process of applying practice theory, using knowledge and evidence to make practice decisions and interventions.

Additional resources Further reading McLaughlin, H. & Teater, B. (2017). Evidence-informed practice for social workers. London: Sage. A useful practical guide to interpreting evidence for practice. Gray, M., Plath, D. & Webb, S. A. (2009). Evidence-based social work: A critical stance. London: Routledge. The most comprehensive review from a critical stance of the EBP movement.

Journals To explore current debates, you should look at journals concerned with social work education or research. Extensive collections of papers were published in 2007 in the Fall edition of the American Journal of Social Work Education (volume 43, issue 3), and the September edition of Research on Social Work Practice, which give a good picture of issues debated at conferences during that period.

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Most social work journals contain empirical social work research and debate about theory: the following emphasize empirical research in social work: Journal of Research on Social Work Practice – Sage Journals Nordic Social Work Research – Taylor & Francis for the (Nordic) National Associations for Social Work Research (FORSA) Qualitative Social Work: Research and Practice – Sage Journals Social Work Research  – Oxford Journals for the (American) National Association of Social Workers (not an international journal, since its board only has US members)

Websites https://www.podsocs.com/podcast/evidence-based-practice/ A useful interview (about 30 minutes) with Debbie Plath, one of the co-authors of the comprehensive account of the EBP movement by Gray et al. (2009). http://www.campbellcollaboration.org/ The Campbell Collaboration is a website that collects evidence about successful interventions in a range of social science disciplines, including a social welfare group. To find this, go to the website, click on ‘coordinating groups’, then ‘social welfare’, then ‘social welfare reviews’ to access a list of topics covered. http://www.cochrane.org/ The related healthcare site, the Cochrane Collaboration, has a much more extensive range of studies, but most of its content is not relevant to social work. If you work in healthcare, you might find useful material. Other useful sources of research summaries are: http://www.scie.org.uk/; http://www.iriss.org.uk/ The Social Care Institute for Excellence (SCIE) and the Institute for Research and Innovation in Social Services are the two main UK bodies disseminating knowledge and information about social work and its practice. Both websites contain extensive resources, including videos. SCIE provides Social Care Online, an extensive searchable database of publications on social care and social work: http://www.scie-socialcareonline.org.uk/default.asp. You can register to receive listings of new publications in areas that interest you. http://www.rip.org.uk/ Research in Practice (on work with children and families). http://www.ripfa.org.uk/ Research in Practice for Adults.

CHAPTER 3

Linking practice and theory MAIN CONTRIBUTION This chapter aims to help practitioners with building links between practice and theory so that they can feel confident in enabling practice and theoretical ideas to interact.

MAIN POINTS ●●

●●

●●

●●

Generalizing about our practice by building theory helps practitioners to achieve consistency and accountability. Links between practice and theory are not linear processes of deduction and induction, but complex responses to current ideas and social needs: even stimulating ideas may be difficult to use as guidelines for practice. We often need to adapt and transfer theories between different settings, cultures and specialisms. Critical reflection and its components offer structured ways of working on practice–theory links.

PRACTICE IDEAS ●●

●●

●●

●● ●●

Learning transfer needs to occur between practice cultures, settings, specialisms and theories and between countries. Process knowledge about how practitioners make decisions and judgements, as they work through various stages of practice, helps when making theoretical decisions in practice. Travelling knowledge is the process by which knowledge and ideas are transferred between different agencies, locations and countries. Use of self and emotional intelligence help turn theory into action. Reflection, reflexivity, critical thinking and critical reflection are ways of making connections between practice and theory.

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Major statements Connecting practice and theory is an arena that sees perennial conflicts between the interests of agencies, education and practitioners in social work (Smid & van Krieken, 1984). From the 1970s onwards, agencies began to assert greater managerial control over using knowledge in practice. Until then, after the end of the period of increasing prosperity in the West after the Second World War, this issue had mainly remained in the academic sphere (Payne, 1991). You could see the debate about evidence-based practice (EBP) (see Chapter 2) as an attempt to reassert academic knowledge as the main source of knowledge for practice. From the 1960s onwards, theoretical debate escalated in the social sciences, leading to the proliferation of social work theories examined in Chapter 2. This plurality of theories led to attempts to distinguish between them, in the ‘theory wars’ between 1970 and 1990 focusing on competing political belief systems. Historical tensions in social work between a focus on clinical and social ideas mirrored the conflict between the Western and communist political systems that was playing out at that time. But many practitioners sought a more eclectic practice that incorporated both perspectives in theoretical developments, often using systems theory. During the same period, Schön’s work (1983) developed techniques emphasizing reflection. The aim was to respond to complexity and variability in interpersonal practice in many professions. Fook and Gardner (2007) built up a model using these and related ideas in their handbook on critical reflection. Their work represents a significant current stream of thinking.

Making theory useful This chapter focuses on how we make theory useful, picking up the argument in Chapter 1 about the uses of theory. We saw in Chapter 1 that many practitioners see social work as a practical activity, something that we do, and theory as different, something that we think and talk about. But many writers, for example Gray and Webb (2013a: 4), assert that we cannot separate practice and theory in everyday life or in social work. Smith (2007) argues that having a body of theory offers normative generalization; normative means that the generalizations include the values that we aim for in our practice. He suggests that because the generalizations that theory offers include values, it is easier to make fine distinctions than crude political judgements. We can, furthermore, connect personal identities with policy debate and avoid quick fixes that just aim at the obvious positive results. Generalization also allows us a broad strategy into which we can fit more detailed everyday practices.

PAUSE AND REFLECT  How might generalizations help us? Make a few notes about how generalizations might help with understanding complex human lives.

Linking practice and theory

Some suggestions Complex people – ourselves and our clients – and complex situations in a complex society lead to many variations in how things work. Consequently, we will need to respond with a variety of different kinds of interventions. Generalizations help us to classify situations and interventions. Generalizing through theory helps us to: ●● ●●

●● ●●

be consistent and well-organized in what we are doing; align our work with the best-informed systematic guidance – in Chapter 2, I discussed the debate about how far this should be based on empirical research; explain what we are doing to clients and gain their informed consent to interventions; explain what we are doing to our managers, our colleagues in other professions, the public, policy-makers and politicians. All have an interest in the value and quality of our practice.

Spong (2007) focuses on the importance of scepticism and belief as part of the relationship between practice and theory. Scepticism is important because it reduces tendencies to: ●● ●●

use authoritarian forms of practice; use expert knowledge to assert authority over clients.

Thus, scepticism is a crucial part of the shared principles of practice. Social construction theory is sceptical that there is any one true representation of reality. It proposes that, rather than being a true believer in one theory, we acknowledge that because we can see there are a range of ideas available, there is always going to be uncertainty about the best thing to do (Spong, 2007). Using theory helps to provide stories about (Payne & Reith-Hall, 2019b) or metaphors for what is happening in people’s lives and pictures of the possibilities that are open to them. It provides an explanatory system for clients to believe in. People sometimes talk about the application of theory to practice. In Chapter 1, I argued this does not happen in that way in social work. Clients and practitioners meet together in agencies and have an impact on each other. Other arenas of political and social life also have an influence, often through what social workers, clients and agencies bring to the interaction. It is more accurate, therefore, to see practice and theory as acting in a mutual process in which each has an influence on the other.

PAUSE AND REFLECT  How are practising and thinking different? Make some notes on your thoughts on the connection between doing and thinking. Is thinking something you like to do? In what ways do you think about what you do? When you do things, how does this affect your thinking? What makes something a practice and something a theory? What connections and disconnections do you experience between practice and theory? Do you find yourself using theory when you are doing something? Is theory relevant to a practice at all? Try sharing your views with others and finding out how much people agree or have a different take on the connection between practice and theory.

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Some suggestions Here are some thoughts I have. I find some ideas really attractive. Concepts such as empowerment, flexibility and resilience stimulate and interest me and might be relevant to how I do social work. But when I look at them, I see that the words need filling out and that complications need exploring. I often find it hard to follow detailed discussions about philosophies and ideas; I want to see them put into practice. This is for two reasons. One is that I want to see whether the people who are using these ideas can connect them with the real world in a way that helps me to understand them. The other is that if I am going to use them, I need to turn them into practical actions. Thinking beyond our own feelings, research shows that many people come into social work with aspirations to make a difference, change the world or help people. Hindmarsh (1992), who studied 22 new graduates of social work in New Zealand and summarized much of the world literature, argued that a sense of opposition to the status quo motivated a large number of people’s decisions to enter social work; we should try to help things ‘get better’. Through helping others and supporting social change, these people aimed to act on this feeling of opposition. Social work has always had a dual aspiration, both to achieve social change and social justice and to help troubled people, individuals, families and communities to find ways towards a better life (Payne, 2006). With such aspirations, the motivation and fascination that we sometimes get from theoretical concepts can lose their enchantment. Secker’s (1993) study found that most students using social work theory had difficulty in connecting it to practice. They kept finding conflicts between different theories and were unable to make connections between the academic theory they were taught and informal sources of theory. One possible answer to these problems with linking practice and theory, which we met in Chapter 2, is that social work agencies give guidance, instruction and supervision to their practitioners based on their policies, their social role and a systematic review of the evidence that is relevant to their work. This makes it clear what practitioners’ aims and role should be. Practitioners receive training in refining and using interpersonal skills from their professional education. Agency mandate and policy together with your learning guide you in carrying out the tasks for which you are employed. Why bother with theory, then? Practitioners sometimes find that agencies over-control and create barriers, often because of financial austerity, that restrict the range of what social workers can do. Each country’s economy and policy limits the kinds of social work we can take up. As a result, social workers become alienated and isolated. In this sense, how we experience agencies can play out the oppositions we see in the world, the very ones that social workers are setting out to resolve. Hindmarsh (1992) suggests that social work education, including theory, gives practitioners confidence, self-awareness and a framework of practice and identity as a practitioner. Theory, then, can help us to stay on course and achieve some of our aspirations to change the world. Beckett and Horner (2016: 246) identify four important ways to liberate social work from being a purely technical activity that you can learn from guidelines: ●● ●●

It deals with inherently uncertain situations … which are also unique …

Linking practice and theory ●● ●●

to which each practitioner brings different skills and orientations … and which generate value questions as well as knowledge questions.

These are very similar points to the criticism of using research through EBP that we met in Chapter 2. Plurality (Borden, 2010a) is another difficulty. It may seem good to have the large range of theories we found in Chapter 2 available to use, but the variety competes, conflicts and confuses. There seems to be endless circular criticism and debate about the minor elements of one theory or another. How do you, and indeed why should you have to, choose between them or work with your team and agency at combining them as I suggested in Chapter 2? But achieving this is easier said than done, and it can be hard to turn an idea into practice. A concept such as empowerment, for example, can set a general direction for your actions. To create a generalizable practice theory from this concept, however, a practitioner must think through and explain different views of what empowerment might mean in many different situations. It is not surprising that books about practice theories are so general as to be of no practical use, or so detailed that practitioners cannot remember all the elements they have to consider. This chapter suggests three possible ways in which social workers can deal with these complexities: ●●

●●

●●

by understanding theory–practice connections, to see how practice and theory influence each other; by theory adaptation, theory selection and theory-combining – the eclecticism referred to in Chapter 2 – to help practitioners deal with plurality; by using critical reflection techniques to help them apply ideas creatively to practice situations.

The next section deals in turn with each of these approaches to using practice and theory together.

Practical approaches to using theory Developing links between practice and theory We may look at the connections between practice and theory in different ways. Figure 3.1a, 3.1b, 3.1c, and 3.1d presents some ideas as diagrams; I have adapted and developed the main points from Carr (1986). I ask, in each case, ‘Does this happen?’. Figure 3.1a looks at deductive and inductive processes of theory development. We met these ideas in Chapter 1, and they suggest that generalized theory connects to a practice theory, which then connects to practice itself. Deductive processes suggest that practice theory comes from general social ideas, or downwards from the ‘top’, the political–social–ideological arena (see Figure 1.8). Suitable ideas are turned into practice theories, which are tested out in practice. Research and scholarship or accumulated practice experience tell us what works. Ideas that have worked in practice gain support; failed theories are rejected.

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General social ideas

General social ideas

Practice theories

Practice theories

Tested in practice

Tested in practice

Failed theories rejected – Successful theories gain support

Practitioners generate ideas from their practice

Figure 3.1a  Top-down (deductive) and bottom-up (inductive) theory development

Debate • Social problems • Experience • Research • Action proposals

Outcomes

• Problems and

• Practice

proposals refined • Interventions devised

experience • Research testing

Emergence

• Articulated • Experienced • Researched

Interventions

• Outcomes • Problems • Interventions

… and so on

Debate

Figure 3.1b  Theory development as a process of enquiry and debate

… and so on Expanded experience is refined, tested and developed, using theoretical ideas

Tested experience expands; more Experience theoretical ideas is articulated, are incorporated refined and tested, using theoretical ideas

Practice experience accumulates

Figure 3.1c  Theory development as a process of accumulation

Linking practice and theory

Practice theory from experience

Practice theory from general social ideas

Practice theory from research

Agency’s mandate and organization limit or adapt application

Practice theory is constrained

Constraints of ideas, experience and research are recognized: this leads to developments in the theory or a decline in its influence

Figure 3.1d  Practice constraints as a degradation or limitation of theoretical development

Inductive processes propose the opposite  – that ideas for practice theory come out of practitioners’ daily experience, upwards from the ‘bottom’, the client–social-worker–agency arena. Research and professional debate test these out, confirming what works, and help to formulate them into theories. These might then in turn influence general social ideas. Not every practice idea makes it all the way to general social influence, although if a social work practice becomes widely used, it is likely to become known about and influential when services are designed. In addition, not every general social idea extends to being useful and effective in practice, even though some practitioners might find them interesting. Does this happen? The accounts of social work theories in Part 2 suggest that the main approach is deductive: theories in psychology, sociology and broad political and social philosophies inform most practice theories, and their originators draw on social work experience to interpret these ideas for practice. But this top-down approach means that theories are not designed with social work in mind. General ideas are interpreted and turned into guidelines in the agency–professional arena, but these often fail to produce a useable approach. As a result, practice theories are often just aspirations or ideals, rather than offering concrete guidance. Another problem is that their guidance for practice and the research testing of their effectiveness may have been done in an academic or psychotherapy setting, which may not transfer to a social work agency. Figure 3.1b sees practice and theory as being involved in a continuing process of enquiry and debate. Concerns emerge about social problems, what they are and why it is important to respond to them. These concerns may come from experience or research. As concerns emerge, people make proposals about what we should do about these concerns. The discourse here may take place in all the arenas, each having some influence. A debate takes place and refines understanding of the problems and the proposals, and people devise interventions that might

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help us to take action. These are then taken up and tried out in practice experience and research. The outcomes of this experience and research are articulated and then debated. These further debates identify useful outcomes, problems and then further interventions, which then also go through the testing and experience process. I have presented this process as a continuing development rather than as a circular one. This is because later debates, interventions and outcomes emerge from and progressively build upon previous actions. Although debate and testing happen at every stage, we do not go back to the drawing board with each new problem; instead, we constantly build and improve on previous ideas. Does this happen? Continuing debate and adaptation is characteristic of the development of many of the longer-standing theories, which we will look at in more detail in Part 2. Ideas are incorporated into the mainstream, or they seem to lose importance and are replaced by renewed ideas. For example, the emphasis in psychodynamic theory started with a debate between diagnostic and functional ideas, formed a psychosocial model and then shifted towards attachment and relational ideas. Behavioural practice has incorporated cognitive elements. Radical theory shifted away from Marxism; there was a period of doubt and then a move towards critical ideas; now Marxism is having a resurgence. Among the concerns about seeing theory–practice connections in this way are that theory, instead of providing secure guidance, is an always-shifting progression of changes. Nothing about theory is ever decided, and the use of theory seems to be about constantly renewing fads and enthusiasms, rather than about clear systematic professional guidance for practice (Howe, 2009). On the other hand, this model realistically sees social work responding and constantly renewing as social life and ideas change. Figure 3.1c takes up this idea that theoretical development progresses. It sees practice and theory as interacting in a bottom-up process. In this model, as practice experience accumulates, it is articulated and refined using theoretical ideas and tested through research. The theory is refined by further tested experience and may incorporate further theoretical ideas; these are then in their turn further tested and refined. And so the process continues. Does this happen? This model recognizes a reality of social work development since the 1960s – that experience and theories interact with each other, and useful ideas are borrowed from other lines of development. What may have been a practice theory with a clear ideological or research base becomes adapted to include elements of other theories. Eventually, the theory as people practise it becomes an amorphous collection of ideas whose origins are hard to disentangle. This enables practitioners to use a wide variety of theoretical ideas, but theories used in this way seem to offer no clear direction. Taking the above point further, Figure 3.1d presents a model that accepts that practice ideas come from a variety of sources: research, practice experience and theoretical ideas. Because most social work is practised in agencies, these ideas need to be incorporated into a practice that is sanctioned by agencies. Agency practice often limits or adapts how theory is implemented, and this constrains how we can use practice theory. Once agencies recognize constraints on the ideas, experience and research that formed a theory, developments may occur in the theory to make it more relevant. These constraints sometimes mean that the theory cannot be used in the reality of agency practice, and the theory loses influence.

Linking practice and theory

Does this happen? This model recognizes another reality of social work development: that people like the ideas of a particular theory, but find their agency a hostile environment in which to practise these ideas. They feel constrained, rather than enabled, by the agency’s responsibilities, and come to reject an apparently attractive theory because they find they cannot carry it out in practice, or they feel that agency constraints are part of their feeling of always being in opposition. Hindmarsh’s (1992) research shows that this happens. Induction and deduction aspire to fit what happens in social work practice and theory into a logical model in which there is an unchanging end-point: a theory or a practice that is accepted. Hearn (1982) contends that we should avoid seeing practice and theory as two ends of a dumb-bell, but rather see them as always intertwined and relating to each other in a variety of ways. The other models suggest that the connections between practice and theory are complex and continuing. Harrison (1991), an American studying British social workers, found that they did not experience work as highly programmed or ordered but as a ‘seamless integration of thought and action’ following from their own typical way of thinking things through. Any approach to theory–practice connections needs, therefore, to reflect a variety of interests: research, practice, agency management and social work education. These interests interact all the time and are constantly adapting practice and theory in relation to each other. Rather than seeking connections between practice and theory, it may, however, be more helpful to practitioners to examine how they use ideas to think about the situations they face in practice and who influences that thinking.

Adapting and transferring theory We saw in Chapter 2 that most social workers practise eclectically, which inevitably means adapting theory. There are other ways in which we adapt theory: by shifting it from one setting or client group to another, or by transferring it from another discipline into social work. Transfer of learning is about the possibility of using ideas and knowledge gained from one area of practice in another (Cree & Macaulay, 2000). And knowledge travels from one person to another, one agency to another, one region and country to another. ‘Travelling knowledge’ is inevitably adapted to new cultures and approaches that already exist in a new culture (Harris et al., 2015: 481). One situation in which social work theory adapts or transfers material from wider ideas arises when ideas become incorporated into a general approach to social work that many practitioners use. For example, most social work is open-minded and non-directive towards clients. There are practical reasons for this because clients might not cooperate with someone who was too directive. But this general approach also comes from the longstanding influence of psychodynamic theory (Chapter 4) on social work. We saw in Chapter 1, however, that developing shared principles about specifying aims and action sequences have overlaid this non-directive approach. But we can see the original openminded relationship in the shared principle of alliance. This is because, as we saw when looking at EBP in Chapter 2, these general principles about creating an alliance with clients through effective relationships are relevant to most social work interventions, whatever practice theory we adopt.

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A second common situation in which theory is adapted or transferred from wider ideas arises when a theory is relevant to and applied in specialized settings. The perspective and its wider theory then become more important in what the worker does in that setting than it is in general social work. We saw in a case study in Chapter 2 how influential attachment theory (discussed in Chapter 5) was on work with children. Social work occasionally develops its own theories independently; task-centred work is an example of this. More commonly, however, social work theories select from and develop ideas from other academic and professional fields. Accreting theory in this way means that social work ideas connect to and originally came from wider bodies of knowledge and theory, and may, in turn, contribute to those wider bodies. For example, feminist theory has been significant in social work, and studies in social welfare and policy have influenced the wider feminist debate. Social work adaptations may, however, become decoupled from developments in the main body of the original theory. Thus, social work’s distinctive view of a theory has the same view of the world and may share some of the same original literature with the external body of literature. Some influence may continue in either direction, but the connections are usually sparse for workers in everyday practice. Some further examples. A practitioner in a women’s refuge might be closely in touch with and committed to feminist theory. A practitioner in a therapeutic community for mentally ill people might be in touch with aspects of psychoanalytic theory on groups and institutions. Practitioners in an acute psychiatric unit might be actively involved in cognitive behavioural treatment or in recovery ideas (see Chapter 10). These specialist settings may then have an influence on social work more directly than the wider bodies of ideas do. Social work theory is therefore often at some distance in time and interpretation from ideas in wider theoretical debate.

Transferring between specialized and generalized theory This book focuses on social work theory used in non-specialist social work. Wider bodies of theory may have no direct or influential relationship with the usual use of the related social work theory, although we saw in Chapter 2 that direct use of some social ideas and brand-­ name psychotherapies occurs without their being adopted into full-scale social work practice theories Workers in specialist agencies that use specialized theory develop a greater knowledge of and commitment to some specialized theory than the average practitioner in general social work, but we can often learn from them. The dual process theory of bereavement (Stroebe & Schut, 1999), for example, used in end-of-life care, does not have an equivalent in general social work, being concerned with ambivalent reactions after the death of a loved one. It connects with broader social research about the extent to which people’s social reactions are automatic or controlled by their minds (Sherman, Gawronski & Trope, 2014). The idea that distressed people shift between alternative and incompatible reactions to a life event is a generalization of the bereavement idea, and this may help us to understand ambivalent reactions in other settings. The broader idea that people switch between automatic and thought-out reactions in their social relations is another useful insight that we can use more broadly.

Linking practice and theory

Adapting theory in phases and processes One way of adapting theory is to shift between different theories as your work moves through different phases. Pružinská (2011) studied 461 Slovakian social workers working in a general government agency. They emphasized different theoretical models at different stages in the social work process. For example, they used a humanistic, open, non-directive approach at the assessment stage, but more structured cognitive behavioural approaches when attempting behaviour change. Another important adaptation was to truncate the full use of procedures or stages of intervention because agency pressures meant that they did not have enough time to work through every stage. Pružinská also found that the social workers’ overall view of social work influenced and adapted how they used practice models. The following case example shows this at work.

Case example: Maintaining coherence while using different theoretical models at different stages A social worker helping families care for their children saw practice humanistically and presented her social work task to a female client and her family as a shared developmental process. Later, however, when introducing cognitive behavioural work to improve skills in communication and organization in the family, the practi-

tioner discussed this as a separate stage in the sharing process rather than as a social learning or behaviour change technique. She felt this maintained coherence throughout the process of her work with the client, while allowing her to draw on different techniques when they were most appropriate.

Debates and conflicts, such as mutual criticism between clinical and social change theories, also exist within social work. Understanding the points made in criticizing a theory can help us decide what aspects of it to include or exclude from an eclectic general theory that we use in practice. Process knowledge about the way in which practitioners make decisions and judgements helps when making theoretical decisions in practice. Dealing with a problem in our lives usually involves working through a series of stages. This sees social work as a process – a series of actions and the factors affecting them that go towards making or achieving something (Payne, 2009a: 161). Instead of seeing ourselves as dealing with a succession of one-off events, we connect interactions with clients over a period of time, identifying a structure and organization in what we are doing together. This is how we come to see the different events as part of a whole that leads to an outcome. One of the helpful things about many social work theories is that they help us to identify stages in what can otherwise seem to be a confusing progression of events. Sheppard et al. (2000) and Sheppard and Ryan (2003) report empirical studies in which practitioners pursued two processes: critical appraisal of the situation and then hypothesis

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Focusing

Querying

Causal inferences

Making sense of the client’s situation

Partial hypotheses

Legal responsibilities Professional mandate

Critical appraisal of the situation

Whole-case hypotheses

Speculative hypotheses Rules of action

Hypothesis formation

Practice theories

Intervention

Figure 3.2  Sheppard et al.’s process knowledge Sources: Sheppard et al. (2000) and Sheppard and Ryan (2003).

generation, which allowed them to work out ways of intervening. Figure 3.2 illustrates the processes that Sheppard et al. and Sheppard and Ryan identify. Critical appraisal included focusing attention on issues that clients faced, querying and not taking for granted information that the practitioner received and following this up by making causal inferences about what was going on in a case. All this enabled practitioners to make sense of clients’ situations by creating hypotheses about the clients’ situations. Practitioners used three kinds of hypothesis. Partial hypotheses were limited to specific aspects of the case. Whole-case hypotheses tried to analyse the total situation that the client and practitioner faced. Speculative hypotheses involved practitioners in thinking out which interventions and legal or administrative procedures might be required. They then created rules of action based on their assessment of the problem and their legal and professional mandate, which gave them guidelines to follow as they worked with clients and other agencies. Social work theories offer generalized forms of such guidelines to act on.

Adapting theory through the ‘use of self’ and emotional intelligence Many practitioners, however, find it hard to make a generalized theory personal enough for them to be able to carry it out. Howe (2009: 170) points up the ‘use of self ’ as an important skill that helps to turn guidelines into action. Your own life experience can contribute to the process of working with your client. For this to happen, you have to be self-aware – to be able to think about both the best and weak aspects of how you deal with problems.

Linking practice and theory

Case example: Carrie’s fear of crying focuses her use of self Carrie works with children. She had to visit a couple she was working with whose three-­month-­old baby had died in an accident. They were very upset and, as a person who experienced strong emotions herself, she feared that she would break down and cry when listening to them talking about what had happened. Her supervisor said that expressing emotion like this was unprofessional; she had to be strong to support the parents. A colleague talked through with Carrie how she would handle it. Together they looked at her beliefs about social work practice and her personality. She realized that, to her, being genuine in how she reacted to clients’ experiences was an important social work value. Many social

workers would agree, and it is a major feature of humanistic practice (see Chapter 13). She also questioned whether expressing emotion would weaken the support she could give the parents. Sharing their emotions would, she thought, strengthen their relationship and allow her to offer greater support because they would all feel closer in their relationship. After this discussion, Carrie resolved to meet the parents and express her emotions as they affected her at the time. In fact, she did not cry, because she was concentrating so hard on listening and discussing the parents’ reactions that she did not need to express her own feelings. That happened later, talking it through with her husband.

There are three important points about this case example. First, it shows how an awareness of self, that is, knowing how you might react to a situation, enables you to anticipate potential problems and manage them appropriately. Second, Carrie did not take for granted simply one way of thinking about the process of this planned interview. Instead, she looked at how expressing emotions might have both strengths and weaknesses. As we will see later in this chapter in more detail, not taking for granted and looking at different possibilities are important parts of being critical when you are reflecting about the right action to take in social work practice. I identified this in Chapter 1 as an important shared principle of all social work practice theory. It is also a feminist approach to see issues as ‘and also’ rather than ‘either or’ (see Chapter 17). Third, this is an example of supervision in which a manager, her peers and her personal relationships all contributed to help Carrie practise effectively and think critically.

PAUSE AND REFLECT  Repressing or expressing your emotions in practice Do you think good professional behaviour requires you to repress or express your emotions when working with clients?

Some suggestions To show clients your sincerity in your relationship with them, you often need to express the powerful emotions you feel when working with them. It may sometimes be indulgent, however, to express your emotions. Ask yourself whether you might be showing off what a ‘feeling person’ you are, perhaps overreacting rather than reacting genuinely. In addition, some

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people find emotional expression embarrassing, or it makes them feel that you are weak or unhelpful. Sometimes, therefore, we must plan to manage our emotional expression to behave in ways that best help people to feel comfortable working with us. So this is another feminist ‘and also’ and not an ‘either or’. Social workers can usefully both experience and express their emotions in ways that allow them to manage their emotional reactions and also allow their clients to experience their emotional reactions as helpful. Howe (2008) connects the use of self with the idea of emotional intelligence, which he suggests is an important characteristic of good social workers. Goleman (1996) identifies the importance of emotional intelligence in parenting and many other social situations, and later (Goleman, 2007) develops this idea to include social intelligence, a competence in building social relations. Emotional intelligence comprises an interaction between: ●● ●●

self-awareness and self-management (intrapersonal intelligence); awareness of others and the capacity to manage relationships with others (interpersonal intelligence) (Morrison 2007: 251).

People with emotional intelligence have developed skills in perceiving and identifying feelings in others. They integrate emotions with thinking to improve their capacity to access and manage their own and other people’s feelings. Social workers who have developed emotional intelligence are likely to be better able to engage with others, carry out social work assessments, make decisions and collaborate with others. As professionals, they are likely to be better able to deal with stress, build resilience to adversity and cope better with difficulties in their practice (Morrison, 2007). Howe (2008) argues that emotional intelligence permits practitioners to move from observing and monitoring their own and their clients’ behaviour towards managing the environment around them. This section has explored several ways in which practitioners adapt theory as they use it: ●● ●● ●● ●● ●● ●● ●●

transfer of learning about a theory between disciplines, cultures and specialisms; adapting theories while working through different phases of work in a case; using specialist theories that align with those of colleagues from other professions; using ideas from wider bodies of theory; understanding critiques by looking at the debates among theories; using process knowledge to make better adaptations between practice and theory; understanding the use of self and emotional intelligence in using practice theory.

Reflection, reflexivity and critical thinking Contemporary thinking about the best ways to use our self as part of the social work process, incorporating and contributing to theory as we do so, focuses on a set of related ideas: ●● ●● ●● ●●

reflection; reflexivity; critical thinking; critical reflection.

In this section, I separate these ideas to explain the differences and connections between them and how they are used in social work.

Linking practice and theory

Reflection – what is it? Reflection describes what a mirror does. When you look in a mirror, it ‘turns back’ (re-flects) an image, giving a picture of things, people and events that are happening within the scope of its surface. That image usually includes you, the observer who is looking, unless you stand to the side so that you are out of sight, and it is always an image, not the reality, of the scene. For example, reflected images are always inverted, so we never see a completely accurate picture. Perhaps you have had the experience of picking up a hairbrush while looking in a mirror, and starting to brush on the wrong side, because you have not compensated for the inversion. So, although it is not without its difficulties, the image nevertheless helps us to see, evaluate and react to ourselves and our surroundings. It helps us with the use of self. The idea of reflection has been used in a genre of writing that helps professional practitioners to plan and conduct their work with a greater understanding of the situations they are facing. Some of this writing also claims that reflection helps to develop practice theories for professionals: they use the ideas inspired by reflecting on particular incidents to adapt existing theories or create new ones. Beckett and Horner (2016: 246–7) suggest that reflective practice helps to: ●● ●● ●● ●● ●●

test out theoretical ideas and research findings against your own experience; clarify the theoretical ideas behind your actions; challenge your assumptions; challenge your agency’s assumptions; generate feedback between you, your colleagues and your clients.

Most writers see reflection as a more or less complicated circular process. Jasper’s easy to remember experience–reflection–action (ERA) summarizes the main points (Figure 3.3): you have an experience, you reflect upon it and this changes the way you act in the future. I have added some points from other writers to Figure 3.3. Borton’s (1970) reflective framework suggests that you reflect upon different aspects of the situation at each stage: description, theory and knowledge, and action reflection. This makes it clear that reflection is more than the ‘thinking about it’ phase – you should pay attention to the whole process. Gibbs’s (1988) reflective cycle details the actions associated with each stage. When you are experiencing the events, your reflection is descriptive: you describe what happened and unearth how your thoughts and feelings reacted at the time. Moving on to the reflection stage, you bring your theory and knowledge to bear. This allows you to evaluate the experience and decide what was good or bad about it, what went well and what led to problems. At this stage, you are trying to make sense of what happened. Thompson and Thompson (2018) emphasize three dimensions of reflection, cognitive, affective and values, and many writers (for example, Bassot 2016: 65–78; Butler, 2019) point to the importance of reviewing your own and others’ emotional reactions as part of reflection. At the third stage, your reflection shifts towards action. Does your ‘making sense’ reflection suggest other ways in which you could have acted? In turn, does this help you to plan to do something different next time something like this happens? Most agree that active use of the idea of reflection in social work originated in the work of Argyris and Schön (1974; Schön, 1983, 1987). Schön was an educationalist, Argyris an organizational sociologist, so they focused on different ways of using reflection. Schön was mainly interested in training professionals to develop and use knowledge by being more thoughtful about their practice, while Argyris was more concerned about how people adjusted to the pressures of working in complex organizations. Both these issues are important to social workers.

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Thinking about social work theory Experience Descriptive reflection Describe what happened What were you thinking and feeling?

Action Action-oriented reflection What else could you have done? If it happened again, what would you do differently?

Reflection Theory-and-knowledge reflection Evaluate: what was good/bad about the experience? How can you make sense of what happened?

Figure 3.3  The reflection process Source: Jasper (2003) with additions.

Redmond (2006) shows that reflection has a longer history, in particular citing Dewey (1933), the American philosopher of education, who also influenced social work through his impact on pragmatic philosophy, problem-solving and task-centred practice. Dewey distinguished trial and error experiments from reflection. Experiments, in his view, simply told you what worked, while reflection was a creative process that produced new ideas (Redmond, 2006: 10). Reflection is crucial to learning from experience or from research, because it enables you to reconstruct or reorganize the experience as something that you can use. Reflection approaches have been widely used and systematically developed in teaching education and have subsequently influenced nursing, social work and other professions. The argument for reflection as a practice in these professions is that it: ●●

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recognizes and values human relations as a special feature of practice in those professions; proposes a way of developing generalized theory from practice.

Gardner (2003) develops a mode of critical reflection in community work situations, which we can transfer from working with collectives to practice with individuals: ●● ●● ●●

●●

seeking subjective histories and narratives from the people involved; making sure that those least likely to be heard are included; enabling participants to make connections between broader structural issues and their personal experience, which is a feminist approach; paying attention to processes as well as outcomes.

Reflection: debates Arguments for using reflection concentrate on the flexibility and creativity that it can offer to our practice. Criticisms of it focus on its emphasis on the worker’s own

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thinking, rather than responsibilities to agencies and drawing in clients’ perspectives. This section reviews some of these issues. Debates about reflection connect with the literature that we met in Chapters 1 and 2 that contrasts interpretivist with positivist views of knowledge. Proponents of reflection try to describe realistically how professionals use knowledge in working with people. They argue that ‘people work’ has a different character from work with natural substances, such as engineering, so it requires a different kind of knowledge used in different ways. Professions such as engineering use the phrase ‘technical rationality’. Natural substances, as opposed to human beings, always perform in the same way, provided there are similar conditions. For example, water always runs down to find the lowest point, although in cold conditions it freezes and loses this characteristic. But given the same conditions, you can always predict what water will do. Working with human beings is not predictable in the same way. Even so, some professionals who work with human beings can operate in technical rational ways. This is because some aspects of their practice also use natural substances. For example, doctors use medication, which has predictable effects on the human body. Garrett (2018a: 5) argues that technical rational approaches to social work are an additional view of social work, an alternative to the three views that I discussed in Chapter 1. He calls it the managerialist-technocratic perspective, connecting it with the incursion into social work of new public management or managerialism and business language and techniques. The communication aspect of medicine – interacting with people, a characteristic also found in other caring professions such as social work, nursing, teaching and similar professions – does, however, use knowledge in a more flexible way. Argyris and Schön suggest that workers using this kind of knowledge have guidelines for good practice and use these to carry out their work in a practical way. When they come across a new situation, they try practical experiments, new ways of working, which then adapt the guidelines. Education for such professions involves helping people to identify when a new situation has arisen and how to develop new guidelines using practical experimentation. Reflective practice involves more than carefully thinking things through and taking all aspects of the situation into account (Payne, 2009b). It implies doing this in a structured system, such as that described in Figure 3.3, either while we are taking part in the situation (Schön, 1983, calls this ‘reflection-­in-­action’) or as a learning or review technique to improve future practice after the event (‘reflection-on-action’). Writers on reflection call upon a range of ideas. Mezirow (1981) draws on the work of the German philosopher Jürgen Habermas (1986 [1971]), who identified three different ways of understanding the world around us: technical, practical and emancipatory. Each of these has a different approach to research and education that influences different cultures and ways of thinking within a society. These ideas extend the discussion of knowledge, theory and EBP that we explored in Chapters 1 and 2. Habermas (1986 [1971]) says that technical knowledge is based on empirical research into observable events, governed by technical rules that tell us whether or not something was correct; in Chapter 1, I referred to these as ‘accepted scientific processes’. Research in such fields is an instrumental action: when we have identified what is true, this allows us to plan our actions so that we can achieve our aims. Knowledge becomes an instrument in our planning

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towards achieving our objectives. EBP sees knowledge in this way. Practical knowledge is based on a systematic investigation into different points of view about the meaning and importance of what is happening around us. Research in practical knowledge involves ‘communicative action’, in which different points of view are argued out to a conclusion, which in turn allows us to interpret the world around us. Emancipatory knowledge allows us to take both technical and practical knowledge further. By examining the different points of view that emerge through exploring practical knowledge, we can free ourselves, through self-reflection, from the limitations of the assumptions about a particular point of view. If we can achieve this transformation in ideas, we can understand and avoid or reduce the effect of forces that create barriers in achieving what we want to do. I discuss other aspects of Habermas’s contribution to social work in Chapters 11 and 12. Mezirow (1991) goes on to argue that adult education has a role in perspective transformation, so that people may become more conscious of barriers to achieving their personal aims. This, in turn, connects with the work of Freire (1972), who argues for conscientization (consciousness-raising in feminist theory) as an important objective in adult education and community work, because people cannot develop themselves until they become aware of social barriers to change; I look at his work more fully in Chapters 14, 15 and 18. Brookfield (1990) picks up the organizational perspective introduced by Argyris in emphasizing the need to create a learning environment in which reflection can take place successfully.

Example: Knowledge and prevention in child welfare services An example of these different forms of knowledge can be found in Murphy’s (2009) study of preventive child welfare in Ireland. Her analysis of the history of ideas about prevention connects with the history of social work in several Western countries. The idea of prevention as an objective in social work grew out of the success of public health interventions in preventing disease. Family support services in social work were a way of preventing children from coming into state care. This is an instrumental use of knowledge: services plan to use social work as an instrument to improve family functioning and achieve the pragmatic objective of reducing the number of children cared for by the state. At the same time, radical social work (see Chapter 15) raised the possibility of stimulating employment, reducing poverty, improving education, healthcare and housing and providing community development. If you did this, families and children would have fewer pressures on their lives and more resources to respond to difficulties in their communities. This is an example of practical knowledge. Different ways of dealing with the families’ and children’s problems in deprived communities were set against each other, debated and to some extent brought together. This was done by providing professional family support services in community settings with considerable local participation in community development. US experience of similar debates and developments leading to Head Start, the 1960s poverty programme for deprived children that is the source of later developments, such as the Sure Start

Linking practice and theory

programme of the early twenty-first century in the UK and other local initiatives to support children’s early development in urban communities, followed a similar track. Political differences about the value of these approaches, research evidence about their effectiveness and economic change from the 1980s in many advanced countries reduced the resources available for public services. This led to a tightening of focus, so that prevention became focused on preventing child neglect and abuse. These aims displaced broader positive objectives that sought children’s, community and family support and empowerment. Emancipatory knowledge identifies different interpretations of prevention that exist in debates about preventive services. Without resolving these different interpretations, we cannot use any technical research knowledge to achieve preventive objectives; we have to decide on our aims first. Murphy points to the importance of cultural ideas about families. ‘Familism’ policies, for example, marginalize children because they emphasize adult relationships within the family role to support employment, housing and economic policies.

It is not easy to develop reflective practice. Goodman (1984, cited by Jasper, 2003) suggests that people’s reflective skills develop through three stages: ●●

●●

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reflection to achieve specific objectives, such as fitting in with the practices and policies of the agency; reflection on the relationship between principles and practice: practice-theory connections; reflection to incorporate ethical and political concerns, which might be particularly relevant to critical and feminist practice but includes concerns for the underlying politics of all theories.

Bruce (2013), emphasizing reflection as a journey in which we grow in confidence and skill, points to the importance of a mentor to help to incorporate widening areas of knowledge and skill in our reflection. In social work, professional supervision usually also connects to agency accountability, so that agency and policy perspectives may be included in our personal reflection and allow our experiences and developing ideas to be contributed to our team and agency. This is not always the case with colleagues from other professions, where management may be separated from personal mentoring (Scragg, 2019). Reflection may also be undertaken with peers in pairs and in groups (Bassot, 2016: 105–16), and can use art, music and poetry at trigger mechanisms for creative thinking (Johns, 2017: 113–19). Bruce (2013) and Thompson and Thompson (2018: 102–22) also draw attention to the importance of reflective journals as mechanisms for building reflection and the supporting information and evidence for it. Another useful strategy is to find ways of including clients’ and carers’ responses and ideas explicitly in our reflection, including finding ways of getting explicit feedback from them and others involved with our work, such as colleagues from other professions. Cultural ideas sometimes reflect the views of different minority ethnic groups. The following case example shows how different cultural interpretations of the nature of the problem presented problems in providing appropriate help.

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Case example: Chinese and Western views of mental illness Mr and Mrs Ho were a Chinese couple living with their daughter in a large Western town. Their daughter developed anorexia because of bullying at school. Her parents were most upset when this was referred to a mental health service by the school. They said that their culture regarded mental illness as a matter of shame for the family and refused

to participate in their daughter’s treatment. Their doctor therefore referred the daughter to a young person’s advisory service, whose social worker focused on developing family support for improving the daughter’s relationships at school. Removing the focus on psychological problems was satisfactory for the family.

I turn now to criticisms of reflection approaches. First, they may assume that we can respond effectively to every variation in the situations that we deal with by simply changing the existing guidelines for action. Second, even if we could do that, reflection assumes that others will accept the changes that practitioners identify in the social order and social relationships. In both cases, more may be required. Existing agency mandates constrain practice that seeks to change the present social order, and practical experiments that conflict with existing guidelines, as we saw in discussing Figure 3.1d. Third, reflection assumes that professionals have enough discretion to carry out practical experiments, and the power to achieve the necessary changes, whereas many professional jobs are constrained by agency policies or government regulators. Fourth, reflection assumes that all problems are within the capacity of some rethinking by a professional, whereas many require additional resources. Fifth, barriers such as time constraints, an unsupportive organizational culture, colleagues or managers may get in the way (Thompson & Thompson, 2018: 122–41). Increasingly, however, reflection is a recognized element of al professional work, and agencies that fail to provide support and time for it can be regarded as failing or managerially inappropriate. To deal with these points, our practice has to include ways of working on situations for which wider change and additional or different resources are needed. Critical reflection (see later in the chapter) and critical practice (see Chapter 16) take up reflection and use it to seek additional human and economic resources.

Reflexivity Reflexivity derives from qualitative research methods, particularly as applied in feminist research. It means a cyclical process in which we study how the things that we observe affect our thinking and how that then affects what we do. Traditional research methods, as we saw in Chapter 2, assume a neutral observer looking at social situations from the outside. Critics have pointed out biases arising from the social assumptions and constructions of researchers that make this assumption of neutrality wrong. Feminists, followed by researchers in disability and more generally in health and welfare and the social sciences, moved towards research methods that involved the people who were being researched more actively in the process. Ethnographic methods, in which the researcher is a participant observer in the events and situations being researched, included specific attention to how researchers were affected by their observations and how this then affected their

Linking practice and theory

behaviour. Feminists and disability researchers sought to develop collaborative methods in developing research objectives, carrying out research, analysing data and disseminating the results. These approaches included building interpersonal relationships with the people being researched rather than maintaining a stance as a neutral observer. Research was sometimes managed or influenced by representative groups of the people being researched. In addition, there were also developments in working as collaborators with people affected by the research (Finlay & Gough, 2003). Fook (2016: 56) distinguishes reflexive thinking from reflective thinking, although she acknowledges that they are connected ideas and you can use them together. Reflective thinking is a process that you follow through, while reflexivity is a stance, a way of looking at the world. Using a reflexive stance means that you always try to understand different perspectives on a situation. Parton and O’Byrne (2000) describe reflexivity as a way of responding to the uniqueness of individuals. It involves thinking about both our response and that uniqueness, so we are not being reflexive unless we try to find the uniqueness of the individuals we deal with and try to respond to it. While theory enables us to generalize about issues, reflexivity picks up how individuals are affected by the issue. If we look at that individuality, we inevitably see that the theory may help us but it is not quite right in the particular case we are studying, so we adapt it. Finlay (2003) identifies the following ways of being reflexive: ●● ●●

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Introspection: looking into our own mind and working out how we are thinking and why. Intersubjective reflection, that is, joint introspection involving the participants: in social work they are our clients and the people around them and perhaps our colleagues and managers. Setting up systems for mutual collaboration, so that processes for influencing each other’s thoughts are established and agreed. Using reflexivity as a social critique. If we say we have been working reflexively, we are implying criticism of people who have not taken the trouble to do so. Using reflexivity as ironic deconstruction. Here, the process of thinking together identifies where the people involved, including ourselves, have used power and authority to affect the neutrality of our thinking. In this process, we begin to question taken-for-granted patterns in the way we share thinking, an example being a husband and wife’s normal power relations.

Taylor and White (2000) discuss studies in health and social welfare that use such methods to uncover systematic behaviour that is not prescribed by practice theory. For example, they show how, in interviews, clients established their credibility, entitlement to services and ‘moral adequacy’ and gave their story authenticity by describing details of their actions. Such findings have implications for how to practise according to theory, because they suggest that our objectives in interactions with our clients are often different from theirs.

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Case example: Hayley’s crisis questions led Soumen to defend his family’s ‘moral adequacy’ Hayley was working with Soumen, his wife and two pre-school children because of allegations of poor standards of care. She found that the family seemed chaotic, experiencing constant emergencies when plans for caring for the children went wrong. Crisis intervention theory suggested to Hayley that she should find out how the family coped with previous crises, to see if they had learned unhelpful coping practices. Although she had a good relationship with Soumen, however, she found that he talked about how well they had managed particular situations, while his wife became

silent and did not seem to connect with these past events. Soumen had interpreted Hayley’s questioning as critical and wanted to assert their family’s ‘moral adequacy’ by showing the worker how well they had managed in the past. After discussing this with her supervisor, Hayley shifted to a more narrative, strengths-based approach (see Chapters 11 and 12), emphasizing a more balanced view of past family care. This allowed Soumen and his wife to explore their experiences and opened up talk about the value of different approaches to caring for the children.

Redmond’s (2006) research on an educational project to develop reflective thinking with social workers and other professionals is an example of using reflexivity.

Example: Reflexivity seen as rotating practitioners’ models of the situation they are working with Redmond’s idea was that practitioners had a model in their head that evaluated clients. This model changed as the practitioners’ understanding of different views in the situation was rotated as the project progressed (Figure 3.4 is my diagram showing Redmond’s idea).

rotation

Practitioner’s model of the client 180º rotation: understanding the client’s view of the practitioner

360º rotation: practitioner’s approach to the client changes because of understanding from the 180º rotation

rotation

Figure 3.4  Redmond’s model rotations Source: Redmond (2006).

Linking practice and theory

Working with the parents of disabled young people, for example, a practitioner’s evaluation might be that a parent was ‘confused’ about the practitioner’s role. The first stage would be to ‘rotate’ the practitioner’s model (a 180° rotation), so that the practitioner would use the clients’ words to describe practitioners. This is an example of using description as a method in the first stage of a reflection. A parent might use the words ‘pushy friend’ to describe the practitioner, expressing the thought that practitioners presented an impression of being friendly, but had a hidden, professional agenda. When the practitioner used this phrase, he or she could see that the apparent confusion was not just a failing in the client’s perception, but had emerged from the ambiguous aims and behaviour of the practitioner. The next stage would be to rotate the practitioner’s model again (a 360° rotation in total) so that the practitioner could use the understanding gained from the 180° rotation to change her behaviour. In this example, the practitioner would be open about their agenda for change alongside their supportive style. This would in turn help to remove the clients’ confused behaviour.

Critical thinking Ideas of reflexivity have been particularly applied in critical thinking about practice. The term ‘critical thinking’ has two meanings. One refers to the study of established methods of guiding thought processes, using ideas from rhetoric and logic (Bowell & Kemp, 2002). Thinking about how language is used by clients or colleagues helps us in practice by identifying the important points of clients’ and colleagues’ thinking. The second meaning of critical thinking refers to using reasoned thinking, questioning existing assumptions and testing them against evidence and observation. Glaister (2008: 8) refers to ‘open-minded, reflective approaches that take account of different perspectives and assumptions’. She argues that critical thinking improves our capacity to handle uncertainty and change. She presents two guiding principles: respecting others as equals and having an open approach, not taking things for granted. Her approach identifies reflexive principles as basic: forming effective relationships so that workers can incorporate multiple perspectives in their thinking, seeking to empower people by increasing their opportunities and making a difference so that the client’s experience of life is better. This might involve thinking about the quality of the client’s life in the round, instead of focusing on concrete tasks and objectives. Gambrill’s important works (2016, 2019) use the term in this sense, connecting them to EBP. The latter book focuses on the critical appraisal of research and good practice in logical thinking, linking this to an awareness of social work issues. Payne, Adams and Dominelli (2009) describe critical thinking techniques as follows: ●● ●●

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Examine the language used to identify hidden and untested assumptions. Consider different sides to any judgements or evaluations you make by reflexively putting yourself in the position of others involved. Question ideologies that have been used or implied. Ideologies are systems of thought, often derived from political or moral principles, that have an impact on how we behave. Look for contradictions implied in the thinking. Value openness as a way of maintaining equality between participants, and including all participants in the work.

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The authors argue that this leads on to practical techniques: ●●

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Examine evidence about the situation through different perspectives, thus avoiding risk and opening up opportunities. Contextualize your exploration of the evidence by making explicit the value positions implied by the evidence you have chosen to use. Develop an overview of the implications of the whole situation. Test out your judgements and decisions with colleagues, clients and others involved before acting.

The next case example illustrates how reflexivity can help with critical thinking about your own and other people’s values. Seeing the application of the theory from a potential client’s point of view helps us understand how to present our approach in a balanced or positive way. It also draws attention to possible failings in the theory. For example, one of the potential criticisms of crisis theory is that it concentrates on things that have gone wrong rather than on strengths. Ideas such as using diaries and journals or structured questionnaires or discussion techniques to guide reflection can help people to see events from the points of view of different participants. Critical incident analysis  – selecting critical (or particularly significant) incidents from a case or area of practice – can help to focus reflection (Fook et al., 2000; White et al., 2006: 15–16).

Case example: Henry’s death and his marriage I worked with Henry, a dying man whose relationship with his wife had become more conflictual. He blamed her behaviour for difficulties in their marriage. Reflecting, I considered possible reasons why this might be and talked over explanations with both partners. His wife thought that he was projecting some of his behaviour onto her (to use a psychoanalytic term; see Chapter 4). This means that he complained about her alleged unfaithfulness and criticized her for this because he knew she criticized his (also alleged) unfaithfulness. Their two children thought different things about their parents’ behaviour and relationships. Being reflexive also meant putting these ideas into the discussions with Henry. Thinking critically, I was aware that some of the conflict arose from changes in

attitudes to what is acceptable in gender relations. Henry took it for granted that unfaithfulness is natural in a man, but not in a woman, but this double standard is no longer acceptable in contemporary attitudes. One of my aims was to get him to acknowledge changes in the social order of gender relations, so that both he and his wife could agree about the good and bad things in their marriage, and he could say sorry before he died. Practice knowledge (Earnshaw Smith, 1990) tells us that dying people often think about the past and try to set things right in their relationships. For Henry, this meant looking at changing social values and thinking about setting things right with his wife according to new rather than old values, reflexively including alternative ways of looking at things.

Linking practice and theory

Secker’s (1993) study of social work students using theory shows how a reflexive approach may benefit practice. She found that some students were fluent in using theory because they had particular social skills. They listened well and tried to tie ideas to what clients told them. They could develop ideas, drawing on a range of different courses and making connections, rather than seeing pieces of knowledge as separate. They also discussed their ideas well with the clients concerned, so that they could test out the validity of their application. A successful use of theory requires social and interpersonal skills, and the self-confidence to discuss ideas reflexively, rather than a detailed understanding of or discussion of theory, so that clients are participating in the construction of practice. Crawford, Dickinson and Leitmann (2002) used student reflection in groups with practice educators (field supervisors) to help interweave theory, practice and reflection. All this work draws attention to the importance of involving clients, service users and members of the community as well as multiprofessional colleagues in reflection. It need not only be a professional or only a social work activity; indeed, it cannot be if it is also to be reflexive. Clients may also transfer learning from one experience to another. Case example: Josie discusses theory openly with her clients Josie was helping Jane, a mother whose husband’s family had accused her of going out with ‘other men’ and leaving the children alone when he was working on a night shift. Jane denied this and counterclaimed that her husband went out drinking and did not contribute to childcare responsibilities. Josie suggested to Jane that it often helped in relationships that people should not make accusations, but should instead focus on times when people helped each other. Then they could discuss together the factors that had led to that helpful time. Doing this, Josie avoided using jargon from strengths-based practice (where she got

the idea; see Chapter 11), but explained something practical that Jane and her husband could do. She agreed to come back for a joint session using this way of looking at a problem and, in later meetings with Jane and her husband, got them to try out this approach at least once each week and then discuss it with Josie afterwards. This gave them positive actions to focus on, which reflected existing successes in their relationship. The promise of later discussion meant that they knew there would be a review of whether they had completed their ‘homework’, and this put pressure on them to keep to the plan.

Critical reflection Critical reflection is a twenty-first-century development that seeks to put facets of these ideas together. In critical reflection, critical thinking and reflection ideas are expanded using critical social theory, which does not take our assumed patterns of thinking and social organization for granted. This offers practitioners helpful alternative ideas when you want to shift your own perceptions and those of clients and colleagues. It encourages you to look actively for ideas that contest existing patterns of influence and power in social relationships. Who suffers from social inequalities and conflicts of interest in this situation and how does it affect them? Can you rebalance oppressions and disadvantages affecting your clients and the people around them? Can you look at their identities and lives through a new lens, identifying chances they haven’t had that you can react to?

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Gould and Baldwin (2004) connect critical reflection with how well organizations develop good practice. They argue that social work agencies need to become learning organizations, facilitating flexible responses to new situations. Otherwise, they cannot identify new social trends that are having an impact on clients. In addition, they cannot capture and develop new practices as they emerge out of experience. I noted earlier in the chapter that achieving learning organizations was an important aim of the work of Chris Argyris, one of the founders of reflective practice. If, as McDonald (2006) suggests, practitioners and clients are always responding to change as it affects economics, politics and ideas, social work organizations need to be able to learn about those changes as they happen and devise ways to deal with them. Critical reflection joins effective supervision and evaluation of services as techniques that can develop learning organizations. Howe (2009) sees reflection as important because it helps us deal with uncertainty and enables practitioners to become emotionally available; that is, so that clients feel they are available, rather than being preoccupied or authoritarian. Baldwin (2004) identifies four organizational threats to critical reflection: ●●

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Managerialism, an organizational commitment to new public management techniques, is a problem because it insists on the right of managers to control practice. Therefore, it furthers organizational rather than professional aims. In addition, it relies on rationalist techniques, such as eligibility criteria for services, targets and performance indicators. This leads managers to evade the uncertainties that may arise when organizations emphasize professional management. EBP favours objectivity in evidence-gathering that is at odds with reflective practice using cooperative, inclusive relationships between practitioners and clients. Rational implementation of policy reduces the flexibility of organizations to deal with change. Failures in critical analysis may exist, an example being taboos on discussing issues that are too difficult for the organization to deal with.

Baldwin also proposes, however, that critical reflection offers clear opportunities for social work agencies because it offers methods for: ●● ●● ●● ●● ●● ●●

exploring situations and difficulties; the management of professional discretion; the management of innovation, particularly where practice is complex; replicating cooperative inquiry within organizations; strengthening teamwork; facilitating participation.

Fook and Gardner’s (2007) important text sets out (in chapter 4 of that book) a critical reflection process, a training model for introducing critical reflection into an organization. Again, this draws attention to the importance of how the organization works as a starting point. For example, a large, formal, bureaucratic organization operates differently from a small, informal organization without much of a hierarchy. The preferred model is as follows: ●●

Establish small facilitated groups, with voluntary membership. These groups enable dialogue with a focus on the communicative process, space for individual reflection and enough time for members to present and reflect on a critical incident.

Linking practice and theory ●● ●●

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Use examples of specific and concrete practice experience. Individuals are directly involved so that they can work on their own experience in a participatory climate: the facilitator starts by modelling a reflection on their own experience. Use critical reflective questioning in a trusting and collegiate environment. Unsettle assumptions that are not explicit, leaving outcomes open-ended so that creative options are enabled (stage 1). Sue White (2006) talks about the reflexive practitioner as a trickster, acting perhaps mischievously, ironically, humorously to create lively talk. Such an approach helps us cross troubling boundaries to combat occupational liturgies. Here, for example, the idea of liturgy describes professional language as being like the conventions of a religious service, running along repetitive themes rather than developing creative and innovative rational thoughtfulness. Devise new practices and approaches separately from the ‘unsettling’ stage; otherwise, people often move towards solutions or outcomes rather than analysing the situation adequately (stage 2).

Conclusion: using practice–theory links Chapter 2 looked mainly at how theory and knowledge should influence practice, while in this chapter we have explored how practice and theory interact in complex ways. These concepts are not ‘either or’ but ‘both together’. You cannot deduce logically from theoretical ideas what to do in practice. You can, however, use practice experience to find ways of testing out and incorporating ideas into your thinking to help you plan effective interventions: ●●

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Adapt and transfer theory from one setting, culture or specialism to another by using different theories in different phases or aspects of your work. Use process knowledge to understand your thinking as you move from making sense of a situation towards deciding on the appropriate interventions. Use emotional intelligence, which enables practitioners to understand clients’ emotions better and manage the emotions they experience through their work. Consider critical reflection, which has developed as an important way of using theory. It involves: –– reflection in action during interactions with service users; –– reflection on action, individually and with supervisors and with peers, both to look back and to plan; –– ERA: thinking through an experience, reflecting on it and then taking action on the reflection; –– reflexivity: understanding the full range of perspectives of people and agencies involved; –– critical thinking: questioning existing assumptions about situations; –– critical reflection, using critical social theory, which continually questions the existing social order.

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Additional resources Further reading Schön, D. A. (1983). The reflective practitioner: How professionals think in action. New York: Basic Books. The classic book on reflective practice. Although readable and valid, it needs to be updated with more recent texts. Taylor, C. & White, S. (2000) Practising reflexivity in health and welfare: Making knowledge. Buckingham: Open University Press. A good research-based account of reflexivity applied to practice, using recordings from practice. Fook, J. & Gardner, F. (2007) Practising critical reflection: A resource handbook. Maidenhead: Open University Press. White, S., Fook, J. & Gardner, F. (Eds.) (2006). Critical reflection in health and social Care. Maidenhead: Open University Press. These two books document the most important twenty-first century developments in social work reflection. The Handbook sets out the theory and describes an educational programme that trains you to use it, while the edited collection contains a wide range of conceptual and practical papers.

Journals Reflective practice: International and multidisciplinary perspectives. Taylor & Francis. A journal covering a wide range of professions.

Websites http://socialworkpodcast.blogspot.com/2009/08/theories-for-clinical-social-work. html The Social Work Podcast offers an interview (about 50 minutes) with Joe Walsh, the American author of a book on clinical social work theories. The interview explores why theory is helpful to practitioners in settings where social work is, as often the case in the USA, seen as clinical or treatment, and focuses on psychological interventions. https://www.podsocs.com/podcast/critical-reflection/ This podcast (about 30 minutes) is an interview with Jan Fook, an important writer on critical reflection and critical practice generally. http://swscmedia.com/2013/03/critical-reflective-learning-podcast-by-dr-neil-thompsonswscmedia-series-for-wsw/ Neil Thompson’s podcast (about 20 minutes) reviews ideas about reflection and reflective practice, and moves on to critical reflection as a way of thinking about practice without taking things for granted.

PART 2

REVIEWING SOCIAL COHESION THEORIES This first group of theory chapters reviews social work practice theories whose main aim is to meet the International Federation of Social Workers (IFSW) objective to promote social cohesion in the lives of the people whom social workers serve. The final chapter, on practice using macro, social development and social pedagogy theories, also has significant empowerment and liberation objectives and arguably some social change and development objectives, although its primary aims are towards social cohesion. It therefore connects with the two later groups of theory chapters. 4

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Psychodynamic attachment practice

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Crisis, trauma and task-centred practice

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Cognitive behavioural practice

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Motivational interviewing

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Systems practice, complexity and chaos

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CHAPTER 4

Psychodynamic relational practice MAIN CONTRIBUTION Psychodynamic ideas are distinctive in social work because they emphasize the importance of people’s feelings and internal conflicts in creating and resolving the problems that they face. They are valued as a rich fund of ideas for practice. In the history of social work, they have had a strong impact on how social work is practised and have helped shape its focus on people’s psychological reactions to their social environment as the source of personal and social problems. Psychodynamic practice, therefore, demonstrates how the social cohesion objective of social work supports the existing social order by helping people to adjust to the society around them. Two important sets of psychodynamic ideas are currently significant. This chapter includes a broad introduction to psychodynamic ideas, and then concentrates on relational practice. Chapter 5 builds on this to examine attachment practice. In relational practice, practitioners build relationships with clients and the people around them to help them change and manage patterns of behaviour in their day-to-day social relations.

MAIN POINTS The first part of this chapter introduces psychodynamic ideas, drawing on psychotherapy using ego, object relations, self and relational psychologies (see Figure 4.1 and its associated commentary to understand these terms). It then focuses on relational social work, an influential current practice application of these ideas. Chapter 5 moves on to look at attachment, another widely used model of practice that uses psychodynamic ideas. ●●

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Psychodynamic theory is an important source of cultural ideas and social work practice conventions. Criticism of psychodynamic practice claims that the focus of psychodynamic ideas on insight into individuals’ psychological functioning is not a good basis for intervention and has limited applicability in practice. Moreover, many question its cultural and social assumptions and its emphasis on early experience as the source of current behaviour. Value issues arise from individualism and determinism in psychodynamic theory; that is, it focuses on people as individuals and leads to their psychology being seen as the main influence on their behaviour. 97

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Psychodynamic theory is based on metaphors about structures in people’s minds, namely the id, ego and superego, how these develop and how to intervene with them. The main use of psychodynamic theory in social work is relational practice, in which the person-in-environment is the focus of attention. Applications in groupwork and residential care have also been influential. Psychodynamic ideas are a rich source of complex ideas for interpreting behaviour.

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Anxiety and ambivalence are derived from the inadequate resolution of problems in an earlier period of life. In turn, they lead to powerful feelings of aggression, anger and love. Coping is the ability to manage present problems even though you fear that you may not be able to deal with them. Defences and resistance are two common psychological barriers to working on life issues. They are ways of resolving the psychological impact of past problems. Enacting is a process by which you repeat past relationship experiences to help people identify, practise and establish new ways of behaving in relationships with others. Transference and countertransference are technical terms in psychoanalysis, interpreted for social work to mean the effect of past experience that is transferred into present behaviour patterns in the relationships between your client and you. In reflecting on how clients react to you and how this makes you feel, you can directly experience how clients behave with others, and your feelings in response suggest how others might feel about that. Relationships with people may be used to model effective thinking and self-control, and as a vehicle to gain influence and confidence to explore psychological issues; this is relational practice. Working through is a process of repeatedly remembering crucial examples of problem behaviour as they occurred, exploring what happened and thinking about ways in which events and their emotional consequences might have been different. (Sources: Partly from John and Trevithick, 2012; Froggett, 2002).

THE DEBATE SUMMARY The main areas of debate about psychodynamic practice in social work are: ●● ●●

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its scientific status and empirical support for its use; its focus on internal psychological functioning, which fails to incorporate the social issues that affect practice; its use of insight limiting it in practice; the cultural assumptions it makes; its assumption that earlier experience strongly influences current behaviour.

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Debate about psychodynamic practice  he scientific status of and empirical support for psychodynamic T practice Sigmund Freud, the original source of psychodynamic ideas, was trained as a doctor and aimed to create a science of the mind. Psychodynamic theory, therefore, much like a science, tries to analyse aspects of mind based on careful observation and subsequently engages in critical analysis and philosophical debate about its observations and findings. Much of what is written about psychodynamic theory involves detailed analyses of case studies, but although these are often fascinating to read, they do not provide any confirmation of how exactly mental processes and social work interventions influence behaviour (Walsh, 2014). For positivist critics, psychodynamic theory is flawed because it is based on metaphorical ideas about structures and movements in the mind that cannot be directly observed but rather are inferred from interpretations of behaviour and people’s own descriptions of their thoughts. However carefully you test these interpretations and descriptions of the self, it is impossible to confirm their accuracy. Many psychologists and others therefore reject psychodynamic theory as an evidence base for practice with human beings. Against this, as we saw in Chapter 2, there is an increasing body of evidence that most forms of psychotherapy and counselling in which practitioners rigorously apply a model of practice are effective in helping many people. There is also growing research supporting the use of practices related to attachment theory and some of the practice techniques that have developed using relational and attachment ideas. Moreover, the basic principles of psychological social work practice can be seen to be influencing each other to produce broadly similar eclectic types of practice. Goldstein and Noonan’s (1999) book demonstrates this by linking short-term ego psychology in psychodynamic practice with some elements of cognitive behavioural practice (see Chapter 6) and other models of service delivery in current agencies. This demonstrates the usefulness of psychodynamic theory, in that it provides a rich set of interpretive ideas to help practitioners explore what is happening in their clients’ minds in their day-to-day work.

The exclusion of the social in psychodynamic practice The second major area of debate around psychodynamic theory is that it overemphasizes psychological factors and psychological interventions, to the exclusion of social and sociological explanations and social interventions. Consequently, social factors in clients’ environments are given less prominence than internal psychological ones. This limits the possible range of interventions that social workers can undertake and means that they start from a narrower set of assumptions (Strean, 1979). Psychodynamic ideas have limited concern for social reform, and this excludes a major element of social work (Strean, 1979). Other theoretical problems follow from this psychological emphasis, such as the tendency to blame people for what has happened to them, ‘victim-blaming’ as it is described in social construction theory. Psychological theory makes individuals responsible for events

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in their lives and their causes, whereas many problems that an individual faces stem from social factors whose impact comes from outside the individual. For example, psychological approaches might lead you to believe that unemployed people are lazy and have not tried to get a job, that an offender is innately amoral or that a neglectful parent is disorganized or evil. The expectation is that these people can reform by making more effort to educate themselves or change their attitudes, perhaps with help. Alternatively, the psychological model can lead to a more medical model of thinking; that is, that the individual’s problem arises from poor or inadequate mental functioning. In this way of thinking, alcoholism or drug misuse are diseases that need to be cured rather than an individual’s reaction to social experiences. These are oversimplified accounts of these problems, since economic downturns create unemployment and social conditions such as poverty and poor education contribute to addiction, crime and family problems. Clearly, not every individual affected by these problems is solely responsible for what happens to them, and their psychological functioning is unlikely to be the only source of the problem on which we should focus our interventions. Having said this, not everybody reacts in the same way to social pressures, so individual psychological factors may also be important alongside social factors. They may create troubled reactions to the social environment. In addition, psychodynamic theory is social in the sense that it understands people’s life issues as stemming from how the psychological and the social interact, as in attachment and relational theories. The problem is that practitioners and specific theories often overemphasize the individual and psychological because that is the main function of social work practitioners in many services, particularly when they deal with individuals who have mental illnesses and are psychologically distressed. These theories give us ideas that help us work on these important matters, but at the same time they may lead us to neglect social issues.

The limitations of insight in practice Psychodynamic intervention focuses on changing behaviour through insight. This means that practitioners aim to influence people by getting them to understand themselves better through building a relationship with them and trying to influence them over a period of time. As a talking therapy, psychodynamic intervention prefers clients with psychological problems who can express themselves well and who can take part in discussion and selfexamination. This approach is more appropriate to mental health services and long-term engagements with clients, and less appropriate for short-term help or situations where the agency’s focus is mainly on delivering social care services. It also plays down the importance of less articulate clients, working-class people and people with more practical problems (Strean, 1979). The use of insight as a major therapeutic technique may lead practitioners using a psychodynamic approach to stop at the point where clients have understood what is happening to them emotionally. But this does not help them to take practical action to make a positive change. Since psychoanalysis is non-directive, refusing to give advice or organize practical moves towards change, this tends to make workers’ help insubstantial.

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Case example: Julia’s social work career Julia’ first job in social work was a temporary job in an adult services team, mainly working with older people who were becoming increasingly frail. She used a set of forms and procedures that were agreed between her agency, social care providers and healthcare organizations in the area, following national guidelines, and her main task was to assess people to identify the package of care services they should receive. Cash for care policies meant that Julia started from a budget set by an agreed resource allocation system, and after assessment, her clients’ family members managed the budget for the services. After that was arranged, she did not maintain continuous contact with the clients or their families. Her next job was with a community mental health service, where she provided crisis services as part of a team consisting of a psychologist, a psychiatrist and several community psychiatric nurses. Much of this work involved sorting out practical living problems, social security difficulties and arranging services. Julia was also involved in supporting people with longer term mental illness, but this mainly

involved performing routine checks and ensuring that they were still using their medication and services such as day centres. After some years, Julia obtained a post in a secure unit for mentally disordered offenders, where each member of the social work team built up relationships with a small number of patients in the unit, all of whom had committed serious offences such as arson, murder or rape. Where appropriate, the team planned and arranged the patients’ discharge, under the long-term supervision of a psychiatrist and the social worker. It was only in this post that Julia found relationship-based psychodynamic theory useful in working with nearly all her clients. Previously, she had only occasionally used some of these ideas, when clients needed to think more than usual about their direction and future plans. Because this is the focus of many social work jobs, many practitioners are doubtful about the relevance of psychodynamic theory to their work, even though they find its ideas interesting and stimulating, but there are jobs where it can be very useful.

Originating in middle-class Jewish Vienna, psychodynamic theory is limited by the cultural assumptions of its time. It takes a white, middle-class perspective as the norm, and there is a danger that deviations from this seem to be abnormal behaviour that should be ‘cured’. For example, there can be significant variations in how children are treated or expected to behave across cultures and ethnicities, and if this deviates from the norm set by psychodynamic theory, it could lead a practitioner to believe that treatment is needed, whereas it may be better to work towards society’s acceptance of a wider range of child care practices. Similarly, the historic attitude of psychodynamic theory to homosexuality sees it as a deviation, related to maternal relationships, that requires treatment. Current thinking sees this as objectionable (Strean, 1979: 56) in both its attitude to women and the assumptions that it makes about gay and lesbian relationships. Finally, psychodynamic theory’s account of the innate qualities of women reinforces stereotypes of them as primarily domestic and childbearing, and as socially, intellectually and perhaps morally inferior to men. Many current social ideas about ethnic, cultural and gender issues could be used to enrich the use of psychodynamic theory in social work, but since, despite interest in relational and

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attachment ideas, it does not now form a central basis for social work, these ideas have not been incorporated into it. For example, Clarke (2003) argues that insights from psychodynamic theory may help us to understand the complex emotional responses involved in how racist behaviour develops. Bonner (2002) argues that this and ideas about intersubjectivity, ethnocultural transference and racial enactments could contribute to the use of psychodynamic theory in dealing with minority ethnic groups. I look at some of these practices when examining the example text of Goldstein, Miehls and Ringel (2009) later. In addition, psychoanalytic ideas have contributed to feminist perspectives on psychology, for example in Mitchell’s (1975) work on psychoanalysis as a useful means of understanding how men achieve and maintain supremacy in a patriarchal society. This may help practitioners to understand and work with some of the social processes by which women’s lives are dominated by men’s assumptions. Contemporary psychodynamic theory, therefore, has less influence in social work than it might, for two main reasons. First, the historic cultural assumptions of psychodynamic theory limit its applicability in contemporary society since it establishes ‘normal’ ways of relating to others (for example, it views successful personal development as being contingent on traditional relationships with parents). Second, while psychodynamic theory might adopt and contribute to a wider range of ideas and approaches to add to its interpretive richness, and we can see this happening particularly in feminist thinking, its isolation as a complex and separate stream of thought means that this happens only rarely. The central assumption of psychodynamic theory is that present behaviour arises from past experience and, in particular, relationships. This raises the problem that, to achieve change in present behaviour, clients and social workers must engage in a long-term process whereby they examine events, issues, emotions and relationships in their clients’ past. In this way, psychodynamic theory does not fit with most current practice, in which clients’ current concerns are important priorities, or with the shared principles of social work agencies (set out in Figure 1.7), which are positive and look to the future. Psychodynamic theory’s deterministic assumption is that past experience dictates present behaviour and makes it difficult for people to change their own behaviour. Other theories see behaviour as emerging from a wide range of social and psychological factors and therefore much more open to change. Nevertheless, there are advantages to the backward-looking, problem-based, causation-­ focused approach of psychodynamic theory. For example, it can help and motivate the family members of clients who suffer from poor mental health to manage often difficult and frightening behaviour if they understand some of the possible causes behind it. Psychodynamic practice helps them to ‘make sense’ of seemingly incomprehensible reactions. Despite criticism of practical problems in using psychodynamic theory in social work, there are some advantages to understanding its ideas. Psychodynamic perspectives help us to understand the origins of many important ideas that we take for granted. Conflict, aggression, mother–child relationships, ego, sublimation, repression and resistance are all terms we use, often without a thought for their technical meanings or the theories from which they originated. These ideas are all valued because, even with their limitations, they offer a sense of the complexity of human life and development, and how our minds and bodies interact with each other and the social environment.

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Major statements It is not easy for anyone to convey in one book the full range of psychodynamic practice. Borden (2009) usefully summarizes the main streams of traditional psychodynamic therapy that influenced social work. Brandell’s (2004) broad account of practice according to this model provides a picture of psychodynamic social work that remains true to its Freudian origins. It illustrates a clinical psychotherapeutic approach to social work. There are various streams of current social work practice that draw on psychodynamic ideas, and these are set out in Figure 4.1. Goldstein (1995, 2002) and her associates (Goldstein & Noonan, 1999; Goldstein, Miehls & Ringel, 2009) have written extensively about how the psychodynamic ideas of ego, object relations, self and relational psychology (see Figure 4.1) are used in psychotherapeutic social work; that is, a practice that aims primarily to change people’s behaviour and the impact of feelings and thinking on it. This work represents a renewal and development of ideas over a 15-year period, and demonstrates the detailed practice prescriptions available in these perspectives. Ruch, Turney and Ward’s (2018) approachable collection of papers offers a comprehensive view of relational practice from British sources; it adds to the chapters in an earlier edition (Ruch, Turney & Ward, 2010). McColgan and McMullin’s (2017) collection of articles on practice using relational ideas in different settings, many working with children, gives a vivid impression of how to use this perspective. Freedberg’s (2008) thoughtful feminist perspective on social work relational practice also usefully illustrates how critical and other perspectives make connections with, and in the process shed new light on, psychodynamic theory in social work. As with many psychological approaches, these social work texts overlap with books from psychological and other mental health professionals using the same perspective. I refer to some of these in this chapter. There is no one text, therefore, that represents a ‘preferred’ account of psychodynamic ideas in social work practice: they are all useful in different ways. In the application section of this chapter, therefore, to describe sample texts I have summarized a selected aspect of Brandell as the general text, giving an impression of its broad contribution, and a more specific account of relational practice by Goldstein, Miehls and Ringel (2009), including more recent contributions from the edited books by McColgan and McMullin (2017) and Ruch et al. (2018).

Wider theoretical perspectives Psychoanalysis Psychodynamic perspectives come from psychoanalysis, which is based on the ideas of Freud and his followers and later developments of their work. The term ‘psychodynamic’ is, however, broader than ‘psychoanalysis’. It emphasizes that the mind (the ‘psycho’ element of the term) is our dynamo: our minds both motivate and direct or manage our behaviour. Since the 1960s, practice theory emerging from this idea has been called psychosocial because it looks at how the mind and the behaviour influence and are influenced by people’s social environment, and this connects with a broader psychosocial movement in the social sciences (McLaughlin, 2019).

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Psychodynamic ideas were influential during the period 1930–60, when social work was becoming established; they therefore underlie the ‘traditional social work’ that many other theories have developed from or reacted against. Because of this, elements of these ideas still influence everyday practice. Another reason for this pervasive influence is that psychoanalysis is well known in Western culture and most people have some awareness of its basic concepts, so it forms a culturally shared language about problems of the mind. However, psychoanalysis (as opposed to psychodynamic theory) is mainly used in specialist, psychiatric settings and is very rarely used by social workers.

PAUSE AND REFLECT  Psychoanalytic ideas with cultural influence on social work Think about and note down some terms and ideas that you think most people will have heard of that originate from psychoanalysis. What do people generally understand by these? Try asking some people who have not studied the subject.

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People often refer to mistakes made in speech that apparently reveal hidden thought processes, sometimes of a sexual nature, as ‘Freudian slips’; the technical term is parapraxis. An example of this is in a speech by President Bush (senior) in which he states, ‘For seven and a half years I’ve worked alongside President Reagan … We’ve had triumphs. Made some mistakes. We’ve had some sex … uh … setbacks’ (from a speech in 1988; http:// www.liveleak.com/view?i=bb3_1189010008). A common image from psychoanalysis is that of a patient undergoing psychiatry, lying on a couch talking, with the psychiatrist sitting out of sight listening. This is a picture of traditional psychoanalytic treatment. The description of someone as ‘defensive’ or ‘well defended’ when they deny something about themselves that is obvious to others from their behaviour demonstrates the widespread use of psychoanalytic jargon. It comes from the psychoanalytic idea of defence mechanisms.

Common-sense understanding of psychoanalytic jargon does not always fully represent the complexity of psychodynamic ideas. Yelloly (1980: 8–9) gives the example of the meaning of ‘unconscious’ to show how rich psychodynamic ideas are. When some thoughts and feelings arise that are not compatible with other beliefs we hold strongly, psychodynamic theory talks about resistance. Here, the mind does not allow the contested ideas into the conscious, preventing this by a process called repression, meaning that the ideas are pushed down below the level of conscious thought. But this is not about people refusing to admit something. Repression covers up the ideas so successfully that people are not even aware of them and their mind is not even aware of the reality that ‘I don’t go there’. Distinctive ideas like this influence popular culture because they offer striking and creative metaphors of behaviour and how thinking influences it. Figure 4.1 shows the three main aspects of psychoanalytic theory. Structural theory describes metaphorical structures in the mind such as the id, ego and superego. Developmental

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theory demonstrates how people build up these structures by going through psychological stages, and how their behaviour may be affected in the long term by disruptions to this development. Treatment theory explains how to deal with behavioural problems that come from the disrupted development. In the USA, some other forms of psychoanalysis still influence social workers if they specialize in a counselling-style treatment of people with psychological problems. US social work texts therefore deal more fully with these, and Borden (2009) shows how different ideas and approaches within psychoanalysis are associated with key thinkers, with discourse swinging between them over the course of the twentieth century.

Relational theory Structural theory how structures in people’s minds motivate and manage their interactions with others.

how people’s past relationships influence how they relate to others now

Ego theory Treatment theory how behavioural problems can be treated using relationships between practitioners and clients

how people’s patterns of thinking develop and affect/control their behaviour.

Object relations theory how people’s perceptions of the world outside themselves affect their behaviour.

Attachment theory

Developmental theory

how people’s behaviour is affected by experiences of attachment to others.

how people’s patterns of thinking develop, building on their childhood experiences.

Self theory how the structure of people’s identities affects their interactions with others.

Historic elements of psychoanalytic theory

Current psychodynamic ideas in social work

Figure 4.1  Historic and current types of psychodynamic theory Sources: Yelloly (1980) and Perlman and Brandell (2011).

These approaches, which affected social work, psychotherapy and counselling, include: ●●

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a focus on a child’s early experience of relationships as a source of behavioural tendencies and personal and social problems; the importance of taking into account both psychology and social understanding; the importance of relationships as a basis for helping people.

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The right-hand column of Figure 4.1 sets out current thinking derived from this discourse and how it applies to psychodynamic theory in social work. Ego, object relations, attachment, self and relational theory are not completely distinct ideas but are emphases, and all call to some extent on all three elements of psychoanalytic theory. As the figure implies, the earlier ideas in the list draw more strongly on structural and treatment theory; the later ones lean on developmental theory. Psychoanalytic structural theories start from metaphors for the structure of the mind, and I show in Figure 4.2 how they are understood from a social work point of view.

The environment or situation

The mind The person Unconscious Preconscious Conscious

Ego

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Figure 4.2  Psychodynamic social work ideas about the structure of the mind Source: Inspired by Walsh (2014: Ch. 3).

Figure 4.2 shows that, in psychodynamic theory, the mind consists of a small area of conscious awareness and a much larger area of unconscious mental activity. We are mostly unaware of thoughts in the unconscious mind, but some of them are preconscious so are accessible to us at times with effort and help. The ego manages relationships between the conscious and the unconscious. It is informed by principles created within a superego. This aspect of the mind forms part of our person, and develops through interactions with other people in our social environment, often our parents. Social workers concentrate on the person-in-­ environment (called the person-in-situation in older texts) rather than the person’s mind in isolation, which clinical psychologists or counsellors emphasize. The following case example illustrates how some of these concepts come together in understanding a person’s unexpected reactions in their situation.

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Case example: A young carer – 1. David’s unconscious feelings about his mother David was a teenage ‘young carer’ for his mother. She was socially isolated because her physical disability kept her mainly in the home, and depressed because of its impact on her life. There were two younger children in the family. David was very strongly attached to his mother and worked to keep the household going. People in the wider family, at his school and in social agencies admired his commitment to helping her. His mother reported to her social worker, however, that he sometimes got angry, shouted at her and hit her, but she begged the social worker not to take this

up because she did not want David’s support withdrawn. The social worker thought that although people often report abuse when they want a practitioner to take some protective action, she also wanted to support and protect David and make sure that the younger children were safe. When the social worker talked the situation over with David, he denied that any of these events had happened and got angry with her for questioning his commitment to his mother. I comment on how the social worker took this up after explaining some of the relevant theory.

Our starting point in understanding what happened with David comes from the basic idea of psychoanalysis, that people’s feelings and attitudes to drive their behaviour. We look at the feelings and attitudes as well as the behaviour to understand how both are affecting the person. When we see inconsistent or unexpected behaviour, thinking about what is going on in people’s minds helps us to understand how the psychodynamic process in people’s minds might be affecting their external behaviour. The important psychodynamic idea of the unconscious suggests what might be going on in David’s mind. We often have many conflicting feelings about situations that are important to us, and some things are so important to our stability that feelings which conflict with them become unacceptable to us. We therefore use defence mechanisms to protect ourselves against them, so that we can avoid facing up to the conflicts. Perhaps David has committed himself so completely to helping and supporting his mother that all his feelings reflect this dedication to her. It is more likely, however, that he is frustrated that his commitment to her means he is, for example, not able to join his friends in shared leisure activities. He may also feel that his mother should work harder to improve; that she should snap out of her depression in response to his love and kindness, for example. Helping her is so important to him that his mind does not allow these conflicting resentful thoughts into his conscious. Instead, he represses them, pushing unacceptable feelings into a mental box and keeping the lid on them. The psychodynamic unconscious contains these forcibly hidden ideas, which are there whether or not we think about or are even aware of them; they are often deeply concealed. Many repressed thoughts are dynamic, in the sense that they cause us to act even if we are unaware of them. Aggression, in which deeply concealed feelings often turn into destructive impulses against others, is another important idea in psychoanalysis. Thinking about all this, it is possible that David is repressing his frustration as a defence against any bad feelings towards his mother, which would make it hard to carry on being the calm and supportive young carer. This frustration leaks out in the aggression he demonstrates towards his mother. In the unconscious, drives (or instincts in early translations of Freud’s writing) are mental pressures to relieve physical needs such as hunger or thirst. Drives create tension, which generates energy or libido, pushing us to act in order to meet the need. There are several different types of physical needs, and sexual tension, even among young children, is very important in creating drives.

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Psychoanalytic theory proposes that our minds contain three main structures: the id, ego and superego (see Figure 4.2). The id, or literally ‘it’ – an undifferentiated pressure from an unknown source (Wood, 1971)  – is generated by drives. It pushes us to act to resolve our needs, but our actions do not always bring the desired results. The ego is a set of pragmatic ideas about how to understand and manage the environment. It develops when the id finds that simple behaviour does not resolve needs. For example, when they are very young, infants cry when they are uncomfortable and, whatever the reason for the discomfort, parents react to the crying. Later, babies learn to control the excretion of faeces as the ego learns that parents and others disapprove of excretion in the wrong place or time. They learn when muscular tension means they need to go to the toilet, and as this learning helps them successfully manage their excretion, they are rewarded by parental approval. In this way, they learn that managing their behaviour brings nice things. The ego is said to manage object relations: this term refers to all relationships outside ourselves, with both people and things. The superego develops general moral principles that guide the ego in doing this and that come from our parents and from observing how other people behave. An important feature of the personality is how the ego manages tensions. The need of the ego and superego to exert control over the id to achieve social acceptability creates further conflicts, and this produces anxiety. The ego uses defence mechanisms to manage anxiety, and one of these mechanisms is repression, which affected David in the case example. Other important defence mechanisms are: ●●

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projection – unwanted ideas that the ego wants to protect us from become attached in our minds to another person or thing; splitting – contradictory ideas and feelings are kept in separate mental compartments and applied to different people or situations, leading to inconsistent behaviour; sublimation  – energy (from the id) that is directed towards unwanted activities (often sexual) is redirected towards more acceptable activities; rationalization – people believe in acceptable reasons for particular activities and repress emotionally unacceptable reasons for behaviour.

Freud’s later work, and that of many of his most important followers, moved from an early emphasis on drives to concentrate on ego and object relations, since this is how, according to psychodynamic theory, we manage our environment. These theories propose that children have the capacity to deal with the outside world from an early age and the ego’s development is reflected in the growth of our capacity to learn from experience. This involves the use of rational parts of our minds in thinking (cognition), perception and memory. Building on these ideas in the USA, Harry Stack Sullivan’s theories of the self, later developed by Kohut, have been important in social work (Perlman & Brandell, 2011). Psychoanalytic developmental theory proposes that the interaction between these mental structures leads children to develop through a series of stages. At each stage, particular behaviours are more prominent than others, but as children progress they build on the behaviours associated with previous stages. At a very early stage, babies gain satisfaction from sucking, at a mother’s breast or a bottle, for example, to satisfy the need for food. Sucking is still satisfying in later stages, such as in eating sweets or in sexual activities, even if other behaviours have become more important in most contexts. Sometimes, even though adults have a wide range of satisfying behaviours and activities to choose from, they become unconsciously attached to

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behaviour associated with particular stages (fixation). They are driven to seek that form of satisfaction to an unreasonable degree and consequently cannot use the full repertoire of behaviour available to them. The ideas of separation–individuation theory suggests that infants do not distinguish themselves from the ‘mother and baby’, and development begins as they learn to see themselves as a separate being and become increasingly individualized, achieving autonomy in adulthood (Blom & Bergman, 2013). Children start in a stage of primary narcissism, seeking only a gratification of their own needs. They then learn through social interaction, at first with parents, that they must compromise and consider the needs of others as well. In each stage proposed by Freud, the focus of attention is on a particular need. The first stage is oral (hunger as children learn to wait for their next feed), the next is anal (as they learn to manage excretion), then phallic (identification with same-sex parent as they learn to manage appropriate relationships in the family) and then Oedipal (attraction to the opposite-sex parent as they establish their sexual identity). In a latency period, sexual tensions are quiescent because drives are managed through a resolution of Oedipal conflicts, and after this, during puberty, social learning channels sexual development towards external partners rather than parents. Associated with the stages of development is the idea of regression. This occurs when people who have progressed through the later stages fall back on behaviour associated with earlier stages under some present stress. We contrast regression with fixation, in which individuals have never progressed and are stuck in the behaviour of the early stage. Erikson (1965) expands on these stages of development. He suggests that, at each stage, the rational mind deals with a maturational crisis presented by the social circumstances of our life. His work, which has influenced social work, and crisis intervention in particular, emphasizes cultural and social pressures rather than inner drives (Yelloly, 1980: 12) but is not well supported by research (Gibson, 2015). Other psychodynamic theorists and practitioners who have had an impact on social work include Melanie Klein (1959; Salzberger-Wittenberg, 1970), Winnicott (1964) and Bowlby (1951, 1969, 1973, 1980, 1988). They have primarily influenced practice with children, important because of social work’s role in many countries in investigating and caring for neglected or abused children and supporting deprived families in managing childcare. Psychoanalysis gained its early influence on social work because its accounts of how early relationships influenced later behaviour helped practitioners to understand and work on children’s relationships with their mothers. One of the still-used key concepts of Winnicott’s work is ‘good-enough parenting’, in which parents provide a home environment that is helpful to a child’s development. Bowlby directed the psychoanalytic interest in early mother–child relationships towards research and theory about maternal deprivation. This is the idea that if we deprive children of contact with their mothers, their personal development is impeded. More recently, this has developed into more extensive theory about the importance of attachment, which I pick up in Chapter 5. The effects of loss of attachment are especially important, for example after the death or other loss of a parent, such as by divorce (Garber, 1992). The idea of loss has a wider importance in psychoanalysis, and there are several different approaches to bereavement and grief (Berzoff, 2003). Mourning is a response to all kinds of loss, not just the death of someone close (Salzberger-Wittenberg, 1970). Parkes and Prigerson (2010) interpret bereavement in many situations as regression to childhood experiences of stress owing to loss. A large variety of other factors apart from maternal deprivation, however, including the social environment,

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can affect a child’s personal development, and many social and psychological factors help to protect against its damaging effects (Rutter, 1981).

 reatment in psychoanalysis and its influence on social work T intervention Classic psychoanalysis required therapists to be ‘blank screens’, making themselves as anonymous as possible so that patients could project their fantasies onto the therapists. This idea survives in social work in that practitioners usually aim to be non-directive in their relationships with clients, allowing clients to lead the direction of the intervention. A more modern interpretation of this arises in relational theory, which emphasizes creating a therapeutic alliance through a relationship with the client and securing commitment to objectives and interventions. This is an interpretation in psychodynamic theory of the shared principles (Figure 1.7) of many social work theories. Another influential psychoanalytic treatment concept is transference. Psychoanalysis argues that patients often transfer unconscious feelings about their parents onto the therapist, behaving as though the therapist were that parent. By stimulating transference, therapists can get patients to act out conflicts arising from their early relationship difficulties with their parents, thereby revealing the source of the present behavioural difficulties. Social work adapts this idea, referring more generally to how the emotional remains of past relationships and experiences affect our present behaviour and relationships (Irvine, 1956). Countertransference occurs when therapists irrationally react to their patients by bringing in their own past experiences to the relationship between the client and practitioner. Again, social work adapts this idea, proposing that practitioners should be aware of their reactions to clients. Being made to feel protective or angry, for example, by a client often mimics how the client makes other people who are important to them feel and helps the practitioner to identify and work on the client’s relationship problems. We have seen that psychoanalytic treatments are strongly concerned with insight, or revealing hidden thoughts and feelings. Undesirable behaviour may be caused by repressed conflicts leaking out in various ways, requiring more than ordinary attempts to disclose its origins. Once revealed and properly understood, the conflicts no longer cause difficulties in behaviour. Case example: Dealing with David’s anger – 2. The social work response Looking back at the previous case example of David, a practitioner might try to open up a discussion of David’s hidden feelings or conflict by saying that it would not be surprising if he became frustrated and angry about the demands of his situation. The practitioner could demonstrate acceptance of these feelings by saying, for example, that many people in David’s situation would feel frustration and anger, and in this way might help David to express them verbally.

By doing this, David might be helped to understand how these feelings are affecting him so that he no longer needs to lash out at his mother. In practice, a simple comment will usually not be enough to make a difference, and the practitioner would repeatedly have to demonstrate acceptance as situations arose in which David expressed his hidden feelings. It would also be important to help David find ways of managing his aggression.

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Ideas about insight are also used in ego psychology practice, although they have been reworked. Ego psychology practice emphasizes ego support over trying to change behaviour by revealing its causes through enabling people’s insight. Ego support concentrates on helping people manage their relationships with the outside world through extending rational control of their lives. Using this approach to practice, the social worker might focus on helping David identify times or situations when he is likely to become angry and think about how to manage and control this behaviour. Alternatively, the practitioner might organize opportunities for respite from caring for his mother and encourage him to take part in leisure activities with people of his own age, thus helping to reduce the stress of responsibility.

Connections Psychosocial practice Prior to the 1960s, most social work theory was based on psychodynamic ideas or psychosocial theory. Distinct streams of thought within psychosocial theory are usually now taken together as basic ideas about practice, examples being Teater (2014) and Langer and Lietz (2015): ●●

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Psychosocial, formerly diagnostic, theory (Woods & Hollis, 1999) focused on the diagnosis, assessment and classification of treatment as a basis for exploring the person-in-­ situation, or more recently the person-in-environment (Karls & Wandrei, 1994). Functional theory (Smalley, 1967) emphasized the function of social work agencies in giving practice its form and direction. Its lasting influences include social work’s emphasis on process and growth, free-will and self-determination and the importance of structuring practice around agency function and time (Dore, 1990; Dunlap, 2017). Problem-solving casework (Perlman, 1957a) focused on exploring problems that clients presented and on improving their capacity for coping with them. It was a forerunner of task-centred casework that emphasized problem analysis (see Chapter 6) Problem-solving is the basis of ideas such as strength and solution practice, which emphasize working on problems, but neither empirical research nor practice development has focused recently on defining a practice based on problem-solving (Shier, 2017). The International Federation of Social Workers (2014) global definition of social work has moved to a more modern convention in referring to life challenges rather than problems.

Psychodynamic groupwork and residential care Psychodynamic theory has been applied to residential care practice through three main theoretical developments (Righton, 1975): ●●

Planned environment therapy (Franklin, 1968; Wills, 1973) was originally based on work with maladjusted adolescents during the Second World War. Rooted in psychoanalytic theory and radical education, it is used by some schools for young people with emotional and behavioural disorders.

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Milieu therapy is a mainly American concept, seen in the work of writers such as Polsky (1968), that is based on psychodynamic groupwork with young people who have emotional and behavioural difficulties. Therapeutic communities (Pearce & Haigh, 2017) are used in both community and hospital mental health settings to provide a participative democratic regime.

The psychodynamic groupwork of Bion (1961) generated the idea of group dynamics, which are hidden pressures, like repressed thoughts, that drive people’s behaviour in groups. This is also widely used in social work. Bion theorized that in groups people behave according to basic assumptions about power and leadership within the groups. Basic assumption behaviour often gets in the way of the group’s formal task. Furthermore, Foulkes (1964) introduced the idea of the group matrix, the totality of communications and relationships in a group that enables group members to develop a shared meaning of group events. It is associated with the idea of group spirit and Bowlby’s concept of a secure base in attachment theory (Rawlinson, 1999; see Chapter 5). Froggett (2002) discusses how psychodynamic group approaches assist in containing problems in secure bases within the matrix. Other well-known contributions include Menzies-Lyth’s (1988) research, which shows how staff facing difficult emotional situations in hospital settings used psychological defences to maintain their emotional equilibrium, and Bettelheim’s (1950) atmospheric accounts of psychoanalytic residential care practice with disturbed children, which called on his wartime concentration camp experience.

The politics of psychodynamic theory Psychoanalytic theory has influenced social work theory in three phases (Payne, 1992). At first, before the 1920s in the USA and the late 1930s in Britain, it had little impact. After this, there was a period in which it became dominant in social work thought, and this lasted until the end of the 1960s, culminating in psychosocial practice. I explain how views of relationships within social work changed during this period later in the chapter. Since then, it has been one of many contested theories, used mainly by specialists working in psychiatric settings that also use the ideas, and retaining a more general background influence because of its impact on ‘traditional’ social work practice. Meyer (2000) saw its influence as a legacy, and Danto (2017: 409) values its ‘breathtaking’ scope and possibilities. The influence of psychodynamic therapy on social work can be seen in social work’s emphasis on relationships (Perlman, 1957b) and its permissive, open, listening style of practice (Wallen, 1982). It also encouraged seeking an explanation and understanding of personality rather than action, and emphasized feelings and unconscious factors (Yelloly, 1980) rather than events and conscious thought. Many ideas, such as the unconscious, insight, aggression, conflict, anxiety, maternal relationships and transference, come from psychodynamic theory. These are terms that are often used in watered-down form as a common language in social work and everyday life. Psychodynamic theory gains some of its importance by their continued availability to practitioners. The important focus in social work on childhood and early relationships and maternal deprivation comes from psychodynamic theory, and this has led to the current importance of

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attachment theory. The emphasis on mental illness and disturbed behaviour as a focus of much social work comes from the importance in the 1920s and 1930s of social work’s association in the USA with psychiatry and psychodynamic treatment. Insight as an important part of social work understanding and treatment originally comes from psychodynamic theory. We give less emphasis to social factors in social work than to psychological and emotional ones because of the influence of psychodynamic theory (Weick, 1981). That influence continues partly because, in the USA, social work has a very strong role in mental health services, and psychological therapies have a greater importance there than in European welfare states and the less-developed services of many resource-poor countries. Much of the critique of the use of psychodynamic theory in social work discussed in the debate section comes from an unrelenting attack from cognitive behavioural perspectives and EBP on the interpretive and metaphorical style of psychodynamic practice. Similarly, critical theorists attack psychodynamic theory’s failure to incorporate a critical analysis of the current social order. From these two perspectives, psychodynamic practice is not sufficiently supported by positivist research and fails to incorporate a critical social analysis.

Values issues The main values issue with psychodynamic practice arises from its psychologistic individualism, which can be a strength or a weakness depending on your point of view. Psychodynamic perspectives in social work assert the individuality of each human being and the unique way in which internal emotions and drives create each individual’s behaviour from their social experiences. This view respects human beings by helping them to make sense of their experiences and their present strains and stresses, and has led social work to give prominence to the self-determination and individualization of clients and their problems. On the other hand, we have seen that focusing on the psychological can result in victim-­ blaming and can affirm cultural, racial and gender stereotypes. By assuming that past experience is responsible for present behaviour, and by emphasizing the difficulty of internal psychological change, psychodynamic practice may make us over-cautious about barriers to change than practice theories focused on the present and future. Furthermore, psychodynamic ideas do not address social change or excluded or oppressed groups since they presume an existing social order to which individuals adapt, although they encourage concern for changing individuals’ immediate situation. Their psychological focus means that they may neglect social explanations for clients’ problems, and this contributes to negative stereotyping by assuming that people’s problems come from their psychological make-up rather than from external factors that they can have little control over. I discuss, in Chapter 5, a good example of this in common uses of attachment theory. This, again, can result in victim-blaming. Another key values issue within psychodynamic theory is that it is deterministic, assuming that present behaviour is strongly influenced, some would say determined, by earlier experience and in particular by relationships in childhood. This raises the question of whether it is realistic to expect that it is possible to change such ingrained patterns of behaviour, and furthermore whether this change can be brought about merely by gaining insight into a person’s development. Because the theory proposes that psychological defences are very

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entrenched, simply understanding through greater insight into our own minds why they have arisen might not be enough to allow us to make changes in our lives. If that is so, psychodynamic theory in some ways rejects the possibility that human beings can ever change themselves, and in emphasizing the power of the mind suggests that social interventions might not be able to achieve change. This leads psychotherapists, counsellors and clinical psychologists to over-emphasize their professional skills in achieving mind-changing therapies and to devalue social work’s mixture of personal help and social change. Social work’s value base, on the other hand, strongly emphasizes that people can make changes in their lives and acknowledges the importance of social relationships and institutions in facilitating this.

Applications Psychodynamic theory is currently applied in a variety of ways, as we saw in Figure  4.1. Maroda (2010), a psychiatrist, helpfully summarizes the main elements of psychodynamic practice techniques, as shown in Figure 4.3. You can trace these back to some of the historic ideas of psychoanalysis, but she updates them and makes them relevant to everyday experiences. For example, looking back to psychoanalytic treatment in which patients projected their personality through transference onto the ‘blank screen’ of a neutral psychoanalyst, she talks about difficulties in practitioners’ self-disclosure in their professional relationships. This refers to working out how much you should disclose about your personal life to clients. An example of the relevance of this issue to social work is talking to clients about your own children. A client with her own childcare problems may not want to hear about your difficulties. On the other hand, clients may value knowing that you have personal experience of the situation they are going through. A good general rule that I follow is to ensure that anything I disclose about myself has to have a clear benefit for the client. This guidance about how to act in difficult interactions with clients is one of the reasons that many practitioners value psychodynamic theory.

PAUSE AND REFLECT  Looking at underlying factors in behaviour Look at the examples in the third column of Figure 4.3, which are adapted from Maroda’s examples or my own experience, and in each case think about how looking at the client’s feelings about an issue reveals what might be happening in the client’s relationships.

Some suggestions As a social work practitioner, I have often had to help people ‘regulate’ emotion; that is, I have helped people who cannot express their true feelings about their relationships. This is sometimes a matter of working on their social skills and explaining to them how to raise any issues they might have in ways that facilitate a discussion but are not critical or result in conflict. Most of the time, however, it is a matter of understanding what may have caused the client to feel and behave a certain way towards someone. For example, a client’s parents may have been

Psychodynamic relational practice Technique

Role in practice

Example

Emotional engagement

You need to share the client’s concerns, feeling empathy with them

An unconfident person may become overreliant on relationships with practitioners, rather than learning how to build effective social relationships

Mutual influence

You need to immerse yourself in the client’s view of the world, and demonstrate you are understanding it

Clients need to feel your empathy but may make demands for excessive reassurance of it, or expect an alliance that colludes with their biased perception of important relationships when these need to be challenged or goals for change set, for example in adequate care for children or the questioning of oppressive marital relationships

Regression

You can understand clients’ vulnerabilities better by enabling them to go back to important emotional experiences and act out what happened

Help the client to experience the emotions and reactions to important events, both negative and positive, in their life experience, for example how they felt about relationships with their parents or bullying at school. However, a repeated return to negative experiences can get in the way of progress

Evaluating interventions

You need to track how clients are responding to your interventions as you go along and not only at the end of the intervention

Clients may be challenging or difficult to engage through anger or depression. You need to think whether expressing these emotions is confirming present behaviour or whether they are expressing something that helps them move forward

Self-disclosure

Disclose information about yourself and react immediately when this will help and not hinder develop the relationship and emotional exchange

Clients often express important emotions, such as sadness and anger. You should react with your genuine emotional reactions if this will be positive for the client, for example enabling them to see how people react to how they are. You should be cautious about reacting when you are revealing material about yourself with no therapeutic purpose

Managing emotion

Emotion is integral to cognition and brain functioning; identifying sources of emotional reaction helps manage it

Adults may fear to express anger because angry responses were rejected by parents who expected calmness, but may find this frustrating because they cannot express relationship difficulties in their marriage or in work teams

Confrontation and anger

Identify and practise how to express difficulty or conflict in emotionally important relationships

Questioning, confronting, expressing frustration and anger, and setting limits to behaviours can all be rehearsed with practitioners

Erotic feelings

Sexual feelings – attraction or disgust – are often ways of seeking control of others

A loving male partner who is always sensitive and supportive to enable women to achieve more in their work may be valued and enhance the relationship because of his support, but also control the woman’s selfexpression and self-development

Figure 4.3  Maroda’s psychodynamic techniques Source: Maroda (2010).

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unable to accept their angry behaviour when they were children, so the client never learned how to calm down from anger and focus on repairing their relationships. Another example I often come across is when a woman client is frustrated by her husband, even though other people who know him see him as loving and supportive, because the support is too controlling and does not allow the client the freedom to make mistakes or strike out in her own direction.

 xample text: Brandell (2004) on psychodynamic E social work The Preface explains that in Part 2 of the book I summarize in each chapter one or two example texts used by social workers, which show how the theory being considered is used in comprehensive accounts of social work in the tradition of that theory. I explain the general criteria I use to select these texts in the Preface and the specific reasons for the choices made in the major statements sections of each chapter. Calling on the importance of process from functional social work, Brandell (2004) identifies four elements of dynamic therapy, set out in Figure  4.4. The starting point, dynamic assessment, makes it clear that most problems faced by clients are caused by several different factors. Therefore, practitioners should not assume that there is only one source, and should realize that the different factors probably interact. The main factors to look for are: ●●

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understanding precisely the presenting problems that clients bring to the practitioner and the range of antecedent factors that led to clients deciding to get, or being referred for, help; understanding how clients characteristically deal with the world outside themselves, in particular psychological defences and strategies for adapting to, alleviating or overcoming anxiety and other emotional responses to difficulties in their lives; examining ego functioning; that is, how clients deal with external threats and difficulties; examining self-cohesiveness; that is, clients’ views of themselves as a person, and the extent to which this is consistent and organized; strengths and weaknesses in clients’ present psychological functioning  – their mental state; areas of life that clients find they are dealing with effectively and feel that they are competent to deal with – competence and efficacy; how the practitioner responds to and feels about the client; constructing a picture of how the psychological factors are interacting with the innate characteristics of the client (a dynamic–genetic formulation); making a plan for treatment.

Brandell (2004: 137) makes the point that agencies often require practitioners to come up with a statement too early, often mainly describing problems and needs that fit a pre-­ formulated guideline. Describing American clinical settings, he discusses the need to make assessments that fit the American Psychiatric Association’s (2013) Diagnostic and Statistical Manual, and this point equally applies to assessment documents such as the UK’s single assessment process (on working with children) and the common assessment framework (in

Psychodynamic relational practice Element

Important ideas

Practice implications

Assessment

Multideterminism : any mental event or aspect of behaviour may have multiple causes and serve several psychological purposes for the individual

Practitioners must explore a range of aspects of psychosocial functioning before developing a treatment plan

Beginning treatment

Creating an effective treatment relationship within a holding environment helps to form a therapeutic alliance between practitioner and client

In the early stages, a focus on creating a secure environment for working with the client and developing a relationship has priority

Middle-phase treatment

Practitioners use various interventions to help clients work through important psychological problems to remove the client’s resistance to gaining insight

In this phase, practitioners use techniques that confront clients’ avoidance of dealing with their psychological problems

Termination

Practitioners prevent the reversal of the client’s progress in the future by allowing separation from the therapeutic alliance and facilitating future independent development of the client’s individuality

Practitioners focus on helping clients to maintain psychological strengths independently in the future, and arrange follow-up to reinforce and check further progress

Figure 4.4  Brandell’s four elements of psychodynamic social work Source: Brandell (2004: 133–254).

providing social care for adults). Psychodynamic assessment looks not only at apparently problem behaviour, difficulties in childhood development and social dysfunctions, but also at clients’ strengths and assets, their family, community and social environments and the resources available to help clients. In this way, it is much broader than many clinical psychology, psychiatry or counselling assessments. This requires a longer assessment process, including interviews with family members, and some broader investigation of involvements with other services and organizations in the client’s life, such as school, work or leisure organizations. This often runs alongside the initial responses to problems that require immediate action. Assessment outcomes start from a summary of information about the client, together with a mental status examination of current behaviour and psychological issues, the client’s cognition, that is, their thinking abilities and their capacity for insight into their situation, and their behaviour. The next element of the assessment is ego and superego functions: can clients manage their drives and impulses, tolerate guilt and frustration and be flexible in how they defend themselves psychologically against threats? What is their potential to work in relationships, as demonstrated by their relationships with family and community members and the practitioner? How far can they integrate contradictions in their lives and manage the pressures of daily living? Clients’ self structure and self–object relations should then be reviewed: do clients have a realistic view of themselves and have sensible, well-organized aims in life? Competence and efficacy come next: what have they achieved, in school or work, in their family relationships and leisure, and what does this show about their self-confidence and their ability to use their strengths and overcome weaknesses? Finally, the dynamic–genetic formulation looks at how their experience and strengths have combined with and made use of their

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innate capacity to result in the person that the practitioner will work with. The treatment plan follows on from this. Although I have presented this in everyday language and generalized the material that Brandell discusses, his account, full of polysyllabic jargon, focuses on individuals presenting mental health problems, and this indicates the important role of this form of practice in US social work. Brandell’s account of beginning treatment contains ideas drawn from psychoanalytic history. It starts with creating a holding environment, based on Winnicott’s ideas about ‘good-­ enough parenting’ in working with children; it also connects with the ‘secure base’ of attachment theory. The practitioner has a genuine interest in and concern for the client, creates a safe place for clients to express emotions such as anger, fear and frustration that it is difficult for them to express elsewhere, and allows them to build a relationship with the practitioner.

Case example: Should Diana get her children back? Daisy was a child protection social worker working with Diana and her partner, Sean. Their two children were being looked after by the local authority and were placed with foster parents after they had been found neglected because of Diana and Sean’s heavy drinking. During several visits to the children at the foster carer’s home, Diana had been very obviously drunk, and this led to a withdrawal of the arrangements for the children to have regular contact with Diana. When Daisy next visited, Diana and Sean, both drinking, were very angry and aggressive

towards her, expressing the fear and anger they felt about the decision, as well as their frustration about their inability to control their drinking behaviour. Diana later visited Daisy at her office. They made plans for Diana to separate from Sean and for him to move to a local hostel, then Diana would work to change her alcoholic behaviour and see the children at a contact centre. Over several more months, Diana, with ups and downs, improved steadily and resumed contact at the foster carer’s home, at the same time making plans for a better home environment.

In this case example, Daisy provided a holding environment by not overreacting to the emotional turmoil of her visit, although for her own safety she and Diana together worked out some ground rules for behaviour for future visits. She also helped Diana to make and carry out positive but realistic future plans when Diana had expected to be given no further chances. This case example also illustrates the three important features of relationship in psychodynamic social work: ●●

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Transference–countertransference – the anger and fear expressed by Diana in reaction to Daisy’s authority, as though she were Diana’s violent parents, shows how she was transferring and demonstrating in this present authority relationship her fears about her past relationship. This led Daisy to feel she had to react to control Diana and Sean’s behaviour, and demonstrates the pattern of Diana’s formative past life. Real relationship – the relationship has to reflect the realities of how the participants in it take on their responsibilities and roles in relation to one another. In a real relationship,

Psychodynamic relational practice

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Daisy made clear what was unacceptable in Diana and Sean’s behaviour, but by working positively on future plans that respected their parental roles, she did not react to the countertransference by becoming overcontrolling, as Diana’s parents had done. Therapeutic alliance  – by managing future behaviour on visits, establishing a new programme for contact with the children and helping Sean and Diana work on their alcohol problems and parenting responsibilities, Daisy created an alliance in which they both took on responsibilities to move forward again, in spite of a difficult event. Again, this is one of the shared principles of social work practice theories.

As clients and practitioners move into the middle phase of treatment, they work through resistance using various dynamic techniques, detailed later. Earlier in this chapter, we looked at some general information about resistance: this happens when clients avoid engaging with their problems by either becoming silent, talking about unimportant issues, being late or missing appointments, or on the other hand are unduly emotional, keep finding practical difficulties with plans or are over-compliant, almost ‘working to rule’ instead of being flexible. Another form of resistance may arise because the emotional problems provide some benefit in relationships, as we will see in the next case example.

Case example: Gillian’s use of emotion in managing the relationship with her family Gillian was a woman with a history of depressive illness. Her husband and teenage sons complained that this made her very dependent on them, prevented her from working and required long-term medication for agoraphobia, a fear of open spaces that confined her to the house. Attempts to help her live a more normal life led to outbursts of severe depression,

crying and emotional behaviour. After this, her family told her social worker that this was so distressing they accepted that nothing could be done and they would continue to support her at home. It seemed to the social worker that Gillian was using her extremely emotional behaviour to gain her family’s compliance with her dependence on them.

Working-through is a repeated process (one of the shared principles of social work practice theories, an ‘action sequence’ used in psychodynamic practice) of remembering crucial examples of problem behaviour as they occurred, exploring what happened and thinking about ways in which events and their emotional consequences might have been different. If practitioners are not careful, this can become repetitive, merely allowing people to express hopelessness. Therefore, it is important to help clients see how alternatives might have been possible and plan for different ways of handling them in the future. Brandell (2004: 192) points out the connections with narrative and social construction ideas. Another important way of working is through interpretation. The practitioner works with the client and observes their behaviour. This allows practitioners to build up a picture of resistances, conflicts and their origins in past experiences or innate tendencies. Interpretations are explanations of these observations that enable clients to use this new knowledge to rethink their behaviour and plan to behave in alternative ways. Practitioners need to make

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interpretations work by helping clients to think again or plan anew. Change is not achieved just by explaining something, but by working with clients to react to the interpretation. Other important dynamic techniques include the following: ●●

●●

●●

●●

Exploration is working jointly on a description of behaviour and events that enables clients to understand them better. Ventilation, by expressing emotions such as anger, anxiety or fear in a secure holding environment, allows clients to move on from their feelings and act rationally again. Practitioners connect the ventilated feelings with events and relationships so that clients understand where their strong feelings come from and can manage them better. Clarification involves reflecting on how the individual’s environment has affected them, exploring patterns in behaviour and how these have developed so that, by understanding them better, clients can adapt their behaviour. Sustainment aims to improve clients’ self-esteem or self-confidence by the social worker being understanding and interested, expressing a wish to help them and having confidence that they can make progress as they are adapting their behaviour. The following case example shows many of these dynamic techniques in action.

Case example: A single parent makes a new start Catarina had two children by two different male partners, neither of whom had remained in touch with her. She had enjoyed the experience of having the children at home as babies but disliked their moves to become independent of her and make contacts outside the home. Her mixture of anxiety and depression meant that they stayed at home to support her. Their resulting poor school attendance led to referral for social work help to avoid legal action being taken. Catarina knew she needed to change, but she found it hard to find work and support the children in being more independent. The practitioner helped her to explore how she had come to have the children without a continuing relationship with a

male partner. This, she felt, came from her own mother being more interested in her relationships with men than in Catarina, leading to a lack of confidence that she would be loved. Catarina expressed her anger and hurt about this, and connected it with her fear that her children would also reject and move away from her. Catarina and her social worker looked at ways in which she could plan to support the children in school and build up her work skills, so that she could create a different kind of relationship with them while also establishing a new direction for herself. The practitioner talked over Catarina’s plans regularly with her and pointed out when her activities had been successful.

The final stage is termination. The practitioner and client go through a process of identifying what has been achieved and making plans for further progress. Some kind of ritual of leave-making may also be useful. More recent developments include planning a follow-up session to reinforce progress and future plans, and to evaluate the treatment. Brandell’s (2004) discussion of practice with different client groups provides a more detailed explanation of a wide range of dynamic techniques.

Psychodynamic relational practice

Important ideas in relational practice The main principles of relational theory for social work practice are drawn from psychodynamic ideas connecting behaviour with feelings and relationships. Stevenson (2005: xi) formulates them as follows, and her account is picked up by Ruch (2018: 26): ●● ●●

●●

past experiences affect current behaviour; people are not always conscious of the various effects of past experience on their current situation; professional relationships evoke feelings and behavioural reactions that connect with past experiences (Stevenson’s loosely phrased description of the significance of transference and countertransference in practice interactions).

Ruch suggests that the importance of the social contexts in which relationships take place allows for the use of systems ideas (see Chapter 9). These incorporate elements of complexity, variability and social networks ideas into an otherwise solely individualistic and psychological practice theory. Linking systems with psychodynamic ideas was an important contribution of Hollis’s psychosocial practice theory (Woods & Hollis, 1999) in the later twentieth century. As Chapter 9 argues, this linkage was widely adopted in most practice formulations of systems ideas, although much practice has moved on in its understanding of systems ideas. McMullin (2017) suggests that focusing on relationships helps practitioners work together with clients even where there are strong emotions, of anger, anxiety, concern, fear or mistrust. A strong relationship helps us work through difficulties where we must sometimes be challenging or intervene where the client is unwilling to accept our involvement. It also helps in tackling situations where external factors such as poverty or racism have an impact on clients’ lives (Keval, 2005). It allows social workers to rise above social and political demands to see social work as a process of implementing agencies’ policies and procedures driven by neoliberal economic priorities (see Chapter 16). It therefore contests a rational/technical approach to social work (Phung, 2018: 269). All this is what social workers came into social work to do, and relationship work facilitates the use of their human communication skills and the human creativity of their education. McColgan and McMullin (2017) establish a four-stage process for relationship work using those skills: ●● ●●

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Engage: building a rapport by sharing ideas, information and thoughts. Negotiate: identifying and agreeing expectations explaining proposed actions and ways of working. Enable: open communication about aims of plans, and shared reflection on actions and progress, evaluating interventions, resources, barriers and enabling factors in the people and situation you are dealing with. Ending: reflection on and evaluation of successes, strengths for future use, coping strategies learned and signposting to other services. Solomon (2018) suggests that endings are different from outcomes. It helps to consider the best way of ending every contact with a client, as well as completing the process of intervention so that the ending of the whole helps people move forward in the future. You can make the link to the differences between positivist and interpretivist thinking that we met in Chapter 2. We saw there that positivists focus on the outcomes, while interpretivists think also about the process of what you do.

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All relationship processes require us to pay attention to important emotions and feelings, including resilience, resistance and aggression (McMullin, 2017: 23–4); anger, aggression and hostility (Smith, 2018); hopelessness, depression and despair (Parkinson, 2018) and love and positive feelings (Turney, 2018). Relationships are often complex in both long- (McMahon, 2018) and short-term relationships (Kohli & Dutton, 2018). This means that we should be able to identify the emotions that are being expressed in both behaviour and in discussions, to accept clients expressing emotions and establish support from colleagues in dealing with our own emotions and our reactions to clients’ expressions of emotion. We also have to maintain professional boundaries in expressing our own emotions (see Chapter 3, case example: Carrie’s fear of crying focuses her use of self). An important facet of relationship practice is the use of self in relationships with clients and those around them. Our self is the totality of our developing unique human personality and identity, demonstrated in our feelings and thoughts as they are expressed in our professional relationships. Since it is developing, it builds from a stable core of our identity through experience, which gives us the self-confidence and self-belief to generate creative ways of responding to the situations we meet in our practice. But it is not unchanging: it develops with our experience and skill and it sometimes loses elements that we do not use regularly. It uses the spiral of reflection and review discussed in Chapter 3 to identify and understand what we can offer to others in our relationships. We think through and map elements of the personal experience, professional skills, political and social values and spiritual strengths. These interact to provide a core to our self, while providing useful resources to enable us to be responsive to others (Ward, 2018). Case example: Devina visits a suicidal young mother Devina, a social worker in a psychiatric team, was asked to work with Kiran, a young woman with a new baby who had been discharged home after treatment for depression, probably post-natal depression. She agreed with her team leader that she should make an appointment for a home visit to carry out an initial assessment. Arriving for the appointment, she found Kiran drinking a glass of water with crushed sedative pills in it. Never having encountered such a situation, Devina was surprised at the self-confidence of the authority with which she took the glass from Kiran’s hand and put it on the table beside her. She recalled her training in talking about people’s suicidal thoughts, which also gave her confidence to talk directly with Kiran’s feelings and plans for taking her life. Kiran had forgotten about Devina’s visit, and rather than a ‘cry for help’ or an attempt to push Devina into taking action too quickly, the story she told was of anger at her husband’s lack of understand-

ing for her strong emotions; he had just left after an unsympathetic argument. Devina thought about her values about people taking their own lives. In principle, she thought people should be free to do this, but she needed to balance this value with her judgement about the professional duty to support and help Kiran with her depression and with caring for her new baby. She decided to express both points of view, and suggested they move on to review how things had gone since Kiran had come home. In particular, to assess the extent of any domestic abuse, she asked about who controlled money and relationships and the extent of Kiran’s freedom to have contacts with friends in her marriage. The glass sat on the table as Kiran told the story of events over the past few days and her relationship with her husband. At the end of the interview, they planned a further visit to explore care for the baby, and agreed to go together to the kitchen to pour away the contents of the glass.

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In this case example, Devina was aware of her personal reactions, taking authority, using her professional training and skills in building understanding about Kiran’s situation and relationships, and balancing her political and spiritual values with Kiran’s needs and those of her baby and her responsibility to safeguard their interests.

 xample text: Goldstein, Miehls and Ringel (2009) E on relational principles and techniques Goldstein, Miehls and Ringel (2009) see relationships as the core of any social work practice, and particularly significant for clinical practice, where genuineness and mutual engagement in a one-to-one relationship are used to improve both clients’ skills and strengths and also interactions with their social environment. Figure 4.5 summarizes Goldstein, Miehls and Ringel’s (2009) account of the development of ideas about relationship in social work. We can see repeated struggles with some of the enduring challenges in social work practice. Examples are the balances between standing back and personal engagement, between focusing on individual opportunity and responsibility or providing support and services, between focusing on problems or strengths, between ‘how did we get here?’ and ‘what shall we do?’ and between recognizing hopes and opportunities and acknowledging barriers and oppressive realities. Goldstein, Miehls and Ringel’s (2009) account details psychoanalytic sources of many of the explanations and interventions proposed in relational work; I do not summarize these in all their complex detail. Key highlights are: ●●

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The British object relations theory emphasis on people’s needs for relatedness and attachment. The American interpersonal school’s emphasis on how personality is shaped in interactions with families and other social environments and revealed in interpersonal relationships. The American object relations theory focus on the tension between the self ’s need for autonomy and its wish to retain attachments to caregivers. The self-psychology emphasis on achieving opportunities for growth, creativity and individuality, regardless of social sanctions or value constraints. The self-in-relation (feminist theory) emphasis on how self-esteem and agency develops from being recognized and valued in deepening relationships with others. Intersubjectivity theory’s focus on an authentic practitioner enacting (that is, repeating past relational experiences of) working together in a mutual relationship and revealing their self-identity in relationships. In doing so, they acknowledge asymmetries while participating in mutual regulation, so that clients can experience influencing their interventions, perhaps for the first time in their lives having the experience of having influence in a relationship with a powerful person.

Building on these complex theoretical accounts, Goldstein, Miehls and Ringel (2009: 79–130) derive a practice that uses relationships in facilitate assessment and intervention in social work practice.

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Period

Description

Relationship style

Critique

1920s–1940s

Early psychodynamic Neutral, objective style enables social work thinking; clients to disclose inner life; diagnostic casework detailed diagnostic exploration of problems

Neglects warm supportive engagement to repair negative experiences; intrusive investigation

1930s–1950s

Functional theory

Mutual engagement to encourage and support clients to make choices, releasing their potential for personal growth; agency function bridges clients’ personal needs with social reality

Too much stress on clients’ individual responsibility and agency function leads to inflexibility in providing services and support

1940s–1960s

Psychosocial casework

Relationships used to identify interacting personal and social causes of problems, and encourage growth, development and change in the ‘person-in-situation’

Focus on practitioner’s ‘benign parent’ role in guiding and correcting clients’ behaviour

1950s–1960s

Problem-solving allied to psychosocial practice

Relationships used to work in alliance with clients to gain mastery over problems in their lives

Too much focus on clients’ pathology

1960s–1980s

Empowerment ideas from feminist and rights movements

Relationships can improve clients’ self-esteem, positive identity and sense of power and control

Over-optimistic because of economic, political and social realities

1970s–1990s

Systems ideas to bridge micro and macro divisions

Mutuality and authenticity in relationships models relatedness and reciprocity between social and personal factors

Minimizes real personal struggles, interpersonal practice skills and clients’ psychopathology

1990s onwards

The self, attachment and intersubjectivity

Relationship allows participation in personal experiences to strengthen personality, skills and self-identity

Fails to incorporate oppressive social barriers to personal growth

Figure 4.5  Development of ideas about relationship in social work thinking Source: Goldstein, Miehls and Ringel (2009).

Assessment Assessment in relational practice focuses on biopsychosocial factors that clients share about their lives; that is, you make the connections between the varying impacts and interactions of biological, social and psychological factors in forming people’s lives. You work with the client to identify information that will be useful and helpful sources of that information from different agencies and people who know or are known to the client. Although you start by creating

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a beginning grasp of the client’s personality and problems, you continue to refine your assessment throughout your work with a client. Relational assessment looks at current interpersonal relations and the social environment as well as past development and cultural factors affecting the client’s motivation, personality, problems and strengths. The first stage aims to get a picture of what they are like and what they are hoping for. Attune yourself to the client’s pace and style of communication with you. You try to understand and co-construct with the client their story, listening exploring and clarifying what they say. Your aim is to understand their subjective experience, remembering that other sources may give alternative perspectives that can offer clients new ideas. Your own interaction with the client offers you clues about the client’s relationships. How do they behave towards you? Thinking about this, you need to bear in mind your professional and agency role and be self-scrutinizing about your attitudes. For example, are they always keeping their distance or looking for positive reactions from you? Is that how they behave towards others? Think about your own feelings towards the client. Do they make you angry or frustrated or positive? How does that work? The subjects of relational assessment are as follows: ●● ●●

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Their current life situation and interpersonal relationships. Their self-concept and how they regulate their self-esteem; that is, what do they do to feel good? How do they react when people criticize them or make them feel bad? Patterns about their relationships and what motivates them. The quality of early caretaking and interpersonal experiences and the effect on them now. For example, does a chaotic family life mean that they want things organized and structured? How they regulate their emotions and how they ‘mentalize’ relationships and behaviour; that is, how do they picture the effects of other people’s views of relationships and behaviours on how they act, and can they build their own picture of how other people see them? Identify significant events earlier in their lives and what these meant to the client. Identify gender, cultural, sexual orientation and other factors in the social environment in the past and now and their effect on them.

Intervention There are two elements to interventions. One is to provide a safe ‘holding environment’ in which clients can explore relationships between themselves and others and with their social environment, and try out new ways of relating to others and reacting to their social situation. The second element is to use actively the interaction between yourself and the client to change the situation they are in. Intersubjectivity refers to the impact that two subjects can have to create social change. Subjects are people who are actively working to change or influence a situation, as opposed to ‘objects’ who have things done to them by others. Involving a social worker in the client’s situation means that there are two people who are actively trying to make a difference, rather than just one who may struggle on their own because of their past history or social factors restricting what they can achieve. The

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implication of intersubjectivity is that each participant in a social situation has a stronger impact because their interaction, their working together, opens up additional possibilities for change. To create the holding environment, you help clients to feel safe. For example, if they are experiencing powerful emotions, you accept that this is so, help them talk about how they feel, how it gets in the way of what they are trying to achieve or sometimes helps them; for example, by motivating them to take action. You work out with them how they can regulate the emotions more successfully. How can they maintain their motivation? How can they cooperate better with others who are involved? As well as being empathetic, it may help clients if you are able to agree clear boundaries about appropriate behaviour, for yourself as well as clients. For example, you can be clear about when you are available, and when you will use your legal powers. Your own practice needs to be consistent and reliable, with on-time, planned and purposeful meetings. Attune your behaviour to their reactions. For example, if they are unconfident, encourage and help them to express their ideas and incorporate what they say into your plans, before coming up with your own answers. To make intersubjectivity work, you create a collaborative process between you. This is what Brandell (2004) and other writers call a therapeutic alliance, one of the shared principles identified in Figure 1.7. Work on being responsive to what clients talk about and how they are feeling. Think about how their current experiences are making them feel and behave, and be restrained in pushing an anxious or angry client, while encouraging or even being more directive with clients who are unconfident and uncertain. Respect and value clients’ aims and achievements, actively engaging in understanding their account of events that are important to them and therefore not being a distant, passive recipient of what they tell you. Participate with them in making the story full and clear. Explain how and why you are reacting to what they say as part of the process of co-constructing their personal narrative around the issues you are working on. Help clients make the transition into your working sessions together, for example by texting them a reminder of the agenda each week or asking them for a text in advance about issues they may want to work on. Moreover, confirm what you have agreed they will work on before you meet again in a quick text or email after the session. You may have to take responsibility for raising difficult issues when the client is fearful of revealing something that might make you critical. Be sharing and self-disclosing if doing so will help a client. Perhaps they will feel that you are dealing with them more as an equal. Be open but equable about differences and disagreements between you, so that they can see you are managing, and helping them manage, difficult feelings in the relationship and they can take less responsibility for this. Openness means that you will be more transparent about yourself than in a traditional professional relationship, and it is important to think through whether you are using openness to help, avoiding gratifying yourself by showing how open and ‘with the client’ you are. Encourage new relational experiences, for example in new settings, or help people to make new connections and undertake new activities, for example by going to new places or testing out new behaviours in new places.

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Case example: Encouraging Mosima to try out new relational experiences Mosima was a single parent migrant new to the town, who had been placed in an isolating apartment in a converted industrial building being used to support new migrants some distance from the town centre. Her English was poor, and her toddler and baby had not made any contacts with other children. The migrant support unit social worker referred her to a church mother and toddler group, where she could take a weekly English class, including exercises for going out and trying

practical English. She could have the baby with her, but volunteers provided a play experience for toddler children to avoid too many distractions in the class. Mosima was not confident she would be able to tackle this, and the social workers arranged for a specific volunteer to meet her at her apartment and be with her for the first visit. Over the following weeks, Mosima made some contacts with other mothers in a similar situation, and the toddler made some friends.

Encouraging people to take on new experiences may involve helping them to understand the uncertainties that are preventing them from taking a step in a new direction. As part of your discussion, try to identify the feelings that the client is experiencing. Is she fearful from lack of knowledge? Is he uncomfortable being with women? Alongside this, explore life experiences that may have led to these feelings preventing them from taking action. Relational theory sees these combinations of feelings about experience in the past as ‘self-objects’; that is, the person has taken into their thinking a perception of themselves as being unable to cope with this kind of issue. Remember in psychodynamic theory that an external event or place is an object; thus, they become in their minds a person who does not do that. New experiences are needed to displace these negative self-objects, but you need to make sure the experiences are going to be positive. Case example: Understanding and replacing unhelpful self-objectives Herbert was a project social worker helping Ajay in his transition from foster care. Ajay had gained qualifications at further education college in catering, but didn’t seem to be able to get a job in the cafés in the high street. Herbert got him to talk about how he thought through the interviews he had been to on the days before and then as he went to the interview. Part of what was revealed was that his African Caribbean father had always said that managers in his experience never wanted to employ black men and he had mainly got jobs through his personal networks with friends and family members. His older sister had also told Ajay that girls wouldn’t think he was attractive or interesting, and

when he found that many of the other workers were young women, he felt unconfident. As a result, his picture of himself was as someone from an outsider ethnic group who would also be an outsider in the prospective employee group. Herbert arranged through the college for Ajay to have a placement with an older male chef at a local café, talking to the chef beforehand about how important it was to guide Ajay in his contacts with the mainly female serving staff, and giving him the chance to stand in behind the bar at quiet times. This gave Ajay greater confidence that he would be able to do that kind of work, and in fact the placement café agreed to employ him for a trial period, finally taking him on permanently.

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A crucial aspect of this case example for understanding relational practice is that Herbert did not make assumptions about Ajay’s concerns. Instead, using his relationship with Ajay, he found out the psychological barriers in his experience that Ajay faced, so that he could address the reality of Ajay’s feelings. In the help Herbert gave, he modelled not by criticizing or commenting on the barriers, but by finding a way forward through going back to the college where Ajay felt safe and finding resources there to help Ajay move forward. Thus, with his practical help in organizing an experience that helped to displace Ajay’s negative self-object, he also demonstrated how to work mutually within a relationship and to build on relationships that had been successful. Goldstein, Miehls and Ringel (2009: 131–63) go on to explore ways of using transference and countertransference, particularly in understanding and working through issues of cultural difference. The principles behind this approach are that people with difficult experiences in their past have disruptions in their capacity to use the resources of their personality and skills in current situations. This is because the past often rears up to get in the way of acting successfully. By looking at situations in which this happens, you can recognize and repair the disruption. When clients are angry, silent, disappointed or exhausted so that they seem unable to move, even though they want to, this may be a disruption leading to apparent resistance. You can discover the experience that is disrupting their ability to move on by working through with them their disappointment or anger with your failure to help them. You identify things that they want improved in your work together, which they see as failing. Doing this, you begin to enact in a mutual and positive dialogue the disappointments in the past relationship, which are disrupting their ability to use their personality and skills. This may also be used to explore difference, such as different ethnic backgrounds, cultural experiences or sexuality, and how it may prevent you from creating a relationship that will help them. In doing so, you are re-enacting the past relationships that have also failed them, and demonstrating a way forward through new relationships.

Case example: Jemima assesses Joe and Peter as adoptive parents Jemima was carrying out an assessment of Joe and Peter, who were living in a well-established same-sex relationship, for being adoptive parents. She found them cautious, often silent or unresponsive in many of the discussions they had about their partnership and way of life. Eventually, she raised this perception with them, and explained how it made it difficult for her to have confidence in her own picture of how they would be as adoptive parents. She wondered if they

had experience of an older heterosexual woman doubting their life choices and wanted to be cautious in revealing things that might upset her. They talked about a sister and parent in each of their relationships who had been critical in various ways, and difficulties with female work colleagues. Jemima went on to talk through with them how they would deal with similar reactions if they did adopt children, and this led to a more open discussion.

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This case example demonstrates the relational approach of mutual engagement, with Jemima acknowledging her own sexuality but not talking about experiences of rejection, which she judged would be over-sharing. Understanding from their description of the disruption because of their negative self-objects enabled her to stay with the professional helping role of working on how they would manage the roles for which they were being assessed. Further aspects of relational approaches to brief work, couple, family and group helping and teaching and learning supplement Goldstein, Miehls and Ringel’s (2009) exploration of relational assessment and intervention principles.

Conclusion: using psychodynamic practice theory Psychodynamic theories have provided a rich source of ideas and metaphors for practice in more therapeutic or clinical settings. We all use psychodynamic metaphors as shared cultural currency to express common ideas about how people are influenced by their past in their thinking. Being aware of the historic importance of psychodynamic ideas as the source of many practices in social work allows practitioners to think critically when they use what appear to be perfectly natural techniques that in fact derive from psychoanalytic ideas. Contrary to psychodynamic ideas, however, social work practitioners are usually cautious about whether in many situations it is useful to delve into our clients’ pasts to understand how problems have developed, rather than focusing on their present predicament. Relational practice, however, proposes that doing this in a measured way can help to resolve many situations that social workers face. Certainly, it offers many creative options for using the relationships we build up with clients effectively. While psychodynamic ideas can be applied in many different situations in this way, they focus on mental health and emotional problems, and are probably of most use in mental health services. They are sometimes used in specialist settings in mental health and having a good knowledge of them enables connections with other professionals to be made if you practise in such agencies. Furthermore, Brearley (2015) argues that all social work requires us to address people’s emotional reactions and relationships as well as the policy and structural factors that are often the origins of their difficulties; it is not an either or, and psychodynamic ideas provide a creative way of doing so. Chapter 5 explores attachment practice as a further way of using psychodynamic ideas.

Additional resources Further reading

Brandell, J. R. (2004). Psychodynamic social work. New York: Columbia University Press. The most extensive broad account of psychodynamic social work.

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Ruch, G., Turney, D. & Ward, A. (2018). Relationship-based social work: Getting to the heart of practice (2nd Ed.). London: Jessica Kingsley. McColgan, M. & McMullin, C. (Eds.) (2017). Doing relationship-based social work: A practical guide to building relationships and enabling change. London: Jessica Kingsley. These two collections of papers describe and illustrate relational practice and theory. Goldstein, E., Miehls, D. and Ringel, S. (2009). Advanced clinical social work practice: Relational principles and techniques. New York: Columbia University Press. This is a very comprehensive and detailed account of relational theory, which allows an advanced practitioner to build on the relational ideas briefly covered in this chapter. Freedberg, S. (2008). Relational theory for social work practice: A feminist perspective. New York: Routledge. This useful and practical text marries relational theory with feminist ideas.

Journals Journal of Social Work Practice  – Group for the Advancement of Psychodynamics and Psychotherapy in Social Work; Taylor & Francis. Psychoanalytic Social Work – Taylor & Francis. Smith College Studies in Social Work – Smith College School of Social Work; Taylor & Francis Therapeutic Communities  – A useful journal covering this psychodynamic approach to residential work: http://www.emeraldgrouppublishing.com/products/journals/journals. htm?id=TC

Websites http://socialworkpodcast.blogspot.co.uk/2009/12/psychoanalytic-treatment-in.html The Social Work Podcast has in interesting interview with Dr Carol Tosone about current psychodynamic social work practice. http://www.aapcsw.org/ The main asset of the American Association for Psychoanalysis in Clinical Social Work website is its online journal. http://www.gaps.org.uk/ The website of the Group for the Advancement of Psychodynamics and Psychotherapy in Social Work also has a useful trove of articles and publications. http://www.therapeuticcommunities.org/ The Consortium for Therapeutic Communities has a useful website, covering residential work using this psychodynamic model of practice.

CHAPTER 5

Psychodynamic attachment practice MAIN CONTRIBUTION Attachment ideas focus on the element of caregiving within social work. They do this because they emphasize the importance of providing a safe haven for people who feel threatened and at risk in their lives, so that they have a secure base from which to function and live independently in the world. Initially developed in research with children, attachment theory now extends to the importance of attachment as a way of regulating emotions (or, using psychological jargon, affect) through close relationships at every stage of life. Successful experience of attachment helps people deal with stresses and traumas in their lives, including losses such as bereavement.

MAIN POINTS This chapter builds on the general account of psychodynamic theory in the first part of Chapter 4, so some of the general main points in that chapter are relevant. ●●

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Attachment theory proposes that people have an inborn need to be close to an attachment figure who helps them maintain their psychological security as a basis for wider exploration of the world. When people feel threatened with difficulty or danger, their attachment behavioural system is triggered and they exhibit proximity-seeking behaviours, with the aim of achieving closeness to an attachment figure. Once they feel secure, they can operate more independently without activating their attachment behavioural system. The prominence given to development assumes, like psychoanalysis, a biological basis for behaviour and social relations. Children’s attachment behaviour is directed towards a primary caregiving figure, often a parent. In some ethnic groups, attachment may be to a family or wider collective of caregivers. As young people develop into adulthood, their range of attachment behaviour and attachment figures widens. When the caregiving figure is absent, young children exhibit attachment protest: anger, crying and trying to be with the caregiver. Young people and adults may also be distressed when they lose an important attachment figure in their lives. Four main attachment behaviours are present in all cultures: 131

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proximity-seeking, trying to be close to caregivers; secure base affect, feeling that you can trust caregivers; safe haven, knowing that you can turn to caregivers for comfort; separation protest, children cry and try to follow the caregiver; adults may become angry or depressed at the loss of an attachment figure.

PRACTICE IDEAS ●●

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Attachment styles are patterns of attachment behaviour that children develop, depending on their experience of their relationships with important caretakers in childhood; they may continue into adulthood. Attunement is the practitioner’s empathy with and responsiveness to the client’s emotions, being aware of and adjusting your own emotional reactions to the client to demonstrate your awareness of and sensitivity to what the client is feeling. The idea comes from the accuracy with which a close caregiver of a child or adult can work out the reasons for attachment behaviours that they see as disturbing or difficult in children and, avoiding retaliation, respond in ways that calm these behaviours (Howe et al., 1999: 49; Fonagy, 2001: 119; Holmes, 2001: 17; Blood and Guthrie, 2018: 42). Mentalization is the ability of people to understand that others have expectations, experiences, hopes, ideas and values that are different from their own, and to envision others’ thinking. This allows people to interpret the thinking behind others’ behaviours, comparing and contrasting it with their own thinking. In this way, people can make links between reality as represented in their own thinking, and external realities (Fonagy, 2001: 165–70). Providing a secure base, offering a sense of safety for clients to venture into explorations of their social environment. Secure base priming is the use of transitional objects to help people call up important memories and feelings of secure experiences in their past. Examples of primers might be photographs of loved ones, music and souvenirs of holidays together (Shemmings & Shemmings, 2019).

THE DEBATE SUMMARY Many aspects of the general critique of psychodynamic theory in social work are also relevant to considering attachment theory. In addition, the main issues of debate with attachment theory are: ●● ●●

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whether people’s characteristics have an impact on attachment and caregiving behaviour; the extent to which research based on brief attachment stress in early childhood and projective techniques in adulthood really defines characteristic behaviour when many other life factors may intervene; ‘mother-blaming’ (Shemmings & Shemmings, 2011: 22), deriving from the assumption of early attachment writing that children needed only one caregiver and this would usually be the mother;

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infant determinism, an assumption that early childhood experience would continue to affect the whole life; agency, legal and political use of attachment to prescribe and then enforce assessment and intervention where the research does not justify a reasonable level of certainty (White et al., 2020: 45–82); overuse of attachment as an explanation for too wide a range of problems, particularly in children (White et al., 2020); The misunderstanding of ‘disorganized’ or ‘insecure’ attachment as adverse attachment styles, when they are more a description of ways of adapting to uncertainty and change that are characteristic of personal development for some people.

Debate about attachment People’s characteristics and attachment We might assume that people may have characteristics that inhibit their ability to form attachments and to be caregivers. Do inherited characteristics and temperament affect children’s capacity to achieve attachment and adults’ ability to provide appropriate caregiving? Does a congenial, smiley child lead to a more positive caring response from caregivers? Howe (2011: 201–12), reviewing the evidence, concludes that personal characteristics and temperament do not have a major effect on attachment and caregiving. This includes gender or disability. For example, some people imagine that the stereotypical male might be less emotionally open to attachments than the stereotypical woman. Research has shown no gender difference in the capacity to form attachments or be a successful caregiver. Disabilities, for example being blind or Deaf, do not, moreover, lead to major difficulties for children in making attachments or in caregivers being unable to attune to the child’s needs and become successful caregivers.

The research and its application The strange situation procedure, although well accepted, uses a brief period of attachment stress with infants and young children, rather than their broader life experience and relationships (Field, 1996). Adult analyses of attachment patterns and styles involve interpretation of how people talk about their attachment and intimacy experiences, appearing to differentiate attachment styles and patterns of behaviour. Nevertheless, people have a wide range of experience in life as they grow up, much of which is not concerned with attachment. Many practitioners are therefore cautious about laying too much stress on attachment as a broad explanation of life experience, and look at a range of factors that also affect children and adults alongside attachment.

Maternal deprivation and ‘mother-blaming’ Current research and thinking goes far beyond the starting point of Bowlby’s work on offending by young people and the care of children in mid-twentieth-century wartime. Yet his original interests, drawing on psychodynamic theory’s emphasis on childhood relationships, have sometimes skewed our perceptions of what is most important. This may lead to misunderstanding of

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caregiving in early childhood and inappropriate judgement of caregivers, and particularly of mothers. We can see a possible source of this misunderstanding, for example, in his wartime study on ‘juvenile thieves’ as it comes to its conclusion (Bowlby, 1946): The foregoing statistical analysis has demonstrated that a prolonged separation of a child from his mother (or mother-figure) in the early years commonly leads to his becoming a persistent thief and an Affectionless Character (p.  49) … From its earliest days psychoanalysis has emphasized the critical importance of the child’s first few years (p. 53).

The popularization of his 1951 report on childcare provision to the World Health Organization (WHO) (Bowlby, 1953), widely read by social workers until the 1970s, similarly concludes: The proper care of children deprived of a normal home life can now be seen to be not merely an act of common humanity, but to be essential for the mental and social welfare of a community. For when their care is neglected … they grow up to reproduce themselves … Deprived children, whether in their own homes or out of them, are the source of social infection … The twin problems of neglectful parents and deprived children are viewed as inevitable … the main reasons for this fatalism are three in number: the belief that a large number of these children are orphans and have no relatives; an economic system which from time to time creates unrelieved poverty on a scale so great that social workers are powerless to help; and a lack of understanding of psychiatric factors and a consequent powerlessness in managing cases where they are important (p. 239) … The second factor still at work is a lack of conviction … that mother-love in infancy and childhood is as important for mental health as are vitamins and proteins for physical health (p. 240).

Although Bowlby is here primarily criticizing official inertia and misunderstanding and the deficiencies of economic management, as you would expect in a report for an international organization, the picture is of care and health systems failing children by not securing ‘mother-love’ for as many children as possible. This may be misinterpreted as Bowlby saying that maternal failings or depriving children of mothers, or at least other consistent caregivers, are important causes of problems in attachment, which lead to long-term psychological and social harm and behavioural problems. Such misinterpretations might also lead to other inappropriate assumptions – that gay couples cannot become successful caregivers of children, for example  – but there is no evidence for this and similar assumptions about attachment. As the theory developed, Bowlby moved his ideas beyond these caricatures, suggesting that in childhood and certainly over a lifetime many different forms of caregiving, for example in many ethnic groups by a wide family group (Keller, 2018), may be successful and that people can adapt to and benefit from a variety of caregiving experiences. Most attachment writers would accept that maternal deprivation, in itself less commonplace than when Bowlby was writing, can be replaced by other relationships, and people can be helped to change inappropriate attachment behaviour (Rutter, 1981). The old-fashioned and gender-biased idea has

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been replaced by a much more complex and nuanced understanding of attachment both in childhood and in adulthood. A further cultural critique (Duschinsky, Greco & Solomon, 2015) comments on the ‘profoundly conservative’ (p. 176) features of attachment ideas, in its emphasis on returning to a safe haven rather than seeking change and development, and in its acceptance of dependence on the caregiver in family or other close relationships, rather than wider networks. We must be cautious in practice of assuming that protective relationships are more important than opportunities for adventure.

Infant determinism and bias towards children’s services There are two elements of this critique of attachment ideas. The first is that in working with children, the first few years determine personal and social development throughout childhood, and even into adulthood: once it has gone wrong, nothing can be done. The evidence is that a wide variety of relationships and life experiences are important for children’s development towards adulthood, and even in adulthood people can change. This also means that caregivers can change and can improve the quality of their attunement to their children’s needs. Thus, an important development in attachment practice in recent years has been parental guidance programmes and family support (Shemmings & Shemmings, 2011; Schofield & Beek, 2014). There is little evidence supporting the long-term impact of ‘attachment parenting’, in which parents, particularly mothers, make efforts to retain physical closeness to a baby, holding it as much as possible and breastfeeding. While this may be enjoyable to some mothers and parents, there are also concerns it may be too demanding and draining for the parents. The message is moderation. The second concern about infant determinism in attachment theory is the suggestion that infant caregiving and childhood attachment patterns form patterns of behaviour throughout life. Harris (1998) argues that both genetic factors and peer relationships in later childhood have a greater influence on behaviour in young people and in adulthood. One consequence of infant determinism may be an excessive focus on working with children and caregiving in their families as a priority in social and health services. That is, it is more important for policy in the social services to get children and family services right than it is to tackle mental health and social issues that adults face. This risks ignoring the immediate needs of adults with mental health and other social problems. It is also ageist; it puts one age range of people who need help before others, who might need more or different help.

 sing attachment theory to prescribe and enforce child welfare U judgements Research in child welfare services suggests that concern about child safeguarding has led to political pressure for assertive enforcement of protection of children from parental abuse and neglect. Legal proceedings and defensive practice in agencies have demanded too high a degree of certainty in assessment and intervention decision-making based on assumptions that attachment is both natural and a scientific fact (White et al., 2020: 45–82). Partly, this draws on the political and professional search for scientific certainty, rather than an

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acceptance of human variability. It leads on to attachment being overemphasized and disorganized attachment being seen as a negative adjustment to inappropriate parenting, points that I deal with in the next two subsections. Critical comment suggests that these reactions to attachment theory may arise from oppressive discrimination against class and minority ethnic group childcare practices.

 veremphasis on attachment as an explanation of childhood O difficulties Because of the powerful impact of attachment ideas in childhood studies and practice in professions influenced by psychology, it may become too dominant in services trying to respond to children’s problems. You need to look at other aspects of behaviour and options for intervention. Similarly, the power of attachment ideas in work with children has contributed to a delayed and weak development of the use of attachment in working with adults, bearing in mind that extensive research in clinical psychology has been available since the 1980s, and the impact of attachment on Murray Parkes’s ideas on bereavement and adult psychiatry (Parkes, Stevenson-­ Hinde & Marris, 1993; Parkes & Prigerson, 2010). Transfer of this work to social work is slowly developing, but it is not yet well-integrated into social work practice, although it has made progress, particularly in US mental health practice. I discuss further issues around mother-blaming and children’s services provision when looking at ‘the politics of attachment theory’ later in this chapter.

Insecure and disorganized attachment Some people may assume that secure and organized attachment are the most favourable forms of attachment. Several attachment styles are labelled insecure and a small group of children are described as having disorganized attachment. Many of this category may also be labelled insecure. Across cultures, 60 per cent of children are secure, so insecure attachment is not necessarily a negative label, because it describes quite a large minority. Rather, it describes relationships where caregiving is present but changeable and variable, so that children become anxious about what the reaction to their needing support might be. Indeed insecure-avoidant children are often quite self-reliant as a result. In these categorizations of attachment, they might be resistant to contacts or avoid situations that might feel uncertain. Disorganized attachment may indicate a form of adaptation to situations where caregivers are absent or frightening rather than negative behaviour. Over a lifetime, this adaptation may present both problems and benefits for the individuals affected, even if in childhood some distressing behaviour is apparent. Holmes (2001: 51–64) discusses a psychoanalytic debate between a deficit model of psychological adjustment and a conflictual model, in which confronting problems leads to resolution of conflicts in adults’ minds. Should we see disorganized attachment as meaning a lifetime deficit? Holmes argues that attachment theory suggests that life problems can be rectified by creating a secure base, then exploring the inconsistencies in life and relationships, thus leading to a successful resolution of difficulties.

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Major statements Attachment theory comes out of the work of John Bowlby (1907–90), a psychoanalyst working mainly with children and young people. His early work, on maternal deprivation, was very influential on social work from the 1960s onwards (Bowlby, 1946, 1951). Later work led to a three-volume statement of his ideas (Bowlby, 1969, 1973, 1980), which extended his psychotherapeutic work with children and young people to a broader theory of attachment and loss in both children and adults. Later ideas, for example about the importance to children and adults of a secure base (Bowlby, 1988), built on this initial work. Bowlby’s work is research-­ based and focused on children, but is still readable and stimulating half a century after first being written. Its age and paediatric psychiatry focus make it inappropriate as the basis of current social work practice, whether with children or adults, although its ideas are still very much present in social work writing. Because Bowlby’s work is largely about children, although his ideas go further, his first influence has been in work with children in the public care system. In turn, because child safeguarding has become increasingly important in this field, attachment practice has sometimes been focused on repairing damaged relationships with parents, or replacing them in foster and adoptive care. A Canadian psychologist colleague of Bowlby’s, Mary Salter Ainsworth, working in the USA, developed a ground-breaking laboratory technique, the strange situation procedure (Ainsworth et al., 1978). Children played in a well-equipped playroom that was strange to them, and reactions to their parent leaving the room and being reunited with them were observed; sometimes strangers were also present. The crucial thing about this experiment is that it shows that people’s security about themselves and others comes from how they think about caregivers’ responses to them. From seeing how children experience attachment distress and how caregivers deal with attachment protest, different styles of attachment were identified. This kind of research has continued, and there are different formulations. A widely used formulation of attachment styles in children is the A, B, C + D model (Howe, 2011: 41–54). A, B and C styles are organized; that is, they reflect patterns of behaviour that are well established in the children that adopt them. The D style is disorganized; that is, the child does not adopt a consistent pattern of behaviour, and may be variable and volatile in temperament. The A style is avoidant, where children have experienced caregivers as distant and uninvolved; they react by regulating their behaviour so that they seem controlled and contained. The B style is balanced, with children seeing caregivers as dependable and responsive, so that they express distress at separation from a caregiver, but go to them to be comforted when they are reunited. Most children are like this. The C style is ambivalent, sometimes called insecure, where children are very distressed by separation from the caregiver, and can be clingy and demanding at times, but are sometimes angry and resist attempts to comfort them. The D style develops in children who experience their caregivers as either unsafe (for example, abusive) or unavailable (for example, alcohol or drug abusers). A mix of angry or avoidant strategies or apprehension and inertia emerges, and you can never be certain how they will react to stress. Several important writers have developed influential practice concepts building on Bowlby’s ideas. The Adult Attachment Interview (AAI), developed by Main and her

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colleagues (Hesse, 2008), is the basis for development of attachment practice with adults. In its original form, the hour-long interview asks questions about the respondent’s relations with caregivers since childhood, and the replies are coded to identify adult attachment styles, related to children’s styles identified in the strange situation procedure. The four main styles are as follows. Adults defined as secure are comfortable with both intimacy and autonomy; others display a variety of patterns reflecting anxiety about or avoidance of intimacy with attachment figures. A semi-autonomous or ‘free-to-evaluate’ (F) style describes adults who value attachments but are realistic about their quality and nature. Dismissing (D) styles, a bit like the child A (avoidant) style, describe people who don’t make too much of their attachments, speak positively of their parents’ support, but not in detail. Pre-occupied-entangled (E) states of mind are a bit like children’s C ambivalent style, confused, perhaps angry, about relationships. Unresolved or disorganized D patterns of behaviour are like disorganized patterns in children and prevent people from using attachments to regulate their behaviour consistently. The AAI extended many of the attachment concepts used with children to form ideas about how adults adapted or maintained attachment styles formed in childhood and in later life. Various other, and sometimes simpler, assessment tools were developed for use with adults. These include story stem techniques, in which respondents are asked to complete a simple story and their answers reflect their attachment styles. A variety of branded psychotherapies using attachment ideas are available. For example, Crittenden’s (2016) dynamic-maturational model (DMM) is relevant for both young people and adults. It proposes that attachment behaviour develops as patterns of responses to life’s pressures. Both cognition, their thinking, and affect, their feelings, need to be explored. In this formulation, people seek safety when in danger, comfort when distressed, proximity to an attachment figure when feeling isolated and predictability when they see themselves in a chaotic situation or their minds are in chaos. In assessment, practitioners need to explore which of these functions is met by the patterns of behaviour that they see. All this clinical psychology and psychotherapeutic work is comprehensively reviewed in two handbooks on work with children and young people (Cassidy & Shaver, 2018), and on attachment in adulthood (Mikulincer & Shaver, 2016). These are included in the further resources at the end of this chapter and provide comprehensive reference sources for various forms of psychotherapy, research and assessment tools in the domain of clinical psychology, though their detailed research-based exposition makes them unsuitable for use by beginning social work practitioners. Bowlby worked with social workers and often wrote with them in mind. A more recent and approachable, but brief and introductory, account of attachment theory concerning both children and adults by Howe (2011) and an older account of working in child safeguarding and family support practice by Howe et al. (1999) are widely valued accounts of social work practice in this field. More recently still, a range of research and interpretation of attachment relevant for social work has emerged from Shemmings and Shemmings (2011, 2014, 2019) and their book on working with disorganized attachment is used as an example text in the applications section of the chapter; it mainly concerns work children but includes some material on adults. An extended text on adult attachment social work is still to appear, but edited

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texts on attachment work with children and adolescents (Bettmann & Friedman, 2013) and adults (Bennett and Nelson, 2010) contribute useful ideas also in the applications section in this chapter.

Wider theoretical perspectives Attachment theory builds on the developmental strand of psychodynamic thinking (see Figure 4.1), with less emphasis on ego, relational and self-psychology ideas and on psychoanalytic treatment methods. It is closely connected, however, with the object relations psychoanalytic theorists who were influential during the 1950s and 1960s at the time when Bowlby was developing his main ideas. Present developments draw on the positive psychologies (see Chapter 11), where rather than look at problems, interventions seek to build strengths and forward movement for the future. The policy movement of the 1990s and early 2000s towards permanency in placing children in adoption and fostering is partly informed by attachment’s theory’s emphasis on the secure base and the possibility of repairing relationship difficulties in early childhood through this (Aldgate & Gibson, 2015). This is, for example, reflected in authoritative guidance from the UK National Institute for Health and Care Excellence (NICE) on working with children adopted from care or in care (NICE, 2015).

Connections Attachment interacts with wider psychoanalytic theory, and this helps us to understand both attachment and psychodynamic practice better. For example, Blom and Bergman (2013) discuss the distinctions between attachment theory views of child development and the separation–individuation views that we met in Chapter 4. Separation–individuation ideas suggest that infants start from a complete inability to see themselves as separate from their relationship with their mothers and needing to build up their individual identity. Attachment, on the other hand, sees children as biologically programmed to engage with the outside world and attachment behaviour as the way in which this develops. In later life, separation–individuation theory is concerned with how young people begin to achieve autonomy and independence from relationships with the parents, whereas attachment focuses on lifelong needs for attachment of various kinds and in various situations. These are two sides of a balance that everyone faces as they develop. Neuroscience research and attachment theory have become connected, since research has begun to explore chemical and neurological changes and brain trauma in childhood as a factor in child development difficulties. This is an important current area of research, although it offers little concrete guidance for practitioners at present (Schore & Schore, 2010; Aldgate & Gibson, 2015: 90–1; Page, 2017: 18; Millar, 2018: 332–4). A variety of branded psychotherapies using attachment theory have been developed. Page (2017: 11–15), for example, identifies Attachment and Behavioural Catch-up (ABC); story completion systems such as the attachment story completion task (ASCT); the Circle of Security; Promoting First Relationships (PFR); Group Attachment-Based Intervention (GABI); a variety of intervention protocols for working with children, and Video-Feedback

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Intervention to promote Positive Parenting (VIPP) among video-assisted systems, one of which is described more fully by Shemmings and Shemmings (2011) in the example text discussed in the applications section of this chapter. Many of these interventions focus on improving mentalization, which allows children and caregivers to improve their capacity to respond to each other. To use these systems, practitioners need to be part of supervision and training systems.

The politics of attachment theory In addition to the political professional debates around psychodynamic theory in general, dealt with in Chapter 4, attachment theory has generated debates within the discourse about the nature of social work over the past decade, in which many social work commentators have seen specialized technical forms of social work, such as attachment theory, recruited to reduce costs in times of economic austerity and target interventions at oppressed people and people in poverty. I suggested when looking at the critiques of the use of attachment theory in social work that it was connected to ‘mother-blaming’ and policies that unduly emphasized children’s early difficulties and prioritized children’s service provision. Picking up these issues, Parrott with MacGuiness (2017: 127–8) argue that attachment theory is an aspect of the social construction of political views of poverty that criticize and seek to manage the lives of poor people. This is because attachment patterns are rarely explored with middle-class families, while families in poverty are more likely to have their caregiving and attachment patterns critically explored by social workers on behalf of the authorities. Beckett and Horner (2016: 127) argue that attachment theory, with its biological base looking at the characteristics of parents’ caregiving, may induce early intervention in families with a history of difficulties in childcare. As a specialized form of practice, attachment theory makes available targeted interventions for families whose childcare has been found wanting, rather than broad provision designed to support families. It also pushes resources towards early preventive intervention, rather than help to troubled teenagers. Garrett (2018b: 119) brings together these points and connects them with the enthusiasm for neuroscience knowledge about chemical and neural influences on behaviour. Schore and Schore (2010), for example, discuss connections between neuroscience and attachment research. Attachment behaviour becomes established as patterns of behaviour in early childhood, and is associated with specific neural pathways and brain activity. Adult attachment behaviour is exhibited in emotional and behavioural regulation. The social worker’s external engagement in helping clients regulate behaviour and emotion establishes internal regulation. While these links may be made, there is little concrete evidence of chemical and neurological implications of attachment patterns. The attachment–neuroscience connection encourages a belief in as yet undeveloped scientific and technical interventions, in the hope that these may be targeted and thus less expensive than human interventions and broad service provision for families. By focusing on the early years, political and social trends allow families to be blamed for children’s later difficulties, rather than developing critical analysis of education and social resources for families in

Psychodynamic attachment practice

poverty. Garrett (pp. 127–9) argues that attachment theory is over-used to attribute children’s difficulties to families, the home and mothers, rather than wider social forces, inadequate resources for education and inadequate youth service provision. These debates are further examples of how broader psychodynamic theory may come to be victim-blaming.

Values issues The values issues around psychodynamic practice were identified in Chapter 4, and are equally relevant to attachment practice. They include the issues of individualization and determinism, which arise in the way that attachment theory places responsibility on the psychology and behaviour of children and caregivers for attachment difficulties, rather than on the social circumstances that placed them in a difficult environment for developing appropriate relationships. A focus on psychological difficulties often leads us to devalue clients’ efforts.

Applications The main model of attachment theory is set out in Figure 5.1. It proposes that people have an inborn need to be close to an attachment figure who helps them to maintain their psychological security as a basis for wider exploration of the world. When people perceive themselves to be threatened with difficulty or danger, their attachment behavioural system is triggered and they exhibit proximity-seeking behaviours, with the aim of achieving closeness to an attachment figure. Once they feel secure, they are able to operate more independently without activating their attachment behavioural system. They achieve this security by caregivers providing a safe haven in which they support people’s exploration of further life experience from a secure base. Social work applications, therefore, focus on helping family caregivers to strengthen the consistency of the attachment bonds that they achieve with their children. Where people experience disorganized attachment behaviour, or have other difficulties in attachment, caregiving that offers a safe haven and secure base for further personal development can alter patterns of attachment behaviour. Adults sometimes experience problems in emotional regulation deriving from patterns of attachment behaviour. For example, they may avoid relationships that get too close, or on the other hand become dependent on attachments that they have achieved. Avoiding attachment means that they are unable to pay attention or become inaccessible when a partner or child needs their support. Being too dependent may mean that they are overwhelmed by a partner or child’s emotional distress. Important areas of social work with adults include caregiving and loss in human relationships. Among the issues with which attachment interventions may be helpful are looking at caregiving for older or disabled people. What are the rewards and stressors in caregiving relationships, and how do these vary between different ethnic or social groups, for example (Bennett, Sheridan & Soniat, 2010)? Attachment interventions with families

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People learn as infants to seek proximity to caregivers who become attachment figures. Attachment figures provide a safe haven, allowing children to explore new experiences. Separation from attachment figures leads to distress, separation protest and proximity-seeking behaviour. Caregiver behaviour leads to organized or disorganized patterns of attachment behaviour. Unless amended, attachment patterns persist, affecting adults’ regulation of emotions and behaviour.

Figure 5.1  Model of attachment theory

are discussed in Shemmings and Shemmings’s (2011) book on disorganized attachment, presented more fully as an example text later in the section. Bettmann and Jasperson (2010) identify a wide range of research undertaken by social workers using attachment ideas and interventions. Attachment ideas can inform many situations that social workers deal with. Examples include adults moving home, changing jobs or moving into a care home, and young people leaving foster care, changing schools or starting work. Careful assessment is required to understand the patterns of attachment that people have experienced. It is important to help people focus on the relationship consequences of change, and help them explore how patterns of part attachment are affecting changes in present attachment (Blood & Guthrie, 2018). Fewell (2010) describes mentalization-based interventions, which provide training and experience to improve clients’ abilities to imagine others’ pictures of behaviour and relationships, based on the evidence of interactions around them. You take an inquisitive, not-­ knowing stance to help people explore how others interpret and understand interactions, not informing people of your alternative perception but helping them reflect on their own and others’ understandings.

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Case example: Attachment work with traveller families Hamilton-Perry (2014) describes a project working with traveller families, where there are often large families, constantly travelling, with traditionally self-employed people who experience seasonal employment. Children may develop secure attachments within the family, but often do not have attachments to a place as a safe haven. Families would not cooperate with the strange situation proce-

dure for assessment, because of lack of trust in official services. Story stem and brief use of elements of the adult assessment interview were used for assessment. As part of working with clients, the practitioner used the idea of mentalization, getting people to think through how other people in the traveller community thought about them and viewed themselves.

We can also learn from ideas of attunement, in which practitioners and caregivers can learn to connect with clients who seem disconnected from contact. Caregivers who are attuned are more able to respond to hard-to-understand communications. Brown and Sorter (2010) describe listening closely to how people communicate with you, and varying the intensity, rhythm, pitch and tone of your voice to match theirs. Shemmings and Shemmings (2019) also discuss calming the body, using relaxation and rhythm in interactions and eye movement desensitization and reprocessing (EMDR), a technique using rapid eye movement that has been found to help people manage difficult emotions and stress, including post-traumatic stress disorder (Shapiro, 2018).

Case example: Josie helps to make positive progress through Erica’s anger Erica and Kevin were a newly separated couple with young children. Erica was so angry with what she saw as her husband’s avoidance of communication about the arrangements for caring for their children that she was speaking about this to her social worker, Josie, at great speed, in disjointed sentences, waving her arms around, and then turning away breathless with the rush of anger. Josie said in a lower tone of voice, ‘Why don’t we go and sit down to talk about this?’, coming close to her, then taking her by the arm away from the kitchen

and into the sitting area of their apartment. When Erica became breathless, Josie talked about how she could feel how strongly Erica felt, but at a slower pace, matching the breaks in Erica’s talking. Gradually, clarifying and mirroring the points Erica was making, but slowing the conversation down and speaking in quieter tones, Josie moved towards a less frenetic conversation, while staying with the important topics that Erica was raising. Eventually, they were able to begin to talk about ways of planning communications with Kevin.

Carney and Young (2012) describe attachment ideas as a basis for working with domestic violence. The idea is that some violent people have a lifetime experience of failed bids for attachment, and mentalize themselves as unsuccessful, unworthy or incompetent in relationships. They may experience too much dependency in their relationships, because of insecure attachment patterns. Anger is a common reaction when attachment needs are not met, sometimes leading to violence. Howe (2011: 164–9) notes that controlling or coercive behaviour may result from avoidance, distancing or other attachment patterns, and this is common in

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domestic violence. Attachment-based help focuses on helping violent offenders understand the impact of their childhood experiences of attachment on their behaviour and teaching people to self-regulate their reactions when they experience attachment anxiety in their intimate relationships. Studies also show that some women experiencing domestic violence may be too dependent on their partner because of insecure attachment experiences.

 xample text: Shemmings and Shemmings (2011) E on attachment theory with children Shemmings and Shemmings (2011) provide a useful account of theory and research on attachment, mainly in work with children. Concerns about childcare are so important in social work that this focus is relevant for many practitioners. We have seen that Bowlby’s ideas centre on how infants become attached to a person at a very early age. This attachment is expressed in behaviour because the infant tries to be in close physical proximity to that person. Through their interactions with this attachment figure, infants build up a picture in their minds, an internal working model, a mentalization, of how relationships usually work. This is eventually extended to other people, and the model becomes less of a working model, being a more fixed expectation of how people behave towards the child and how the child should behave in reaction to that. The four main components of attachment are as follows: ●● ●● ●● ●●

The attachment figure becomes a secure base for us. We seek proximity to our secure base when we are afraid, hungry or ill. We use the secure base as a safe haven when we explore new experiences. We experience distress as a separation protest when the attachment figure becomes unavailable to us. This might happen to children when parents who are a secure base are absent and to adults when they are cut off from a spouse or partner who is their secure base. This might happen to adults when they are away from home or when they are bereaved.

These ideas were explored in a classic experiment, the strange situation procedure, which is usually carried out with children aged between one and three years. There are seven stages to this, set out in Figure 5.2. Figure 5.2 mentions three types of reaction in which children seek proximity to a carer: ●●

●●

●●

Secure children have learned that they can safely express their need for proximity in the carer’s presence, and the carer will try to understand the need and help to manage the distress. They will go to the carer on their return, and the carer will react supportively and lovingly. Insecure avoidant children have learned that they should not display their feelings so they repress and suppress their anxiety. Although upset when the carer leaves, they appear unmoved when the parent returns because the carer clearly expresses that they expect the child to manage their emotions. Insecure ambivalent children have learned that the carer does not react consistently, and the children also react randomly and unpredictably. When the carer returns, they switch in a haphazard way between wanting proximity and continuing to play. The carer’s efforts to calm the child’s distress are misattuned because of a failure to pick up on the reaction the child finds helpful.

Psychodynamic attachment practice Stage

Event

Reactions

Preparation

The child plays; the parent is present and uninvolved

Independent play is the starting point for the procedure

First appearance of the stranger

The stranger enters, chats to the parent and offers a toy to the infant

The child looks to the carer for reassurance but does not respond directly to the stranger

First separation

The parent leaves the room, and the stranger leaves the child to play. If the child stops playing, the stranger tries to interest the child in the toys

Even when the carer leaves, most children do not go to the stranger

First reunion

The parent returns and waits for the child to respond; the stranger leaves

Three alternative reactions depend on whether child is securely or insecurely attached (see text), all representing an organized way to seek proximity

Second separation

Once the child settles, the parent leaves the room

The child cries and goes to the door (separation protest)

Second appearance of the stranger

The stranger re-renters the room and tries to interest the child in a toy

Most children do not go to the stranger

Second reunion

The parent re-renters, waits for the child to respond and then picks up the child; the stranger leaves

Three alternative reactions recur

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Figure 5.2  The strange situation procedure Source: Shemmings and Shemmings (2011: 23–8), derived from Ainsworth et al. (1978).

Across many different cultures, about 60 per cent of children fall into the secure category, about 25 per cent are insecurely avoidant and about 11 per cent are insecurely ambivalent. All of these forms of attachment behaviour are organized in that the child is making a contribution to his or her survival in the relationship with the carer, having learned what works best in maintaining this particular carer’s proximity. The remaining small group of around 4 per cent of children exhibit disorganized attachment. Contradictory behaviour is the main characteristic of this form of attachment. For example, the child approaches the carer, but fearfully or looking away, or the child freezes (stops moving) when the parent enters. Children who show disorganized attachment behaviour are overwhelmed by fear because they do not know what to do to maintain safety and proximity. As infants, this disorganized behaviour resolves itself quickly into an organized pattern. Adolescents with disorganized attachment behaviour are punitive towards the carer, being aggressive or threatening, or more apparently caring by being excessively polite and helpful. Each of these reactions is an attempt to control or manage the carer’s behaviour. Disorganized attachment behaviour results from unpredictable or malevolent behaviour by the carer. It is strongly associated with the child going on to experience mental health problems in adolescence and adult life and to repeat this kind of parenting with their own children. Many factors affect whether a person’s attachment behaviour is disorganized: there is no simple connection between the events in the child’s life and their attachment

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behaviour. Shemmings and Shemmings (2011) review this as a series of pathways. There are several main factors that can generate disorganized attachment behaviour, and as children follow their pathway through life, the extent to which these factors are important increases or reduces. Moderator variables in the child’s life reduce the effect of a factor, and mediator variables change how disorganized attachment occurs when the factor arises. Disorganized attachment mainly arises from the quality of the protective behaviour that carers exhibit. More children who are ill-treated by their carers exhibit disorganized attachment than children who have little experience of family violence. This is because the child experiences ill-treatment and danger from a person who would be expected to provide protection in their relationship. Carers who behave in this way may have experiences in their lives that leave them unable to be appropriately protective. Unresolved trauma, abuse or loss in the parent’s life means that the parent experienced fear, helplessness and anger that prevented them from being able to comfort or soothe the child when this was required. Other relevant factors may include parental insensitivity, an inability to react owing to depression or drug or alcohol abuse or to marital disharmony, and frightening parental behaviour such as dissociative behaviour (behaving as though disconnected from the present situation and feeling shut out from current events), rough handling or withdrawn behaviour. In these instances, the carer is unable to provide care and support because their behaviour is the source of the need for care and support. These factors in the carer’s behaviour do not, however, always lead, either on their own or together, to disorganized attachment. The relevant mediator is likely to be the carer’s capacity for mentalization and reflective function. This is the carer’s capacity to explore their own mind and experience and to be prepared and able to see the child as an independent being who is similarly capable of reaching understanding and thoughtful progress in their life. An inability to value the child’s independent life in this way may mean that the various combinations of factors in the parent’s life are pulled together along a pathway of experiences leading to ill-treatment and onwards to disorganized attachment. Neurological, biochemical and genetic factors also affect how children and parents relate to one another. The neurotransmitter oxytocin is associated, for example, with social recognition, trust, love and caregiving behaviours, and there is evidence that mothers with poor regulation of oxytocin display less sensitive parental behaviour. Another neurotransmitter, dopamine, is connected with how people regulate stress and cope with difficulties in their lives. Practitioners use a number of these ideas in working with children who have disorganized attachment. Assessment scales and tools have been devised for exploring attachment behaviour and measuring the experience of frightening or insensitive carer behaviour (Prior & Glaser, 2006: 96–155; Shemmings & Shemmings, 2011: 65–83). They focus on identifying children who need help and on identifying the behaviours of carers. Howe (1995) suggests that assessment practice using attachment theory involves looking at: ●● ●●

present relationships, especially their content and quality, function and structure; relationship history, and how it displays various types of attachment behaviour;

Psychodynamic attachment practice ●● ●●

context, such as particular stresses of the environment on present relationships; content and quality, which is looking at the affective tone of relationships, whether there is an emotional bond between people, and their operational style; that is, how they regulate the relationship.

Case example: Two single mothers’ approaches to their daughters A single mother developed a close relationship with her only daughter and controlled her behaviour by trying to explain rationally why her daughter should behave or react in desired ways. In childhood, this often led to lengthy conflict or impasse, but in adulthood the daughter found it easy to ask for support and help from others and developed effective relationships. In another similar relation-

ship, the mother was absent a great deal and relied on a series of instructions and the daughter’s ‘duty’ to behave appropriately and not embarrass her mother. This also used rational means, but was not allied to the loving relationship and constant interaction of explanation; and in adulthood this daughter avoided intimate relationships and had very little contact with her mother.

This case example demonstrates how two different approaches to developing attachment relationships with a child have long-term consequences. Although each mother might disagree with the other’s approach, the important thing for the long term is the children’s security in knowing that the mother’s style of attachment will be consistently pursued. A range of interventions have also been developed; those that are best supported by evidence focus on improving carers’ sensitivity to children and changing carers through foster and adoptive care (Prior & Glaser, 2006: 233–60; Shemmings and Shemmings, 2011: 173– 219). Mentalizing and reflective function approaches focus on increasing the carer’s capacity to mentalize about other people. A good way of working on this is to get them to mentalize about the practitioner; to do this, the practitioner provides mentalized experiences as an example. The next case example provides an illustration of this, which shows how the process of providing mentalized experiences is not the same as being empathic in the way that humanistic counselling proposes (see Chapter 10).

Case example: Mentalizing about removing a child from the mother’s care Caitlin feared that the children’s social care services were considering removing her daughter from her care. She came to the office to see her social worker, Hannah, to discuss her daughter’s progress at nursery and to ask for help with social security allowances. They had a good relationship, but on this occasion Caitlin expressed a lot of anger about Hannah’s attitude: ‘looking down your nose at me, when I don’t have any money or strength to do all the things you want me to do’. Hannah’s response was to say that they should take a break; she made

coffee for them both. As they sat drinking this, she apologized for upsetting Caitlin, and said that she wondered whether Caitlin was thinking of Hannah as mainly someone who was criticizing and judging her. Doing this, she was drawing attention to an aspect of Caitlin’s mentalization. There was some truth in this because she often had to make assessments about how Caitlin’s daughter was doing. Then Hannah moved the discussion on to the main things that she had thought about when she was doing her assessment.

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The practitioner’s approach here is tentative, because mentalizing is difficult, but it helped the carer to consider a range of things that might be on Hannah’s mind so she could be seen by Caitlin both as helpful and as assessing the situation. Techniques are also available using videotaping and have been found effective. For example, Phillips (2011: 181) describes filming a parent–child interaction and getting the parent to speak for the child and mentalize the child’s experience by writing subtitles that describe the child’s behaviour to put on the screen. He suggests that watching and exploring their interaction with their own child can increase their sensitivity in dealing directly with their children. Other studies involve instructing a carer to play on the floor with the child, with the child leading the activity. The carer then reflects on the experience and on how they think the child was thinking about what they were doing. Such an approach encourages a reflective capacity in the carer (Prior and Glaser, 2006: 239–41). Many agencies use parent education or parent and child play informed by practitioners’ interventions, as we saw in the extended case study in Chapter 2 on the organization of a child and adolescent mental health service. Shemmings and Shemmings (2011: 203–19) describe a project that builds on this approach in child safeguarding work. The practitioner observed the carer with the child and gave them increasingly difficult tasks to see how sensitively the parent introduced them and gained the child’s compliance. In another project, work with children to identify abuse used story stems. Here, the practitioner starts a story of an event in family life that the child completes, indicating their expectations of how they are treated within their own family or in other social situations. The connections with psychodynamic theory are clear from this summary of attachment theory and social work. The focus on emotions and early childhood development as the basis for later relationship and emotional problems, and practice based on understanding and insight are typical of many psychodynamic theories. Attachment theory may be important for work with children, where it is well supported by research in child development, but its application to adults is less well evidenced. Moreover, its social work application produces only a sketchy set of ideas for practice, although it gives a good basis for a confident explanation of childhood problems. It takes up some ideas from cognitive and learning theory, particularly in its emphasis on therapy as learning. This is a point at which practice ideas from cognitive ­behavioural therapy might be included in the general approach set out for practice in attachment theory. A further publication (Shemmings & Shemmings, 2014) builds on this analysis of the most concerning attachment behaviours with detailed accounts of practice in the ADAM (assessment of disorganized attachment and maltreatment) project, which is particularly relevant to child protection work.

Conclusion: using attachment theory As with other psychodynamic theories, attachment provides interesting ideas that can help us understand behaviour, and how it develops from childhood into adulthood. Research offers us ways of assessing and intervening with children’s and adults’ attachment behaviour, and helping caregivers support both children and adults more successfully. A variety of projects have developed interventions with troubling client groups, and attachment has been taken up

Psychodynamic attachment practice

by official reports and agency practice guidelines. Improving people’s mentalization provides a strong concept that focuses on people’s ability to understand and react appropriately to others’ perceptions of them and of social reality. Practitioners, aware of debate and critique, however, are cautious about unthinking use of attachment ideas. There may be many other aspects of people’s life experience that have led to difficulties in people’s lives. Moreover, attachment is a psychological theory and over-use may underplay poverty and other social pressures that lead to relationship stresses between caregivers and the people they care for, in childhood and in adulthood.

Additional resources Further reading

Howe, D. (2011). Attachment across the lifecourse: A brief introduction. London: Red Globe Press. Howe, D., Brandon, M., Hinings, D. & Schofield, G. (1999). Attachment theory, child maltreatment and family support. Basingstoke: Macmillan. These two books are good starting points. The first extensively reviews current theory, balancing evidence about attachment in adulthood, with the better-established work on attachment in childhood strongly reflected in the second book. Bennett, S. & Nelson, J. K. (Eds.) (2010). Adult attachment in clinical social work: Practice, research, and policy. New York; Springer. Bettmann, J. E. & Friedman, D. D. (Eds.) (2013). Attachment-based clinical work with children and adolescents. New York: Springer. These two books contain useful articles demonstrating the application of attachment ideas in various forms of social work. Blood, I. & Guthrie, L. (2018). Supporting older people using attachment-informed and strengths-based approaches. London: Jessica Kingsley. Although less theoretically ‘pure’, this book demonstrates how you can eclectically incorporate attachment ideas into broader perspectives on practice, and provides lots of practical examples of work with older people. Shemmings, D. & Shemmings, Y. (2011). Understanding disorganized attachment: Theory and practice for working with children and adults. London: Jessica Kingsley. Shemmings, D. & Shemmings, Y. (Eds.) (2014). Assessing disorganized attachment in children: An evidence-based model of understanding and supporting families. London: Jessica Kingsley. These two books provide practical and well-informed accounts of attachment theory and practice in social work with children, young people and their families. Cassidy, J & Shaver, P. R. (Eds.) (2018). Handbook of attachment: Theory, research and clinical applications (3rd Ed.). New York: Guilford. Mikulincer, M. & Shaver, P.  R. (2016). Attachment in adulthood: Structure, dynamics, and change (2nd Ed.). New York: Guilford.

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These two very extensive reference sources on research and practice draw mainly on clinical psychology and psychiatry. The first covers attachment ideas relevant to all age groups and the second focuses on attachment in adulthood. White, S. Gibson, M., Wastell, D. & Walsh, P. (2020). Reassessing attachment theory in child welfare. Bristol: Policy Press. An important analysis of debates about attachment theory.

Websites https://www.nice.org.uk/guidance/ng26/chapter/Recommendations#assessingattachment-difficulties-in-children-and-young-people-­in-all-health-and-social-care National Institute for Health and Care Excellence (2015). Children’s attachment: attachment in children and young people who are adopted from care, in care or at high risk of going into care. NICE guideline [NG26]. London: National Institute for Health and Care Excellence. Authoritative statement about practice in considering and assessment attachment issues with children. https://www.researchinpractice.org.uk/all/topics/attachment/ A useful range of research-based resources on attachment, including a recorded webinar hosted by David Shemmings. Some of the publications are paid-for, but they are inexpensive. Furnivall, J. (2011). Attachment-informed practice with looked after children and young people. Insight 10. Authoritative account of attachment practice with children from the Scottish government research dissemination agency. https://www.iriss.org.uk/resources/insights/ attachment-informed-practice-looked-after-children-young-people Mary Ainsworth. A half-hour BBC documentary about Mary Ainsworth’s work, the strange situation procedure and therapies based on it. https://www.bbc.co.uk/sounds/play/p00f8n6q Secure base. A useful website at the University of East Anglia about the concept of the secure base and ways of providing a secure base for children and young people, particularly in adoption and foster care. http://www.uea.ac.uk/providingasecurebase

CHAPTER 6

Crisis, trauma and  task-­centred practice MAIN CONTRIBUTION Crisis intervention and task-centred practice continue to be important in social work because they offer brief, structured models of intervention, which address clearly definable problems that will respond to active efforts to resolve them. This focus on the shared principles of defined positive aims and action sequences makes them easy to grasp. There is an evidence base for their efficacy, especially in task-centred practice, and overall both models are practical and easy to justify in busy social agencies. Crisis ideas have influenced work on human trauma within social work (Loughran, 2011: ch. 9; Yeager & Roberts, 2015b). This is a current area of service development concerned with responses to often sudden and extreme events that are likely to cause serious disruptions to people’s lives with serious mental health consequences. There has been concern for helping people with post-traumatic stress disorder. Ideas of crisis have also influenced services dealing with emergencies and disasters in people’s lives, such as natural disasters and political conflicts. The ecological crises of climate change have strengthened theorization in the field of disasters and political conflicts (Ramon, 2008; Lavalette & Ioakimidis, 2011), but practice theories are not yet strongly developed and crisis intervention is sometimes thought relevant (see Chapter 16).

MAIN POINTS ●●

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Both crisis intervention and task-centred practice are brief, structured theories that deal with immediate problems. They may be less helpful when dealing with long-term care and social issues. Both models have research support, and task-centred practice has been widely validated in different countries and settings. Contracts made between clients and practitioners have been criticized for making the relationship too formal. Less formal, but still explicit agreements are instead increasingly being used in task-centred practice. The focus of crisis intervention and task-centred practice on practical responses and their consequent success in achieving political support may lead to an uncritical acceptance of their failure to tackle social oppression or other social causes of clients’ problems. 151

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Both models enhance accountability to clients by focusing on their priorities and experiences. Crises are a turning point in people’s lives when their usual ways of resolving a problem fail. People experience feelings of tension and disorganization when crises affect their lives. Crises occur when ‘hazardous’ events disturb an existing steady state in which people can manage the events that affect them. A precipitating factor then generates a state of active crisis. Crisis intervention focuses on people’s emotional reactions to events in their lives that are perceived as significant. People can be shown how to build on their existing strengths by identifying new support systems and learning new coping skills. Task-centred practice is built on a sequence of identifying and prioritizing the problems chosen by the client and then undertaking tasks to deal with those problems.

PRACTICE IDEAS ●●

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Crisis is used in two ways: to refer to a process of events in people’s lives that provides a focus for practitioners to work with clients, and to refer to commonly occurring elements in life that present a series of maturational tasks for people to complete. Both theories use brief interventions. Both theories use structured, planned and directive programmes of intervention. Tasks are structured elements of intervention in task-centred practice. Tasks also refer to important challenges in life that, at every stage of our development until death, have to be overcome in order to achieve emotional satisfaction and to maintain positive social relationships. Contracts or agreements with clients help them to participate in and structure treatment plans.

THE DEBATE SUMMARY The main areas of debate about these models are around ●● ●● ●●

their short-term focus; their structured programmes of intervention; the neoliberal emphasis on outcome-focused, apparently economical, practice models.

Debate about crisis, trauma and task-centred practice Short-term interventions These models emerged in the 1960s around the time that the long-term psychodynamic models of ego-supportive and psychosocial social work were being found ineffective. They became influential partly because they presented a practical response to the reality that short-term

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interventions were often all that was required to achieve progress that clients perceived as helpful and achieved measurable resource-light results for agencies. For practitioners, crisis intervention and task-centred practice represent a trend in social work towards clearer, more focused activity than is seen with the long-term, non-directive, insight-giving methods of psychodynamic work. In this, they reflected the second shared principle (see Figure 1.7) of achieving clearly specified and positive outcomes. Other short-­ term practice models have followed this trend, but the ideas of ‘crisis’ and ‘task’ have an analytical power that other developments have not displaced; they make sense to both clients and practitioners. The short timescale may also be useful where people have limited capacity to focus on important issues, such as clients with intellectual disabilities, or where they have limited commitment to the intervention, because for example they are offenders or they abuse drugs. The trend to the short term, however, has been criticized. Thompson (2011: 13) argues that there is an overemphasis in crisis theory on internal emotional reactions. This emphasis might be an advantage, since the theory provides guidance for dealing with what can sometimes seem frightening emotional reactions. Kadushin (1998) proposes that adaptations to conventional interviewing and practice techniques from psychodynamic theory are required to implement brief, focused therapies. For example, the need to establish a relationship rapidly means presenting a warm, intelligent impression from the outset. Focusing on the present and on solutions, rather than exploring problems and their history in detail, are also important. Practitioners are not attempting an overall ‘cure’ but the resolution of specific issues ‘for now’. The short-term focus of these models means that they are not the first choice where constant debilitating crises and long-term psychological problems are the main issue or where long-term care services are being provided. They may be used in child safeguarding work or when working with long-term conditions or increasing frailty in old age to achieve results when a specific problem arises or when events throw up a crisis. In such cases, however, supportive work, the provision of services, longer term efforts to bring about change or longer-­ term supervision to prevent deterioration or risk are often also required. Moreover, neither model works well with people who do not accept the right of the worker or agency to be involved in helping them.

Structured programmes Many social workers find the clarity of the processes involved in these models attractive, but they may oversimplify the complexity of the issues in people’s lives. In particular, the models’ structured nature and their focus on the concepts of ‘crisis’ and ‘task’ mean that they may define social problems in behavioural terms and according to the practitioner’s assumptions. Practitioners may, as a result, fail to identify the broader social issues and structural failings that have led to the problems and may twist clients’ perceptions into their own model. Their structure and clarity may, however, help practitioners to find a way into a complex situation. Both theories, however, primarily have social cohesion objectives: problem-solving, using a (conventional social work) individualizing relationship. No questions are asked about who defines or causes the problem. Clients are treated using a medical model: problems are like

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illnesses, and the social worker’s job is to solve them, just as it is the doctor’s job to cure physical ailments. Crisis intervention, with its more pronounced psychodynamic roots, places more emphasis on emotional responses and irrational or unconscious behaviour than does task-centred work, which assumes that clients are human beings using their rational capacities. However, cognitive behavioural practice has had an impact on both models, leading to a shift in brief practice using either model towards more cognitive practice. For example, Dattilio and Freeman (2007) offer an account of crisis intervention that is strongly focused on cognitive behavioural strategies, and Roberts (2005) also emphasizes this. In addition, Thompson (2011: 13) suggests that crisis intervention theory would be better balanced if it emphasized the development of support systems to prevent or resolve crises. Caplan and his research team moved into this field, which I cover in Chapter 9 because of its theoretical connection with systems theory. One of the problems with Thompson’s point is that there is not enough time in many agencies to develop a support system around a client within the period of a crisis before practitioners have to move on to the next case without a longer-term plan being in place. Crisis theory also recognizes that clients may not be ready to work on long-term issues once the immediate problem has been dealt with. Thompson (2011: 14) also reports criticisms of a failure to recognize cultural and family contexts and social divisions. These points might equally be made about task-centred practice. In both cases, this reflects the liberal or neoliberal political philosophy and social order perspective behind social cohesion objectives in social work. It is possible, however, to adapt the theories to a focus on the family or community. The trauma and disaster focus of current crisis intervention (Yeager & Roberts, 2015b) and research in task-centred practice both raise the need to engage community resources and commitment. Because their aim, however, is to be brief and focused, it does not seem unreasonable to limit their perspective to an issue in someone’s life. Clients can, of course, make plans to handle such issues in the future by building family and community supports as part of crisis resolution or by tasks working on such support. These criticisms also need to recognize the reality that most social work is concerned with individual problem-solving, and these techniques are well designed for that. Furthermore, the idea of using contracts in classic task-centred practice has been criticized. Rojek and Collins (1987, 1988) argue that it offers a false sense of equality between practitioners and clients. If you talk about a contract with your client, it implies an equality that conceals your hidden power in the relationship, which comes from your official role and professional status. Power imbalances between clients and practitioners with official roles prevent the mutual cooperation implied by the model. In response to this, Corden and Preston-­ Shoot (1987, 1988) argue that contracts can benefit client–practitioner relationships by making them more specific, so that each person has a clearer sense of where they stand. In fact, contract work achieves results in allowing people to attain the desired ends, again a shared principle (see Figure 1.7). Some writers emphasize written contracts for this reason, but others have moved towards the concept of less formal, more fluid ‘agreements’, leaving the legalistic term ‘contract’ behind. This does not, however, address the issue that clients may feel pressed or even pressurized into an agreement by the power of the practitioner or agency, or by the urgency of their need for the agency’s resources.

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Neoliberal support of outcome-focused economical practice In addition to these areas of debate, there is also a political critique around agencies’ potential misuse of these models of practice, to the disadvantage of clients who may need more extensive provision. The success of these two approaches to social work comes from the attractiveness of their clear and simple approaches and the practical usability of the basic ideas of ‘crisis’ and ‘task’. Their effectiveness in dealing with the presenting problems may result in society avoiding longer-term and more deeply seated responses to social oppression. Gambrill (1994) argues that task-centred work – and by extension many forms of brief therapy – provides a minimal response to severe social problems. It thus conceals resource inadequacy and the failure of political will to respond realistically to deep-seated problems of poverty and social inequality. This debate arose at the time these theoretical models were gaining influence, as social work was becoming a much larger-scale profession within extensive welfare states. The focus and brevity of these treatments offered an economic approach during this expansion compared with longer-term methods that would have increased costs to an impossible extent and required a greatly expanded workforce. Moreover, involvement in the front line of public services put social workers in touch with the crises in people’s lives in a way that did not happen as much when they were trying to deal with longer term problems or were offering care over the long term. Task-centred work offered clearer accountability and a focus on outcomes for the influx of less experienced, less well-qualified and more infrequently supervised workers employed in settings requiring public scrutiny. It is also generic and can be applied in any setting with any person (Doel & Marsh, 1992: 6). The research-demonstrated effectiveness of task-centred work also made it much more politically acceptable to agency managers and funders. It supported a profession that was at times embattled by criticism of its effectiveness. Some research support for crisis intervention also exists (see Parad & Parad, 1990: 16–18). In addition, task-centred work has been popular with clients because of its clarity and sense of direction, and because it actively involves people in a sense of partnership (Gibbons et al., 1979). However, its simple concepts belie its complexity, and it is hard to train people to use it well (Marsh, 2007: 192, 196). Ford and Postle (2012) suggest that its structured approach permits it to incorporate a variety of social work practices within the restrictions of current agencies.

Major statements Crisis intervention American texts present a multiprofessional perspective, bringing together psychology, psychiatry and social work; this reflects the historical source of the theory within the mental health professions. They also reflect the fact that crisis theory is used in the USA in emergency practice settings, such as crisis mental health and rape crisis teams. The most authoritative and comprehensive statement from a social work source is Yeager’s (2015) Crisis Intervention Handbook, updating Roberts’s well-established text. However, this is an extensive edited collection covering a multitude of topics in great detail, and it is less concerned with exploring the underlying theory. James and Gilliand’s Crisis Intervention Strategies (2017) offers a

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respected work from a psychiatric perspective and, as with Yeager, detailed material on specialized areas. Kanel, a psychologist (2015), offers a long-standing practical guide that is firmly underpinned by theory. Other texts that extract a distinctively social work perspective from this broader perspective are those by Loughran (2011), which helpfully reviews different theoretical approaches to crisis intervention, and Thompson (2011), which briefly summarizes the main social work approach. Because of its concision, I have structured the discussion of an example text in this chapter using Thompson’s account, with additional material from the other sources.

Task-centred practice You can find the classic statements in Reid and Epstein (1972a, b) and Reid (1978, 1985). Later texts that involve the creators of this approach are those by Tolson, Reid and Garvin (2003) and Epstein and Brown (2002). A UK text that provides an approachable overview is Marsh and Doel (2005), used as the example text in this chapter along with additional material from the other sources.

Wider theoretical perspectives Crisis intervention The classic formulation of crisis intervention as a technique is in Caplan’s (1965) book on preventive psychiatry. This source indicates the method’s origins in mental health work and its focus on the prevention, rather than the treatment, of illness. A famous paper by Lindemann (1944) describes the grief reactions of various groups of people as they coped with the death of family members in a major fire disaster in Boston, MA, the Coconut Grove fire. They managed their bereavement crisis better if they had coped with previous crises in their lives, but less well if they had not resolved past problems. A group of mental health workers around Lindemann and Caplan constructed the ideas of crisis intervention over two decades while working with several community mental health problems. Their work influenced social support and networking ideas (see Chapter 9). Traditional crisis intervention uses elements of ego psychology from a psychodynamic perspective (see Chapter 4). Recent developments have incorporated a wide range of theoretical perspectives (Loughran, 2011). The main focus is on emotional responses to external events and how people can be helped to control them so that they can then move on to resolve the difficulties they are facing. Young (1983) draws parallels between the concepts of crisis intervention and ideas from Chinese philosophy, and Kanel’s work (2015: 4) also discusses this. Young points to the ‘doctrine of the mean’; that is, keeping our system in balance to lead to a state of harmony, which reflects the Chinese philosophical assumption that people naturally gravitate towards fulfilment. The idea of wu wei proposes that life is constant change; people should study the changes that are affecting them and try to harmonize themselves with them. You could use this Chinese emphasis on harmony in practice that typically draws on Western theory. This idea is discussed further in Chapter 10 on humanistic practice.

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Task-centred practice Task-centred work originated wholly within social work, although it is influenced by cognitive behavioural clinical psychology. It grew from a famous series of studies by Reid and Shyne (1969) and Reid and Epstein (1972a, b); Marsh and Doel (2005) and Fortune (2012) give an account of these. The starting point for these studies was the assumption in prestigious family social work agencies that people required long-term psychotherapeutic help. They discovered, first, contrary to expectations, that cut-down long-term treatment was as effective as long-­term treatment that ran the full course. Second, planned short-term treatment was also effective. Task-centred practice was based on this experience and was also found to be effective. The task-centred focus on specific problems has links with Perlman’s problem-solving approach to casework (see Chapter 4). Reid and Epstein, the original creators of the theory, later developed their shared ideas in different directions. Epstein (Epstein & Brown, 2002) maintains an emphasis on using brief methods, using task-centred work eclectically in a wide range of practice. Reid, however, loyal to the more behavioural theoretical stance of his early years, merges his task-centred practice ideas into a many structured interventions. An example is his book The Task Planner (2000), which formulates standardized plans for a wide range of human issues that affect clients. The books published towards the end of the authors’ lives reflect these different directions. Both are examples of the shared principles (see Figure 1.7) of formulating clear aims and action sequences. The current use of task-centred practice is less distinct from other brief approaches than it was in the 1980s, when it was the main form of brief social work practice. It continues to be influential, however, because its procedures are well defined and worked out to apply within social work roles, and because the idea of ‘task’ attractively emphasizes positive activity. In addition, research has shown them to be effective in a variety of countries and situations (Tolson et al., 2003; Marsh & Doel, 2005). The effectiveness and replicability sections of the pre-treatment considerations chapters in Tolson et al. (2003) contain good summaries of and citations to the research base. Marsh and Doel (2005) provide a more extended research review. The main reason for this effectiveness is that the basic elements of the approach help to gain clients’ commitment through a clear focus on the specified outcomes they are concerned about and a limited time commitment, an example of the shared principle of alliance (see Figure 1.7). Compared with more therapeutic approaches that work by exploring emotional and interpersonal issues primarily at the behest of the practitioner, task-centred practice is a practical, advice-giving style of work that is valued by clients who prefer more direction rather than an exploratory style. Other brief, structured programmes of intervention relying on empirical psychological research (for example, cognitive behavioural and solution-focused practice) are worthwhile for similar reasons. Therefore, these models, and the similar cognitive behavioural methods, are the most widely used examples of a range of brief treatment approaches in social work, although in the twenty-first century they are increasingly being displaced by strengths and solution practices.

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Connections The crisis intervention and task-centred practice models of social work have some common features, forming connections with each other. Both stress brief interventions, although we can string these together in a series if we are providing long-term care and support. Reid (1992: 12) acknowledges the influence of crisis intervention on the development of task-­ centred work. Golan (1986: 309), viewing the relationship in the opposite direction, claims that research on task-centred work supports the sort of practice interventions proposed by crisis intervention theories, although this research did not set out to show this: she was interpreting the results. Both crisis and task-centred work are structured, so action is planned and fits a preordained pattern. Contracts or other explicit agreements between social worker and client are used in both models. Reid and Epstein (1972a: 26), however, specifically distinguish the task-centred approach from crisis intervention. They say that task-centred work deals with a wider range of problems and emphasizes clear definitions of target problems, tasks and time limits. They stress links with functional casework (see Chapter 4), with an emphasis on time limits, client self-direction and having a clear structure and focus in the process of work. Crisis intervention and task-centred theory also have other differences. While both try to improve people’s capacity to deal with their problems, when they should be used and the focus of the work differ. Crisis intervention is, classically, action to interrupt a series of events that are disrupting people’s normal functioning. It deals only with the consequences of the one major issue (the series of events), as defined by the situation; this is an example of the shared principle (see Figure 1.7) of disrupting existing or taken-for-granted patterns of behaviour in a psychotherapeutic theory. Task-centred work and other therapies do not necessarily focus on an immediate situation; rather, they identify and respond to major priorities in people’s continuing problems. Crisis intervention uses practical tasks to help people readjust, but an important focus is individuals’ emotional response to crises and long-term changes in their capacity to manage everyday problems. Task-centred work focuses on performance in practical tasks that will resolve identified problems, and success in achieving tasks helps emotional problems. Finally, crisis intervention theory is based on the origin of life difficulties, whereas task-centred work takes the problems as given, to be resolved pragmatically. Not only are there many connections between crisis intervention and task-centred practice, but there are also connections between these models and other theoretical traditions in social work. Task-centred work has links with behavioural approaches (see Chapter 6), and its history is part of the movement to develop evidence of successful practice and a more eclectic and integrative practice drawing on research evidence (Rzepnicki, McCracken & Briggs, 2012). Neither approach is formally connected with behavioural approaches. When task-­ centred casework was formulated, it rejected any specific psychological or sociological base for its methods and sought to be ‘eclectic and integrative’ (Reid, 1992: 13). Many behavioural ideas, such as conditioning, play no part in task-centred work, and it deals with broader classes of behaviour than behavioural work normally covers. Gambrill (1994) argues, however, that, as it developed, it increasingly used behavioural methods. She thinks that, because it reformulates and simplifies these, task-centred practice confuses the development of cognitive ­behavioural theory by denying its origins. This may be so, but it is now widespread in social work thinking. I think she was protesting about the adoption of the practice of

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formulating clear outcomes as a shared objective (see Figure 1.7), and I do not think this trend can now be reversed, even if it detracts from the purity of cognitive behavioural methods. Task-centred practice is also picked up as a way of structuring practice in other theories. For example, Wilks (2012: 103–6) argues that task-centred practice is a good way of providing structured stages in advocacy practice.

 he politics of crisis intervention and task-centred T practice Parad and Parad (1990: 4–5) reject ‘theory’ as a description of crisis intervention, reserving this term for ‘scientific’ theory. Neither practice focuses on social change, and the neoliberal political critique discussed in this chapter’s debate section suggests that they are mainly technical responses to immediate problems. This makes them attractive to public agencies and cohesion views of social work, compared with those favouring the explicit political focus of critical theories, which also had a currency as these models were rising to prominence. Crisis intervention and task-centred theory have had greater staying power as part of agency provision, if not in the devotion of socially committed practitioners. The partnership approach and clarity of task-centred work and the emphasis on looking at environmental pressures have led to claims that they are both effective in use with anti-discriminatory work, offering empowerment and dealing with structural oppression (Ahmad, 1990: 51; O’Hagan, 1994).

Case example: Peter’s father’s divorce Peter, a young man in his twenties, had difficulty in going to visit his father in hospital when he was seriously ill, possibly dying, because it reminded him of how angry he had been when his father had left the family during his divorce. During his everyday inter-

actions with his father, Peter kept these feelings hidden, but his increasing awareness of his father’s possible death made him want to talk to his father about his anger. A conflict emerged between the father and son on the ward, and a social worker was asked to help.

Major social transitions such as birth, marriage, divorce and death tend to bring previous conflicts within families to the front of people’s minds, providing an opportunity to deal with feelings left over from the past or to cement existing conflicts. One issue is that children are sometimes not involved in decisions at the time, so their feelings are not fully understood and talked through, being left to be dealt with at the time of a later crisis. Parad (1965) argues that people approaching agencies do so when they experience crises in their capacity to manage their lives. The crisis is what motivates them to come to seek help, or leads other agencies to refer or require them to get assistance. Thus, everyone coming to an agency for help can be seen as being ‘in crisis’, so that crisis intervention is relevant to all social work. The use of Erikson’s (1965) analysis of developmental crises through which we achieve a resolution of basic psychosocial life tasks (see Chapter 4) makes clear the concept’s relevance to many personal difficulties.

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Values issues Both these approaches focus strongly on the shared principles of transparency and accountability to clients, aiming for clearly specified positive outcomes and specified action sequences (see Figure 1.7). The focus on clients’ experiences and priorities, and their own objectives and the use of agreements, also demonstrates that the respect for clients’ rights is important in both models. While the practitioner defines and manages the process to be followed, the concepts of crisis and task are intuitive to many clients and the people around them, so it is easy to engage them. Accountability to and self-determination by clients are therefore strongly enhanced. Their intuitive and practice-based approach also commends them to many agencies and politicians who might question more esoteric therapeutic methods and objectives, and they therefore enhance political and social accountability for the profession.

Applications The most important applications of crisis intervention are in the field of suicide prevention, rape, domestic violence and other emergencies of this kind. In the USA, local services in each of these areas are documented in Yeager (2015), James and Gilliand (2017) and Kanel (2015), which also cover applications in services dealing with trauma, children and youth, victims of violence, and health and mental health crises (such as grief and bereavement, post-traumatic stress disorder, addiction and people affected by HIV/AIDS). The use of crisis intervention in these services reflects the current inclusion of psychological and mental health responses to disasters and social conflict, where concern about psychological difficulties after serious life events such as accidents was previously less well provided for. Crisis intervention started from, and continues to be used in, mental health services. An important current use is in home treatment for crisis resolution, in which multidisciplinary teams visit people experiencing a mental health emergency and try to resolve problems, reducing the need for emergency admission to psychiatric care (McGlynn, 2006). The ideas are also used in managing stress through debriefing people after major disasters (Flannery & Everly, 2000). Applications of task-centred practice focus on a wide range of situations in a variety of social work agencies, such as resolving financial or employment problems or organizing family care arrangements.

Example text: Thompson (2011) on crisis intervention Thompson (2011) sees a crisis as a turning point in people’s lives, at which time their usual ways of coping with a problem fail and they are pushed to find a new strategy. The meaning of ‘crisis’ in crisis intervention theory differs from its everyday meaning as a disastrous event or a time when people experience a lot of stress. Crisis intervention theory focuses on people’s perceptions of events, rather than the events themselves. Something that objectively seems quite minor may tip someone into crisis. It is also used in services dealing with important life transitions, such as moving from school to work or retirement (Richardson & Loughran, 2011). James and Gilliand (2017: 19–23) review a range of definitions and point to important

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aspects of crisis situations. These include feelings of tension and disorganization in life that immobilize people from taking action to overcome obstacles to important life goals. James and Gilliand (2017: 19–20) identify five models of crisis intervention and see contemporary practice as combining elements of all of these: ●●

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The equilibrium model was Caplan’s (1965) original approach. It sees people as being in a state of psychological disequilibrium. They need to return to a steady state in which they can deal with issues in their life effectively. The cognitive model is associated with work by Roberts (2005). People are seen to think in a faulty way about events that surround the crisis. The psychosocial transition model is associated with developments of Erikson’s (1965) model of developmental crises arising as people move through life stages. People are seen as going through a particularly important psychological or social change as part of their development. The developmental-ecological model uses Erikson’s (1965) developmental stages and connects them with ecological systems theory (see Chapter 9). Assessment and intervention focus on the social environment in which people are facing a change in their life situation. The contextual-ecological model similarly uses ecological systems theory (see Chapter 9) to emphasize the context in which people struggle with crises. That context is examined using layers of meaning attached to the proximity of the events that caused the crisis, whether the relationships affected are close or more distant, and the importance of the timing of events and special occasions such as anniversaries. Case example: Ecological systems practice with Karina’s response to her parents’ divorce Karina was a mid-teenage girl, with younger brothers, whose parents were going through an acrimonious separation. The parents found it difficult to agree the arrangements for sharing the children’s care, and a social worker, Lisa, was required to provide reports for the court. As part of the process, Lisa found herself drawn into helping the children, and particularly Karina, adjust to the changes. You could see this as partly about a disruption to the equilibrium in the daily arrangements of the family, as the children had to move twice a week between the family home, where the mother continued to live, and their father’s new apartment. Karina and her mother felt emotional impacts from disruption in their mutually supportive relationship and Karina found it difficult to spend more time in her father’s care, as her much younger brothers needed a lot of attention and got priority time. Cognitively,

anger and blame were affecting the parents’ perceptions of one another, and this pressurized Karina to take sides, then to worry about taking sides, then to worry about her future in marriage. You could also see the events as the parents and the children going through life changes. Working on this might have been a good approach for Lisa, because it would have normalized the conflicts, seeing working through them as a positive development. But in the end, Lisa focused on ecological considerations, helping Karina to think through, with both parents, ways of organizing her contacts with them. They also worked on her emotional and practical priorities; for example, Karina prioritized women’s relationships and the physical changes of puberty when with her mother, and on building family relationships, including with her brothers, when with her father.

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Thompson starts with two aspects of a crisis. The objective aspect is the external factors that make up the crisis situation: the personal, social and economic circumstances of the people involved. Some of the theoretical models we have looked at emphasize these contextual, ecological factors more strongly than cognitive or equilibrium models. The subjective element is made up of the perceptions and personal reactions of the people involved and how these affect the crisis situation. Figure 6.1 shows how a crisis process continues for a period. The starting point is that people normally function in a steady state (Rapoport, 1970: 276). This does not mean that things are unchanging for them. Rather, it means that, as things happen to them, they can cope; that is, they can respond to events changing and developing in their lives. Steady state implies that people can manage new events in their lives and deal with social change. Earlier concepts of crisis used the idea of equilibrium or homeostasis, which saw people’s lives as being in balance, with the crisis knocking them off balance; the idea of steady state is more respectful of clients’ normal coping skills. A hazardous event is an event or series of events that people find it hard to cope with. It leads to increasing tension as they cast around to find ways of dealing with the new disturbing situation. It is not a crisis, but it puts people at risk if further events upset their already disturbed steady state. The next element of the process occurs when people react badly to a precipitating event. This is something that happens to them that represents both danger and opportunity (Kanel, 2015: 5–9; James and Gilliland, 2017: 26), and thus becomes meaningful, important and sometimes threatening. As people try to manage both the events and their own reaction, they use coping mechanisms that have worked before. However, if the usual methods seem not to work on this occasion, fear, tension or confusion rise. Picking up Caplan’s (1965) terminology, Thompson calls this the ‘impact stage’.

Steady state (managing events with usual coping skills)

Improved steady state

Resumed steady state

Decreased steady state Hazardous event, rising tension difficulty in coping

Precipitating event

State of active crisis (tension, disorganization, immobilization)

Figure 6.1  The concept of crisis Sources: Adapted from Hill (1965) and Thompson (2011).

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At this point, people begin to experience a high level of discomfort, a state of active crisis, as their normal steady state feels completely disrupted. Thompson calls this the ‘recoil stage’. They experience confusing and powerful emotions, physical complaints such as sleeplessness and stomach upsets, and erratic behaviour as they increasingly desperately try to find ways of dealing with the problem. The state of active crisis, or period of recoil and disorganization, resolves for better or worse over about six weeks. If resolution is unsuccessful, a person will function less well in the future and be more liable to bad reactions to later hazardous events. If they resolve the crisis well, they may resume their previous competent steady state or have experiences that improve their functioning in the future.

Case example: Haroun Singh experiences his wife’s death Haroun Singh, who worked hard earning good money as an accountant, found his wife’s death difficult since he and his two sons had seen her as responsible for managing the household and caring for the family. She had continued with these responsibilities during her last illness, even though friends had tried to persuade her to do less. After her death, Haroun was depressed and felt guilty because he had not understood how ill his wife had been and now felt he had imposed a traditional view of her role in the family upon her, even though they were trying to construct a new life with more ‘modern’ Western values.

Haroun’s doctor referred him to the mental health crisis centre because his depression was so severe that he was having suicidal thoughts; suicide is sometimes associated with guilt. The team social worker enabled him to discuss his feelings with his eldest son, and they planned jointly to carry out household tasks as a mark of respect to their wife and mother, rather than rely on Haroun’s mother to provide domestic care for them. They went to Asian cooking classes together, building a relationship with each other, developing new interests together and finding new community links.

In this case example, the period during which Haroun’s wife was ill and Haroun’s lack of sensitivity in his marital relationship meant that their family life was being managed inappropriately. This represents the hazardous event that Haroun and his sons coped with but began to find more and more difficult. The mother’s death was a precipitating event and, when combined with the family’s failure to deal with the hazardous event appropriately, led to immobilization and chaos. When Haroun and his sons became aware of and expressed their emotions, and made plans to respond in a new way, they demonstrated an improved steady state. Family relationships improved, and it is likely that any later crises in the family would be better managed through the acquisition of new skills. It is also likely that Haroun and his sons would not demonstrate such a lack of awareness of their family responsibilities in the future.

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PAUSE AND REFLECT  Jeanne debates whether to report a rape The following case example presents a more complex set of issues around understanding the different factors creating crises in people’s lives. After reading it, think through different scenarios that might arise from Jeanne’s experience. Should she see what happened as a rape? Should she make a complaint to the police?

Case example: Jeanne’s dilemma Jeanne was a young woman earning her way through university by working as a cleaner. She felt under a lot of financial pressure as a single parent with two children. While working in one house, she met the student son of the person who owned the house and, one evening after she had finished work, they went out for a coffee and talked about their university experiences. When she went to clean the house the following week, he was in bed, having come home late from a party, and was still drunk. He became amorous and, although she tried to resist, they had sex. She was upset about this chain of events and so, on

finishing work, she talked over her experience with a friend. Her friend felt strongly that this was rape, whereas Jeanne was more ambivalent, feeling that she had consented at the time and also being aware of her loneliness and sense of responsibility for her children. She did not want to get the young man into trouble or to upset his parents, and possibly find it more difficult to get cleaning work in the area as a result. On the other hand, she did not want anything similar to happen again. She became very miserable and indecisive, with her friend suggesting that she should be angry and go to the police.

Some suggestions The rape may have been a precipitating event, but there are also other factors creating the state of active crisis for Jeanne. Crisis theory says we should look particularly at emotions: these include her own emotional reaction to the event, her relationship with her employers (the young man’s parents), her feelings about the shared student life experience she has with him, and the anger and emotional pressure put on her by her friend whose emotional reaction to the situation is different. The event has led to a state of active personal crisis, but reporting the event to the police may apply further emotional pressures to Jeanne. She worries that it may, for example, lead to public conflict involving her employers and having to give evidence in court, with her emotional ambivalence being revealed and tested. Does she feel strongly enough about whether the event is rape to report it? There may also be public consequences that she cannot know about. For example, other women may have been raped by the same man. There may also be public policy consequences; for example, the police may fail to protect women from rape if her worries are realistic and the issue is dealt with insensitively during the investigation and court hearing. These factors often lead women to fail to report rape. Similarly, if there is a high level of HIV/AIDS in the community, Jeanne may face the personal crisis of deciding whether to have a test for infection. Her decisions may be affected by or lead to public debate on some of these issues.

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Thompson (2011: 20–3) proposes three main strategies and a range of therapeutic activities for dealing with crises, which I have set out in Figure  6.2. It is important to keep the structure of the three strategies clearly in mind since the situation may at first appear chaotic to the practitioner. These strategies are central in building a relationship between the social worker and the client that offers calming support (a shared principle of alliance), identifying other support systems and introducing the client to new coping mechanisms. The helping process then proceeds according to the usual social work model, starting with assessment. Thompson again divides these into two elements, principles and skills, as set out in Figure 6.3. Throughout these formulations, the balance between emotional responses and more rational coping and planning is a distinctive element of crisis intervention. Practitioners need to enable the client’s expression of an emotional response to hazardous and precipitating events and situations in the state of active crisis. At the same time, it is important to ensure that this does not impair any work on developing support and coping. Thus, early assessment avoids getting into detail, and it is important to manage time and strategy effectively so that poor coping mechanisms do not become ingrained and lead to a reduced steady state. For the same reason, Thompson’s (2011: 46–62) intervention methods focus on avoiding delay, working intensively in the short term rather than aiming to develop a long-term strategy. Listening is key to all this, however, because failure to pick up important emotional and practical issues in the client’s life may mean that you develop an unhelpful strategy. You might use several treatment methods (Loughran, 2011), but the direction of practice is future-­ oriented and time-limited and should come to a clear conclusion, so that the client feels the state of crisis has been worked through and they are resuming their steady state. Again, this represents a shared principle (see Figure 1.7) applied in this theory. Thompson also emphasizes being proactive in reducing distress and in planning and implementing future coping strategies straight away. Practice focused on emotional reactions to events and also on social responses that will support clients and develop their coping ability are equally important. You can see many of these points in Haroun Singh’s case.

Rapport and positive interest, offers calming reassurance and supporting self-esteem Mobilize appropriate support systems, through advocacy, family and community engagement Facilitating the learning of more effective coping mechanisms through therapeutic interventions

Use other approaches to helping, for example advocacy, groupwork, cognitivebehavioural work, task-centred practice and solution-focused work Systematic practice, offers clarity through actively working with the client Goal-setting, offering a feeling of control over the situation as success with one (realistic) goal leads to greater self-confidence

Strategies

Figure 6.2  Crisis intervention strategies and interventions Source: Thompson (2011: 20–3).

Interventions

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Begin assessment early Focus on both emotional reactions and external factors

Listening skills Remove barriers to listening, such as the client’s anxiety or depression, others’ interference, and preconceptions

Look for social resources: family and social networks; barriers due to social divisions

Reflecting feelings as you experience them Raises clients’ awareness, checks your understanding

Focus on positives: strengths and easy wins

Reinforce successful coping Clarify strengths, check responsiveness to new situations, engage in building the relationship, recognize and reinforce the positives

Avoid medical labels: behaviour is a crisis response, not a mental disorder Identify problem focus: main issues may not be the precipitating factor Formulate clear plans Balance potential gains against risk

Gather information About emotional responses, through ventilation, and the options clients may be willing to try Be calm Manage your time Holistic thinking Keep the three-point strategy in mind throughout

Principles

Skills

Figure 6.3  Crisis intervention assessment principles and skills Source: Thompson (2011: 26–43).

Kanel (2015), while using a similar process model, emphasizes the practice skills involved at each of her three stages, particularly in the final stage (the client’s ability and skills in coping). This is summarized in Figure 6.4. An important formulation of crisis intervention process is Roberts’s seven-stage crisis intervention model (Yeager & Roberts, 2015a: 21), illustrated in Figure 6.5. This provides a more extended account of the process but similarly emphasizes emotional reactions. It also shows evidence of Roberts’s emphasis on mental health services in its inclusion of ‘lethality measures’ as part of the initial assessment. The actual process of crisis resolution is, strikingly,

A: attending skills, develop and maintain rapport

B: identify the nature of the crisis and therapeutic interaction

Figure 6.4  Kanel’s ABC skills model of crisis intervention Source: Kanel (2015: 48–81).

C: focus on coping skills – assess existing skills and develop new ones

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Crisis assessment (and measure lethality if there is a risk of suicide) Establish rapport and rapidly establish relationship Identify major problems and crisis precipitants Deal with feelings and emotions through active listening and validation of feelings expressed Generate and explore alternatives Develop and formulate an action plan Crisis resolution Establish a follow-up plan and agreement

Figure 6.5  Roberts’s seven-stage crisis intervention model Source: Adapted from Yeager and Roberts (2015a: 21).

not delineated as part of Roberts’s account. It focuses on understanding the crisis and planning intervention, but not on the process of intervention itself, the assumption being that a range of intervention approaches will be relevant in different models. Roberts’s account is, therefore, eclectic: the crucial elements are exploring and understanding the crisis, while many different interventions are valid responses to the crisis. Both formulations are examples of an action sequence shared principle.

 xample text: Marsh and Doel (2005) on task-centred E practice Task-centred practice is a striking example of repeated use of the shared principle (see Figure 1.7) of using action sequences in practice; this is set out in Figure 6.6. There are several components of the initial sequence, as the client is taken into the agency and the task-centred process is set up: ●●

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The mandate comes from clients’ informed consent and the legal and agency responsibilities imposed on practitioners. Clients present their issues, all of which have two elements: things that are wrong and things that they want to achieve. The aim of practice is to achieve the goals.

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Initial sequence

Practice sequence

Explore problems

Focus problems

Refine goals

Develop and agree tasks

Carry out tasks

Review previous tasks

Develop and agree tasks

Carry out tasks

Review previous tasks

Develop and agree tasks

Carry out tasks

Review previous tasks

Develop and agree tasks

Carry out tasks

Review previous tasks

Develop and agree tasks

Carry out tasks

Review previous tasks

Recorded agreement

Set time limits

Final sequence Develop and agree tasks

Carry out tasks

Figure 6.6  Sequence of actions in task-centred practice

Review previous tasks

End and evaluate

Continuation

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Mandate: Informed consent Agency responsibilities

Crisis, trauma and task-­centred practice ●●

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The first stage of practice explores clients’ problem stories to enable both clients and practitioners to move beyond the immediate worries or issues presented in the referral. This ensures the identification of issues that might otherwise not immediately have come out. For example, issues may not be presented because clients feel anxious about discussing them, or both clients and practitioners may think that particular problems are not the province of social workers. Clients’ problems are often complex and interrelated, so they are disentangled in order to identify priorities and so that each issue can be assessed separately in relation to agency or legal requirements on practitioners. General aims are refined so that they become separate, specific, clearly defined goals. Time limits are introduced to increase motivation and enable people to assess their priorities and progress. Recorded agreements are drawn up that identify and clarify the mandate, problems, goals and time limits.

Case example: Multiple definitions of problems – Joan’s job Joan, a young woman with a history of depression, was referred to a mental health service. The practitioner discovered that her inability to find a job was worrying her most, and began to work out a plan in which they would share a series of tasks to find one. Before completing this, however, the practitioner visited Joan’s home to find that her mother preferred her to remain in

the house to help domestically with the elderly grandparent who was also living there. Joan’s father felt that working in a shop, which Joan preferred, was not socially acceptable. He wanted her to learn office skills at college. The practitioner first had to resolve the different perceptions of Joan’s family duties before continuing with the job hunt.

This case example illustrates the reality that people share some problems with others who may not acknowledge and define the problem in the same way. As a result, their priorities may be different from those of the practitioner’s main client. After the problem has been prioritized, the practitioner and client agree tasks that move towards the goal and carry these out together. At their next meeting, they review any progress made towards completing the tasks and then develop new ones. This process is repeated within the time limit, and so the sequence will continue: ●●

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Tasks represent incremental changes on the path from priority problems to priority goals. They involve joint, coordinated actions and not intentions. Task development means defining the task so that those involved understand it and any barriers to achieving the goal, and are aware of the support and rehearsal required. Rehearsal might involve clients practising, with practitioners, skills that they need to carry out the agreed tasks. Review involves regular reflection on problems, goals and tasks in order to guide any subsequent action.

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As they reach the time limit, practitioner and client go into the final sequence: ●●

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Planned ending involves evaluating the work done, any new skills acquired and the success that has been achieved in moving towards the goals. Continuation means exploring the need to work on continuing problems, goals and tasks with new agreements and within new time limits.

We can now look in more detail at how to carry out the stages of this process. Action

Practitioner’s role

Scan

Elicit the problems as expressed by the client in broad outline

Additions

Disclose problems identified by others or mandated by a court or by agency requirements

Details

The practitioner and client jointly investigate each problem

Quotations

Summarize each problem in one simple statement in the client’s words

Prioritize

The client takes the lead in prioritizing the problems …

Select

… identifying with the practitioner the lead problem selected for them both to work on

Figure 6.7  Exploring problems Source: Marsh and Doel (2005: 16, 34–5, 70).

Marsh and Doel (2005) identify the phases of exploring problems as set out in Figure 6.7; I have divided up the final phase of selection in this account. The additions stage is important because clients may not be aware of, or give enough thought to, problems identified by others. Marsh and Doel (2005: 70) identify three important requirements for the selected problem to be dealt with effectively that confirm the need for consent to be an important factor: ●● ●● ●●

The client acknowledges the problem and is willing to work on it. The client is in a position to alleviate the problem, given help. The problem is specific and relatively limited in scope. Case example: Exploring Ethan’s drug problems Ethan was referred by the court to a drug treatment centre for help with controlling his drug habit because he had been arrested several times for theft offences, so he could buy drugs illegally. He wanted to concentrate on housing difficulties and relationship problems with his girlfriend, but the practitioner pointed out the need to demonstrate to the court that progress had been made with Ethan’s drug addiction as well. They

agreed, however, that Ethan could not promise not to commit any more thefts, since this problem was too wide in scope and not sufficiently specific. The selected problems that he was prepared to work on were, in order of priority, his housing, his relationship and his drug use problems. Ethan had some doubts about whether he could resolve the drug use problem, but, with the practitioner’s help, he was prepared to try.

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In defining goals, Marsh and Doel (2005: 36) recommend the well-known SMART formula, which states that problems should be: ●● ●● ●● ●● ●●

Specific Measurable Achievable Realistic Timely (Doran, 1981).

Motivation on the part of both the client and the carer is important to achieve the goals, so that they genuinely see them as alleviating the problem. The goals also need to be feasible, so that the client can complete them without too much support or involvement from others, and desirable, so that they seem ethical and reasonable to those involved. The agreement can be recorded in a formal way, occasionally in a legal document, such as a supervision order for children in need, which often has conditions; alternatively, agency guidelines may provide a formula that practitioner and client can start from. Where the process is more voluntary, some practitioners use flipcharts and come up with a list of bullet points. Where literacy or understanding is a problem, for example, if clients cannot read a written document, or if intellectually disabled clients require constant reminders and clear simplified explanations, symbols or simple diagrams may help. Computer clip art, emojis or stickers may also be useful in such situations, provided it is culturally and ethnically appropriate. Task development involves creating actions that are a step towards the agreed goal and should be part of an overall plan, so that practitioners and clients can see where each task will lead and how it will contribute to the final goal. Some tasks occur within sessions between the practitioner and the client; some are in the form of homework, to be done between sessions. They should not be too trivial or so large as to be overwhelming: big tasks should be divided up. Tasks may be set just for an individual, to be done either by the client, balanced against tasks performed by others, or by the practitioner or another person by agreement. Tasks may also be reciprocal: the client acts on one aspect of a task and the practitioner or another person on a balancing task. Some tasks may be jointly undertaken, in that the client and practitioner carry out the task together. Some are one-offs; others are repeated. Following the task planning and implementation sequence, set out in Figure  6.8 and devised by Reid (1978, 2000), has been shown to improve success rates in devising and carrying out tasks. Reviewing tasks that have been agreed involves reporting back on what has been done and what the outcomes were, rating their success. Reporting back involves looking at the experience of working on the task: how long it took, what skills were learned, whether confidence was enhanced. Success should be celebrated; goals not achieved should be reviewed to see if there are lessons to be learned about the obstacles to completion and other alternatives. The outcomes can be rated from 1 to 5, ranging from no success to complete success. These results can then inform the development of the next task. After the task has been reviewed, it should be put back into context to evaluate how much it has contributed to the overall goal.

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Choose the task from several options generated Agree the task Plan the details

Enhance commitment to the task by looking at how it will contribute to the overall goal, identifying good feelings about it

Consider possible obstacles and identify ways round them

Provide guidance such as coaching, modelling and rehearsal

Summarize the process Figure 6.8  Task planning and implementation sequence

The final evaluation looks backwards over the whole task-centred process. It covers five points: ●● ●● ●● ●● ●●

The beginning – what was the situation when we started? The written agreement – what did we agree to do? The goal – what was our aim? Did we achieve it? General points – what was most useful and what got in the way? The future – will we be able to do this again and what more is needed?

Conclusion: using crisis and task-centred theory Many practitioners and agencies use the concepts of crisis intervention and task-centred practice to formulate practical, short-term responses to people who come to them with troubles in their lives. Crisis intervention is widely used in services dealing with emergencies in people’s lives that arise from specific events, such as suicide prevention, in dealing with rape and domestic violence, and in working with mentally ill people whose ability to function seems to have deteriorated. Kanel’s (2015) analysis suggests crisis services are useful where there is danger, victimization, loss and developmental crises. While these last two are the traditional focus of crisis intervention, Kanel also points to developmental crises that extend beyond the difficult transitions within the life course. These are where danger and victimization may arise at a particular time when life changes, for example in the case of teenage runaways and elder abuse.

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Crisis intervention theory offers practitioners a process for exploring and understanding events in people’s lives that seem to have disrupted their usual capacity to manage situations that affect them. A wide range of practical therapeutic interventions can be built on that understanding using other practice theories. In many agencies that do not deal with emergencies, however, crisis intervention may offer a helpful set of concepts at assessment stage. Task-centred practice offers a useful process that can be applied to a wide range of short-­ term problems referred to social workers, or when specific action to tackle a problem is needed within a situation where the practitioner’s main role is providing ongoing care and support. It is particularly helpful because it respects clients’ priorities and can be clearly explained and justified to clients and their families and communities, as well as to agency managers and their political masters.

Additional resources Further reading James, R.  K. & Gilliand, B.  E. (2017). Crisis intervention strategies (8th Ed.). Boston, MA: Cengage. Kanel, K. (2015). A guide to crisis intervention (5th Ed). Boston, MA: Cengage. Yeager, K. R. (Ed.) (2015). Crisis intervention handbook: Assessment, treatment, and research (3rd Ed.). New York: Oxford University Press. These three books are up-to-date and comprehensive alternative resources on American crisis intervention practice. McGlynn, P. (Ed.) (2006). Crisis resolution and home treatment: A practical guide. London: Sainsbury Centre for Mental Health. A useful practical guide drawing on current UK mental health practice, and available on the internet from http://www.centreformentalhealth.org.uk/pdfs/Crisis_resolution_and_ home_treatment_guide.pdf Loughran, H. (2011). Understanding crisis therapies: An integrative approach to crisis intervention and post-traumatic stress. London: Jessica Kingsley. A good account of crisis work using a range of theoretical concepts. Thompson, N. (2011). Crisis intervention. Lyme Regis: Russell House. A brief account of crisis intervention ideas. Marsh, P. & Doel, M. (2005). The task-centred book. London: Routledge. Tolson, E. R., Reid, W. & Garvin, C. D. (2003). Generalist practice: A task-centered approach (2nd Ed.). New York: Columbia University Press. Good accounts of task-centred practice from, respectively, Britain and the USA. Payne, M. (1998). Task-centred practice within the politics of social work theory. Issues in Social Work Education. 17(2): 48–65. An analysis of the development of debate about task-centred practice.

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Websites http://www.patient.co.uk/doctor/Crisis-Intervention.htm This website offers a brief summary of the use of the theory, aimed at UK National Health Service patients who might find themselves referred to a crisis intervention service. http://socialworkpodcast.blogspot.com/p/site-map.html The University of Buffalo podcast listing has several podcasts on crisis and disaster work (scroll down for the crisis section), which includes a series of three broad introductions using suicide work. https://www.insocialwork.org/episode.asp?ep=216 This podcast is an interview about using texts to work with young people in crisis. The following websites offer brief (and elderly) audio accounts of crisis intervention and task-­ centred practice: https://content.iriss.org.uk/crisisintervention/glossary.html; https://content.iriss.org.uk/taskcentred/index.html.

CHAPTER 7

Cognitive behavioural practice MAIN CONTRIBUTION The main contribution of cognitive behavioural therapy (CBT) theories to social work is to emphasize the importance of developing people’s rational management of their lives. CBT practice focuses on how to manage and change people’s behaviour to resolve social problems that affect them. Although now a single form of practice, CBT was built up from two main theoretical strands: behaviourism, supported by learning and social learning theory, and cognitive theory.

MAIN POINTS ●●

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The behavioural part of CBT practice aims to define and address people’s problem behaviours, particularly social phobias, anxiety and depression. The cognitive element of CBT practice addresses problems in how people’s thinking affects their behaviour. A ‘third wave’ or holistic form of CBT, including mindfulness, incorporates how external events have provoked important emotion, examines emotions, imagery and beliefs, including spirituality, and underlying schemas, the unhelpful ways of thinking in clients’ minds. Measurement is important in CBT, so careful assessment and monitoring of the individual’s progress is important. Research evidence for the effectiveness of CBT is strong and is important for both theory and practice. The main techniques of CBT are well defined and technical rational in their approach to human behaviour. They include respondent and operant conditioning, social learning (including skills training) and cognitive restructuring of people’s beliefs. Social learning techniques such as assertiveness and skills training are used more widely than in CBT, as part of groupwork and in feminist practice. More specific techniques are used in clinical settings where supervision and training in their use are available. The use of CBT has been controversial because of its association with the debate surrounding evidence-based practice (EBP). 175

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Neuroscience research examines how brains process perceptions about the world. This provides evidence about how people’s thinking interacts with their behaviour. The subject matter and science base of neuroscience connect with the science-based concerns of CBT and, as we saw with attachment theory, are an increasing influence on social work knowledge.

PRACTICE IDEAS ●● ●● ●●

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Behaviour therapies focus on changing specific behaviours. Cognitive therapies focus on changing inappropriate thinking processes. Cognitive behavioural therapies focus on how thinking processes generate behaviour patterns. Social learning focuses on the learning that results from people’s perceptions of social experiences. Assertiveness training enables people to practise behaviours so that they can gain confidence in these behaviours, thus improving their overall social confidence. Reinforcement of useful behaviours is used. Modelling is a form of social learning in which people understand and copy useful behaviours from a valued role model. Scaling is rating the strength of a feeling or importance of a behaviour on a scale of 1–10.

THE DEBATE SUMMARY The main areas of debate about CBT are: ●●

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The importance and value of its empirical base and its association with evidence-based practice (see Chapter 2). Its psychological focus, which fails to take account of social and environmental factors in the causation of many of the issues that social workers deal with. Its focus on psychological problems, in particular anxiety and depression, rather than the broad range of issues brought to social work services. There are also questions about the balance between behavioural and cognitive elements of CBT. Its failure to incorporate the needs of minority ethnic groups and diverse social identities.

Debate about CBT  BT’s positivist empirical approach, associated with evidence-based C practice The strong argument for CBT, continually emphasized by enthusiasts, is its empirically tested success in attaining results. This does not mean, however, that CBT is always applicable – it must be appropriately deployed (Dobson & Dobson, 2017: 285–6). Controversy surrounding the evidence for CBT’s effectiveness began historically in the 1960s with the behaviourists’

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trenchant attacks on psychodynamic models of social work, which were the first criticisms of the influence of psychodynamic practice. The behaviourists criticized the ill-defined outcomes of psychodynamic practice, which were based on assumptions about psychological structures within the mind that we cannot examine empirically. Many of the arguments for CBT are presented with messianic zeal, with sometimes intemperate attacks on opponents. This academic point-scoring turns many practitioners off. Accepting the arguments put forward by CBT requires acceptance of the relevance of positivist research methods in social work, modernist ideas about knowledge and linear models of explanation. Chapter 2 reviews how quantitative and experimental research methods, such as those used in CBT, emphasize the modernist idea that there is a universal knowledge that is relevant in every culture. Such methods seek cause and effect explanations of behaviour. All this connects with a positivist research tradition, disputed by interpretivist writers, who argue that human beings are constantly interpreting the world around them and do not operate by fixed researchable rules. Writers from each of these perspectives often seem to talk past each other, pressing their point of view rather than addressing the points being debated. For these reasons, many people feel that debates about CBT are a good example of sterile conflict over theoretical ideas, which contribute little that can help practitioners. One advantage of accepting the positivist argument is that such methods are acceptable when working with other professions, particularly medicine and psychology, whose knowledge bases emphasize positivist research techniques. In this way, CBT connects with arguments that the professional standing of social work would be enhanced by this form of academic validation. Accepting this argument, however, means choosing a theory of practice simply to appear professional according to the values of different professions. Research (Cort et  al., 2009; Moorey et  al., 2009) has shown that it is possible to teach selected CBT techniques that experienced practitioners from several professions can use, without using CBT fully. Findings like these do not mean that anyone can simply deploy tricks learned from CBT. Using CBT comprehensively with a range of clients requires training and supervision. Borrowing techniques in clearly defined situations, however, can be helpful as part of a wider service where there is adequate professional supervision. There are also several branded psychotherapies drawing on various CBT methods, of which perhaps the best known are Acceptance and Commitment Therapy (ACT), Dialectical Behaviour Therapy (DBT) and Mindfulness-Based Stress Reduction (MBSR) (Boone, 2014; Crane, 2017). These represent third wave or holistic modes of practice, which use elements of the client’s thinking and social environment as part of the intervention. For example, ACT aims to help people become more flexible in how they assess their lives and behaviour, DBT focuses on helping people to reconcile when opposite in their thinking and MBSR helps people stand back from immediate pressures (Kennerley, Kirk & Westbrook, 2017: 402–6).

Psychological focus Critical and feminist theory criticizes CBT for its individualist focus, seeing all problems as coming from an individual’s mind and ignoring the impact of social oppression. The positivist research methods used to test practice techniques are also claimed to be unsympathetic to the needs of women as clients and practitioners. CBT and similar individualized therapies fail to

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see that individual problems are mainly manifestations of oppressive social structures. CBT sees these structures as an important source of both the problem and the social perception that this is a problem that requires individuals to change. The claimed evidence base of CBT is destroyed if you reject the idea that the problem behaviour of individuals ought to be the main focus of social work interventions. Building on these ideas, the feminist critique goes further, to question CBT’s way of thinking and researching. Being focused only on identifiable behaviours, CBT fails to understand the way in which behaviours originate from social interactions with powerful individuals, and in the case of feminist thinking, with powerful men, in a paternalistic social structure. The critical and feminist claim is that this failure of understanding in CBT negates the value of behavioural and cognitive change. Such change will be ineffective in the long term if it does not tackle the social structures of oppression that are manifested in individuals’ problems. It is also contrary to the values of social work, which incorporate knowledge from social as well as psychological sciences. Social work also tries to change both social and individual factors involved in the issues the profession seeks to tackle.

PAUSE AND REFLECT  Fabia’s life objectives Review this case example to identify alternative explanations and approaches that might be used.

Case example: CBT to help Fabia Fabia was referred for help with depression and feelings of personal inadequacy in caring for her two young children. It appeared to the doctor who referred her that these feelings were an extension of postnatal depression, and that her care of her children was not a matter of concern. After carrying out an assessment prior to proposing CBT, the practitioner focused on Fabia’s anxiety about not being able to help her children develop as she would wish, alongside her feel-

ings of depression associated with the feeling that her life had no purpose. Fabia had previously been a successful lawyer, but had agreed with her husband to make a commitment to focus on childcare for this period of her life; she very much wanted to be a successful mother, putting this alongside her long-term career objectives. Since many of her fears were irrational, the practitioner judged that a programme of CBT could quickly remove many of her difficulties.

Some suggestions What possible alternatives can we try instead of CBT? Rather than attempting to remove Fabia’s problem anxiety and depression, for which CBT might well be effective, it might be better to use humanistic, solution-focused or feminist approaches that would concentrate on thinking through Fabia’s life objectives and perhaps renegotiating a reorganization of family responsibilities with her husband. Their decision that she would concentrate on childcare

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might reflect a tension between her needs or wishes to have a successful career and to be a successful mother. But it might also reflect social assumptions about the role of women in marriage and childcare, which the couple have not thought through in the context of the tension in Fabia’s feelings and mind. Moreover, because CBT focuses on identifiable behaviours, seeing them as problematic, it fails to explore positive development of her life objectives, which might emerge from strengths or solution practice.

Relevance to social work Thomlison and Thomlison (2017: 57) raise the same criticism of CBT as a brief therapy that we have already met with crisis and task-centred practice. That is, agencies and practitioners prefer it because of its brief timescales and clear objectives and outcomes, as time is money in neoliberal, austerity policy social care provision. In addition to these points, much CBT practice is not relevant to the provision that most social services deliver to their clients. For example, Dobson and Dobson (2017: 315–22) list well-conducted review articles that demonstrate the effectiveness of CBT for psychological conditions, mainly various forms of anxiety, phobias, depression and post-traumatic stress disorders. Another example: Thomlison and Thomlison (2017: 63) cite a wide range of reviews of empirical support for CBT relevant to US social work that mainly covers psychological problems. Successful behavioural practice requires client commitment to and understanding of the need for behavioural change and working on thinking processes. Many social care clients need services or have problems that are not relevant to this focus or are uncomfortable with this kind of practice, and may therefore not be prepared to participate. Broader, but less rigorously analysed, accounts of CBT that focus on social work responsibilities may be found in Sheldon (1998, 2012) and Thyer and Kazi (2004). A development of CBT practice in the twenty-first century is the ‘third wave’, aiming to include holistic aspects of clients’ life experience and identity. These aim to be sensitive to clients’ acceptance in and response to important relationships and ideas such as spirituality and mindfulness (Nurius & Macy, 2012; Boone, 2014; Crane, 2017; Stepney & Davis, 2018). You can argue that this provides a broader and more flexible approach than traditional CBT practice to issues that may be within social workers’ fields of practice. The cognitive focus of much current CBT practice and ‘third wave’ developments also raise questions about how we balance them with behavioural practice. The current focus on cognitive interventions works with categories of problems, such as anxiety or depression, rather than using detailed and individualized behavioural assessment proposed by behavioural methods. Moreover, the ‘third wave’ focus on thought and social processes means that while people learn about their thinking processes, such as schemas, this may not help them to change their behaviour (Thomlison & Thomlison, 2017: 57). These points are similar to the critique of insight in psychodynamic practice.

Responsiveness to minority ethnic and other diverse identities Another concern about CBT is that it has been slow to identify and work with learning and cognitions that specifically affect specific social groups, in particular minority ethnic groups. Research has gradually been accumulating methods and understanding to tackle the needs of

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minority groups (Gonzales-Prendes & Cassady, 2019). Practitioners in many countries find that the theorization of CBT does not fit well with indigenous beliefs and values.

Major statements Early influential writers on behavioural practice were Thomas (1968, 1971) and Fischer and Gochros (1975) in the USA, and Jehu (1967, 1972) in the UK. It is difficult to identify a recently published text from a social work source that specifically theorizes CBT social work practice, for three reasons. One is that CBT practice is now such an important element of EBP that general introductory texts from this perspective, such as those by Gambrill (2016) and Sheldon and Macdonald (2009), often include significant elements of CBT without specifically theorizing CBT practice. The second is that CBT is part of the range of counselling and clinical psychology theory that is used in mental health and other clinical social work. A text specifically focused on social work is therefore less important than it once would have been as social workers can draw on general CBT texts if they work in these fields. Moreover, many techniques are specialized in their application to particular client groups. For example, the well-regarded social work text of Ronen and Freeman (2007) is an edited collection covering different mental health problems, rather than a comprehensive theorization. The third point follows from this. Many texts apply to specific health and social care fields and can be used by all the professionals who work in those fields, including social workers. Examples are Sage et al.’s (2008) text on CBT in chronic illness and cancer, and Clarke and Wilson’s (2009) text on CBT in acute inpatient mental healthcare. Increasingly, also, workbooks and self-help guides using CBT techniques are available for non-professionals to use I have therefore selected as an example text a well-regarded clinical psychology text by Kennerley, Kirk and Westbrook (2017), which balances both cognitive and behavioural approaches and emphasizes self-help approaches as well.

Wider theoretical perspectives Overview: sources of CBT Cognitive and behavioural ideas come from four main streams of psychological research and writing, as shown in Figure 7.1. These are: first, learning theory leading to behaviour therapy; second, several cognitive therapies, including reality and rational emotive behaviour therapy; third, social learning theory and social skills training; and fourth, ‘third wave’ ideas that seek to incorporate environmental, social and spiritual factors. Historically, learning theory came first and developed into clinical psychology using behaviour therapy based on psychological research. The psychodynamic and perhaps conventional view is that behaviour comes from a process that goes on in our minds. This has connections with philosophical ideas about what the mind is and whether it is the seat of our humanity, what Christians call a soul. A related question is whether environmental influences limit people’s freedom or whether they are free to act according to their will, with what their mind wishes. Learning theory does not deny that this may be so, but it argues that we cannot know what is happening in someone else’s mind. Therefore, we can only study and influence the behaviour we can see. Except for some inborn reflexes, we learn most behaviour: it

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Reality therapy Rational emotive behaviour therapy (REBT)

Third wave therapies

Cognitive therapy

Learning theory

Operant conditioning Respondent conditioning

Cognitive behavioural therapy (CBT)

Behaviour therapy

From the 1940s

Social learning theory

From the 1960s

Social skills training

From the 1980s

Figure 7.1  Sources of current CBT Sources: Selected and simplified from Mansell (2008: 20), Nurius and Macy (2012), and Stepney and Davis (2018).

originates from influences outside ourselves. It follows that we ought to be able to learn new behaviour to meet our needs, and that new behaviour can be learned to replace existing behaviour if it is causing us problems. Psychological therapy based on learning theory, therefore, focuses on various ways of conditioning behaviour; that is, doing things in a consistent way that will train people to adopt a changed behaviour. This contrasts with some psychotherapeutic ideas such as psychodynamic theory, which aims to understand behaviour, where it originally came from and what changes may take place in our mind as we make changes in our behaviour. Many practitioners, however, felt that behavioural practice aiming to condition or train people in specific behaviours seemed to be effective for a few psychological problems but was limited in dealing with the more complex social issues found in social work. Social learning theory (Bandura, 1977) extends these ideas. It proposes that most learning is gained by people seeing behaviour going on around them and thinking about what they see. They can therefore learn by copying the example of others around them; this is called modelling. Helping people to develop social skills in this way increases the treatment options available in basic behaviour therapy. Cognitive theory is in part a development of behaviour theory and therapy, its emergence having been made easier by the availability of social learning theory. It also grew out of therapeutic developments of a pragmatic kind, devised by writers such as Beck (1989; Beck & Beck, 2011) and Ellis (1962; Ellis & MacLaren, 2005), who were concerned with psychiatric conditions such as anxiety neurosis and depression. Another cognitive approach, Glasser’s (1965) reality therapy, was also important for social work because it originated from residential work with young women. Cognitive theory argues that our perceptions or interpretations of the world around us affect our behaviour as we learn. Apparently inappropriate behaviour may therefore arise from misperception and misinterpretation, rather than from disorders of conditioning. Therapy tries to correct the misunderstanding, so that our behaviour reacts appropriately to the environment.

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Gambrill (1995) identifies the main contributions of behavioural practice as being that: ●●

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It focuses on specific behaviours that worry clients and others around them; if we change the behaviour, we remove the concern. It relies on behavioural principles and learning theory. Practitioners make a clear analysis and description of problems, based on direct observation. Methods of assessment, intervention and evaluation are explicitly defined. Factors influencing behaviour are identified by changing some factors in the situation and looking for the changes that result. Progress is monitored using subjective and objective measures, comparing data about the present with data about the situation before the intervention took place. Practitioners help clients to use changed behaviours in many situations (generalization) and maintain improvements after the intervention has ceased.

The positivist approach of behavioural work means that it uses a linear model of explanation: A leads to B and then C in a straight line of explanation. For example, the linear model of explanation is implemented in single-case experimental designs (Kazi, 1998), in which practitioners define behaviours to be worked on, carry out an intervention and then test whether there has been a change. A careful definition of target behaviours is followed by measuring in a planned way how often these behaviours occur during a baseline period. The intervention then follows, and occurrences of the behaviour during and after the intervention are also measured. After one period of intervention, there is sometimes a reversal period in which the practitioner returns to their own baseline behaviour and the target behaviour is again measured. Intervention then starts again. In this way, we can test whether the intervention or something else is creating the behaviour change. This approach has, however, been criticized from the critical realist and social construction perspectives (see Chapter 2) because it may reduce the complexity of our understanding of mutually interacting social factors to an oversimplified model of behaviour. We also saw in Chapter 2 that it has to be carefully designed to avoid assuming that natural changes are the result of the treatment. In learning theory, behaviour is caused by antecedents, or things that have already happened. When we behave in particular ways, this has consequences for us, and these then form antecedents for later behaviours. Figure 7.2 illustrates this in the left-hand column; the other columns show some of the different approaches to changing the contingencies that might affect behaviour. Behavioural practice is mainly concerned with changing contingencies that affect antecedents and behaviours (Gambrill, 1995). Social learning theory focuses on how we learn from social situations when we see how others who model the appropriate behaviour act successfully (vicarious learning). Cognitive methods are therapeutic procedures that focus on changing thoughts and feelings alongside, instead of or as a precursor to, changing behaviours. The behavioural and cognitive elements of CBT sit uncomfortably together, as I argued in discussing the debate about relevance to social work. A good example of this is Macdonald’s (2015) brief account, which goes into some detail about behavioural theory and techniques, and the research that supports them, with less on cognitive ideas and being more critical of its

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A Antecedents

If we change the antecedents …

B Behaviour

we will change the behaviour …

C Consequences

and its social consequences

Basic (linear) model of behaviour

Model of behaviour change

We learn social behaviour by observing and modelling others As we experience the effects of new behaviour, this reinforces it

Social learning also changes behaviour

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Thinking and perception patterns …

affect behaviour; changing them; and …

producing new social behaviour

Cognitive learning also has an impact on behaviour

Figure 7.2  Cognitive behavioural models of practice

research base. Thomlison and Thomlison’s (2017) account, on the other hand, focuses more strongly on the cognitive element, reducing the emphasis on behavioural conditioning. These authors emphasize (p. 57) the eclectic theoretical sources of CBT and the fact that behavioural assessment is required to identify the precise techniques that will be appropriate for particular issues. Thyer and Myers (2011) deal with this issue by seeing cognitive theory mainly as a development of social learning theory. As a consequence, they treat cognition as a behaviour susceptible to behavioural treatments, rather than as a separate type of mental process.

Connections The main aims of behavioural social work are to increase the desired behaviours and reduce the undesired ones, so that people respond appropriately to social events. CBT theorists argue that this increases people’s capacity for leading a full and happy life. An insight into people’s problems often helps because it speeds learning, but there is no evidence that it is necessary or that it is enough to get people to change. Writers on CBT practice claim that warm, trusting personal relationships between workers and clients help in behavioural work, as they do in other forms of social work. Behavioural social work can be used in many social work situations. The authors in Cigno and Bourn’s (1998) edited collection describe direct work with children and child protection, people with severe intellectual disabilities, offenders, carers, individuals with addictions, people with mental health problems, and those in residential and group care for elders. Behavioural and CBT practice is also widely used in clinical psychology and in some specialized forms of counselling. Cognitive theories established a position in social work theory during the 1980s primarily through the work of Goldstein (1981, 1984), who seeks to incorporate into them more humanistic ideas, such as a focus on people’s feelings and attitudes, alongside rational thinking processes. This development was suggested by the fact that behavioural ideas concern the nature of the mind (Chatterjee & Brown, 2017) and how perceptions and understanding are

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framed (Kelley, 1955; Goffman, 1974) and processed. Social construction and humanistic ideas (see Chapters 11–13) claim that perceptions and their processing vary legitimately, and that people’s reality is what they perceive and understand. Allied to cognitive ideas, this allows us to accept that clients’ understanding of the world is relevant to their rational thinking. There is, therefore, no need to see clients’ perceptions as wrong and to attack them. This element of acceptance frames CBT in ways that seem more natural to the conventions of social work. The crucial aspect of Goldstein’s work is, then, the inclusion of the humanistic element. Theories of CBT are primarily a Western model of practice since they emphasize the psychological change of individuals, rather than the broader social groupings that might be more relevant in developing countries; they also use a Western model of scientific method, which is less influential in many Eastern countries. This group of theories is, for example, not covered in Kumar’s (1995) Indian review of social work theories. A non-Western interest in EBP is put forward in Thyer and Kazi’s (2004) edited text on EBP, which includes chapters from Hong Kong and South Africa. These chapters are, however, primarily about the evaluation of social projects and social development, rather than about the practice of CBT itself.

The politics of CBT CBT is used primarily in specialized settings with particular client groups. It is often used for school phobia, for childhood problems and in psychiatric settings, particularly, in the case of cognitive methods, with mild anxiety and depression. The extended case study on child and adolescent mental health services in Chapter 2 shows how it may contribute in this setting. Criminal justice settings have also used specific formulations of CBT practices, which I discuss more fully later in the chapter. One reason for the success of CBT social work in such settings is that clinical psychologists, and to a lesser extent other medical and nursing staff, can offer supervision and provide a sympathetic environment and a patient-centred setting for these therapeutic methods. Such advantages are less easily available in conventional social work agencies, with their wider social mandate. A major difficulty with CBT is its technical rational character, with much jargon and many formal procedures, apparently worked out in set systems. When these procedures have been applied to particular service responsibilities, they have often been ‘manualized’; that is, set out in a manual of procedures for practitioners to follow. Such an approach may suit some clients or workers who like to see an ordered, explicit approach to problems that can be clearly explained and justified. Manualization gives useful guidance and support to less experienced practitioners, but it may seem dehumanizing and inflexible. Where practitioners have a good level of training, support and experience in CBT, they are able to use the methods more flexibly than this, but of course the risk is that less experienced practitioners with fewer qualifications and little or no supervision will be pressed to follow manuals rather than build up the skills they need to use CBT flexibly. Behavioural social work has had considerable theoretical influence, but it has not succeeded in gaining widespread usage, except in specialist settings or for particularly relevant problems.

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Values issues Values are a major concern that many practitioners have with CBT. Since practitioners use CBT to manipulate behaviour, clients may be unable to consent. This could lead to these techniques imposing social expectations on unwilling clients and pursuing social or political policies that could, at the extreme, be used for authoritarian political control. Supporters of CBT argue that clients’ consent is ethically required and practically necessary if the approach is to be successful. Many clients are able to ask for or appreciate the value of changing their behaviour, and may be frustrated that they cannot make the change themselves. Moreover, as we have seen, there are self-help books that enable them to use some of the techniques themselves. In addition, the most ethical treatment is one that works best, and CBT has been well validated within the limitations of its model of research. All techniques can, of course, be abused in the wrong hands. Watson (1980: 105–15) argues that the fact this may occur is not a sufficient answer to the ethical problem. Behaviourism, the basic theory underlying CBT practice, inherently assumes that all behaviour is caused by something. If people decide that they want changes that might be achieved by CBT methods, they are acting using their own reasoning freely, in the sense of deciding without any constraints on their decisions. What happens, however, if behaviour is considered socially undesirable, for example by a court or by people able to put social or other pressures on a client? Clients might then be persuaded that changing their behaviour is right, good or adaptive to social conditions. In such cases, we are moving from unconstrained reasoning to decisions being made in pursuit of social goals. The only ethical position that maintains clients’ rights to self-determination is to use the technique only where the client’s own purpose is to free themselves from a particular behaviour, for example where it is compulsive and clients wish to but cannot control themselves. Behavioural models have sometimes been misused. Residential care homes, for example, have used the reward and punishment aspect of behavioural methods in oppressive or abusive ways. One instance is the ‘pin-down’ scandal that occurred in residential homes for children in Britain (Levy & Kahan, 1991). Here, certain behavioural ideas justified locking children up for long periods without day clothes. Sheldon (1995: 237–41) argues that, in this sort of situation, some methods are used where the people concerned are already motivated to oppress clients. Any method could then be misused to do so. However, Watson’s (1980) objection to claims of misuse being discounted because they are bad uses of the theory still applies. It is the methods proposed by this theory that lead to the potential for misuse. Sheldon (1995: 232–4) further argues that no social work methods, including CBT, are so powerful that they can overcome resistance, and that other kinds of work also involve control and limitation of freedom. This seems a weak protestation, however, when CBT particularly claims to be more successful than other social work or therapeutic techniques at behaviour change. Moreover, we should not put people in the position of having to resist oppression, but should protect them from the possibility that this might happen. Sheldon further argues that we should measure any disadvantages of the CBT model alongside its advantages. But while we should take a balanced view of arguments, evidence of effectiveness cannot balance moral objections of oppression or the risk of it, because this would mean saying that the ends (an

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effective treatment) should justify the means of achieving that effectiveness (which would seem to justify repugnant oppression).

Applications Overview of CBT approaches Some basic ideas from learning theory and behavioural treatment are necessary to understand the approach. CBT involves four main sets of ideas: ●● ●● ●● ●●

respondent learning, sometimes called classical conditioning; operant learning, or instrumental conditioning; social learning and modelling; cognitive learning.

All these ideas are directly applicable to social work. The following account relies on Sheldon (1998), Thyer (2012b), Wong (2012), Nurius and Macy (2012), Macdonald (2015), Thomlison and Thomlison (2017) and Stepney and Davis (2019). Respondent learning is an action or behaviour that reacts to or is produced by a stimulus (something in the environment, such as a person, situation or event). Learning takes place when a piece of behaviour is connected more or less permanently with a stimulus. When we have learned a new response to a stimulus, we have modified our behaviour. Many behaviours are unconditioned – they happen naturally. An unconditioned stimulus produces an unconditioned response; for example, people’s eyes water in a high wind, they salivate when given food, they withdraw their hands sharply when burned and they vomit when they eat a noxious substance. Behaviours are conditioned when responses become associated with a stimulus that does not naturally produce the response. An example is if our eyes were trained to water when we were given food. We call these conditioned stimuli and conditioned responses. Conditioned responses become generalized; that is, the person applies them to similar situations. Case example: Getting muddy at the park Feliks was a young child who regularly got into trouble with his mother for getting muddy at the park. This led him to learn to

associate going to the park, rather than being muddy, with his mother’s disapproval. This is a conditioned response.

Such responses are the mechanism that underlies many social phobias and post-traumatic stress disorders. People develop a response to one stimulus and it begins to affect them in other situations. Case example: Feliks and the park again Feliks avoided going to the park because of his mother’s disapproval, but eventually he found it difficult to go out at all, generaliz-

ing his reaction because of her disapproval. This meant that he played in the house rather than going out.

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Extinction occurs if the association between the conditioned response and the stimulus is not kept up. The conditioned response fades away and loses its connection with the stimulus. This provides an important basis for treatment, since both the connection between the stimulus and the response and the ensuing generalization can be extinguished. Case example: Extinction process When Feliks was referred to the Child and Adolescent Mental Health Services (CAMHS), a programme was developed in which he was taken by his mother to the

park in easy stages to learn by experience appropriate things to do there, thus learning that their visits did not have to lead to his mother’s disapproval.

Some kinds of behaviour are incompatible with other behaviours. For example, a completely relaxed person cannot be anxious or violent. Counterconditioning connects desirable responses with a stimulus, so that it acts in competition with the undesirable responses. The most commonly used counterconditioning technique is systematic desensitization. Clients are taught practical techniques of relaxation or are offered other means of personal support. They are then slowly reintroduced to the unwanted stimulus and use the relaxation or support to fight against their anxiety. This approach is often used for school phobia or agoraphobia (a fear of open spaces or going outside the home). People can also be taught to use counterconditioning if they feel anger rising in a marital dispute. Counterconditioning is also used in sexual therapy. Pleasant sexual responses are learned in supportive surroundings and gradually introduced into more ordinary sexual situations that have previously caused anxiety. For example, a man who ejaculates prematurely learns to control ejaculation while stimulated by his partner when full sexual intercourse is not permitted, until he feels confident of control. Transfer to sexual intercourse follows later. Case example: Counterconditioning in enuresis One example of these techniques is in conditioning children who are enuretic  – who wet the bed at an age when they should have learned not to do this. A loud buzzer or bell is connected to an electrical contact placed within a soft mat under the child. The buzzer sounds when some urine reaches the mat, and the child wakes and can complete urination in a toilet. This process has two effects. First,

the child is conditioned to wake when the bladder is full, so avoiding bed-wetting. Second, the tone of the bladder muscle is improved, strengthening the capacity to get through the night without wetting. These responses are set up as a form of counterconditioning to the natural process of reflex urination when the bladder is full (Morgan & Young, 1972; Thyer, 2012b: 69–70).

Most behaviour does not develop from unconditioned stimuli, and operant learning deals with a wider range of behaviours. It is concerned with behaviour that operates on the environment and can be used with complex and thought-out behaviour. In contrast, respondent learning is mainly concerned with learned automatic responses.

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Operant learning was the original form of behavioural practice that focused on changing the contingencies that were affecting behaviours, leading to new consequences (see the first sequence in Figure  7.2). Something happens, an antecedent event  – A  – which produces a behaviour  – B  – which tries to deal with the event, and because of that behaviour, consequences  – C  – arise. Social workers manage contingencies, which affect the relationships between behaviour and consequences that strengthen or weaken behaviour. The main technique is reinforcement but punishment is also used. Reinforcement, whether positive or negative, strengthens behaviour. Punishment, whether positive or negative, reduces behaviour. Positive always means doing something; negative always means taking something away. Both approaches can be used together. Extinction is also an operant learning technique. It differs in principle from extinction in respondent learning. In operant learning, it means removing the relationship between a behaviour and its consequence. With negative punishment, we may remove a consequence that has nothing to do with the behaviour. Unlike extinction in respondent learning, this is not solely avoiding making a response. Instead, it is about positively removing the relationship between a consequence and the behaviour that led to it. Case example: Davey’s homework: extinction in respondent conditioning Davey disliked doing homework. This led to arguments with his parents. Their social worker helped them see that the arguments positively reinforced not doing homework because they take up time and emotional

energy that can then not be applied to the homework. Instead of arguing, she persuaded the parents to try putting the child and the homework in another room, thus withdrawing the reinforcing behaviour.

Positive reinforcement is usually preferable to or should be used with other techniques. For example, extinction gives no control over what behaviour replaces the undesirable behaviour – it might be equally undesirable. Positive reinforcement allows the favoured behaviour to be encouraged alongside the extinction of the unwanted behaviour. In addition, the unwanted behaviour may increase temporarily to test out the new response and this is hard to cope with, so encouraging useful behaviour makes the process easier. Behaviour can also be shaped, learning a skill in small steps. With all these techniques, you must concentrate on trying to get useful behaviour generalized from the immediate situation to wider issues, so that it sticks in the client’s repertoire of behaviour. The main process in social learning is modelling. Hudson and Macdonald (1986) describe this as follows: ●● ●●

●● ●●

A person sees someone else performing an action and pays attention to it. The observer forms an idea or code in their mind for how the behaviour is done, including some rehearsals in practice or in their mind. The observer identifies circumstances in which the behaviour occurs and has consequences. When an appropriate situation arises, the observer repeats the behaviour according to the idea of it which has been formed.

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Seeing a feared behaviour performed by a role model helps many people to appreciate that there will be no adverse consequences. Most people learn practical skills or behaviour by watching a demonstration of what to do. We all do this by watching ordinary people demonstrate new skills on YouTube. In social learning, you try to get someone who you like and trust to model a new skill. Experimenting while in a supportive environment and receiving feedback and encouragement are an important part of this. This work has led to skills training programmes, anger management classes and similar ways of helping people to learn new behaviours. Sheldon (1998: 23) summarizes the important factors in social skills training programmes as follows: ●●

●● ●● ●● ●● ●●

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Specify problems where there are gaps in a client’s behavioural repertoire and the ways in which new behaviours would help to fill the gaps. Divide the problems into small components or stages. Help clients to identify mistaken thinking (cognitions) that may hinder them. Demonstrate the desired behaviour, and then get the client to rehearse it. Connect chains of small behaviours together to make more complex behaviours. Help clients to understand how to discriminate between situations where it is useful and not useful to use the behaviour. Introduce real-life difficulties. Set real-life practical assignments and get clients to report back.

Assertiveness training is a technique derived from social learning theory used for people who lack confidence. Workers help them to try out appropriate forms of behaviour in a supportive environment, so that they are enabled to practise these in, ideally, increasingly difficult real-life situations. Cognitive learning aims to help people with two main things. First, it tries to correct disorders of perception and attribution. Perception is about how someone sees what has happened to them. Attribution is the judgements they make about the meaning of their experiences. The second main area is catastrophic thinking, or imagining that things are worse than they are. Among cognitive behavioural therapies are the following: ●●

●●

Coping skills contain two elements: a self-verbalization, an instruction to ourselves, and the behaviour that results. Difficulty in coping with situations may arise from an inability to work out what to do in order to self-verbalize or from an inability to act on our instructions. Meichenbaum’s (1985) stress inoculation training aims to reduce or prevent stress by teaching clients what to say or do in difficult situations. Ronen (1998) suggests that focusing on skills related to self-control may be helpful in direct work with children. In addition, practitioners make changes to reduce any stress in the client’s environment. Cognitive restructuring is perhaps the best-known form of cognitive therapy and includes Beck’s cognitive therapy and Ellis’s rational emotive behaviour therapy (REBT, formerly RET). In Beck’s cognitive therapy approach, clients collect information about how they interpret situations and the social worker questions and tests out how these work. In REBT, irrational beliefs dominate clients’ thinking, which leads to three things: first, ‘awfulizing’, or seeing things as unreasonably negative; second, a low tolerance for

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frustration, feeling that it is impossible to bear uncomfortable situations; and third, ‘damnation’, feeling that you are in essence bad because you have failed at something. You question and attack the irrational beliefs that underlie these reactions, including disorders of perception and attribution Case example: The threat of unemployment A lorry driver was threatened with dismissal because he was seen driving unsafely. He perceived this as unfair, which might have been a misperception, and he thought that the manager was determined to dismiss him to save money. This is an attribution of an explanation of behaviour

●●

that may have been unstated or may not even have occurred to the manager. Cognitive therapies might concentrate on giving the driver the skills to interact with the manager and reduce the driver’s inappropriate negative thoughts about the manager’s attitude.

Structural cognitive therapy is concerned with three structures of belief in clients’ minds. Core beliefs are assumptions about ourselves; intermediate beliefs are explicit descriptions people make of the world; and peripheral beliefs are the plans of action and problem-­ solving strategies that we use daily. Workers focus on beliefs at the periphery that cause problems but use the process of change to explore the origins of these beliefs in deeper ideas.

Criminal justice CBT is widely used in criminal justice settings, in community settings to prevent progression to more serious offending and in prisons to reduce recidivism. These provide a good example of the practical use of CBT techniques in agency programmes. Elements that are often included are social skills training, anger or aggression management and efforts to change faulty reasoning, often with a moral element. A US government study refers to six commonly used programmes: ●● ●● ●●

●● ●●

Aggression replacement training, which includes all three of these elements. Strategies for self-improvement and change, focusing on substance abuse. Moral reconation therapy, concentrating on moral reasoning and the individual’s acceptance of responsibility for their criminal behaviour, reasoning and rehabilitation. Devised by Ross and colleagues (Ross, Fabiano & Ewles, 1988; Ross Fabiano & Ross, 1989) in Canada, this approach was applied in the Welsh STOP (Straight Thinking on Probation) programme (Raynor & Vanstone, 1994, 1998; Raynor, Smith & Vanstone, 1994) at a time when probation was still considered part of social work. Relapse prevention therapy, also focusing on substance abuse. The skills and education programme Thinking for a Change (T4C) (Milkman & Wanberg, 2007).

A critique of reasoning and rehabilitation in the UK applies to many of these programmes, and helps us to see some of the potential criticisms of applying CBT techniques in wide-scale agency programmes. CBT here seemed prescriptive, as following a detailed manual of action

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and as using an explicit teaching programme; it was an example of the problems of manualization, discussed earlier. The aim was to move offenders away from stereotyped thinking about their own needs and position, and allow them to see situations more broadly and from different perspectives. They would then also be able to think through their problems more rationally and find alternative ways to deal with them. The reasoning and rehabilitation programme was criticized for its racism and lack of flexibility, for the way it forced practitioners to comply with interventions, for negating the importance of self-determination as a principle underlying effective CBT practice, for using strict procedures that treated people as machines and for not responding to the social and economic causes of much offending (Neary, 1992; Pitts, 1992). The way in which the programme gave priority to managing its general objectives, rather than individuals’ needs and wishes, was also criticized (Oldfield, 2002; Raynor, 2003). This CBT approach, however, fitted well with an increasing emphasis on offence-focused work with offenders, driven by political and policy trends as well as theoretical developments in professional practice. A change to reviewing offenders’ offences and the patterns of behaviour that led to them may be presented politically as a focus on the offence, rather than on the welfare of the offender.

Mindfulness Mindfulness is an attractive set of ideas that derive from two main sources: ●●

●●

Buddhist thought, and the psychology developed from it, which includes studies of meditation, including transcendental meditation, and its consequences for the way our brains work (Wong, 2019). Social learning and other ideas in CBT, which stress the importance of focusing attention on defined behaviours (Hick, 2009).

These concepts also have connections with everyday ideas, research on interviewing and communication, and ideas about reflective practice (see Chapter 3), all of which emphasize paying attention to the people you are interacting with and being receptive to their communication. They also connect with the shared principles of alliance and rights. In Buddhist thinking, mindfulness is ‘bare attention’, unconditioned by social expectations and external demands, and is a preparation for and precondition of liberating yourself from current demands, so that you can cultivate your mental capacity to experience and understand the world (Mace, 2008). You pay attention in a disciplined way to your body and its breathing, your mental patterns, your reactions to stimuli outside yourself and your fears about external realities affecting you, as part of a process of ridding yourself of these limitations. All this generates the capacity to clear your mind and develop positive abilities in thinking and ‘clear comprehension’ (Mace, 2008: 23). There are four main forms of branded mindfulness-based psychotherapy that may be helpful to social workers, especially where they are dealing with people suffering anxiety and depression: ●●

MBSR  – mindfulness-based stress reduction is used to help people who are affected by major or chronic illness become more mindful about their attitudes to the condition. They receive training in self-monitoring and managing stresses, in using formal stress-reducing

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techniques such as yoga and in more generally being aware of stressors in everyday activity. Group discussion is used to promote individual learning. MBCT – mindfulness-based cognitive therapy is similar to MBSR, aiming at ‘decentring’, that is, shifting people’s emphasis in thinking and priorities in life away from stressful cognitions. There is less focus on bodily sensations and mood and more on identifying negative cognitions. There are various derivatives of MBCT for specific conditions connected with cognitive functioning, such as eating disorders. DBT – dialectical behaviour therapy originally focused on helping people with self-­harming behaviour and borderline personality disorder who have experiences that they think invalidate them as people, with the result that conventional psychological treatments focused on behavioural problems make them feel even further rejected. After initial agreements between practitioners and clients about the emotions and reactions leading to the out-of-control behaviour to be tackled, a mix of individual support and skill training is used to manage clients’ emotions and help them feel more effective in dealing with the situations they are facing. act – acceptance and commitment therapy (usually not ACT, which implies assertive community treatment, a case management approach employed with mentally ill people) uses many similar ideas, but its main focus is on developing the self as a context for making behavioural changes. Clients work on identifying and rejecting aspects of their current self, such as overdependent relationships, that seem substantial and continuing but can be altered so that they are less important and can be changed. The approach involves a menu of specific procedures.

Developments in neuroscience Social work thinking is increasingly taking into account recent developments in neuroscience (Applegate & Shapiro, 2005; Farmer, 2009). This is relevant to CBT for two reasons. One is that neuroscience draws on an explicit knowledge base in the physical and medical sciences that connects with CBT’s emphasis on scientific knowledge as an important foundation for practice. The second reason is that neuroscience can offer insights that increase our understanding of how psychological and social relationships are processed in our brains. We know that the physical state of our bodies affects how our brains work: this is why relaxation is effective in dealing with anxiety. We also know that our state of mind and our beliefs can have important consequences for our bodily functions.

Example: The neuroscientific basis of drug abuse Social workers often deal with people who abuse drugs of addiction, such as cocaine or heroin, or become addicted to medication such as tranquillizers. Recent research has demonstrated how these drugs work to change the transmission system in people’s brains and nervous systems, making them more amenable to the pleasure of using drugs and less able to respond to other psychological rewards such as sex, food and humour (Farmer, 2009: 142).

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Miehls (2011: 81–8) summarizes the key areas of neurobiology in social work as: ●●

●●

●● ●●

plasticity – the capacity of the brain to reshape itself by improving connections between neurons; for example, forging attachment in childhood generates new neural connections (see Chapter 5); the different development of the right and left hemispheres of the brain, giving rise to different impacts of behaviour; information-processing and memory; the impact of physical and psychological trauma on brain development.

Applegate and Shapiro (2005) and Farmer (2009) focus on the structure of the brain, how messages are transmitted in the brain and across the nervous system, and how these processes may go wrong. Farmer (2009) examines evidence that particular areas of the brain are linked to certain important areas of human behaviour, including remembering, learning and mirroring, which allows us to learn physical and social skills by watching others, and leads finally to the human ability to use the brain to understand itself. Much current neuroscience research explores the functioning of areas of the brain itself and how chemicals improve or inhibit neurological connections between the body and the brain. Information that affects how people interpret their perceptions of other people is transmitted through the nervous system. A stimulation (such as observing a piece of behaviour in another person) passes along the nerves via a series of impulses that are fired off from the observation. A part of the nerve, the axon, sends out a chemical, a neurotransmitter, which affects a receptor on the other side of the gap between this and the next nerve, allowing information on the observation to be passed between the nerves. The neurotransmitter is then taken up in the first axon, to be used again. If this chemical is taken up too rapidly, it leads to changes in people’s mood because the transmission of perceptions and feelings about the outside world is altered. People who work in mental health will be familiar with the use of medications known as SSRIs to treat depression; the well-known anti-depressant Prozac is an example of these. SSRI is an abbreviation for selective serotonin reuptake inhibitor, the neurotransmitter involved being serotonin; when the SSRI reduces (inhibits) the reuptake of serotonin, it improves the person’s mood (Applegate & Shapiro, 2005: 3–7). In children, it is well established that a lack of experience and stimulation hinders the development of neural connections in the brain. This may come about through neglect by parents or extreme financial poverty, which makes the children less responsive to further social experiences. Brain and personal development continues throughout life. For example, neurons continue to be generated in the brain, although the plasticity of our brains – their capacity to change flexibly – reduces after childhood. It is this plasticity that helps people repair the damage of early attachment problems, which we met in Chapter 5. Evidence that there are chemical ‘rewards’ for good bonding experiences helps us understand why later good parenting can compensate for some of the damage caused by poor attachment in early childhood. It also reinforces the physical and emotional benefits of practitioners’ work on improving children’s social relationships and experiences. Farmer (2009) identified four areas where neuroscience knowledge may be helpful to social workers. These are set out in Figure 7.3 and identify the knowledge that may have implications for social workers and consequences for how we should practise.

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Important knowledge

Practice implications

Attachment and bonding

Evidence that bonding may generate brain chemicals (oxytocin, vasopressin) that produce feelings of reward and pleasure

Experiences of bonding may be rewarding and compensate for an earlier lack of attachment

Trauma

Evidence that physical and chemical changes in the brain are connected to unhelpful reactions to stress (serotonin, corticotrophins)

Importance of preventing and responding to stress reactions after crises and in long-term caring

Psychotherapy

Evidence of chemical and brain changes resulting from mental illness and from psychological interventions

Linking medical and psychological interventions may improve the effectiveness of both

Medication and drugs of abuse

Evidence of the diverse and complex impact of various combinations of drugs used for medication and in abuse

Exploring the detailed psychological and social consequences of both medical and abusive drug use

Figure 7.3  Farmer’s important areas of neuroscience knowledge Source: Farmer (2009).

You may resist placing too much emphasis on neuroscience knowledge because its focus on physical changes in the brain and body seems to negate the humanity of social work’s emphasis on the psychological base of human free will, and because of the importance of social relationships for our development and way of life. Neuroscience offers a better understanding of the physical factors that affect psychological reactions and social relations, but it does not say that physical factors override the psychological and social. It is obvious that physical pleasure and pain affect how we behave and how we relate to other people. As yet, social work has not substantially drawn on genetics, but knowledge of it is increasingly relevant to advice to clients, although in healthcare settings there are often specialist genetic counsellors. Pankow’s (2012) account in an American text on social work reflects the American curriculum connection between human behaviour and theory teaching. The following case example illustrates how understanding that an increasing disability may affect a client’s behaviour allows us to deal with people helpfully. Using neuroscience knowledge enables us to incorporate the social into wider interventions. Case example: Mrs Folwell’s arthritis A care assistant visiting Mrs Folwell, an older woman with severe arthritis, talked to her social worker about how difficult both the family and the assistant herself were finding it to build or maintain relationships with Mrs Folwell because of her tetchy manner, constantly complaining and criticizing others. The social worker asked the assistant to remember a time when her

back had been playing up and she had constantly found it difficult to bend down or get into her car. ‘Now think how it must be to find it painful to move every joint in your body every minute of the day. Wouldn’t you get irritated with everything around you?’ This insight helped the assistant to be more sympathetic with Mrs Folwell’s crotchety manner.

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 xample text: Kennerley et al. (2017) on cognitive E behaviour therapy Main characteristics and methods I have adapted the terminology of this clinical psychology text so that it more directly refers to social work. It identifies the main characteristics of CBT in a similar way to Gambrill’s (1995) social work approach, which I summarized in the overview of CBT earlier in this chapter. The practice implications of these characteristics are as follows: ●●

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●● ●●

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A developing collaboration as intervention proceeds between practitioner, with knowledge of how to define and work on problems, and client, with understanding of the issues that face them. Structured and active work, involving agenda-setting in each session, interactions between practitioner and client in sessions and in vivo assignments for clients between sessions. A specified and brief time limit for sessions and length of treatment. Empirical in the approach to work with the client, so that beliefs, plans and thoughts are hypotheses to be tested and data about behaviour and events is collected and checked out. The problem focus means concentrating on issues that are important to the client, defining and then working to resolve them or reduce their impact. Goal-setting strengthens clients’ hopes for success.

You build a positive and trusting alliance in your relationship with your client. Four important approaches are: ●●

●●

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Guided discovery, in which you work with clients using ‘Socratic questioning’ to identify alternative perspectives on the problems and make plans. Behavioural methods based on respondent, operant and social learning to test out ways of working on the problem. In vivo work, in which you take activities outside the office, day centre or residential care home to try out solutions to the problem in everyday life. Summaries and feedback, in which you and the client continually summarize your understanding of the main points of each stage of the process.

Assessment and formulation An important starting point is to agree with the client a clear formulation of the situation that the client is facing. This helps both of you to clarify the problems, acts as a bridge between the theory that you understand and the details of the problem and situation that the client understands. Doing this individualizes even a standardized treatment protocol, so that you start from how the client experiences the problem, not what theory tells you to do. It also guides the work you do together, because you can see what maintains the problems. You focus on what maintains the problem now, not on what caused it in the past. By opening up new ways of thinking, the client can appreciate a different way of understanding how the problems make them feel and builds up hope that you can jointly crack the problem. The formulation also helps you think through difficulties that might come up in your work together.

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Figure 7.4 sets out how you move through an assessment to agree a formulation. Your aim is to make sense of the information that the client gives you. You collect and check information, devise a hypothesis and look for more information so that you can test the hypothesis. This helps you arrive at some tentative ideas about the formulation that you can discuss with the client and then modify. At the end, you agree a working formulation and make intervention plans built upon it. During the intervention, you will gain more information, and you use this to modify the formulation. The following case example identifies some of the factors that emerge in the assessment and might contribute to the formulation.

Case example: Fred’s anxiety Fred was referred for CBT to deal with extreme anxiety about his work (the presenting problem) after changes in his responsibilities (precipitant) and daily pressure from a new manager (trigger). His underlying fear, brought with him from a previous job, was that he was no good at managing staff (a vulnerability factor), as opposed to the technical tasks he undertook previously (new and old behaviours). He feared (emotion) criticism (cognition), and went into work feeling shaky (physiological changes). It was worse when he was picked out (trigger) in weekly plan-

ning meetings when other people were present and targets were set and evaluated (modifiers). He found himself constantly checking and rechecking tasks, even though it was staff motivation that was the main problems (escape and hypervigilance). He found himself exhausted and jumpy with his wife (consequence). His doctor had given him tranquillisers, but he disliked taking medication (consequence). He had tried physical relaxation techniques in the lunch hour, but this didn’t last much into the afternoon (consequence).

As well as discussion, CBT assessment uses three techniques, which can be carried on into the intervention process: ●●

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Measurement, enabling you to get a baseline for the problem, to focus on concrete, directly observable behaviour and beliefs, and to emphasize to clients how they are making progress. Helping clients become their own social worker, by encouraging them to think more rationally about their problems and develop their own responses to them. Socratic questioning, which helps people learn how to review what’s happening to them and how they are behaving, and generate their own ideas for treatment. This is the guided discovery that connects their thinking and feeling with the real world.

Measurement gives people the task of recording important factors that arise on the occasions that the problem comes into play. For example, a parent who ‘loses it’ with their children will keep a record of each event, what triggered it and how they reacted. You can then discuss with them ways of reacting differently. People can scale their feelings in relevant incidents on a scale of 1–10. The aim is to give them clear and simple instructions for something directly relevant to their problem, so that they (and you) can gain a more realistic appraisal of the problem.

Vulnerability factors – beliefs that increase the likelihood of problems (‘I must succeed’, ‘I am worthless’, ‘I must be nice’)

Assessment - gather and test information using a recent episode

Break up presenting problems into: Cognitions - words or images that occur when the problem arises Emotions - one-word descriptions of how the client feels when the problem arises Behaviours - what do you do now that you did not do before the problem occurred? Physiological changes - bodily changes: butterflies in the stomach, sweating, loss of interest in sex, cravings for food, drugs

Precipitants - past events that started the problem off

Maintaining processes: what keeps it going? Often vicious circles or feedback loops. Escape or avoidance (common in anxiety) Activity reduction (common in depression) Catastrophic misinterpretation (physical reactions increase fears – ‘I’m going mad’) Hypervigilance (constantly checking for things going wrong) Self-fulfilling prophecies (negative beliefs change behaviour and others react) Performance anxiety (‘I don’t think I can do this’ leads to anxiety and then failure) Fear of fear (Client fears unpleasant symptoms that they experienced before) Perfectionism (‘I am worthless’ leads to setting impossible standards) Short-term rewards: (good feelings in the short term but long-term problems).

Formulation – summarize assessment and agree intervention aims

Figure 7.4  CBT assessment and formulation

Cognitive behavioural practice

Look for triggers and modifiers: Triggers: current factors that make the problem more or less likely to occur Modifiers: current factors that affect how serious the problem is when it occurs Think about what makes a difference: situations, places, people, thoughts, behaviour or activities, physical variables (drugs, menstruation), feelings (bored, depressed, anxious)

Consequences Impact on life: how have things changed? People: how have others responded? Coping: what have you tried? How did it work? Medication/treatment that helped or made it worse

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Case example: Ferne is anxious about schoolwork Ferne was anxious that her teachers would criticize her work, and this was a factor in her refusing to go to school. She was asked to keep a record with her mother, in which she scaled from 1 to 10 how anxious she felt about a piece of work. When she returned from school, she noted the reality of the teacher’s initial reaction, and later

she and her mother talked about the teacher’s marking. They scaled these reactions also from 1 to 10, so Ferne could see that her worries were not borne out in most cases. They could then move on to thinking what made the teacher positive about Ferne’s work instead of critical, and changing her work accordingly.

Helping clients become their own social worker involves getting them to look at their experiences, using the reflection methods explored in Chapter 3. They look at a relevant experience. Then by observing and analysing the detail of it and reflecting on it, they try another way of behaving and plan to do things differently in the future. Socratic questioning is a process of asking people questions so that they will come to their own conclusions about what happened and what they should do about it. You start with concrete questions about what happened and how the client felt, as you would in any assessment. Information giving can be interleaved among the answers, where clients reveal that they do not know about or understand information. You can also get clients to work on alternative ways of thinking about their problem. Other Socratic questions might be asking about evidence for or against, or looking at consequences and alternatives. ‘Downward arrowing’ involves asking clients to dig into the detail of a general comment that they made, clarifying global or vague statements. Case example: Socratic questions about Ferne’s teachers Ferne’s social worker asked about various teachers’ personalities. What would happen if she got comments from a different

teacher? How would that feel? What does that tell Ferne about the source of her worries?

CBT interventions The overall pattern of CBT interventions is set out in Figures 7.5a, b. Intervention in a minor problem might involve around six sessions, for a more major problem up to 15 sessions and for very difficult problems perhaps 20 sessions. The first two or three sessions would be for assessment and formulation, while the last one or two sessions would provide for termination and would help clients look forward to maintaining their present progress and would reinforce their learning. The main part of the intervention is a series of sessions at a client’s home or in an office, day centre or care home. Tasks are planned and rehearsed, as in task-centred practice (see Chapter 6). Clients then undertake projects or activities in vivo as part of their everyday life, reviewing them in the following week’s session. The extended case study about Freda at the end of this section describes how this works. It is common to call the in vivo activities

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1-3 sessions

Planning for the future

Assessment and formulation

a

Active in vivo work

2-12 sessions

1-2 sessions

b Review of the last week Review of the last session

How are things?

Assessment of current mood Review of activity Activities Assignment of next activity Feedback on this session

Figure 7.5  Patterns of CBT ((a) The overall pattern of CBT sessions and (b) The agenda for a typical CBT session)

homework, but this reminder of schooldays turns some people off, so I prefer to describe them as activities; other people talk about assignments or projects.

Intervention techniques Three sets of intervention techniques are used in CBT: ●● ●● ●●

cognitive techniques; behavioural experiments; physical techniques.

Cognitive techniques involve helping people to identify the feelings associated with problems and the thoughts that come from the feelings. Feelings can usually be identified by single-­word descriptions, while thoughts require longer explanations. For example, an angry husband might say that his wife didn’t value or respect all he did for the family. You can guide people to keep a diary of events, get them to list emotions connected to those events, perhaps scaling them, and then describe the thoughts that develop alongside them. Continuing the

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example, the incident might be an argument about housekeeping money, and anger scaled at six out of ten, and the thought ‘she just doesn’t recognize how hard I work to earn this money’. Get clients to turn questions into statements. ‘What does she think of me?’ builds less understanding than ‘She thinks I make no contribution to the family.’ In sessions, you can improve understanding and recall of what happened through imagery (‘Describe to me what she looked like when you were arguing’) and role playing what took place. Get clients to clarify broad statements: using the same example, ‘What contributions do you make to the family that she does not recognize? How could you help her understand that?’ Introduce clients to distraction, things that they can do to reduce the impact of emotions and thoughts. They can also ground themselves in a safe place if anger, anxiety or depression are getting the better of them. Case example: Using distraction Kath was prone to extreme anxiety or panic attacks when she had to visit offices or talk to officials to deal with problems. Her social worker talked about things she enjoyed doing, such as listening to music and gardening. They agreed that when Kath was feeling anxious about a contact

she had to make, she would listen to some music on her phone first, and then keep the tune in her mind in breaks in the discussion; for example, as a debt counsellor filled in a form on the computer. She could also plan where she wanted to establish new plants in her garden.

Help clients recognize cognitive biases. For example, extreme thinking can include catastrophizing (‘I’ll lose my job if I make a mistake’), dichotomous thinking that events or behaviours are all or nothing (‘I can’t trust anyone in the family to do that, they always get it wrong’), or setting standards too high. Other examples are selective attention (overgeneralizing or thinking only about the possible negatives instead of positives) or self-reproach (taking all the responsibility for something others had a hand in). These sorts of ideas come from Ellis’s rational emotive behaviour therapy, discussed earlier in the chapter. Another possibility is to help clients identify automatic thoughts, so that they see the problem behaviour as a mental event rather than as a reality. The anxious person automatically thinks that all eyes are on them or that people are bound to think they’re incompetent. You work on this by helping people to recognize where the idea comes from, to weigh up pros and cons of their belief or by thinking through how they might cope with the worst possible scenario in their fears. Case example: Jane is ignored by her family Jane’s relationship problems seemed to emerge when she became very angry that members of her family ignored what she said and didn’t take any notice of what she did for them. Her social worker explored where this came from, and they found that her parents had devalued her efforts in helping around the home in favour of her

elder brothers’ more competent performance in household tasks. They also worked out that her anger didn’t get the family to do more in the house, and set about planning agreed tasks with a writtenout rota, so that she could offer reminders and congratulations when people met their responsibilities.

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Behavioural experiments are a more active way of tackling practical problems that are affecting people’s emotions and cognitions. The principle is either to be an observer, and watch and record what happens, or to be an actor in the situation, and do something. In both cases, clients check to see if what they expected happens. Physical techniques involve training clients to learn how to defuse powerful emotions. This includes relaxation, controlled breathing (for example counting ‘one thousand’ before taking the next breath and becoming sensitive to changes in bodily functions, such as tension. Mindfulness proposes getting people to pay close attention to a series of actions that they are taking. Social skills training, such as parental management programmes, work training or communication skills, may help people to deal with practical problems in their lives. Behavioural interventions involve activating clients with a planned series of progressive tasks, getting them to maintain a schedule to monitor their progress. For example, where there are communication difficulties, clients may be provided with some training in how to deal with situations, and they might try this out in practice. Assertiveness training and social skills training in dealing with common situations may also be helpful. Case example: Faisal’s social activities Faisal was a young man with learning (intellectual) disabilities who was living away from his parents in supported accommodation for the first time. His care workers rehearsed with him skills in greeting and having practical conversa-

tions with shopkeepers, cashiers and other people he met in his daily round. He practised a new one every week between the training sessions and scaled the increase in confidence he felt with each successful communication.

Work on schemas can also help people think through the reality of what they believe. For example, using a ‘responsibility pie’, clients list all the people who might have contributed to a problem that they have, and make a pie diagram working out the percentage of each person’s contribution, including the percentage of their own responsibility. I have only recounted here a few of the wide range of practical ideas that Kennerley et al.’s (2017) guide to CBT practice offers. Several of these can be used as ways of engaging clients in practical ways of looking at their problems, without developing the full paraphernalia of cognitive or behavioural interventions. The following case study, however, is at the other end of the scale of CBT practice, exploring a structured use of CBT techniques to help with a child’s serious emotional and behavioural problems.

PAUSE AND REFLECT  Freda’s school-related anxiety (The case study and associated text have been written especially for this book by Emma Reith-Hall)

Look at the following case summary and make a note of the issues you would identify that a social worker might need to tackle. Compare your thoughts with the ideas the social worker used in the following account.

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Case example: Freda’s story Freda, aged 13, lived with her mother (a part-time care assistant), her father (a plumber) and her brother, aged 16, in a medium-sized city. The family environment was secure and stable with no particular stressors. A paediatrician referred Freda to the child and adolescent mental health service, describing Freda as an ‘anxious school refuser’. This problem had been ongoing for two years since Freda had been bullied when she was aged 11. She had returned to school briefly on a part-time timetable, but had stopped attending again after being

bullied by a different group of peers. When referred, she had not yet returned to school, but wanted to go back to the same school. Her parents wanted to support her but did not want to make matters worse by pressurizing her. Freda had lost contact with most of her friends and rarely went out, although she contacted one school friend via texts and social networking. The referral explained that Freda was concerned about her weight and had a poor self-image. She sometimes reported feeling low, being tearful and wishing that she did not exist.

When I received the referral, I considered some issues that might have been relevant, and Figure  7.6 indicates what went through my mind. The figure illustrates that CBT practice requires you to take into account a broad range of considerations, including social and attachment issues, even though the starting point of the referral was ‘anxiety’, which led the team leader to think that a CBT intervention might be used. Before making the decision to use a particular model of practice, it is important to rule out other things that may be more important than the presenting issue of anxiety; some of these issues might need to be addressed using alternative interventions. Potential issues

Questions arising from the referral applied to Freda’s family

School

Is the current educational provision appropriate for her? What is her academic performance? Has she any learning difficulties?

Risk

Assess possible links between bullying and teenage suicide

Physical health

Freda is worried about her weight

Emotional health

She has a poor self-image and experiences bullying. Is there any social phobia?

Anxiety

Assess the level of and reasons for anxiety about school. Referral shows that Freda wants to return to school

Depression

Low mood is mentioned in the referral. Is this connected with low selfesteem, negative thoughts or poor sleep? Is there evidence of self-harm or suicidal ideation?

Family issues

Are there signs of parental illness, domestic violence or parental substance misuse? Are there signs of worries about a parent or family member that mean Freda wants to stay at home? Is anxiety a family theme? A learned behaviour? A child protection issue?

Relationships

Assess family and social networks

Attachment, early years

Assess attachment behaviour, in the past and now

Hopes and goals

General life aims and specific aims around school: the referral says she wants to return, but school refusers often do not share their parent’s goal of returning to school

Figure 7.6  Issues in Freda’s family

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The assessment involved working with Freda and her family to clarify goals, and also factors in their lives that would influence decisions about intervention with Freda. I did this by looking at the ‘Four Ps’ (Carr, 2006). These are set out in Figure 7.7, dividing the factors that might be affecting Freda into four groups, to be talked through with Freda and her parents. When making an assessment using this formulation, there is a predominant focus on social factors, particularly family issues that might affect the person in particular. In this case, an important reason for this was the way in which family factors may have been an important source of stressors potentially perpetuating Freda’s problem behaviour. For example, Carr (2006: 497) talks about ‘An anxiety-oriented family culture, which privileges the interpretation of many environmental events as potentially hazardous’ as a factor that makes it seem almost natural for a child to be anxious about difficult situations because the members of the family often behave that way too. The Four Ps formulation is typical of current social work in that it does not neglect biological and genetic factors and balances personal and contextual factors, so that any psychological and social issues affecting the problem are carefully examined. First, there may be some features of Freda’s background that predispose her to anxiety. Second, there may be factors in her life that build up and perpetuate anxiety once she experiences it. Next, there may be factors that protect her from feeling anxious – people who suffer anxiety can often find useful resources within themselves or in their environment to help them. Finally, I pulled out precipitants for the school’s concern about her, which had in turn led to the paediatrician’s diagnosis and to the referral. The list of perpetuating factors was very much as the referral had led me to expect, so there were no hidden concerns that might have led to broader work with the family or school. On the other hand, it was a relief that there were many protective factors, which meant that there would be strong support from Freda’s family and social network for a direct intervention to work on the thinking patterns that had led to her anxiety. Assessment also needed to engage Freda in developing a detailed understanding of what was happening to her. I built this up by working through a formulation of the onset of problems, explaining that antecedent or preceding events lead to a process of thinking that raises anxieties and feelings about the anxiety, and then leads to the behaviour that is seen as difficult (Stallard, 2005). I talked through this sequence with Freda, so that she confirmed and began to see the importance of the process of her thinking. The original important events and experiences for Freda were of being bullied for the first time, some years previously. This had led to the development of core beliefs, ideas about herself that became part of her personal identity; there were beliefs that ‘I’m a failure; I’m worthless.’ These led on to assumptions predicting that ‘I am always going to be bullied’ and ‘I will always be unattractive.’ These are irrational because, while a fear of being bullied or a perception that you have some unattractive features may be reasonable, it is not rational to believe that you will be bullied or unattractive all the time and in all situations, and that you cannot do anything about this. Challenging these irrational beliefs would give Freda the opportunity to deal with events that might affect her in the future. These assumptions are triggered, or brought to the forefront of Freda’s mind, by events that happen to her. So when, in her next school, where the second previous incident of bullying took place, she had a period of sickness and was again bullied, these confirmed the core beliefs and assumptions and caused automatic thoughts to rush through her head: ‘I’m fat and

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Reviewing social cohesion theories Predisposing factors Biological factors • Genetic vulnerability to anxiety or depression

Psychological factors • Low self-esteem • Shy temperament • External locus of control – feeling unable to exert control over anxiety-provoking events

Attachment and early life • Anxious attachment

Perpetuating factors Personal Biological factors • Dysregulation of: – GABA (the neurotransmitter gamma aminobutyric acid) – adrenaline – noradrenaline – serotonin

Contextual Psychological factors • Avoiding school • Threat- and danger-oriented cognitive set • Hypervigilance • Misinterpreting somatic symptoms as ill health

Treatment factors • Denial, low motivation, nonengagement • Poor communication/liaison between family and agencies • Unhelpful school placement • Lack of knowledge among school staff

Protective factors Personal Biological factors • Good physical health

Contextual Psychological factors • High self-esteem • Easy temperament • Optimistic attributional style • High IQ • Good coping strategies • Internal locus of control

Treatment factors • Acknowledge problem, shared goal, commitment and motivation • Coordinated, joined-up approach from agencies • Freda has been reintegrated to school before

Precipitating factors • Bullying – ‘Bullying by peers and victimisation by teachers may precipitate anxiety problems’ (Carr, 2006: 504) • School transition

• Abuse

• Life stressors

• Bereavement, loss or separation

• Illness/injury

• Moving house

Figure 7.7  Assessing the Four Ps

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Family influences • An anxious parent • A theme of anxiety or threat within the family

Family factors • Modelling, reinforcement of avoidant behaviour • Poor knowledge of anxiety • Overinvolved parent–child interaction • Insecure parent–child attachment • Neglectful parenting • Low parental self-esteem, poor coping strategies • Triangulation • Parents seeking repeated medical examination for somatic symptoms • Parental issues, e.g. substance misuse, domestic violence or physical/mental illness, which may compound the child’s anxiety • Family stress, social isolation and disadvantage

Family factors • Secure attachment • Authoritative parenting • Good communication • High marital satisfaction • Good understanding of anxiety • Parents’ internal locus of control • Good parental self-esteem/coping strategies • Optimistic attributional style of the parents • Absence of domestic violence, parental substance misuse or parental illness • Low family stress • Good family support network • High socioeconomic status

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ugly, people will laugh at me, I might cry.’ This produced an emotional reaction of worry and sadness, which led Freda to think ‘I have to stay off school.’ CBT interventions focus strongly on the current situation. Freda and I explored this by picking up a recent event that had been difficult, in that it had caused Freda to become very anxious. This was ‘thinking about going to school again’. She completed a simple formulation of her thinking: 1 What did you think? – I will be bullied. What if I can’t cope? 2 How did you feel? – Anxious, worried and scared. 3 How did your body change? – Feel sick, can’t breathe, feel sweaty and shaky. 4 What did you do? – Stayed at home. There were four main aims of the first intervention session. The first was to use these two assessment activities as part of ‘introducing CBT’, since engaging in assessment is an important part of beginning the intervention. This built an experience of a working relationship, clarified the issues that we were to work on and established a focus for our action. The second aim was to define the problem, set goals and timescales and think about the resources that we needed to use. We defined on a scale from 1 to 10 how serious the problem was at referral and now, and what point on the scale would be reached when the work had been completed. This technique is drawn from solution-focused practice. Many interventions call on activities drawn from a wide range of theories with separate origins. The third aim was to explain how CBT worked, through the experience of the assessment process and through explaining the principles of managing anxiety. The fourth aim was to coordinate the expectations of Freda’s family, school and other agencies through completing the common assessment framework process, which establishes regular feedback to any other agencies involved. The work then proceeded through a typical pattern for CBT interventions: a series of working sessions with Freda, interspersed with homework (in vivo activities) in which she established and reinforced changes in behaviour, as shown in Figure 7.8. The first homework was to keep an ‘anxiety diary’ of any events that led to anxiety, and of the thinking, bodily symptoms and behaviour that resulted. These were reviewed in the first part of each subsequent session. The second session focused on physiological factors. The aim was to increase Freda’s awareness of the physiological changes that affected her when she became anxious, and help her to learn relaxation techniques to manage these changes. The techniques included practising a deep breathing exercise, a panic breathing exercise and muscle tension and release exercises, listening to a relaxation CD and visualization techniques. The aim of visualization is to help people shift their picture of how they behave in a stressful situation by visualizing different ways of reacting in a place and at a time when they feel safe. This helps them to practise safely various alternative ways of dealing with something they find difficult, and practise managing the anxiety as they visualize the problematic situation. The homework after this session was for Freda to try out the various relaxation techniques and record in her anxiety diary how effective she felt they had been. In the third session, we looked first at the diary, discussed which relaxation techniques appeared to be effective and considered how Freda could adapt her behaviour in response to this learning. The main aim of the session was to explore environmental factors. We looked at

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Session 1

Assessment Learning about CBT Behaviours Homework

Session 2

Review homework Physiological factors Practise relaxation Homework

Session 3

Review homework Environmental factors Identify supports Homework

Session 4

Review homework Thinking patterns Rehearse next actions Homework

Session 5

Review homework Behaviour Identify rewards

Figure 7.8  CBT intervention programme

what had and had not helped her in the past when she had tried to manage a difficult situation. To build on this, we used a ‘brick wall and ladder’ worksheet. This created a picture of the steps on a ladder that would enable Freda to get over a brick wall in her way. The homework for this session involved Freda identifying ways in which she could address the blocks standing in her way, for example by calling on a school friend to accompany her. The fourth session addressed Freda’s thoughts and thinking patterns. The aim was to look at negative automatic thoughts and begin cognitive restructuring. This involved helping Freda to identify dysfunctional or negative views of herself, or how the world, in the shape of her school and potential bullies, operated, and then to learn how to challenge these thoughts rationally and develop alternatives or arguments against them in an organized way. As homework, Freda was to attend a school evening meeting to look at curriculum options for the following year. As well as using her anxiety diary, she prepared for this by rehearsing her responses to possible questions and situations, and the relaxation techniques she could use in this situation. Building on our work on cognitive restructuring, Freda’s homework consisted of identifying thinking errors and listing adaptive thoughts.

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The fifth session worked on Freda’s behaviour, building on her homework and her experience of the options evening. Homework reviews focused on how her belief in her thoughts had been affected by the behavioural experiment of attending the options review. This enabled her to look again at a simple formulation of her cognition, affect, physiology and behaviours using this new experience of the real world. She identified and rated her previous and current experience, and identified the rewards she felt as a result of success with her new experience. Her homework was to attend the first day back at school, on a part-time timetable that had been agreed through the coordination arrangements set up at the beginning. The sixth session reviewed the whole experience. The main focus was on how Freda could manage situations in which she felt stuck, using the techniques she had learned. For example, she could restart her anxiety diary, practise relaxation and work on cognitive restructuring. It was important for her to realize that she could manage any difficulties on her own but that I was available for her to return to if she needed it. This proved not to be necessary, and Freda’s progress at school became satisfactory.

Conclusion: using CBT The main uses of CBT are in mental health services, particularly where depression and anxiety are an issue. It is also used where behavioural change is needed to tackle a learned psychological disorder; that is, where an adverse reaction to life experiences has been built up into a pattern of behaviour. These situations often occur where someone is avoiding something that they recognize they need to do, or where they accept people around them, such as their spouse, parents or peers, telling them that they must change their behaviour. Social learning can also enhance people’s skills to deal with things they find difficult in their lives, and is often used with people with learning disabilities to improve their interpersonal and practical skills. Some very structured forms of CBT have been used with challenging clients, such as substance abusers, who are very hard to engage, as well as in criminal justice settings. While these have been enthusiastically taken up by some agencies, controversy about the values inherent in CBT theory and about the emphasis on positivist EBP research as the basis for CBT has limited its impact on general social work practice in many settings and in many countries. Important characteristics, particularly of behavioural theory, are its highly structured approach (Teater, 2014: 150), careful assessment to identify precisely the behaviours that are being targeted and development of a programme of behaviour change considering only that behaviour. This means that offering the approach to a wider range of clients would require extensive and in reality advanced training in the techniques and experienced supervision that would support their appropriate use. This is inappropriate and unavailable in the average social work agency, but it is relevant in specialized mental health services, and the research most strongly supports CBT in these areas. Some practical ways of working on patterns of unhelpful thinking that get in the way of wider helping services can be useful as a specific intervention when practitioners are involved with a broader range of help. Many possibilities for practical action with clients are proposed by CBT practitioners and can be used as part of other forms of social work, and CBT has created a model of psychological help that underlies other structured psychological techniques which aim to meet other objectives. Chapter 8 on motivational interviewing explores one of these.

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Additional resources Further reading

Dobson, D. & Dobson, K. S. (2017). Evidence-based practice of cognitive-behavioral therapy (2nd Ed.) New York: Guilford. Kennerley, H., Kirk, J. & Westbrook, D. (2017). An introduction to cognitive behaviour therapy: Skills and applications (3rd Ed.). London: Sage. Two good examples of clinical texts on CBT. Ronen, T. & Freeman, A. (Eds.) (2007). Cognitive behavior therapy in clinical social work practice. New York: Springer. A comprehensive edited collection with detailed accounts of practice with different client groups, which authoritatively presents the arguments in support of CBT. Cigno, K. & Bourn, D. (Eds.) (1998). Cognitive behavioural social work in practice. Aldershot: Ashgate. A useful collection of theoretical and practice articles. Crane, R. (2017). Mindfulness-based cognitive therapy: Distinctive features (2nd Ed.). London: Routledge. A good summary of some basic techniques in mindfulness-based CBT. Boone, M. S. (Ed.) (2014). Mindfulness and acceptance in social work: Evidence-based interventions and emerging applications. Oakland, CA: Context. Hick, S. F. (Ed.) (2009). Mindfulness and social work. Chicago: Lyceum. Northcut, T. B. (Ed.) (2017). Cultivating mindfulness in clinical social work: Narratives form practice. Cham: Springer. All these books present a good range of articles showing how mindfulness is applied in social work.

Journals Journals in this field such as Behavioural and Cognitive Psychotherapy or Cognitive and Behavioral Practice are multiprofessional and mainly written for and by psychologists and psychiatrists.

Websites http://www.rcpsych.ac.uk/mentalhealthinfo/treatments/cbt.aspx A good account of CBT for public information, provided by the British Royal College of Psychiatrists. http://www.nhs.uk/conditions/cognitive-behavioural-therapy/Pages/Introduction. aspx A similar public information website for the British NHS that contains a video of a CBT therapist discussing the technique.

CHAPTER 8

Motivational interviewing MAIN CONTRIBUTION Motivational interviewing (MI) is important in social work because it uses a distinctive transtheoretical model (TTM), a theory of the stages by which people move through personal change (Prochaska & diClemente, 1984). It then focuses on building alliances between worker and client to generate motivation towards change. This focus allows MI to guide us in making progress with involuntary or unwilling clients. Originally developed with alcohol and drug abuse, it has proved valuable for social workers, who often work with clients who are demotivated by oppressive social circumstances, especially in criminal justice, child safeguarding and substance abuse work.

MAIN POINTS ●● ●●

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MI focuses on developing and using clients’ motivation to make changes in their lives. It is based on a model of personal change that is transtheoretical; that is, it is claimed to apply across many psychological theories. There have been debates about its applicability to a wider range of clients’ problems, its empirical support and theoretical coherence, and its approach to therapeutic alliance. Although it is recognized as practically useful, there are critiques of its silence on social objectives and social sources of the problems addressed by its techniques. Practice involves commitment to the so-called MI Spirit, a set of working values similar to most social work practice values. The four principles of practice aim to develop clients’ motivation to change. Four important skills are using open-ended questions, affirming clients’ achievements, reflecting to highlight clients’ ambivalences about change and making summaries to link separate elements of clients’ thinking. An important objective is to shift clients’ ‘sustain talk’ towards eliciting ‘change talk’.

Motivational interviewing

PRACTICE IDEAS ●●

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Evocation. MI requires practitioners to evoke or open up the clients’ strength and skill to achieve desired changes in their lives. Self-efficacy. An important aim is to build and support clients’ belief in their capacity to make changes in their lives and social world. Sustain and change talk. Motivation to change is built by helping clients move away from expressing in talk their thinking about difficulties in making desired changes to expressing possibilities for change. Discrepancy. Change is motivated by helping clients become aware of the discrepancy between their life as they want it to be and as it is now. Rolling with resistance. Redirecting clients’ resistance to change through reframing their thinking processes helps retain their motivation to change. Affirmation. Reminding clients of, and acknowledging, their achievements builds change motivation. Elicitation. This involves drawing out ambivalence about and opportunities for change.

THE DEBATE SUMMARY The main areas of debate about MI are: ●● ●● ●●

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whether it is truly applicable with a wide range of clients’ problems; the extent to which using it is supported by empirical evidence; whether its collaborative approach achieves an appropriate therapeutic alliance in practice; the extent to which it is theoretically coherent.

Debate about motivational interviewing Is it widely applicable? MI was introduced in agencies working with substance misuse and represents a shift from medical approaches to this problem towards incorporating psychological factors and the social pressures on clients into intervention. It has also proved to be portable to different professions and a wide range of social problems. Hohman (2016: 3–4) identifies studies in social work with young people in school settings, various public health projects, interpersonal violence, vocational rehabilitation, homeless young women, disabled people, child safeguarding, alcohol and drug treatment and criminal justice. TTM, the basic theory of change, however, developed in helping people to quit smoking, while MI itself was devised mainly in addiction services and much of the research is still in these fields. There are questions, therefore, whether a public health education method will prove to be broadly applicable, especially where the source of people’s problems is poverty, ill health, inequalities and other social pressures. A psychological change model is likely to be ineffective in such situations.

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Consequently, like many of the psychological change theories explored in Chapters 4, 5, 6, 7, 8 and 9, MI places responsibility for change with clients, openly or inexplicitly blaming them for their position. It fails to address social factors that created the problems they face and that maintain them in a situation where it is hard to achieve personal goals. It may, therefore, be less relevant in social work agencies than in the medically and psychologically oriented services where it originated.

Is it supported in social work by empirical research? There is a lot of research evidence about MI, covering therapists in different settings (Miller and Rollnick, 2013; Teater, 2014), although much of this is from the USA where social work is more oriented towards mental health services and more psychotherapeutic in character than the social work of European welfare states or countries in Africa and Asia. There is evidence that it is increasingly adopted in social work settings in the USA, and fits well with social work values (Egizio et al., 2019). The overall finding of the empirical research is that it has a small to medium effect with several difficult behaviours, with most of the evidence being about addictive behaviours (Miller & Rollnick, 2013: 379–80). This level of effectiveness is typical of many therapeutic techniques, as we saw in Chapter 2, but MI achieves this with more difficult client groups. The biggest effects are where it is guided by a detailed practice manual and is closely supervised, so that practitioners use the model carefully. Its claim to effectiveness also benefits from a ‘contrast effect’ (Miller & Rollnick, 2013: 381). That is, a lot of the research in addiction services introduced it in a setting where harsh or confrontational approaches had been used to get people to take part in treatment, and its supportive and caring approach was innovative. It probably makes less difference where a sensitive social work approach is already being used.

Is its model of collaboration relevant in social work? A basic issue with the approach is that it is collaborative. We saw in Chapter 1 (Figure 1.7) that alliance is one of the shared principles of social work and many forms of therapy and counselling. While MI may fit with this ideal, however, its model of collaboration is more limiting. Although it accepts that clients may be demotivated, it requires that they come to accept the agreed objectives. Imposition or pressure to conform does not fit this model. Agencies dealing with addiction, behavioural difficulties, child safeguarding or criminal justice may, however, be at odds with the practice approach if they use the techniques to achieve compliance with legal requirements. Teater (2014: 244) usefully identifies some ways of dealing with this. She suggests, first, that clients need to be able to make the connection between present behaviour and life goals; this is what MI describes as ‘discrepancy’. Second, involuntary clients who do not accept they have a problem may conform with MI while the work is going on and then revert to past behaviour. The third issue is about the social worker’s approach. You have to be genuinely committed to collaboration. Being too strong with suggestions and guidance will negate the value of the approach. Teater’s point is that using the model complete is unlikely to be universally possible. Rooney (2018: 101) comments, however, that the approach may help where the collaboration leads to clear acknowledgement of the problems to be tackled. Many of the

Motivational interviewing

practice ideas may, moreover, help us with engaging difficult-to-help clients, rather than providing a universally applicable model of practice.

Is it theoretically coherent? Egizio et al. (2019: 236) draw attention to criticism that MI is atheoretical, since rather than developing a coherent theory of behaviour change, it brings together different perspectives on behaviour change without a consistent perspective. Trevithick (2012a, b: 359) suggests that Prochaska and diClemente’s TTM theory of change does not theorize change, but only describes it. Many different processes might go on around people who are making changes in their lives. It is doubtful that TTM is universal, relevant to every change situation and to every culture and ethnic group. Theoretical influences on MI suggest that there is more to behavioural change than rational thinking and planning, and looking at wider theoretical perspectives and connections in the next two sections we can see how many disparate theoretical ideas are included in MI. Although there is evidence of MI being used with minority ethnic groups, mainly in the USA and in substance misuse services, this seems mainly to be in services such as child safeguarding and substance misuse. These are often provided by majorities for minority groups, and it is not clear that the model of change or communication style of MI is relevant in indigenous groups or within cultures where family and community engagement in change is required. Hohman (2016: 13–14) suggests that there is little research on its use in community work or in policy and social change, although she offers experience to overcome this lacuna. This point connects with the debate about whether the model is applicable in social work. It does not have answers to many of the social issues that clients of social workers face, even if it has techniques to apply to practice.

Major statements A book by the creators of MI is the main source for the theory (Miller & Rollnick, 2013); the authors are respectively of US and UK origins. First published in 1991, following up a 1983 article that introduced the concept, it is now in its third edition (2013). They edited a series of texts introducing it to different professions, and Hohman’s (2016) contribution to this series is used as the example text in the applications section of this chapter, with additions from other accounts, in particular Corcoran’s (2016) practical guide. An extensive workbook aimed at a range of professions (Rosengren, 2018) is a useful source of practice ideas.

Wider theoretical perspectives The most important theoretical element of MI is Prochaska and diClemente’s (1984) transtheoretical model of change. Change isn’t a turning point achieved after the short period of disorder, as in crisis theory. We should accept that it is a process, taking a long time, in which we go through a series of five stages, set out in Figure 8.1.

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Stage

What is going on

Precontemplation

People are aware of difficulties in their lives and pressures to make changes, but do not accept the full implications of their situation and are not ready to make changes.

Contemplation

People accept that they have a problem, but see the difficulties of making a change. They spend a lot of time worrying about their difficulties and the prospect of change, but cannot see how to make a start.

Preparation

People decide that they must take action to make the change, and may start to make moves, but they remain ambivalent about whether they can make a go of it, and find it difficult to set an objective and make concrete plans.

Action

People develop energy and commitment to take action, and they modify their behaviour and environment, undertake useful tasks and gain experiences. It is easy to mistake all the activity for the achievement of the change itself.

Relapse/termination/maintenance

This stage has developed through several iterations of TTM, bringing together various points.

Figure 8.1  Prochaska and DiClemente’s transtheoretical model of the stages of change

PAUSE AND REFLECT  TTM and intervening in change Look at the account of change outlined in Figure 8.1 and compare it with your experience of practice. What helpful ideas does it offer you? What limitations does it have in accounting for your experience?

Some suggestions The most helpful aspect of TTM for social work is the way it sees behavioural change as a difficult and long-term process, while crisis, task-centred and CBT practice focus on brief one-­ off changes. In this way, TTM recognizes the social complexities and realities of change in many of the situations that social workers are likely to deal with. Other helpful aspects are that it warns against relying on early thoughts about change as signs of ability to change. It also cautions against seeing activity as change. Comparing it with task-centred practice, for example, MI cautions that simply carrying out tasks to deal with immediate problems does not motivate people to work on wider and more complex issues in their lives. The task-centred practitioner would respond that at least it gets some difficulties out of the way and may give people experience of success that can motivate them more widely, although MI would argue

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that simply experiencing success does not help people to actually use their improved motivating feelings. MI provides a route to using motivation effectively. MI also accepts that relapse is common and that dealing with it must be part of any attempt at behavioural change. Again, crisis, task-centred practice and CBT, while they all recognize that achieving change and maintaining it are difficult, do not really make provision for tackling relapse and restarting the process as MI does. A weakness of the theory for social workers is its emphasis on how people move through change, since this means that it offers no theorization of a practitioner’s role in facilitating, guiding or supporting, and in many ways it draws attention to reasons why the process might not work smoothly. MI is an extension of TTM that presents a model of practice to help the change move forward and help people over the bumps in the road. Other weaknesses are that it does not tell us how to help people move on from each stage to the next; again, we need MI or some other practice guidance for that. An issue with MI in this context may be the precontemplation and contemplation stages. The model assumes that, as in substance abuse services, there will be long-term occasional contact with a client, while they go through months of thinking about change until they are ready. While MI helps them to get to the point of being ready, it really kicks in at the planning and action stages. Many social work agencies, with only intermittent contact with clients and with a policy of closing cases that make no progress, will not be able to make a contribution to these stages, and so will not build up the relationships required to intervene successfully when clients are ready to plan and take action. Moving on from TTM, a wide range of other theory makes contributions to MI ideas. Shirran (2018) itemizes not only TTM as a contributor to MI, but also goal systems and goal-­ setting theory, attribution theory and self-determination theory. Goal theories propose that setting rational steps towards goals is effective in changing behaviour, but this takes a mechanistic view of how people change. Such ideas make a wider claim than theories such as task-­ centred practice because, in that theory, practice tasks are ways of learning skills and taking action. Goal theories say that having goals in itself changes behaviour, and they assume that brains operate rationally in response to goal-setting, which may not be true. Attribution and self-determination theory look at how people decide on the source of their successes or failures in life, and believe that internal or external factors lead to their problems and achievements. Hohman (2016: 23–7) also notes that various psychological theories contribute to MI thinking, including: ●●

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Person-centred practice, seeing the individual as individual responsible and needing personal development. Self-determination theory (Shirran also picks this element up) views people as seeking self-fulfilment. Dissonance theory, which sees the difference between what we experience and what we believe as important; this contributes to the MI concept of discrepancy. Self-perception theory, which looks at how people’s articulation of thoughts about themselves influences their decisions and actions; this contributes to MI’s use of people’s ‘change talk’ to decide when they are ready to change.

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Self-affirmation and self-efficacy theory examine how people’s affirmation of the self-­ worth and realistic belief in their capacity to affect the world is an important element of any ability to achieve behavioural change. Psychological reactance theory, which suggests that it is normal for people to become angry and uncooperative when their sense of autonomy is threatened, supports the MI concept of ‘rolling with resistance’.

Connections MI is cognitive and behavioural in its approach, but there is a question about the extent to which the approach contains a social learning element (see Chapter 7). This is because it focuses strongly on specifying and changing behaviour, identifying particular behaviours as problematic. The social learning idea of self-efficacy, a person’s belief that they have the capacity to make changes to the world, is also part of MI. Its approach is educational, in that it seeks to develop clients’ belief in their capacity to change, teaching and giving them confidence in their ability to develop further skills. It urges clients to find learning within their present abilities, however, rather than emphasizing looking outside themselves for models of behaviour. The style of approach is more ‘you can already do this, use what you have’ than ‘you need to learn new things from others’. MI’s focus on talk, such as ‘sustain talk’ and ‘change talk’, makes connections with social construction ideas (see Chapters 11 and 12). It suggests that people have constructed their social relationships around the idea that they cannot change, and this is represented by their talk. Once their talk indicates a new construction of the world, they can build on this to have an impact on their own behaviour in the real world, not just in their constructions about the world. These social construction elements also connect MI to contemporary positive psychologies, rather than the problem-directed cognitive and behavioural psychologies. Indeed, MI’s detailed prescriptions for talk and practice offer a good example of how we can implement positive psychologies in a practical way.

The politics of MI The main element of MI politics is its express focus on communication skills and techniques for influencing clients. The positive view of this is that it gives concrete help to practitioners in what many of us experience as a difficult part of the helping process. The critical view is that putting everything into a manual of techniques (manualizing practice) devalues flexibility and focuses on changing clients’ behaviour rather than working on the social factors that create the problems that affect them; we have seen this issue in CBT and other structured treatments. This is an example of the classic tension in social work between interpersonal help based on psychological understanding and broader interventions in social structures, which do not blame the victim for weaknesses in social relations and support in complex societies. An example of this is the controversy in the UK that arose when MI was incorporated as one of two practice methods into ‘frontline’ courses, which provide relatively brief qualifying

Motivational interviewing

social work education as specialized initial training for child protection practitioners. The brevity of the training, the focus on one area of practice and the use of selected theoretical models, including MI, was controversial. This is because it suggested that the profession would benefit from fast-track qualification for practice with limited theoretical emphases, focused on high-priority client groups, rather than qualification through a broad professional education giving access to a wide range of practice models and preparing practitioners to work with a wide range of client groups. Initial evaluation showed that training with a clear practice focus in this way was valued by practitioners and agencies involved (Maxwell et al., 2016). The long-term consequences for social work as a profession are still unclear. Agencies requiring long-term flexibility in staff who are able to use a range of models and work with several different client groups may also find a more restricted theoretical and practice grounding problematic in the long term. On the other hand, a secure base in one practice area may help learning transfer to other areas. The relevance for the position of MI within social work is, again, that it becomes a technique rather than a theorized practice approach.

Values issues Values are an important element of MI, both the values that you demonstrate as you practise and the values that your client thinks are important. On the first element, MI proposes that successful practice requires you to commit to the MI Spirit. This involves four aspects: ●●

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Partnership – you work for and with a person. Because you are activating their own motivation and potential, they are an essential partner is the work. You’re not doing therapy to them. Acceptance  – you pursue four aspects of respecting the ‘inherent worth and potential’ (Miller & Rollnick, 2013: 17) of all people. This comes from the conventional counselling practice ideas of ‘unconditional positive regard’ (Rogers, 1980: 271; see Chapter 13 on humanistic practice). Another Rogerian principle is accurate empathy, understanding the client’s frame of reference, their view of the world. You support their right to self-direction and the capacity to achieve it. You are also affirming, seeking to find out a person’s strengths, watching out for and acknowledging their achievements. Compassion  – a deliberate commitment to promote clients’ welfare and having their needs met.

So far, you probably think that this is a conventional value system for doing social work. And so it is, but it is not always typical of counselling, medical and psychological services whose starting point is often a disease or medical model of thinking; that there is something wrong with a patiee3nt or client who needs therapy or treatment. As we saw when looking at the debate about MI, the drug abuse services that MI emerged from were often quite confrontational and directive. Emphasizing the MI Spirit aims to change that style of approach. For social workers, it is a reminder how essential these principles are to attempts to change people’s ingrained behaviour, as opposed to assessing for or providing services. It also reminds us of the risk that we can easily slide into being authoritarian or dominating in our attempts to

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make sure that clients are safe, for example in safeguarding practice or in working with older or disabled people at risk. The fourth aspect of the MI Spirit is more novel. It is: ●●

Evocation – you implement a belief that the client has the strength and skill to make the changes that they want to make, and your task is to evoke, open up, the client’s access to those strengths. This connects to strengths-based practice, which, as we see in Chapter 11, is a relatively new emphasis in counselling, psychotherapy and social work.

PAUSE AND REFLECT  Your belief in clients’ strengths and your capacity to evoke them Although most social workers would say they are committed to promoting clients’ strengths, it is often salutary to carry out the following activity. Write a list of your clients’ names. Scale from 1 to 5 the extent to which you consider that the client has the capacity to resolve the issues in their lives that they face. Then scale from 1 to 5 the extent to which you work to evoke that capacity in your work.

Some suggestions The reality of social work is that many agencies that we work with, neighbours of our clients and members of the public think of our clients as ‘hopeless cases’, and it’s easy to become infected with that attitude. The MI Spirit emphasis on evocation pushes us to avoid our work being tarnished in that way. Another striking element of MI, which distinguishes it from other approaches, is the way it emphasizes working with clients’ values as well as their goals, which CBT and task-centred practice highlight. One approach is to do a card sort (Miller & Rollnick, 2013: 80–3). This involves asking clients to sort cards with important values listed on them into five piles such as most important, very important, important, somewhat important and not important. You can vary this by asking for them to sort them into piles as they apply in their lives at the moment, comparing this with what they would ideally like to see. The point is to enable a discussion about what values clients want to achieve, and this helps to motivate them to make progress with those changes.

Applications Accounts of MI practice are not diverse, because the model is relatively recent, so there have not been divergent ways of carrying it out. Moreover, Miller and Rollnick’s (2013) manual of practice emphasizes practicality, with structured guidance, checklists and mnemonics to assist you in following the model, which, as we saw in discussing the research evidence, is important if you are going to be effective. Much of it can easily be picked up and applied to social work. Hohman’s (2016) text, endorsed by Miller and Rollnick, therefore, provides a suitable example of its uses in social work.

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 xample text: Hohman (2016) on motivational E interviewing in social work practice Hohman starts by drawing attention to MI’s main emphasis as a communication technique to make best use of a model of behavioural change by guiding people through change. It is useful to social work practice because it fits with the interpersonal, human approach of much social work and with social work values. It is generic in its thinking and can be used across cultures, although we have seen in the discussion of the debate on MI that there is mainly evidence of majority cultures applying it with minorities in fairly authoritarian settings, such as substances misuse and child protection, rather than MI being useful in alternative or indigenous cultures. The starting point of understanding MI is to apply its four principles, set out in Figure 8.2, using the four skills, remembered using the mnemonic OARS, also presented in Figure 8.2. Hohman’s commentary on the principles (2016: 19–20) connects them to the values expressed in the MI Spirit. She starts from ‘equipoise’ – that we refuse to have objectives that we want to impose on our clients. Society, our agency and our professional judgement may well set objectives, for example to prevent damaging, unsafe or violent behaviour. The MI approach, however, is to evoke clients’ commitments to moving in directions that they want. It is about getting rid of ambivalence about moving in the right direction, and evoking appropriate and helpful ways of moving in that direction. The first principle, to express empathy and reflect back to clients what they are thinking about, allows clients to feel accepted and valued. As a result, they are more willing to think about and express aspects of their behaviour that they are dissatisfied with. When listening to clients, you can do this by: ●●

Observing when something the client says has resonance for you. I find this idea of resonance a useful way of raising our consciousness of empathy. It reminds us of the concept of attunement in attachment theory (see Chapter 7).

Principles

Skills

Express empathy

Open-ended questions

Develop discrepancy Roll with resistance Support self-efficacy

Affirmations Reflections Summaries

Figure 8.2  MI principles and skills Sources: Hohman (2016: 18–22), Miller and Rollnick (2013: 62–73) and Rosengren (2018: 51–137).

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Rephrasing what the client said so that it is emphasized, but avoiding questioning, which clients can experience as hostile. You also express the resonance. Using that resonance to show how you value and understand what the client is saying.

The second principle, developing discrepancy, builds on this, so that clients can express their ideas about the aspects of life that they want to improve and move towards. Our reflection back to them of their ideas points up the discrepancy between how things are now and how they would be if their direction of movement were achieved. You are helping them understand their ambivalence and firm up the choices they want to make. The third principle, rolling with resistance, acknowledges that if clients are not ready to change, they will push back against suggestions, from us or other people in authority, such as their parents, teachers, doctors or relatives. The push back is usually talk about reasons why they cannot change. Case example: Rolling with the resistance of a smoker with COPD Bertie was a heavy smoker who had been diagnosed with Chronic Obstructive Pulmonary Disease (COPD), a serious lung condition. For many years, his wife and doctor had been trying to persuade him to reduce, or ideally give up, smoking, which would improve his physical capacity in many ways. Joe, the social worker assessing him for community services, listened to Bertie’s complaints about how everyone was always telling him to stop smoking and how difficult it was. Joe encouraged him to talk about situations in which he felt he needed to smoke, and then got him to expand on the ‘everyone’ who was putting pressure on him. It turned out that some members of the family refused to allow him to smoke in their homes or to allow his grandchildren, nieces and nephews to visit because of his smoking. Joe reflected back to him his upset that he was missing out on contacts with the young people in his family. Bertie began to see that there would be positives in making

the changes, even though this would be difficult. He also helped Joe to think about the programme of exercise that his clinic wanted him to build up; he could not see how he could do it. Over the three assessment visits, Joe helped Bertie begin to think about whether his wife and two of his children would be prepared to bring their children along to help him take a daily, and gradually lengthening, walk in the park during the summer months. This example makes the point that we do not always have the chance to bring a client to a final conclusion, but as we work away at other responsibilities, we can help them make their own progress until the point, perhaps some time in the future, when they need our help to make a major change. At that point, we might be able to refer them for additional services or spend a planned period of extra time setting them on the path to change. It gives us a forward-­ looking strategy, which redirects and takes us beyond what would otherwise be limiting agency requirements.

The fourth principle, supporting self-efficacy, is another development of the MI Spirit idea of evoking. By helping clients express the possibilities they have in their lives, we are helping them make their own decisions about how to move forward. Getting them to see that they can make some progress and then helping them to think and talk about building upon it improves their self-efficacy. Three important ways of doing this are:

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identifying achievements in similar areas; providing information about how similar people have made progress; persuading or giving hope to clients. For example, you might elicit abilities that they can build on, help them think about the importance of the change they are aiming for and give them confidence that they can use those abilities by looking for occasions when they did so successfully.

The OARS skills are, in some ways, standard social work counselling skills. Open-ended questions are those that have several possible answers, forcing clients to move towards expressing themselves and away from being monosyllabic. It is obvious how these can help in evoking. They can also be an important part of assessment, as well as other kinds of interactions. The ‘assessment sandwich’ (Hohman, 2016: 34–5) is what Joe was doing with Bertie in the case example. It involves spending the first part of an assessment building rapport and the second part dealing with agency forms and assessment tools. These give clients the focus on relevant issues and the understanding of what is going on, which allows them to move on to the third part of the sandwich. This involves evoking options and eliciting ideas about what to do and how to go about it. Affirmations are statements in which you remind and perhaps congratulate clients on things they have achieved. Reflections are of three types; the mnemonic is SAD. You may start with statements where you repeat, rephrase or paraphrase clients’ talk (simple reflections). Moving on, you can exaggerate their talk to reduce their push back (amplified reflections, which lead to ‘it’s not as bad as all that…’). A further possibility is to pick up a client’s statement and build on it to take them further (double-sided reflections). You use these to make ambivalence or uncertainty more positive. Comments sometimes end on a silent ‘but...’ ‘I’d like to help Dad with managing his shopping… (unspoken) but…’. Your double-sided reflection picks up the positive and points to the ambivalence by expressing the ‘but’. For example, you might say ‘I can see you really want to help, but perhaps you’re struggling with all the things that might get in the way.’ Doing this gives clients the chance to understand their ambivalence. Summaries are statements in which you link together a series of comments that clients have made and perhaps connect them to other points they have expressed previously. Engagement and assessment use the OARS approach, building in the collection of good quality information for the agency’s decision-making processes. Another aim at this stage is the MI objective of elicitation. This involves drawing out what a client wants, how they came to be discussing this now and with us in our agency, how they feel about various possible options for change and how they react to the information coming out of the assessment documents our agency uses. In particular, MI seeks to understand their ambivalences about change, how they feel about their options for changes in their lives, and strengths and previous successes in change that they can build on. The options and strengths involve understanding ideas about what they might do, knowledge about resources and barriers, and making some initial plans for change. Forget about voicing your own thoughts, because you already have lots of privileges in the helping process. Instead, aim to elicit clients’ feelings and put them in the foreground. What you do offer, though, is feedback: the principle is elicit–provide–elicit. You are providing information and advice about possibilities, ways in which clients might achieve what you have elicited. You then go on to elicit further responses.

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Moving on from engagement and assessment to intervention, your aims in this later eliciting process is to shift clients from ‘sustain talk’ to ‘change talk’. ‘Sustain talk’ is about the difficulties of making the change, while ‘change talk’ involves thoughts about what might be possible. These thoughts involve expression of needs to change, reasons why they should do so, abilities that they can use, steps that they might take and desires to make the change. Case example: Joanna expresses ‘sustain talk’ but increases ‘change talk’ Joanna, a young mother, was working with her social worker, Casey, through a process of preparing to return two children to her from foster care, after she had become homeless following domestic abuse. Her ‘sustain talk’ was about her worries that her boyfriend might try to move in with them again, the poor furnishing and facilities in her new social housing apartment and her fears that on her own she might find it hard to manage her children’s behaviour in the confines of the apartment. Casey worked to elicit Joanna’s feelings about ways in which she had been firm with her boyfriend in the past, and how he had moved on. She asked about how Joanna’s

friends and family had improved their housing in the past to stimulate ideas about what she could do. One useful feeling she elicited was Joanna’s increasing understanding that her parents had built up their home over time. They were able to talk about making priorities. As well as accepting talk about difficulties with the children, Casey tried to elicit experiences of ways in which Joanna had successful periods of relationships with them. The housing ideas allowed Casey to suggest a period of taskcentred work on searching charity shops and budgeting. Some examples of Casey’s work with Joanna follow in my account of rolling with resistance.

To elicit change talk, you emphasize it as it occurs, adapting OARS to become EARS: elaboration, affirmation, reflection and summarizing. Elaboration involves listening for and picking up on any change talk expressed and getting clients to elaborate on it. You could ask: ‘Tell me more about that’, ‘How could you do that?’, ‘What are the possibilities of doing that?’ A variety of rolling with resistance strategies includes reflection, using the SAD mnemonic (simple, amplified and double-sided reflections; for an explanation, see my discussion of the reflections element of OARS). You can also use SCARED: ●●

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Shifting focus. Examples include explicit agreements to disagree, or, picking up the case study about Joanna, rather than talking about fears about the boyfriend, asking about what might make Joanna feel more in control of relationships with him. Coming alongside, acknowledging the client’s sustain perspective. Another Joanna example: talking about the children, Casey suggested that perhaps they were so difficult that thinking about how to manage them was a low priority. This led Joanna to say that planning for the children was in her mind all the time. In turn, Casey could say ‘that makes it clear how having the children home is a big thing that helps you make progress’. Agreement with a twist, adding to a reflection a comment that reframes its direction. When Joanna was talking about managing the children’s behaviour, Casey made the double-­sided reflection that many parents found the winter months at home with their children difficult, and suggested (the twist) that Joanna might be able to think about some activities in the home and visits outside it that she could plan for.

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Reframing. This involves redirecting a sustain comment as change talk. For example, when Joanna talked about how difficult the lack of furnishing and play facilities in the apartment would be, Casey suggested that many parents spent time thinking about problems with their accommodation so that they could be clearer about how to overcome them. This made the anxieties seem normal, even positive. Emphasizing personal control. For example, Casey suggested that Joanna could only make the decision to allow the children to return when she was confident that they could make a go of their lives in the new apartment. Disclosing personal feelings. Practitioners might use this only rarely, but Hohman (2016: 105) suggests it can sometimes help empathy to express personal reactions to sustain talk. Her example is saying something like ‘perhaps I’m getting ahead of your thinking; let’s go back to the main point of what you were saying’. It shows that you are aware of getting out of step with the client’s thinking.

Conclusion MI uses commonplace communication and influencing techniques drawn from clinical psychology and counselling to systemize a practice for working with difficulties in interpersonal social work. It is valued because it is immensely practical, easy to use and parts of it can be picked up for use in many different situations. While it is, therefore, flexible for practitioners, using it in a bitty way may invalidate the supportive research, which is based on the comprehensive formulation. MI is an implementation of TTM. This account of the process of personal change was previously familiar, but had not been put into practice in such a useful way. Operationalizing this set of ideas about change is, therefore, a useful contribution to social work thinking. Critiques of its value stress that it says nothing about, indeed it studiously avoids, the aims of the work that it facilitates. And it says nothing about the social sources of the problems that it provides techniques to resolve through interpersonal influence. It contributes mainly to the psychological skill base of social work but not to wider thinking about its objectives. Its focus is entirely on clients’ thinking, and it offers little guidance on interventions in community, family and social networks.

Additional resources Further reading Miller, W. & Rollnick, S. (2013). Motivational interviewing: Helping people change (3rd Ed.). New York: Guilford. The current edition of the source text by the clinical psychologist originators of MI. Corcoran, J. (2016). Motivational interviewing: A workbook for social workers. New  York: Oxford University Press. Hohman, M. (2016). Motivational interviewing in social work practice. New York: Guilford. Two practical social work texts about MI.

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Rosengren, D.  B. (2018). Building motivational intervention skills: A practitioner workbook (2nd Ed.). New York: Guilford. Extensive practical guidance on using MI. Prochaska, J. O. & DiClemente, C. C. (1984). The transtheoretical approach: Crossing traditional boundaries of therapy. Homewood, IL: Dow/Jones Irwin. This book is the original formulation of the transtheoretical model of change.

Websites https://motivationalinterviewing.org MINT (Motivation Interviewing Network of Trainers) gives access to a very wide range of resources and research. https://www.youtube.com/watch?time_continue=243&v=n263wS6-l24 A short video providing an introduction to the main principles of MI, based on interviews with a range of therapists from different countries. https://www.youtube.com/watch?v=bTRRNWrwRCo A short video for general practitioners in a British context, conducted by Rollnick, published by the British Medical Journal, on working with someone with weight problems. It illustrates how you get someone working on something that is problematic for them. https://www.youtube.com/watch?v=67I6g1I7Zao A demonstration of an interview with a woman with alcohol problems by a social worker. https://www.youtube.com/watch?v=XsmY1VVxUIE A role play of a therapist working with a young man with drug problems. It offers examples of the sort of comments you can make to people with difficulties, including scaling.

CHAPTER 9

Systems practice, complexity and chaos MAIN CONTRIBUTION The main contribution of systems ideas to social work is integration and response to complexity and uncertainty. A long-standing aim has been to integrate interpersonal interventions involving individuals with interventions that also engage with families, communities and other social agencies. Recent developments focus on understanding and responding to the chaos and complexity of people’s interactions within networks involving human beings and the social and natural world. These contribute the emergence of new policies and ways of doing social work that tackle complexity and uncertainty.

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Systems theory integrates social intervention with individual help. Although it seeks to provide for both social change and development and psychological models of practice, it leans towards maintaining social cohesion rather than achieving more radical social change. Systems theory allows for multifactorial explanation, but this creates complexity, making it difficult to give clear practice guidance, especially on choosing the level of intervention. Ecological systems theory focuses on psychological and individualistic equilibrium (rather than on important environmental or ‘green’ issues; see Chapter 16). Macrosystems incorporate middle-sized or meso or mezzo systems, which in turn incorporate microsystems. A focal system, the one you are working with, is always part of bigger suprasystems and includes smaller subsystems. Holistic, empowerment and anti-oppressive aspects of systems are valued, but holism may lead to a loss of focus and a failure to gain genuine consent, which in turn leads to hidden oppression. Systems interact with each other through complex processes in which information and action form flows of energy within and across the systems’ boundaries. If we explore these interactions, we can understand how people in families, communities and wider social environments affect each other.

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In the USA, ecological systems theory became a predominant practice model because it incorporated elements of psychodynamic person-in-environment practice. This meant that traditional therapeutic processes could be integrated into social and empowerment aims. Ecological ‘life’ models of social work seek to incorporate an awareness of social concepts such as fit, adaptedness, life stressors and the life course, which have been drawn from ecological ideas into practice. Social networking is an important application of systems ideas.

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Systems focus on the connections between, and the resources of, families and groups, and on helping those connections to work well. Life stressors apply energy in the form of stresses to a system; this system may be a person or a family or community. Fit and adaptedness between individuals and their social environments are important concepts incorporated from ecological thinking. Work to initiate, maintain and improve social networks; mutual support is a development of systems ideas. Resilience, the capacity to bounce back from adversity, has emerged from ecological thinking as a practice objective.

THE DEBATE SUMMARY Social work debates about systems theory cover four connected points: ●● ●●

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Systems ideas include the social in social work but are weak in theorizing social change. Ecological systems ideas, like traditional social work, emphasize the social environment rather than green issues. Systems ideas, such as adaptation, assume the status quo rather than social change. Systems ideas provide multifactorial explanations, but theory still struggles to generate clear practice prescriptions because of systems complexity.

Debate about systems, chaos and complexity Including the social but not theorizing social change Systems theory benefits social work because it balances two important elements of social work aims, incorporating both social factors and also psychological functioning. Social workers look at individuals holistically in the context of their whole family and social environment, more so than colleagues in healthcare, clinical psychology or counselling. Other professions emphasize a focal individual; everything else is background, in which families, communities or other agencies help or hinder the education, health or well-being of individual patients. Social work brings to the fore individuals’ interconnections with other individuals and groups in their environment.

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Critical theory complains of the limited usage of systems and ecological ideas in social work. Social work systems ideas have focused on how systems maintain, reproduce and adapt themselves, rather than on the possibility, desirability or inevitability of a significant change in these systems. Part of the reason is that extensive development in cybernetics, biology and the social sciences has so far only slowly had an impact in the social work literature. The idea of complex adaptive systems, for example, refers to large systems with many small component parts. While their complexity makes them seem chaotic, that complexity contains patterns that enable us to understand and intervene in how they work. The same ideas may be used to explore artificial intelligence in computers and ecological systems in nature, and extensive scientific work is only slowly influencing social work. The recent work of Hudson (2010), Hood (2018) and van Ewijk (2018) is beginning to theorize this within social work, and we can expect changes that incorporate these ideas more directly in practice theory, particularly in dealing with complexity and uncertainty. This is work in progress. Some people would argue the opposite – that this area of study cannot be adequately theorized for practice. This alternative view suggests that social work practice has selected from aspects of systems ideas that particularly fit its approach.

The social environment but not green issues The emphasis on the social environment in ecological systems theory makes limited use of ecological ideas in social work. It does not reflect the increasing importance of green issues, such as environmentally sustainable living and responding to climate emergencies and other disasters, because it accepts an individualistic approach to ecology. Ecological systems theory argues that ecology is about conserving the existing environment. While it adds social adaptation as an aspect of practice, it is adaptation to the existing environment. By concentrating on social and cultural objectives, systems ideas in social work treat the physical environment in which we all live as a ‘lifeless backdrop’ (Zapf, 2010) to the traditional concerns of our services. Because social work is based on interpersonal practice, it fails to consider how those relationships are constructed by the physical environment around us and how human behaviour affects the environment (Hawkins, 2010). These critiques have led to the development of eco approaches as part of a social change and development and social justice practice, which are distant from systems ideas. I deal with them separately, therefore, in Chapter 16. Eco feminism (Besthorn & McMillen, 2002) argues that political and social systems, including ideas such as ecological systems theory in social work, oppress women’s concern for sustainable and sustaining environments.

Emphasizing the status quo rather than social change The idea of adaptation, which is particularly used in ecological systems ideas, is an example of the limited use of systems ideas in social work. There are three main issues here. One is that, by stressing adaptation, we may fall into the ‘get real’ trap. This is an oversimplified ecological idea that clients need to adapt to the realities of the pressures upon them. But broader systems ideas suggest that we should also look at whether the realities are appropriate and just, and in the cause of social justice, we should think about changing them as well as, or instead of, the client. The second issue is that we may think that total adaptation is possible and desirable.

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Against this, we have to realize that there are conflicts and uncertainties in life, and people may need to be helped to accept and live with those inconsistencies. The third issue is that people may adapt too readily to the expectations around them. There may be better balances in their lives than the one they have come to, or the one that other people expect them to conform to. They may prefer a different way to adapt to the same pressures, or a different approach might be better for them or the people around them. Many practitioners are, therefore, cautious about assuming that their task is to get people to adapt to others’ expectations.

Complex multifactorial explanations are difficult to use in practice Social work uses systems ideas to include the variety of factors, interacting in different ways, in practice. But does the theory help to identify practices and achieve outcomes? Systems theory says that everything is connected, so you could intervene in the system in many different places and achieve results. Like pushing on one ball in a net bag full of balls, however, all the elements could readjust so that everything looked the same afterwards. On the other hand, you might make a change in one member of a system, perhaps a family, and ripples of influence could spread out, achieving significant movement. It is hard to see or predict how all the interactions in the system will work to achieve the outcomes that you and members of the system are aiming for. The theory does not tell you which is going to happen. It feels like giving the system a nudge and hoping that something will be dislodged, or turning the computer off and on when it hangs, but not really knowing what went wrong. On the other hand, systems ideas avoid the theoretical problems of cognitive behavioural therapy and other theories that use linear cause and effect explanations. There may be a long line between what caused a problem and the present situation, but it may equally well be a short hop to a way of resolving it, based on the present circumstances. It may be more efficient to look at resolution rather than trying to explain or understand the situation (Greene & Lee, 2011: 69). We have seen in looking at several psychological theories of practice that asking why is unhelpful to clients and it is better to concentrate on what is happening to them. On the other hand, we saw in considering psychodynamic theory that many people value being able to make sense of what has happened to them.

Case example: Pete, a hyperactive child in the Marsalis family Joanie Marsalis found her hyperactive child, Pete, very stressful to deal with, and she forced herself to be ever-reasonable and responsive to his demands so that she became a calming influence. This put further pressure on her, because she always had to be present to maintain a calm environment. Her husband, Sevvy, got into conflicts with Pete, in which Joanie tried to mediate. Her constant involvement with Pete meant that she did not give herself enough space and time to relax and share personal activities with Sevvy on her own. What are the options for dealing with these feelings? Joanie could take on extra

stress for a time to change their family’s behaviour patterns, and in the long term the pressure would be less. For example, she could get Pete to accept that she and Sevvy should have time out from dealing with Pete all the time. She could explore alternative support systems for set periods, so that Pete could learn to respond to others and so that she and Sevvy would not be at loggerheads over Pete’s behaviour all the time. She could reward them all by having some special time with Pete and Sevvy together. She could work with Sevvy to agree a shared approach to dealing with Pete’s behavioural problems.

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Figure 9.1 is a diagram of some of the systems we can identify in this case example. There are three microsystems, the three individuals, and three mesosystems, the three pairings of the individuals, Joanie and Pete, Sevvy and Pete, and Joanie and Sevvy. There is a macrosystem, the nuclear family. Pointing these out, though, presents us with one of the problems of systems theory, because we could equally well talk about microsystems as being parts of each of these individuals, for example any health problems that they have, and identify wider macrosystems such as their extended family or community. Figure 9.2 illustrates some further systems connected with the Marsalis family, which at the same time highlights some of the criticisms of systems theory. Here, the microsystems

Nuclear family

Joanie

Sevvy

Pete

Figure 9.1  Some systems in the Marsalis family

Community Maternal family

Joanie Work relationships

Pete

Sevvy

School relationships

Figure 9.2  Some more systems connecting with the Marsalis family

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have remained the same – the individuals – but there are two types of mesosystem. One is another system outside the family that each individual is part of: Joanie’s maternal family, Sevvy’s work relationships and Pete’s school relationships. The family now becomes a mesosystem, but a different kind of mesosystem, shown with a blue dotted instead of a grey dotted line round it. This is because the macrosystem is the community. I have chosen to set out Joanie’s mesosystem as her (maternal) family, but you might ask whether Pete is not also a part of that system. I have selected Pete’s school relationships, but Joanie and Sevvy might have different relationships at Pete’s school, for example being more focused on the staff than the other students. Instead of including the paternal (Sevvy’s) family, I have focused on his work relationships. Feminists would argue that this may also reflect a gender bias in my assumptions about what is important in a man’s life.

PAUSE AND REFLECT  Selecting levels and focuses Looking at my comments on the case study and at Figures 9.1 and 9.2, can you identify some advantages and criticisms of systems theory as a basis for analysing relationships and practice?

Some suggestions The main advantage of systems theory is that it makes clear how chaotic and complex social situations are, and helps us to analyse them more fully than many of the psychological theories that seek to oversimplify them to find targets for action and intervention. On the other hand, among the problems with systems theory is that it gives you no clue to the level at which you should tackle the issues or which elements of them you should work on. A children’s service might be presented with Pete as a problem child, with the family at the meso level. On the other hand, a family therapy approach tells us that often relationships between all the family members contribute to the way in which Pete has become problematic to other people, so it might be better to focus on the network of relationships rather than any one individual. Another important issue is that the choices of focus and level that I have made might reflect my personal preferences or assumptions. A feminist might point out that I have, perhaps reflecting gender bias, selected Sevvy’s work relationships, but Joanie’s family roles could equally well be the focus. A critical practitioner might focus on the choice of family as an important macro or mesosystem. Doing this may reflect a social assumption about the greater importance of the family rather than, say, an ethnic group in people’s lives. It may also reflect another social assumption that socially accepted formal social structures, such as family and community, are more important than other less evident or less traditional structures, such as ethnic, gender or national identity.

Major statements Because the use of general or ecological systems theory is virtually universal in the USA, most introductory and generalist textbooks from northern America assume this perspective. Consequently, many American texts on systems or ecological systems theory have become broad introductory texts. Gitterman and Germain’s (2008) account re-engineers their

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pioneering ‘life model’ for the twenty-first century and is still the most significant theoretical formulation of a systems model of practice, even though it does not incorporate up-to-date chaos, complexity or ecocentric theories. I will therefore use it as the main example text in this chapter, while drawing attention to some of the implications for social work of complex adaptive systems theory. Texts from European countries use some systems concepts, but this is not a significant model of practice. Complexity has become a major way of applying the recent development of ideas about complex adaptive systems to social work. Hudson’s (2010) innovative text follows the American psychological emphasis on how people understand, interpret and adapt behaviour in their social environment. European writers such as Hood (2018) and van Ewijk (2018) have recently developed applications of complex adaptive systems ideas. Luhmann (1995; Schirmer & Michailakis, 2019) argues that an important feature of systems is their complexity; they consist of a variety of elements connected in different relationships, which we can never fully understand. It is important to understand how the system organizes those elements, how they interact and communicate, and how they differentiate their functions as part of the system. Systems are self-organizing: through their communication they transmit knowledge and understanding about the external environment, which allows them to react to the world around the system.

Case example: Kaspar’s interactions with young people in local clubs Kaspar was a man in his mid-twenties with mild intellectual disabilities, who, supported by his parents, was a member of a sports club and helped in a youth club that he had been a member of in his teens. He was good with computers and helped in many practical ways in both clubs. He enjoyed playing card games, and often played with young people in both clubs in downtimes between events or at snack breaks. Some of the less confident members in both clubs enjoyed involvement with him. Organizers had noticed, however, that he sometimes touched them inappropriately, massaging tension in their shoulders, for example. Some young people did not like this and commented to their parents. When the behaviour was reported to the clubs’ leaders, he was ordered not to do it. Later, police found that he had been downloading pornographic images of young people onto one of his computers, and although a prosecution was avoided, child safeguarding was invoked and a

social worker gave advice about managing his involvement with the clubs, helping Kaspar, his parents and the leaders. Part of the social worker’s assessment concluded that the family had ‘self-organized’ to deal with encouraging Kaspar to be sociable and involved in the community by strengthening his involvement in the clubs. But there had not been enough communication to transmit sensible rules by the parents in the family, or by the leaders in the clubs, about what he should be involved with. They had thought that since he was mainly OK, he would transfer this to everything, whereas his sexual feelings made him less OK in the new situations. Within the family, there had not been communication about appropriate and legal behaviour around his sexual interests. Kaspar had dealt with the feeling of being an outsider with club members by finding ways of being involved with them during club activities, but had not learned how to manage his sexual interests appropriately in these relationships.

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A Luhmannian systems view of this situation (Schirmer & Michailakis, 2019) draws attention to the interaction of the systems of the family and the clubs, focusing on failures in transmitting expectations between the different settings. It also points to how Kaspar manages his relationships in the family and the clubs, and with the young people he met. What is useful about this analysis is that it gives the social worker a clear focus on the issues to be managed in what was a complicated and emotional situation. Hood focuses on how systems thinking enables people to make decisions in ways that manage uncertainty. This helps practitioners to understand and work through networks within clients’ social environments and their own professional networks. Van Ewijk argues that complexity and diversity apply pressures to traditional models of social work. He shows how practitioners can develop normative professionalism to transform policies for social work in ways that combat neoliberal social policies. This is achieved by developing clients’ personal capabilities and active local citizenship among social networks. I have combined elements of these approaches in an account of these new approaches to systems working, which are still in development.

Wider theoretical perspectives Overview of systems ideas and terminology Concepts about the structure of systems are illustrated in the diagrams in Figure  9.3. The main ones are as follows: ●●

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Systems are entities with boundaries within which physical and mental energy are exchanged internally more than they are across the boundary. Energy (in this context) is actions, resources (such as effort, money and time) and information. If you provide help and information or get extra money for a family, you are putting energy into the family system. Levels of systems refer to the fact that large macrosystems contain smaller mesosystems, which in turn contain microsystems. The system level selected as the focus of concern may vary. For example, individuals are part of suprasystems such as families and organizations, Energy interchange across the boundary Output Throughput

Input

a. A system More energy interchange inside the boundary than across it

Figure 9.3  Systems concepts

b. A closed system No energy interchange across the boundary

c. An open system Energy interchange across the boundary

Feedback loop

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●●

●●

which are bigger than the individuals but encompass them. The focal system is also made up of subsystems; for an individual, this includes their body and its elements, and their mind. Closed systems have no interchange across the boundary; a closed vacuum flask is an example. Open systems occur where energy crosses the boundary, which is permeable. For example, a teabag in a cup of hot water lets water in and tea out but keeps the tea leaves inside.

Systems operate by processing energy. We can understand the way in which systems work by looking at Figure 9.3c, which shows how an open system may be changed by using energy: ●●

●●

●●

●●

Input is energy being fed into the system across the boundary. We intervene by giving information or arranging resources, and the system changes because of this input. Throughput is about how energy is used within the system. The information or resources change what is going on in the system. Output is the effect on people or things outside the boundary of energy that has passed out into the environment. The system changes, and this affects how others perceive it or act as a result of what people in the system do. Feedback loops occur when the outputs affecting the environment lead to further inputs into the system.

A simple example of the processes is shown in Figure 9.3c. If you tell me something (input into my system), this affects how I behave (throughput in my system), my behaviour then changes (output) and you observe this change. So you receive feedback that I have heard and understood what you said (a feedback loop). Systems have various characteristics: ●●

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Entropy  – systems use their own energy to keep going, which means that unless they receive inputs from outside the boundary, they run down and die. The system’s steady state is how it maintains itself by receiving input and using it. This idea suggests that systems, such as human beings, families or social groups, can incorporate change without changing their fundamental identity. You maintain your steady state if you are resilient in the face of change. Resilience is an increasingly important concept in social work. We met steady state ideas in crisis theory (see Chapter 6). The system possesses homeostasis or equilibrium. As the previous point describes, an element of a system’s steady state is its ability to maintain its fundamental nature, even though input changes it. So I may eat cabbage, but I do not become cabbage-like. I remain me, while the cabbage is digested and gives me energy and nourishment. Part of it becomes output, through heat, activity and defecation. We met equilibrium ideas in Chapter 6 on crisis theory, too, but there we found that there are alternative ways of looking at situations, such as cognitive or transitional models. Social equilibrium is not the only possibility for thinking about how systems manage themselves. Differentiation is the idea that systems grow more complex, with more and different kinds of components over time. Non-summativity is the idea that the whole is more than the sum of its parts. Reciprocity is the idea that if one part of a system changes, that change affects all the other parts. They therefore also change.

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As a result of reciprocity, systems exhibit both equifinality (reaching the same result in several different ways) and multifinality (similar circumstances leading to different results) because the parts of the system interact in different ways. These ideas help to understand the complexity of human relationships and why the outcomes of similar actions vary. Social systems may possess synergy, which means they can create their own energy to maintain themselves. For example, human beings interacting in a marriage or in a work team often stimulate each other to maintain or strengthen those relationships. This builds up bonds within the marriage or the group and makes it stronger. This is an example of non-­summativity, because these bonds could not be achieved without the interaction within the system. Without creating synergy, the group or marriage would have to be fed by outside energy, or entropy would occur.

Connections Systems theory had a major impact on social work in the 1970s, but, except in the USA, this faded. It was renewed in the early twenty-first century by the development of applications of complex adaptive systems. Three forms of systems theory, then, are: ●● ●● ●●

general systems theory; ecological systems theory; complex adaptive systems theory.

Hearn (1958, 1969) made early contributions, applying systems theory to social work. The greatest impact came with two simultaneously published interpretations applying systems ideas to practice (Goldstein, 1973; Pincus & Minahan, 1973). These had considerable international influence. The later development by Siporin (1975) and Gitterman and Germain (2008; Germain, 1979) of ecological systems theory had a considerable impact in the USA.  This draws on the ecological systems theory of Bronfenbrenner (1979), an American child psychologist who described child development using ecological terminology. These ideas have been developed in the USA and Canada over several decades and been expressed in ecosystems and ecological systems theory texts that, as I mentioned when discussing major statements, have become widely accepted general formulations of social work, influencing many other texts on practice. While the UK and other countries are aware of systems ideas, particularly in family therapy, the literature related to ecological systems has not had anything like the same influence, and systems theory is little used in practice texts. Therefore, there are few connections between systems and ecological ideas and other social work theory in the non-US theoretical literature, whereas in the US literature these ideas are central to most forms of practice. This is one of the major distinctions between US and non­US accounts of social work practice. Systems ideas are, however, present in all social work in the assumption that its distinctive feature is the way in which social work practitioners work with family and community relationships as well as with the focal patient in healthcare and the focal pupil or student in education.

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The politics of systems theory Systems theory was an aspect of the reaction against psychodynamic theory in the 1970s. Its sociological focus seemed to counter psychodynamic failures in dealing with the social in social work. In addition, its wide applicability incorporating social ideas seemed to be a new view of social work as a single professional entity rather than a series of specialist services. In the USA and the UK, separate professional organizations within social work had been merged (in the 1950s and 1960s, respectively). In the UK, separate local government agencies had been merged in the Seebohm reorganization of 1971, and many European countries followed a similar trend. The systems theory focus on ‘wholes’ (Hanson, 1995) and integration (Roberts, 1990) was thus an attractive contribution to social work. Another source of influence was its importance in family therapy, which infiltrated social work in the mid-1970s. Here, systems theory is a major perspective, since it provides a way of understanding how all the members of a family can affect and influence one another. This capacity to deal with the analysis of relations among people in groups was also useful in residential care (C. Payne, 1977; Atherton, 1989). Compared with radical theory, the other sociological critique of traditional social work theory that was influential in this period, systems theory did not propose critical ideas that attacked social organization and social policy. One reason for its success has been that it accepts and analyses existing social orders rather than, as with radical and critical theory, analysing and attacking them. It was incorporated into existing accounts of traditional psychodynamic social work, such as Woods and Hollis’s (1999) account of psychosocial practice. Systems theories offer a context for understanding how the public and private interact and how various change agents might be involved. They also raised for the first time as a central aspect of the theory the possibility that practitioners and their agencies might themselves be targets for change. The acceptance of present social orders therefore allows the ideas of systems theory to fit well with a profession and agency structure that is part of the state and has authority and power. Systems theory gained influence when social work was expanding and taking up roles in state agencies in many countries. Unlike critical theory, it relates successfully to psychological theories, since it does not reject theories at this level of human behaviour but permits their incorporation into its wider framework. General systems theory has declined in influence within social work, being replaced by ecological systems ideas. The new perspective of complex adaptive systems, discussed briefly above, emphasizes complexity and chaos theory.

Values issues Teater (2014: 32–4) identifies empowerment, holism and the anti-oppressive aspects of systems ideas as important values advantages of systems theories. She points to the issue, however, that social workers’ agencies often have a limited role and this means not picking up wider implications of clients’ systems. Moreover, looking holistically at a wide range of systems in the client’s life may mean over-assessing by taking too wide-ranging and detailed a

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view of matters beyond the client’s understanding and genuine consent. An example is Howe’s (1989) study of family therapy using systems ideas. He found that clients often did not understand or accept the practitioners’ focus on family interactions rather than on a child’s individual responsibility for difficult behaviour. Two substantial critiques of social work’s use of systems and (particularly) ecological ideas suggest that this usage has not kept up with the shared principles identified in Chapter 1 as developing in current social work practice. One issue is the focus on problems and poor adaptation, rather than the positives and strengths in people’s environments. Another is the limited incorporation of critical social analysis. The discussion of Gitterman and Germain’s ecological systems theory as an example text later in the chapter gives a good example of how this critique points to weaknesses in the links between ecological and systems theory and currently theorized social work values. Another failing of ecological systems theory, crucial in the development of eco practice concerned with eco disasters and environmental sustainability, has been to incorporate a social justice perspective on wider ecological issues (Dominelli, 2012; see Chapter 15). If social workers are to act justly, they must connect the help they give their clients to achieve a secure, healthy and satisfying life with the need of all human beings to achieve the same life objectives. In addition, it would be environmentally unjust to support people now to the detriment of the resources available for people in the future (Muldoon, 2006), so social workers must also consider how the resources used in their present helping might damage future generations, and must moderate their actions accordingly. Consequently, IFSW (2020) has a programme of work on a ‘global agenda’ to incorporate these ideas into social work thinking (Hall, 2012).

Applications Systems practice The starting point of systems practice is to avoid focusing only on the individual. In a classic analysis, Pincus and Minahan (1973) identify four main systems relevant to social work practice, set out in Figure  9.4, with an addition by Compton, Galaway and Cournoyer (2005), which draws attention to the way in which the social constructions of the political, legal and professional environment of social work affect its practice, as we saw in Chapter 1. In some ways, this account merely transposes ideas such as practitioner, agency and client into systems terminology. To treat this as a simple renaming, however, misses the point of seeing these ideas as people and organizations linked in complex relationships with each other, whereas psychosocial practice is individualistic, concentrating on the client and seeing all the other factors as secondary or indirect work. Pincus and Minahan (1973) also identify three kinds of helping system in which social work practitioners operate: ●● ●● ●●

informal or natural systems (such as family, friends, postal workers and fellow workers); formal systems (such as community groups and trade unions); societal systems (such as hospitals and schools).

Systems practice, complexity and chaos 237 System

Description

Further information

Change agent system

Social work practitioners and the organizations that they work in

Client system

People, groups, families and communities who seek help and engage in working with the change agent system

Actual clients have agreed to receive help and have engaged themselves Potential clients are those whom the worker is trying to engage (e.g. people being investigated for child abuse)

Target system

People whom the change agent system is trying to change to achieve its aims

Client and target systems may or may not be the same

Action system

People with whom the change agent system is working to achieve its aims

The client, target and action systems may or may not be the same

Professional system

People within the agency, legal, professional and research communities influencing the change agent and action systems

Professional systems construct the practice undertaken in relation to other systems through the processes discussed in Chapter 1

Figure 9.4  The main social work systems Sources: Pincus and Minahan (1973) and Compton, Galaway and Cournoyer (2005).

Case example: Seeing practice in systems terms Gahan was a mental health practitioner working with Jareb, who had a diagnosis of schizophrenia and lived in supported living accommodation near his parents; they also provided him with a lot of help. In addition, Jareb was regularly visited by a carer employed by a local mental health association that was contracted to provide this support. One aspect of Gahan’s work was building a personal supportive relationship with Jareb. Most of what he did, however, was maintaining a liaison with Jareb’s carer (a formal system), dealing with the commissioning and review of the contract with the mental health association (a societal system) and encouraging and advising Jareb’s parents (a natural system). Thus, although Gahan as an individual was the change agent, his agency (that is, the impact he

was able to have on the situation) came about because he was part of a change agent system, the community mental health team with its connections with two societal systems: the local community healthcare trust and the local authority. Although Jareb was an individual client, Gahan and Jareb together worked with a client system that included other residents in the supported living accommodation, who strongly affected Jareb’s life, and Jareb’s parents. Although Gahan’s target system could have been any of these elements of Jareb’s life, his action system might well have varied from the target system. For example, to influence the housing trust (target system) that provided the accommodation, he supported Jareb (action system) in making applications and his doctor (formal system) in providing additional support.

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This account shows the different focus of systems theory, compared with individualistic, psychotherapeutic practices examined in Chapters 3–8. Those theories offer little basis for including work with anyone except the client themselves and people closely connected to them. Most other similar practitioners, for example clinical psychologists or counsellors, work only through their relationship with the client. Social work, on the other hand, naturally includes engagement with all these other social elements. Johnson (1999) argues that this is a major, and uncelebrated, characteristic of social work; it distinguishes social work from similar professions and enables practitioners to explain to their colleagues how they are different. Building on this key advantage of systems ideas, Evans and Kearney (1996) show how you can look within the social networks and systems for possible targets for action and for power relationships, and involve each in a social work process. In their view, systems ideas help us to maintain consistency in practice with all these different elements, because it makes us analyse all the elements of the system that practitioners need to engage with. Systems theory suggests that you should start from the context in which you operate, its opportunities and constraints, with the aim of being involved and thinking about your powers and responsibilities and the likely or intended effects or outcomes. The following case examples illustrate these points.

Case example: Involvement with different aspects of a family’s needs A social worker became involved with a family because of concerns about the neglect of their children, so the initial context of the intervention was the agency’s responsibility for child safeguarding. The same family was referred to a colleague for help with family relationships, and another agency was asked to assess how to care for an older relative. Each practitioner thus had a different set of aims and responsibilities, which came from their agency contexts. The work each did, however, might

have been similar. Each would look at how pressures on the family created different aspects of their problem, and each would respond to the protection, relationship and service provision concerns. So they would have been able to coordinate their practice so that each supported the aims of the others while working to achieve their own objectives. There would be no point in trying to promote family relationships and neglecting the needs of the older relative or child safeguarding.

The adoption of a positive approach partly emerges from the importance of consistency and context: the context makes clear the responsibilities that come from the agency’s role, and allows the practitioner to deal with complex systems of relationships in the family or community while maintaining a consistent focus on their agency’s main objectives. Practitioners may feel that, in many situations, there is no progress to be made: for example, how can you help a mentally ill man who is incarcerated for life in a secure unit for serious offences? Thinking about it, though, activities such as improvements in his education, encouraging him to maintain relationships with others and renewing connections with estranged family members may all make a significant difference to the client’s life experience in the unit, even if it does not eventually lead to discharge and the resumption of family and community life. It may also be important to family members in repairing their experiences of his behaviour, arrest and detention.

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Case example: Context defines responsibilities with a disabled person Gareth, a disabled man in specialist housing, was referred for mainly practical services from an adult social care agency. In carrying out the assessment, Helen, the practitioner, identified family relationship problems in Gareth’s sister’s family, which meant that she would soon have to move away and be unable to support Gareth. This potential change in carer support might have destabilized Gareth’s situation, mean-

ing that more services would have been needed. Helen therefore spent some time helping the sister resolve her marital conflicts, and this again stabilized Gareth’s support. Although Helen’s manager criticized her for spending this time on someone who was not one of the agency’s clients, she argued that this help for a carer who was part of Gareth’s support system was relevant to their agency mandate.

Identifying patterns of behaviour helps to see positive possibilities, where behaviour in one social system has created learning for use in another. It also helps to identify where changes are needed. For example, a person having relationship difficulties with their neighbours may reveal similar patterns of behaviour in a day-care setting or a social setting, which may help practitioners to identify a possible target area for work on relationship or behaviour problems. Success in learning how to manage relationships in one setting might then be transferred to relationship difficulties with neighbours. Systems theory, therefore, emphasizes process; that is, how relationships and interactions occur, as well as content and outcomes. Practitioners may be able to identify positive skills and relationships in one part of someone’s life that can be transferred to other situations where there are difficulties. It may also be helpful to identify how systems are interacting to create problems in an unexpected area of life. For example, poor relationships within a family may reduce the influence of the family in helping a child to overcome difficulties at school. Working with others is an important bonus of systems theory. It emphasizes how working indirectly with other agencies or with families and networks can have an influence on clients. Joint working is also a product of systems thinking; practitioners interact with networks associated with clients and with colleagues and agencies. The next subsections on family therapy, residential care and social networking all pick up elements of practice that use or develop from systems ideas.

Family therapy Family therapy is a multiprofessional field of practice engaging psychiatry, clinical psychology and social work. The three main theoretical bases for it all draw on systems theories, because practice examines interactions between people as part of their family group: ●●

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Structural family therapy seeks to change the structure of family relationships by observing patterns in relationships among family members and helping people to alter structures that are not working properly. An example is helping a parent to set boundaries for a child whose behaviour is having an adverse effect on other family members. Strategic family therapy focuses on people’s day-to-day strategies for influencing other family members and maintaining their own identity. An example is looking at repetitive behaviours that lead to conflict.

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Systemic family therapy explores possibly hidden social rules within the family that are adversely affecting relationships. An example is where there is conflict about roles based on unspoken gender assumptions about a husband not being actively involved in child care (Walker, 2015).

Solution-focused and narrative practice (see Chapters 11 and 12) are increasingly used in family work, and this is extending and to some extent providing critical perspectives on systems-­based ideas in family therapy and broader family practice (Walker, 2015: 248–9). Both these perspectives have, for example, an emphasis on positives in the family and forward-­ looking perspectives on family life, rather than concentrating on analysing problems in the family’s life.

Social complexity The theme of social complexity has become a major development of social work thinking in the twenty-first century. We should not talk about complexity when we mean that things are difficult or there are a lot of competing interests to consider. This is because including social complexity in our thinking about social issues creates a new perspective on social relations. Van Ewijk (2018) draws out several elements of social complexity: ●●

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The recognition that there is no established, impeccable social order. We cannot expect social organization and cohesion because there are always elements that are not organized within one framework. Social complexity thinking takes into account both the parts of a social phenomenon and the whole and how the parts interact with and within the whole. Because complex situations are always non-organized, complete clarity is impossible, and our understanding always emerges from uncertainty; emergence is about an element of a system becoming distinguishable from the whole. Elements of a system are constantly going through interactive processes within the system and become increasingly self-organized in relation to their environment; their self-eco organization depends on their social connections, but it is autonomous, so that human beings do not ‘just’ perform regularities and predictable outcomes. Instead, they create change, and choice and irregularities emerge. Complexities do not have a core; they are thriving mixtures of interactions. Superdiversity transcends and transforms differences between groups; how differences are perceived in societies is constantly evolving, unpredictably and constantly creating new relations among different groups in society.

Hood (2018: 22–65) explores some of these ideas as they apply to social work practice. For example, he argues that we need to understand and assess needs in ways that understand potential complexities. There is a broad social norm that people have a right to have basic needs met, for example for food and shelter. But there are complexities: does food have to provide balanced or healthy nutrition? Should we be able to experience the social experience of eating with others, for example in residential care or where older people are isolated at home? Housing is not just a roof over the head, but also expresses our social and cultural values. Our needs change and develop: should they always be met the same way or should

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provision for our needs vary and progress? If there are scarce resources, what needs take priority? We may not be aware of all our needs: they may emerge from experience or by external assessment of risk. To Hood, if an unknowable uncertainty is a characteristic of all life, how do people manage that uncertainty, organize to make changes and develop the capacity to exert influence over change? Help cannot be planned in advance on general assumptions about what is needed, but should respond to needs and directions that emerge. Volatility and drift need to be provided for. Thus, a procedural approach, based on the assumption that people always operate rationally, does not deal with such uncertainties. People cannot always create a plan and work towards its fulfilment. Instead, we need to call on the expertise to respond to change and resilience in the face of pressures. Hudson (2010: 47–79) suggests that there is a pervading assumption of evolutionary ideas. It is that we try to understand social relationships through looking at how things have developed and emerged from past events and experiences. Nevertheless, there are alternative perspectives: ●●

●● ●●

●● ●●

Cyclical theories suggest that developments emerge and recede, as they are challenged and respond. Conflict theories propose that clashes of interest create changes. Equilibrium theories propose that social change tends to move towards balance between different interests. Modernization theories assume that technological advance pushes social change. Cultural lag theories assume that cultural responses often lag behind modernizing, developing and emerging trends.

All of these perspectives on change are apparent in one or other of the social work theories examined in this book. Psychodynamic theory is broadly evolutionary, for example, while crisis theory might be considered cyclical and is explicitly an equilibrium theory.

Social networking Developing networks in social support systems emerged in mental health work as a way of supporting isolated people when psychiatric hospitals were being deinstitutionalized in the 1970s (Caplan, 1974; Caplan and Killilea, 1976; Maguire, 1991; Cohen, Underwood & Gottlieb, 2000). Where isolation from social support is short term, there is evidence that re-­ establishing previous links is effective, while long-term isolation requires group- and community-­based work (Eyrich, Pollio & North, 2003). This work also connects with macro practice (see Chapter 10). According to Seed (1990: 19), a network ‘is a system or pattern of links between points … which have particular meanings’ for those involved. Practitioners focus on clients’ networks and agency links that form a pattern in the clients’ daily lives. The aim is to identify formal and informal social networks, extend them and make them usable in helping the client. Networks may be more or less dense or of varying quality, depending on, respectively, the amount of contact between particular parts of the network and the value placed upon it. They may also have a variety of features, such as being concerned with home, work, leisure or care.

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Network analysis is an important area of sociological theory. Like family therapy ideas, it proposes that structured social relationships located in systems of social relationships are a more important determinant of life than are individuals’ personal attributes, particularly in dyadic relationships such as marriage. The assumption is that the world is composed of networks rather than groups, and that acting on these relationships is a more important social intervention than individual methods can be. The main uses of network analysis in social work practice have been in examining, understanding and working with caring networks among members of a community and in situations where informal care is provided to people needing support (Kirke, 2013). Networking tries to connect interpersonal work developing people’s relationships with community work or macro practice. It may be a basis for practice in developing partnerships with service users and the community (Trevillion, 1999) and in multiprofessional teamwork (Payne, 2000). Trevillion sees social workers as potential community brokers, able to link users with a variety of community resources; this has links with empowerment practice. Gilchrist (2019) combines networking with chaos and complexity theory, suggesting that community development often seeks to recreate close interpersonal connections within communities that probably exist only in romantic notions of what communities used to be like. Meta-networking connects human-scale interpersonal networks together to create a pattern of links. This is better than trying to integrate complexity so actively that it makes the world seem chaotic and hard to grasp and understand.

 xample text: Gitterman and Germain’s (2008) life model E of social work The life model draws on a number of ecological concepts, set out in Figure 9.5, with a summary of their explanation and value in practice. We have noted one criticism of ecological theory – it takes for granted that its main aim is individuals’ adaptation to the environment. Gitterman and Germain attempt to deal with this by defining fit and adaptation as being undertaken by both people and their environment. Nevertheless, the authors’ focus is still on improving fit through adaptation, making the assumption that improving fit is a desirable and achievable objective. Critical theory suggests that this is not always possible and that, even if it can be achieved, it might not benefit individuals or oppressed people; conflict and a rejection of fit and adaptation might be a better value position for social work to take. This position can, however, be criticized for being unrealistic, bearing in mind that most social work practitioners are employed by government agencies or other representatives of powerful interests in society. In the context of the issue about fit and adaptation, Gitterman and Germain’s (2008: 56–7) account of power is extremely limited. They refer only to the abuse of power and see it as something held by abusive special interests such as private corporations, political interests or the financial system. Power is analysed only as creating damaging exchanges between people and environments. Gitterman and Germain’s analysis of power does, however, explain how these broad social factors can be understood to damage the reciprocity of exchanges, and presents the role of social work as restoring that reciprocity or at least acting upon those

Systems practice, complexity and chaos 243 Ecological concept

Meaning

Implications for practice

Reciprocity

Continuous exchanges occur between people and their environment

Exchanges in both directions continuously affect people and their environments

Adaptation, adaptedness, fit

People’s needs, capacities and goals may or may not fit well to their environment, and adaptive exchanges release and support adaptedness

Adaptation is change by the person or environment that improves fit. Adaptedness supports or hinders human growth and wellbeing, and enriches or degrades the environment

Habitat, niche

Habitat is the physical and social context within which people live. Niche is people’s place within the community that is living in that habitat

Habitat includes physical environments and social institutions. Niche includes roles, statuses and cultural expectations such as rights

Power, powerlessness, pollution

Abuse of power in support of sectional interests creates social and environmental pollution

Abuse of power creates destructive exchanges which in turn create environmental stressors that impose enormous adaptive tasks on oppressed people

Life course

The non-uniform pathways of biopsychosocial human and environmental development, involving historical, individual and social time

People and environments can develop in diverse ways through their self-regulating nature. This can generate new forms and structures, and produce shifts in the values and norms affected by global, local and personal factors that create historical contexts, life experiences and social transitions

Life stressors, stress, coping

Life stressors are transitions and events that disturb the fit and adaptedness between person and environment, leading to stress that is beyond our coping ability

People can cope, using behaviours and thinking to change themselves, the environment or the exchange between them. In this way, they can manage their negative feelings about life stressors and reduce the negative physical and emotional impacts of stresses on them

Resilience, protective factors

Resilience is the capacity to bounce back from adverse events, assisted by protective factors in the person or their environment and exchanges between these

Biopsychosocial and environmental factors may offer protection to people and their adaptedness. This can include the temperament of the people involved, family patterns, external supports, wider social factors in the environment, critical turning points and decision planning to respond to them, good fortune, use of humour and helping others

Figure 9.5  Ecological concepts in the life model Source: Gitterman and Germain (2008: 51–70).

damaging exchanges. Gitterman and Germain refer to reciprocality, but I use the term reciprocity here since it accurately implies their emphasis on the exchanges being seen as valid or appropriate by the people involved. Critical and empowerment perspectives focus more strongly on the wide availability of power in society and the possibility of enhancing the power of oppressed groups. Moreover, the emphasis on the negative aspects of the power of special interests ignores the potential misuse of power by people in oppressed groups if they

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become offenders or otherwise abusive, for example of children. Power may be used to promote social order and stability. Gitterman and Germain (2008: 57–9) use the ideas of the life course to emphasize the diversity of possible paths that people might take through life. This transcends the assumption of life cycle models to understand human development. These may include Erikson’s stages of human development, which we met when considering psychodynamic and crisis theory in Chapters 4 and 5, and similar ideas that assume a fixed progression through a sequence of life events. The life course idea allows for different family patterns, shifts of values and norms and different experiences of time, for example experiencing change as rapid and therefore a pressure, or as slow and therefore easier to cope with. The life model is presented in Figure 9.6. People follow their life course, a unique pathway that incorporates both their identity as an individual and their environment. They experience life stressors – the transitions, events and pressures that disturb the stability of people’s fit and adaptedness to their environment. The weight given to uniqueness and diversity gives an impression of openness and flexibility and claims to be in line with the aims of cultural awareness. It is not clear, however, why this emphasis should lead to anti-discriminatory practice, as the acknowledgement of diversity does not necessarily achieve equality or respect for others. Stress, the physical and behavioural response to stressors, arises from a disturbance of fit and adaptedness. People appraise situations that they face, first to see whether harm or loss may affect them, and then to identify the resources and actions they could use to cope with what is happening, and to work out how far these resources could help. Coping implies using

Life course – the unique pathway through life Person – following the life course

Stress –

Life stressors

a serious internal response to a life stressor

Ist appraisal – serious harm? 2nd appraisal – resources? Coping

Feedback

Figure 9.6  The life model of social work practice

Systems practice, complexity and chaos 245

behaviours and thinking that allow us to manage ourselves, the environment or the exchanges between these to manage ‘the negative feelings aroused’ (Gitterman & Germain, 2008: 63). The emphasis on stress and coping with feelings here is a limited conceptualization of responding to stressors, implying that what is required is simply psychological adaptation. However, it may be that life stressors are avoidable, or that changeable environmental events may require wider coping with practical matters. Feedback on individuals’ actions from their personal responses and the environment helps them to evaluate how successful they are in coping. Ecological systems theory is an important source of ideas about resilience – the capacity to bounce back from or retrieve gains from adverse events or situations. Gitterman and Germain (2008: 63–6) refer to identifying and making use of factors in the individual or their environment that may help them to cope with stresses. These authors’ view of this concept is again limiting, since they refer, for example, to the capacity to help others being ‘protective’ towards an individual and to the relationships involved in this, whereas feminist ethics of care theories (see Chapter 13) propose that this is a positive feature of relationships that is integral to people caring for each other. This adds to the sense that Gitterman and Germain’s ecological systems theory is concerned with dealing with failings in people or in their lives, rather than with natural exchanges. It may be a characteristic of the problem-solving aspect of social work practice that gives us this sense of dealing with something that has gone wrong, rather than being engaged with a natural life process. Practice is divided into three main stages (Figure  9.7). In the initial phase, the model emphasizes preparation, which is often not a strong element of practice theory. This phase incorporates reflection as part of preparation, with reflection on both the situation and the clients’ perceptions of their reality. Emphasizing clients’ choices is similarly a salient feature of the initial phase. Are they involuntary clients, forced by circumstances or legal and administrative procedures to become involved with the practitioner? How far are their choices restricted by their situation or powerlessness? The delineation of an ongoing phase emphasizes how you can use the life model for short or long interventions and caring processes as it is concerned with engaging with life issues. Working on agreed goals is a crucial aspect of this phase. The life model is practised in eight modalities, a common social work term in the USA, referring to work with individuals, families, groups, social networks, communities, physical environments, organizations and politics. Thus, the model is intended to be applied in all these forms of practice, and Gitterman and Germain’s account deals with them all in some detail. Gitterman and Germain’s model assumes that assessment, monitoring of progress and evaluation of the success of the interventions continue throughout the process. This involves client participation, systematic planning to manage large amounts of data and emphasizing needs and achievements in improving ‘fit’. In assessing an individual, you look at four factors: the nature of the life issues to be worked on, clients’ expectations, clients’ strengths and limitations, and support and gaps in the environment. Family assessment looks at possibilities for changing the exchanges between the individual, the family and the environment. Similarly, in group living or where peer groups or work groups are important in the client’s life, it can also be important to assess exchanges with those groups. For example, if family or group members are making demands on the client, support for the family or group might be better provided

246 Reviewing social cohesion theories

by helping other members of the family or community to manage a problem, rather than putting pressure on a client to change unreasonably. In this example, individuals, the family and the environment, which included the housing Case example: Tyler’s drug abuse and Mrs Garrod’s housing Mrs Garrod was a woman in her seventies receiving an extensive package of social care services to help her manage increasing frailty due to serious arthritis. She found her pain very difficult to cope with. Her grandson, Tyler, was a drug abuser who had periods of disturbed life, including homelessness. When homeless, he often crashed out in Mrs Garrod’s single-­ person retirement apartment, although this was not permitted by the tenancy agreement with the housing provider. Tyler’s mother had given up trying to man-

age his behaviour or help him. A care worker discovered him sleeping in Mrs Garrod’s living room. Reacting to this, the social worker convened a strategy meeting with the housing provider, the care worker, Tyler’s mother, Mrs Garrod and herself. It was agreed that supported housing would be provided for Tyler in a hostel, to enable a very strong line to be taken with him about not making demands on Mrs Garrod. This helped her to accept that he would be supported even when she refused to accommodate him.

and drug support agencies, were all participants in the reassessment that arose from an awareness of how Tyler was exploiting his grandmother’s concern for him, contrary to her healthcare needs. Here, the environment was altered to help both Tyler and Mrs Garrod. The preparation phase requires reflecting on the information that the assessment has produced. This is important so that there can be empathy with the people involved, because conveying empathy requires getting ‘inside’ another person’s life course and their environment. The initial stage similarly involves engaging with the extent of the choices available to clients in their life course. This is important in developing a shared focus on what services are being sought and how this connects to the practitioner’s understanding of what the agency can offer in view of its assessment of the clients’ needs. Clients’ choices need to be available to them, and one aspect of this is the extent to which they accept their own part in the difficulties, both in creating life stressors and in their reactions to them. Using their shared focus, practitioners and clients also need to explore the nature of life stressors: do they arise from stressful life transitions or traumatic events? Similar issues also arise in crisis intervention assessment, since, as we saw in Chapter 5, it can be hard in that model to distinguish hazardous events that create a vulnerability to crises and precipitating events that generate the downward spiral into a crisis. The concept of life stressors found in the life model bears many resemblances to the concept of crisis. The main skills used in the beginning phase are thus enabling people to explore and clarify the situations, the environment in which they have arisen and the personal consequences for them, guiding them to create an understanding or what may be a complex sequence of events. During the initial stage, practitioners work with clients and others involved to define the goals, according to the main areas of social work help, which I discuss next. The ongoing stage of life model practice involves using a wide range of social work skills. Figure  9.7 lists, with some examples, five main areas in which social work may provide help.

Systems practice, complexity and chaos Phases

Stressors

Main issues

Examples

Initial phase: preparations and beginnings Ongoing phase

Stressful life transitions and traumatic events

Environmental stressors

Dysfunctional family processes

Dysfunctional group processes

Interpersonal processes between practitioner and client

Life transitions

From school to work or single life to marriage, retirement, thwarted ambition

Losses or threats

The death of a loved one, natural disasters, chronic illness, disability or pain

Social environment

Neighbourhood conflict, discrimination against minority groups

Social networks

Inability to make friends or support others

Physical environment

Poverty of the environment

Poverty

Inability to provide housing, food or support

Neglect, abuse

Domestic or child abuse, neglect, inability to nurture children or relationships

Family structures

Conflict in the wider family or between generations

Family processes

Secrets or lies between family members

Family transformation

Divorce, children leaving home, death of family members

Factions, scapegoating

Client or others in groups behave badly towards others

Agency’s and practitioner’s authority, responsibilities and sanctions

Admission to care, refusal of service, charges for service

Professional role and socialization

Clients’ racism and the difficulties raised by the practitioner’s duty to challenge it

Difference

Age, class, ethnicity, gender, sexuality

Attempts to control

Behaviour in community or residential care

Content that is (to the client or family) taboo

Sexual issues or drug abuse

Client defences

Hope

Ending phase

Figure 9.7  Main areas of life model practice intervention Source: Gitterman and Germain (2008: 191–413).

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The ending phase may occur when clients and their families complete a planned programme of help or cease to receive services for some other reason, such as when the practitioner leaves the service, when the agency service or policy changes or when the modality of the service changes; for example, someone who has been cared for at home might enter residential care. Practice around ending includes: ●● ●●

●● ●● ●●

working on relationship issues; moving through a process of separation or change, during which there may be negative and positive feelings; dealing with sadness; responding to a sense of release; evaluating the service.

These may affect the practitioner as well as the client and other people around the client. Gitterman and Germain (2008) go on to explore skills in influencing community and neighbourhood life, organizations and agencies (both the practitioner’s and others that are involved in exchanges with clients) and political and legislative movements. This may be an aspect of working with a particular person-in-environment or a more general feature of practice that seeks social improvements for whole communities and groups in need.

Conclusion: using systems theory Social workers use systems and ecological theory in the following ways. Explaining and justifying the aims of social work to clients and colleagues from other professions You can make clear how social work does not focus just on individuals, but also on the family, carers and community around them. This is helpful to healthcare and education professionals because they have a perspective that emphasizes work with individual patients and students. Social work complements this; colleagues can understand better how changing the dynamics and resilience of the family or community can help individuals.

●●

Clarifying options for indirect intervention You can use systems ideas to identify systems other than your client that you should intervene with. Use this to explain to clients or colleagues how it will help to influence another agency or professional or a distant member of the family.

●●

Explore intervention with part of a system as a way of influencing the whole You can think through how changing someone’s behaviour can affect other members of their family and communities. In addition, you can see how encouraging development in one aspect of someone’s life can strengthen them elsewhere. For example, if you can strengthen their spirituality, they may be better able to cope with the stresses of an illness.

●●

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Explore clients’ adaptations to their environment alongside adaptations within their environment to meet their needs You can avoid making the mistake of expecting clients always to adapt their behaviour to others in their family or to the situation they find themselves in. The opposite is also true: sometimes we think that organizations or policies are so unfair that clients should not be expected to accept what is happening to them. But very often, when clients make some changes, the organizations and people around them are helped to adapt too. Ecosystems ideas say that you should find ways of adapting families, communities and organizations so that they meet clients’ needs better. You will usually have to work on both the client and ecosystems together, because if you are not doing this you might be missing something.

●●

Thinking about the sustainability of interventions Do clients, carers, families and the community have the resources to sustain the change you are proposing? It is no use changing clients’ behaviours if, in turn, the family or some other community, such as their workplace, needs help to support them to accept the new identity of the person you are working directly with.

●●

Reading and critiquing American textbooks Most social work texts in the USA take systems terminology and ideas for granted. People from other countries making use of American ideas and research need, therefore, to understand the theory’s main points and be aware of questions about it. American readers need an awareness of the critiques of systems social work that arise from most of the other countries in the world that do not take this approach for granted.

●●

Additional resources Further reading

Gitterman, A. & Germain, C. B. (2008). The life model of social work practice: Advances in theory and practice (3rd Ed.). New York: Columbia University Press. An important American presentation of systems-related theory. Gilchrist, A. (2019). The well-connected community: A networking approach to community development (3rd Ed.). Bristol: Policy Press. Hood, R. (2018). Complexity in social work. London: Sage. Hudson, C. G. (2010). Complex systems and human behaviour. Chicago: Lyceum. van Ewijk, H. (2018). Complexity and social work. Abingdon: Routledge. Three important texts covering up-to-date conceptions of systems theory. Payne, M. (2002). The politics of systems theory within social work. Journal of Social Work 2(3): 269–92. An analysis of the development of the debate about systems theory.

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Wakefield, J.  C. (1996). Does social work need the eco-systems perspective? Part 1: Is the perspective clinically useful? Social Service Review 70(1): 1–31; Does social work need the eco-systems perspective? Part 2: Does the perspective save social work from incoherence? Social Services Review 70(2): 183–213. A helpful evaluation of American ecological systems theory in practice.

Websites https://socialworkpodcast.blogspot.com/2007/07/social-networking-interviewwith-dr.html This podcast (29 minutes) is an interview with Lambert Maguire about social networking.

CHAPTER 10

Macro practice, social development and social pedagogy MAIN CONTRIBUTION The main contribution of these ideas to social work is the priority they give to the social and educational, rather than the psychological, as a focus for intervention. All these practices emphasize engaging people with connected political and social interests in a locality or social issue, or individuals with shared or similar social needs, so that they will come together, identify shared concerns and work jointly to overcome them. Social pedagogy sees social work as helping educate people in living successfully in the social relationships and structures that they are part of; it avoids seeing social work as therapeutic. This chapter brings together these traditions. The focus of these ideas on social and educational development means that they form a bridge between social cohesion and social change and justice objectives in social work.

MAIN POINTS ●●

●●

●●

●●

Macro practice (the American term, with an emphasis on policy change) and community work (the international term, with an emphasis on social change) are practices that help people to come together to identify issues of concern and take action to resolve them. Both practices have been influenced by social development (until the 1980s often known as community development) in resource-poor countries. Social development is the main form of social work in resource-poor countries. It seeks to contribute social progress to economic development in areas where economic development often takes political priority. Social development has been influenced by community work methods. Social pedagogy is a European practice used particularly with children in day, residential and youth provision. In some countries, it emphasizes community work in which there is an interaction between individual and collective self-development and education. Community social work is a largely British practice, strong in the 1970s and 1980s, in which social work in large general public agencies organized its services to focus on the

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needs of small communities. It sought to link social work with a range of practical social care services to provide locally responsive services meeting identified needs, while engaging those communities in volunteering and mutual support. Poverty and social exclusion are important targets of social development in resource-poor and rich countries. Social entrepreneurship, a development of the twenty-first century, aims to build business-­ like professional attitudes and organizational structures among the social professions.

PRACTICE IDEAS ●●

●●

●●

●●

Activation aims to engage people who are immobilized from making progress in their lives so that they can undertake useful personal development, motivating them and giving them experience to take up the positive opportunities they encounter. A common example is activating unemployed people to improve their education and engage in volunteering and community activity to improve their employability. Capacity-building seeks to build the understanding and skills needed to enable excluded individuals, groups and communities to participate more effectively in their communities. Helping people and communities to develop social capital increases the community and social infrastructure as an important resource for communities and individuals in societies. Social inclusion and exclusion focus on the ways in which stigmatized and disadvantaged communities should be helped to play a stronger role in society by being provided with opportunities and resources for participation.

THE DEBATE SUMMARY The debate about macro, social development and social pedagogy theories turns on three issues: ●● ●●

●●

Are these theories part of, separate from or in opposition to social work? Although there are similarities between them, are these theoretically related practices or were they constructed to respond to national or regional social issues? Are they social cohesion or social change and development theories?

Debate on macro, social development and social pedagogy How these theories relate to social work Community work has traditionally been treated as a basic social work method, or, the US term, a modality, alongside casework with individuals and families and groupwork. If you accept this, macro and social development theory is integral to social work, and every practitioner will need to use it sometimes, even though their main work may be elsewhere. For example, child protection usually involves investigation, assessment and help for individuals

Macro practice, social development and social pedagogy 253

and families, but family support work in day centres or the wider community calls on groupwork and community work techniques. Adding groupwork and macro practice modalities to work with individuals and families is often called integrated practice in the USA. The problem with integrated practice is that the personal inclination and commitment of many practitioners to do helping work with individuals and in families is distant from the practice methods of community and social development. This is because the need to focus on tight timetables and clear interpersonal objectives in individual and family practice clashes with the longer timescales and broader social objectives of macro and community work. Interpersonal practice, using the shared principles discussed in Chapter 1, therefore becomes separated from macro and community practice into different agencies, or at least different departments of agencies. In addition, practitioners working mainly with individuals and families do not feel that they have the expertise or mandate to work at the macro level, and vice versa. Many practitioners of community work, macro practice and social pedagogy see the ideals of their work as being in opposition to the individualistic social cohesion objectives of much individual, family and group social work. Community work is to them partly about transforming the present way of organizing society and includes resistance to authority. Individual practice, however, aims to help individuals and families to adjust to potentially harmful social pressures or to mitigate the pressures on individuals, rather than seeking a change that will affect wider society. To its practitioners, social pedagogy is about enhancing personal and social development objectives contesting the reinforcement of present social priorities. None of these methods is clearly associated only with social work. They are sometimes regarded as separate professional activities, as part of wider development work, as part of other professional responsibilities or, in the case of social development, as a separate professional career for Western workers in international non-governmental organizations. Another aspect of this debate is that these ideas emerged in different geographical locations and thus seem less universally relevant than other forms of social work. Social development originated and is most used in resource-poor countries alongside economic development. Social pedagogy is, in many countries, a separate practice focused on the education and personal and social development of individuals and social groups, and the qualifying training is provided in separate universities. This distinguishes it, in those countries, from a more pragmatic and problem-focused social work or social assistance. Therefore, theorization, professional development and agency organization are separated from social work in the approaches of social development, community work and social pedagogy. There are separate national and international organizations for social development and social pedagogy. A good example of the consequences of this separation is the claim that introducing social pedagogy into UK residential work with children was the transfer of a new discipline from Denmark rather than an implementation of an existing social work practice.

 elationships between macro practice, social development and social R pedagogy This debate is partly about whether social work and its theory is universal, an issue that I explored in Chapters 1 and 2. Or does social work require specific cultural and national contexts? These practices come from different theoretical sources. Community and macro work

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originated to improve the social participation of excluded peoples in developed countries. Social development arose to engage social capital – the power we gain by having wide and supportive networks of relationships – in economic development in resource-poor countries. Social pedagogy started as an educational development process in mainland European countries. Community work and social development have shared origins and have seen many exchanges in knowledge. Macro work is an American formulation of community work ideas, often also incorporating social activism and advocacy for progressive social causes. While social pedagogy developed from primarily German and Polish social philosophy, so is theoretically separate from Anglophone discourses on practice, it overlaps with the social work professions and community work practice. For example, in some central European countries, virtually all social care services are provided by pedagogues, and practitioners trained in social work and social pedagogy are interchangeable. Since all these practices call on similar skills, values and theoretical ideas, it is unreasonable to make too much of their separate theoretical sources, but there may be strong national and regional traditions that we must take account of.

Are they social cohesion or social change and justice theories? The ideas of macro practice, social development and social pedagogy overlap with those of critical, empowerment and advocacy practice. The main source of this connection is a shared emphasis on the social rather than the individual and psychological. Critical theories, however, focus strongly on social change to achieve social justice as an ultimate objective. Macro, social development and social pedagogy theories, on the other hand, are generally used within state social provision. This practice aims for social cohesion within the existing social order and seeks reform and social improvement rather than the more extensive social change that critical theories aim for. Midgley and Conley (2010b), in concluding a set of case studies that extended Midgley’s theory, defend social development theory as a form of activism, while claiming that anti-­ oppressive, critical and empowerment theories are idealistic and have not achieved social change. Midgley and Conley see social development as a form of progressive social change incorporating human rights, peace and social justice (2010b: 198). It is unclear whether they mean progressive as a way of referring to progression as movement through a series of stages towards an objective, or in the alternative sense of movement towards more enlightened social conditions. Midgley (1995) uses both ideas. He emphasizes that his approach to social development (as opposed to ideas of economic development) is distinctive because it aims for more enlightened social conditions. Both these senses of the word, however, imply evolutionary social change, whereas critical theory seeks transformation, which implies a change in the underlying social structures. It is clear from Midgley and Conley’s comment that they do not think that social workers can achieve transformation in most situations. While they may be right, this defines their theory as a social cohesion theory accepting the present social order but seeking change or progress in it, rather than as a critical social change theory. As theories focused on the social, all these groups of theories have a broader perspective than the individualistic therapeutic and clinical theories that we reviewed in Chapters 4–9. Macro and community work practice, social development and social pedagogy have often

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been treated by governments as a useful element of social provision, and their practice therefore leans more towards seeking social cohesion, while, as the discussion in Chapters 11 and 12 shows, critical and empowerment theories lean more towards social change.

Major statements Modern texts on macro social work, community work, social development and social pedagogy set out the principles and methods of practice that have been applied to practice in their countries or regions of origin. They are adaptable to other societies, but only community or macro practice has a wide international reach. Contemporary work on social development and social entrepreneurship increasingly draws on work in Asia and Africa, however, and much of this can also be applied and is increasingly influential in developed countries. This is reflected in the content and references for this chapter. It is unreasonable to complain that thought from African and Asian sources is inappropriate for use in Western countries, when American, British and Australian texts are routinely thought to be universally relevant, with little adaptation or consideration of their potential for use in African and Asian countries. An important element of social work, including social development, practice in many African and Asian settings is a postcolonial philosophy (Kleibl et al., 2020). That is, it recognizes that many of the social issues faced by people in these countries are generated by the cultural and social aftermath of colonial occupation by Western nations. These also connect with Indigenist practice, which I deal with in Chapter 18. Many important discussions of social development are texts that focus primarily on practice in resource-poor countries, with more general features that can be applied in industrialized countries. Social development is an adjunct to economic development, rather than as a practice. For example, Desai (2015) provides an account of social development in Asia, focusing on how social institutions in different countries have generated alternative ways of responding to the main issues of social diversity. She makes connections with alternative spiritual and social issues to social development and thus provides a useful exemplar of both issues and methods of practice in this field. This work is based on previous policy and historical analysis (Desai, 2014). I therefore use it as the example text in this chapter, supplementing it with material from Midgley’s Social Development (1995), historically an important theorization of social development practice, and African examples presenting a social work perspective on development practice (Spitzer, Twkirize & Wairire, 2014; Twikirize & Spitzer, 2019). Rural social work focuses on the particular needs and shared interests of rural areas (Pugh & Cheers, 2010). This connects with a concern for theory derived from the knowledge and understanding of indigenous peoples living within societies with a majority culture, which I examine in Chapter 18. Lohmann and Lohmann (2005) emphasize that research has not found any major differences between the needs of rural and urban communities. They argue that an important issue for workers in rural areas is the romanticism about living a traditional lifestyle in a beautiful natural environment, while the social isolation of, for example, mentally ill individuals, older people and people with learning and physical disabilities is ignored. Moreover, the lack of surveillance of social behaviour in rural areas may lead to inadequate protection for vulnerable adults and children. Rural social work therefore has no distinctive practice theory beyond considering these implications when working in rural settings.

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Social pedagogy is becoming more influential in the English language literature, but many of the basic texts are not available in English. Lorenz’s (1994) study of European social work contains a theoretically informed summary. Kornbeck and Jensen’s (2009) collection gives an overview of the role of social pedagogy in several European countries, indicating how it varies according to the country in which it is practised. Theorized accounts informed by personal experience in using social pedagogy in the UK and elsewhere include Kasca (2015), Hatton (2013) and Stephens (2013). Research and commentary on efforts to implement Danish methods of social pedagogy in British residential care (Cameron et al., 2011; Petrie, 2011), but this does not offer a comprehensive theoretically informed account of practice. I therefore use as an example text a well-informed recent interpretation in the UK context by Charfe and Gardner (2019). I have extracted from Popple’s (2015) theoretically informed analysis of community work theory and practice material as an example text covering community work.

Wider theoretical perspectives Introduction to the perspectives Macro practice is the term used in the USA for an aspect of social work that focuses on building new organizations and influencing existing social institutions for the benefit of people who are excluded from, or neglected by, powerful interests in society. Other countries mainly use the term ‘community work’, or a variation of it, to describe this aspect of practice. Macro practice in the USA emphasizes cause advocacy that aims to include policy change as an important component. Case advocacy, in which practitioners argue for services on behalf of individuals, families and communities, is sometimes used as an element of community work practice both in the USA and elsewhere. Because advocacy has developed its own theoretical literature, I treat it as a separate body of theory connected to empowerment practice in Chapter 11. Social development theory, often described outside social work as human development, organizes ideas about macro work into a system of practice for developing the strength and resilience of social institutions, mainly in local communities in resource-poor countries and regions. Economic development often mainly benefits the interests of the rich, and human and social development seeks to enable poorer and more oppressed groups of people in a society to share in the benefits of economic development. Social development is the major form of social work in many resource-poor countries. Social pedagogy is a significant tradition of social work in mainland Europe, contributing a conception of social work as a positive educational process for individuals and groups with shared interests. It is largely absent from social work in English-speaking countries, although there are occasional attempts to transfer it, and its practice has resonances with some residential child care and community work practices. It avoids the negative connotations of Anglo-­ American social work traditions that see social work as a process for resolving problems; in this way, it represents the positive objectives of the shared principles (see Figure 1.7). Chapters 11 and 12 show that strengths, solution and narrative perspectives seek similarly to reduce social work’s focus on problems.

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Social pedagogy provides a holistic conception of practice that brings personal identity and social group membership together. This avoids the priority given in social work in English-speaking countries to individual behaviour and psychology, replacing it with a focus on personal psychological development through education, without the implication that we do the work because of people’s personal problems. In this way, it also has connections with humanistic perspectives on social work, which are dealt with in Chapter 13. The individualistic priority of practice in English-speaking countries often relegates the social aspects of the situation to a context for the main, individualistic, intervention. Ecological systems theory, as we have seen in Chapter 9, is an example of this tendency. In some countries, social pedagogy is mainly practised in community facilities, such as pre-school or after-school groups for children and young people. Hence the term ‘pedagogy’, because it refers to teaching methods and the teaching profession, is often taken to focus on children. Other countries refer to a more extended meaning of pedagogy as an educational process, for example, in guardian pedagogy (child safeguarding and similar processes) or gerontopedagogy (positive practice with older people). Because many of the techniques are similar, macro practice and social development have influenced each other, particularly in the administration of British, and to some extent French, colonies until the 1960s, and through the social development work of the United Nations, which has often called upon community work expertise. More recent developments emphasize decolonization. Social pedagogy connects with youth and community work, and also with day and residential care for children. Although these methods focus on the social, they mainly seek the personal development of relatively small groups within the present social order, rather than seeing such development as forming steps towards achieving broader social change. Thus, all these theories mainly formulate social cohesion and therapeutic practices rather than being social change theories.

Social development ideas and economic development Social and community development is an aspect of the wider development of localities, areas, regions and countries, and is related to economic and industrial development and urbanization. Ideas about development have a long history. The economies of European countries developed from the eighteenth century onwards, and those of many other countries in the nineteenth and twentieth centuries. Weber (1930) famously argues that non-European countries developed slowly because their cultural inheritance did not include the Protestant work ethic of northern European countries. Sinha and Kao (1988b), however, criticize this as an ethnocentric view, and argue that other Western concepts, such as individualism and achievement motivation, are connected with Western economic development. We have to be careful of assuming that Western individualism and go-getting are better than the philosophies of many African and Asian cultures, which emphasize achieving interdependence and accepting traditional values. Economic and social development is now associated in many people’s minds with resource-poor former colonial countries, particularly in the southern hemisphere. Modernization theory argued that their economic and social development could move from underdeveloped, through transitional to developed status, such as that of Canada, European

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countries and the USA, which are often described as Western, industrialized or developed nations (Desai, 2015). This assumed, however, that there is a natural progression to a developed state. Neo-Marxist dependency views argue that multinational corporations have sought to maintain the dependence of resource-poor countries on developed Western economic systems (Hulme & Turner, 1990: 34–43). There is also concern about the impact of globalization, in which a whirlwind of political, economic and cultural changes has led to increased interdependence, with increased cultural and economic dominance, called hegemony, by Western countries replacing the political control through conquest that occurred in the colonial era (Payne & Askeland, 2008). Contemporary social development theory focuses, as we have seen, on alternative decolonizing approaches to economic and social change. The Latin-American Catholic idea of liberation theology influenced South American social work (Gutiérrez, 1973, 1992; Evans, 1992; Skeith, 1992). Traditional Christian ideas were considered as accepting oppression as the preparation for a happier afterlife. Liberation theory contests this by seeking a movement from oppression to liberation within the concrete issues of daily life. In this view, both personal and social sin, that is, structural oppression by social institutions, must be overcome by non-violent social change through personal empathy with others and their social situation, in the same way that Jesus Christ acted. This has provided a religious basis for seeking social change. Liberation theology therefore encouraged the Church to use community work techniques in the predominantly Catholic Latin-American countries. However, its explicit rejection of the existing social order has been controversial in the Church, partly because in areas where it is vigorously adopted it has sometimes set the Church against the state. Many development theories emphasize women’s issues, partly because of their importance in local and family economies in many resource-poor countries. This focus has also occurred in response to worldwide feminist social movements that aim to achieve greater justice, independence and self-control for women and publicize issues of concern to them, especially child care (Yasas & Mehta, 1990; Mokate, 2004; World Bank, 2012). Disability and rehabilitation have also become increasingly important issues for international social development, and working on all these issues makes the best use of human resources in every country (Department of Economic and Social Affairs, 2019). Finally, important social movements responding to local ethnic and cultural needs in different countries also contest the significance of the centralized state and globalization (Guidry, Kennedy & Zald, 2003) and the role of social work as a force for social regulation (Thompson, 2002). Fisher and Kling (1994) argue that social movement theory connects community development ideas with wider forms of resistance among communities by shifting the focus of activism from class to community. Martin (2001) argues that feminist and other new social movements have achieved changes in social policy by symbolic challenges to cultural assumptions. An example is the recognition that women’s self-help movements are the only way to make a substantial difference to postnatal depression as interpersonal help from people with shared experiences has a major effect. Thus, Western social policy becomes more responsive to a role for social work that is about organizing self-help rather than providing direct care.

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Social development ideas Social development has been variously defined, and these definitions are controversial. An important, often-quoted definition by Paiva (1977: 332) is ‘the development of the capacity of people to work continuously for their own and society’s welfare’. This focuses on improving individual capacity within the context of wider social development. Hence, Paiva (1993) argues that this does not exclude four other important aspects of social development: structural change, socioeconomic integration, institutional development and renewal. Jones and Pandey (1981) focus on the element of institutional development, making social institutions meet the needs of people more appropriately; their definition (p. v) is that ‘Social development refers to the process of planned institutional change to bring about a better fit between human needs and aspirations on the one hand and social policies and programs on the other.’ An early official view is contained in the Preamble of the International Development Strategy for the Second United Nations Development Decade, quoted by Jones (1981: 2): As the ultimate purpose of development is to provide increasing opportunities to all people for a better life, it is essential to bring about a more equitable distribution of income and wealth for promoting both social justice and efficiency of production … Thus qualitative and structural changes in society must go hand-in-hand with rapid economic growth and existing disparities … should be substantially reduced.

This shift in thinking from an official concentration on economic planning led to an emphasis on social planning. As a result, institutions could be organized to support economic progress (Hardiman & Midgley, 1989). Asian writers (for example, Khandwalla, 1988; Sinha and Kao, 1988a) focus on understanding and aligning the values represented in a society and the values of the development process. More recent literature emphasizes the important of achieving social equality alongside economic growth. Wilkinson and Pickett’s book The Spirit Level (2010) explores socioeconomic inequalities in relation to a wide range of social and healthcare issues both between and within countries. It covers social issues of concern to social workers, such as mental health and drug use, physical health and life expectancy, obesity, education, teenage births, violence, imprisonment and social mobility. Wilkinson and Pickett conclude that the important health and social problems of the rich world are more common in unequal societies. The differences are large, with these problems being from three to ten times as common in the most unequal societies compared with the least unequal. Moreover, countries consistently experience high levels of social problems; if they have one area of difficulty, they are likely to have others. Wilkinson and Pickett conclude that everyone in any society benefits from equality. Exploring the pattern of rises and falls in inequality in particular societies, they also conclude that the political will to reduce inequality has consistently been shown to improve both equality and the significant social problems that arise from it. Ideas about social capital argue that groups and communities can increase the resources available to resource-poor populations by increasing the number and range of social networks that they are part of. Pandey (1981) identifies three basic strategies in social development, defined according to their purposes:

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Distributive strategies aim for improved social equity between groups nationally. Participative strategies aim to make structural and institutional reforms to involve people in development and social change. Human development strategies aim to increase the skills and capacity for people to act on their own behalf in improving the economy and institutional development of their area.

Potter and Brough (2004: 340), reviewing research into capacity-building, argue that it is more than just education or personal development for individuals, although it may include these elements. Capacity-building programmes for community development include four elements: ●● ●● ●● ●●

the structures, systems and roles in the organizations involved; staff and training, and the personal development infrastructure; the skills of the personnel involved, including volunteers and community members; tools, including facilities and techniques.

Each element is required to make effective use of each of the others, so they build on each other in a complex matrix. Midgley (1993) divides social development ideologies into three types of activity, rather than concentrating on objectives as Pandey does: ●●

●●

●●

Individualist strategies focus on self-actualization, self-determination and self-improvement. Collectivist strategies emphasize building organizations as the basis for developing new approaches to action – these are institutional approaches. Populist strategies focus on small-scale activities based in local communities.

Hujo and McClanahan (2011) suggest that development policies have to be developmental, democratic and socially inclusive if they are to achieve both economic and social development.

Social enterprise Social enterprise is an important new element in social development theory originating in Western developed countries, and adopted in resource-poor countries, partly through unthinking postcolonial influences. Lucas dos Santos and Banerjee (2019) argue that excessive concern with economic issues has led to too much concern for technical solutions and performance, under-representation of oppressed groups and a vision of a pacified civil society centred on efficient organization, inattention to gender inequality and no critical analysis of political assumptions. We can see similar arguments in the critical theory view of neoliberal economic policy on social welfare (see Chapter 18). Instead of developing new services by creating public sector, non-profit or mutual aid services, social enterprise creates profit-seeking businesses, with three main characteristics: ●● ●●

The business aims incorporate social objectives as an important priority. Profits are recycled to support the social objectives rather than being paid as dividends to the entrepreneurs.

Macro practice, social development and social pedagogy ●●

By establishing a business, rather than a charity or public service, the entrepreneur repudiates authority and sets the direction of individual or social change in favour of the service users (Ashton, 2010).

Thus, according to Laville and Eynaud (2019a), economic indicators of social entrepreneurial initiatives are a focus on production or selling of goods rather than advocacy or redistribution, taking on economic risk and providing remunerated work for the local population. Social indicators are benefit to the community, initiatives arising from a citizen group and limited or no profit distribution. Governance indicators include a high level of autonomy from political structures, decision-making not based on capital ownership and a participatory dynamic in the organization. One of the advantages of social enterprise over other structures for social development is that the potential profits can provide independence from control by government or external financiers of charities, who often represent the interests of social elites. It makes social provision financially sustainable by providing independent sources of finance, and focuses on seeking innovation rather than welfare services aimed at maintaining social support (Mawson, 2008). Particularly with minority and excluded groups, social enterprise permits a focus on economic development through creating small and medium-sized enterprises within minority ethnic communities, achieving social development alongside financial independence. Exploring social entrepreneurship as a means of social development in resource-poor nations, Laville and Eynaud (2019b) make connections with debates about the social characteristics of social development that I discussed in the previous section. Social entrepreneurship as part of social development, they argue, is a process that reinforces the political principles of liberty and equality in daily life (as opposed to political freedoms). Some approaches to solidarity are philanthropic; these are about benevolence to people in poverty. Democratic solidarity, on the other hand, seeks to engage the participation of people in poverty in social development. An example is Delgado’s (2011) analysis of social enterprise with Latino minorities in the USA as a form of community social work. Clark (2009) proposes the capabilities of the social entrepreneur, as set out in Figure 10.1. This is a useful formulation because it clarifies that entrepreneurial behaviour is a social concern, without too much of a business or money-making focus. Social enterprise in resource-poor countries has used the microfinance approach to alleviate poverty. Microfinance provides loans to enable small businesses to take off. Other important areas are: healthcare, education and training, particularly to improve the participation of people with learning disabilities and their relatives in society; environmental projects; community and housing regeneration; welfare projects to combat unemployment; alcoholism and drug abuse projects; and advocacy and campaigning, for example through Fairtrade and Traidcraft, which provide a good economic return for businesses in resource-poor countries that export to richer countries (Nicholls, 2006: 14). Kummitha (2016) describes a variety of social entrepreneurship activity in India, focused on social inclusion, including the participation of people with disabilities, revitalizing rural living and rights to appropriate clothing. Social entrepreneurship can address the market failings of conventional business and social institutions. Examples are the failure of business to operate in poor areas, the withdrawal of governments from social provision, the withdrawal of churches from areas where

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Reviewing social cohesion theories Capability

Explanation: you are…

Dedication

Committed to a social goal or purpose

*Focus

Discriminating between potential activities, according to the extent to which they contribute to the purpose

*Advantages, profit orientation

Identifying clearly the gains for different potential participants, as part of finding the right targets

*Ego drive

Wanting to make a difference that others recognize, through knowing your own strengths and others’ views of you

Urgency

Against wasting time, wanting instead to take action now

Courage

Determined when faced with problems

Activator

Wanting to make things happen, especially where progress is slow or has stopped

Opportunity

Seeing possibilities rather than barriers

*Creativity

Buzzing with ideas, opportunities and solutions

Expertise orientation

Aware of your own limits and the need to find others with expertise to contribute

*Team

Getting the right people together

Seeing individuals’ contributions

Seeing and using others’ strengths

*These are the most important themes.

Figure 10.1  The capabilities of the social entrepreneur Source: Clark (2009).

they have marginal support and social provision where there is not enough tax revenue or other finance to support the development of local community-based organizations (Nicholls, 2006: 16). For example, the enterprise can be completely integrated into social provision, separated from it or partly incorporated (Alter, 2006). Varied models of management are possible, and can be applied both in small-scale development and in Western management of health and social care systems (Oham & Macdonald, 2016). Models of social entrepreneurship are thus aligning themselves in resource-poor countries with many of the objectives of social development, and form a way of implementing social development objectives using techniques familiar in community or macro social work practice.

Social pedagogy Social pedagogy developed from the work of German philosophers Diesterweg and Mager (Hämäläinen, 1989, 2003; Lorenz, 1994: 91–7; Charfe & Gardner, 2019: 17–31). It develops social aspects of education that particularly focus on poor people in societies. The theory emphasizes that education can make a major difference to the lives of poor people. It can be used to combat social exclusion and develop social identity, aiming at personal and social growth through problem-solving rather than simply the resolution of personal problems (Hämäläinen, 2003). Engagement in society is an enrichment of the individual (Mathiesen, 1999).

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Stephens (2013: 6) identifies four elements of social pedagogy: 1. The first element is the aim of social pedagogy, to develop people’s personas by nurturing individual potential and achievement, and reducing the impact of conflicts that set up boundaries between people. 2. It acts through assisting personal development, especially in communications among people. 3. Its strategy is people’s educational development. 4. This achieves a universal ethos, or haltung (Eichsteller & Holthoff, 2011; Kasca, 2015: 19), of seeking to empower individuals within their settings to become good individuals in a good society. This includes ideas of unconditional respect for other people and a view of empowerment as achieving self-determination in their lives through improved confidence, self-­belief, skills and greater autonomy in action (Kasca, 2015: 20). Marynowicz-Hetka (2000, 2019a, b), drawing on Polish traditions, sees social pedagogy as an action science, concerned with social activity in which we bring together analyses of social issues from multiple social science perspectives. Thus, people develop tools for analysis of social situations that lead towards action to respond to them. Because social situations and social issues are complex, we need to use transversal or cross-cutting ideas drawing on multiple perspectives. We take part in experiences of activities in a shared setting and look at processes of communication and interaction in the social contexts of these activities. These have social objectives such as living in harmony, contributing to society, and particularly to local communities that you are part of. Similarly, the Swiss writer Staub-Bernasconi (2003) sees social work as transdisciplinary, incorporating a range of perspectives for exploring how we should act in response to social problems in ways that enhance human rights. Stephens (2013) connects these practices with Bandura’s (1977) social learning (see Chapter 7), aiming to improve people’s self-efficacy, their belief in their capability to have an impact on their world. In social pedagogy practice, client and pedagogue bring separate worlds in which they live together in their ‘common third’ world, shared activity (Kasca, 2015: 52–4). Stephens’s (2013) account of practice shows how pedagogue and client plan social learning activities in which emotional internalization of values and norms takes place, which improves clients’ self-­ efficacy in social situations. The experience of such activities connects head and heart: conceived as a ‘diamond-shaped’ process of empowering holistic learning involving many aspects of human living, which creates well-being and happiness in successful interpersonal relationships and communication (see Figure 10.1; Eichsteller & Holthoff, 2011: 38). Gardner (2019: 36–7) draws attention to the concept ‘head, heart and hands’ deriving from the educationalist Pestalozzi. ‘Head’ is our knowledge, ‘heart’ is our deep and unconditional respect for humanity and ‘hands’ denotes the practical use of our shared activity with individuals to promote their inclusion and participation in society. Practitioners are assertive about the importance of developing learning and skills, while acting respectfully in promoting clients’ self-determination. Examples of the areas of interpersonal communication skill they concentrate on include dialogues in relationships, supportive relationships, how to deal with conflict and working on how to operate in democratic and emancipatory ways in organizations (Cameron & Moss, 2011) (Figure 10.2).

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Reviewing social cohesion theories Wellbeing and happiness Heart

Empowerment

Positive experiences through activity

Relationships

Head

Holistic learning Hands

Figure 10.2  The diamond model of social pedagogy Sources: Eichsteller and Holthoff (2011), Stephens’s head and heart analysis (2013), and Marynowicz-Hetka’s focus on activity (2019a, b).

These concepts can be seen in the UK project described in the following case study.

Case example: The social pedagogy pilot programme in UK children’s residential care From 2008 to 2010, a UK project experimented with using social pedagogy in children’s residential care (Cameron et  al., 2011). This led to useful resources being available in English for the first time, many of them on the internet (see the ‘Additional resources’ at the end of this chapter). The project recruited social pedagogues to work in UK children’s homes according to three models: homes where pedagogues already worked, but had no mandate for change; homes where pedagogues were introduced

with a mandate to change the practice in the home; and homes where pedagogues were mainly training others. There was a comparison group with no input from a pedagogue. The project found that structural issues in the management of children’s homes, which in turn reflected value differences about holistic working, made it difficult to introduce social pedagogy in the British setting. The following account extracts the main theoretical points about social pedagogy practice that the project demonstrated.

This project identified four main elements of social pedagogy in the context of children’s residential care (Cameron et al., 2011: 13): ●● ●●

a broad understanding of care as being holistic and multidimensional; helping children to learn in an enriching way by facilitating their capacity to think for themselves;

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●●

developing authentic and trusting relationships between children and adults that included authority and affection and a reasonable degree of privacy for the child; empowerment in the sense of encouraging active engagement in the children’s own lives and in society generally.

The relationships established between pedagogues and children enable practitioners to model this approach to learning and developing themselves, so that children can learn from pedagogues how to handle themselves. This paragraph identifies in italics the main practice principles explored in the project described in the case example, and connects with the concepts identified early in this section. Social pedagogy practice was holistic, seeing children as thinking and feeling, and as having a physical, spiritual, social and creative existence that was expressed in their interactions with the adults as they shared the same living space. The task was to create interactions that allowed the children to express that full existence. The heart aspect of social pedagogy gave importance to both adults and children expressing emotional and ethical reactions as they interacted. The hands aspect of social pedagogy meant using everyday activities of care and life to express the relationships between the adults and children through interactions. The head aspect of social pedagogy gave importance to reflection, not just to produce reports and records, but also as a shared activity of making sense of what was going on in the home together. The Three Ps meant that the pedagogues saw the professional, personal and private aspects of their lives as linked, using their professional skills as part of a shared life with the children, while preserving privacy for what should remain private in the children’s and adults’ lives. The common third was the creative, everyday tasks and leisure time that the children and adults shared and was the medium of working with the children. Teamwork with a range of colleagues and acting as role models of appropriate behaviour and relationships were also important. This theoretical framework was found to be important to guide pedagogues in using experiences of living to work with and help children. Its use was, however, inconsistent with homes where everyday activities were seen as a non-professional routine rather than an opportunity to be with the children, and where working with the children was seen as a series of identified and programmed tasks. The value of this theoretical approach is consistent with the broader ideas of the therapeutic community movement, discussed in Chapter 4, and connects with research into residential care practice in the UK. Brown et al. (1998) found that homes worked well if the social, formal and belief goals were all in concordance, and worked less well where there was dissonance. Where there was concordance, the staff culture was supportive of the children, and the children then also developed a positive culture of mutual support, leading to good outcomes. Whitaker, Archer and Hicks (1998) found that staff worked with individual residents to define goals that identified the desired improvements and took opportunities to work towards those goals, being flexible about how to achieve them but persevering with them. Reparative experiences meant understanding what needed repair, disconfirming unhelpful fixed beliefs (for example, that all adults are untrustworthy), finding daily experiences that confirmed progress, being ready to listen while being sensitive to readiness to talk, combining non-verbal symbols and explicit acts of caring, and valuing successes through occasional celebrations.

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With groups, the work provided opportunities for activities that helped residents to learn to work together, successfully handle their relationships with others, gain self-respect and be valued by others. Social pedagogy provides a theoretical framework for such practice that has been found to be effective. In some countries in mainland Europe, social pedagogy practitioners form a separate professional group whose focus varies in different countries. The Netherlands introduced a policy of social renewal, using community development to integrate action on employment, the environment, welfare and education in deprived localities (Winkels, 1994). In France, animation also has an informal education role through artistic work that is concerned with social development and education through leisure activities (Lorenz, 1994: 99–103).

Case example: Kevin, a hyperactive child Kevin, aged nine, was referred for assessment in a child and adolescent mental health service as being extremely hyperactive. His situation illustrates how the social pedagogy approach thinks differently from conventional social work. The concern about hyperactivity is a judgement made by his teachers and parents. It presents their idea about his relationship with the world and the other people in it. The starting point of the assessment was how this happened, how the behaviour developed and how others reacted to it. The social pedagogy approach is to arrive at an overall view of the hyperactivity in relation to the personality of both the child and the family, and to the social environment around Kevin. The next question is ‘what should I do?’ Social pedagogy argues that you should use the balance between the child and the collective around him: Kevin may only gain the will to develop his behaviour and grow in different ways by

the surrounding collective world responding to and joining in that development. Individual variation in the collective is a sign of its quality, because it contains the resources that allow and help its participants to develop. Kevin may gain ideas about how it is possible to, or how he would like to, behave, and the collective of his family and school can give him the will to behave in that way; they can also control how he behaves so that he may perceive other ways of acting. Kevin makes the choices, but he learns about the options and how to implement them from his parents, his school and his peers. People educate themselves in interaction with others and in the interchange of perceptions about the world. Liberation, in social pedagogy, is found in the mediation of one’s views and behaviour through the collective. Language plays an important part in this, since selfunderstanding comes through discussion and debate in the collective.

These ideas are an attractive basis for developmental work with children in residential care and day-care and in informal education and community work. They have connections with the self-actualization and personal growth of humanist ideas, and with Mead’s (1934) ideas about the interaction with the self and the other (see Chapter 13). They also have connections with critical and feminist thinking in the dialogical process and in the use of language and collective experience as the basis of both shared and personal experience.

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Connections Macro practice, social development and social pedagogy relate to participatory approaches in all kinds of social provision. They all require skills in interpersonal and group communication that relate closely to social work skills and connect to empowerment practice (see Chapter 14). Self-help organizations can also be important mechanisms for these practices by generating increased interpersonal skills. In participating in a variety of ways, individuals can be involved through local grassroots organizations. This helps in their personal education and development. It also helps to give priority to local wishes, avoiding situations in which external political influences or social assumptions such as gender oppression override the community’s interests. There is, however, a critique of participation as an ideal of social development. Midgley (1987) argues that views of participation as being all-important do not deal adequately with the role of the state in modern life, instead relying on individualist, populist and anarchist views of the world. Seeking participation as an ideal of service provision has been described as a new orthodoxy (Stirrat, 1997) and as tyranny (Cooke & Kothari, 2001). The reasons for these concerns about participation are that the user or carer’s internal knowledge and understanding may be limited so that external input and analysis may be needed to achieve successful outcomes. In addition, participative exercises may throw up apparently strong views when a wider range of opinion has not been revealed through adequate consultation. Weaknesses in representation may therefore undermine the value of participation. In addition, people living in a locality or who appear to have related interests may be assumed to have a community of interest when there are hidden divisions between different groups. A plurality of views among participants may make it difficult to make decisions or resolve disagreement. Participants may also be manipulated. Agencies or official interests may in addition set the parameters of participation inappropriately to meet their own objectives and not those of the people involved. These points are an argument for a careful implementation of participation and a careful consideration of the opinions that result. Nkunika (1987) argues that appropriate organizational bases for facilitating participation are needed. Current approaches to development increasingly focus on issues of poverty, migration. employment and enterprise, particularly social enterprise, issues of diversity, ethnicity and colonialism, and issues of new technology, sustainability, gender and urbanization (Allen & Thomas, 2020). Many of the issues in social development concern poverty, gender and ethnicity and their consequences for identity, either gender, ethnic or national identity. Thus, social development increasingly connects to ideas from social construction, feminism and multicultural sensitivity (see Chapters 9, 13 and 14, respectively). Social pedagogy in its focus on liberation through the use of self (Gardner, 2019: 34–5) has important connections with humanistic approaches. Its focus on equality and social justice links to critical practice, and the concern for social connectedness also makes links with both feminist thinking and systems theory ideas.

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The politics of social and community development Social and community development is often peripheral to the main areas of social work practice in Western countries. In non-Western countries, however, if we exclude adoption, health and social security provision and action to deal with young offenders, it is often the main form of social intervention, although social provision is also sometimes needed and provided, especially in urban areas; urbanization often generates need for social provision (Hardiman & Midgley, 1989: 237–57). Social development grew out of community development work in the later colonial period. The experience was reimported to Britain and the USA in the 1950s and 1960s and influenced an explosion of radical community action in the 1960s and 1970s. Attempts were made to develop Western social work throughout the world, which led to social care services and social work education in casework and groupwork in many countries (Brigham, 1977). Walton and el Nasr (1988) call this the transmission phase of interaction between social work in Western and resource-poor countries; Askeland and Payne (2017) refer to an establishment phase in which Western countries sought to extend social work education throughout the globe. This spread was, however, widely seen as inappropriate for indigenous cultures and social needs (Midgley, 1981). Walton and el Nasr (1988) describe Western knowledge as being indigenized in other cultures and authenticized to make it acceptable to local understanding. Payne and Askeland (2008) propose that decolonization requires a process of cultural translation, in which Western knowledge is offered in adaptable forms and, when adapted in alternative cultural contexts, can lead to changes in the culturally dominant Western models of understanding. This then should have consequences for the Western interpretation of the theory, although whether this reverse impact occurs is doubtful. Recent theoretical development increasingly uses indigenous or local knowledge (Hart, 2019; Twikirize & Spitzer, 2019) to create new models of practice, specifically to decolonize knowledge. Postcolonial theory notes that Western models continue to colonize indigenous understanding through cultural influences such as assumptions about how knowledge should be taught in the curriculum and managed through academic journals and publication processes (Kreitzer, 2012; Kleibl et al., 2020). During the 1980s, social development therefore became the model of work that was considered most appropriate for most resource-poor countries (see, for example, Midgley, 1989; Hall, 1993) and it has been most strongly extended there. Schools of social work shifted from teaching Western social work models to a stronger focus on social development, able to use indigenous ideas (Patel, 2015); they also saw the human focus of social work as valuable for counteracting economic approaches to development (Osei-Hwedie, 1990). This change took place at least partly to maintain the schools’ credibility in a period when ethnic and cultural interests were achieving importance in many countries. Elliott (1993), among others, argues that the experience of social development in developing countries is relevant for Western countries. This is because they face wide disparities in poverty and economic development within their borders, making a social development approach relevant to them too. Because of its emphasis on participation and people constructing their own approach to problems and issues, the approach may also be helpful where countries seek to deal with the needs of isolated or marginalized communities, for example where native populations have been oppressed by incomers (O’Brien & Pace, 1988). Social

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development theory is also a useful counterbalance to a Western influence on global social work ideas, enabling a primarily non-Western model to gain wide relevance for practice. Social pedagogy is taken up as a critique of psychotherapeutic social work and an individualistic approach to care because of its emphasis on an educational method and its focus on community and social objectives, seeking greater equality and to counter poverty. We can see this in the occasional attempts to import it into the UK as a way of improving the quality and status of residential care work, as in the project reported by Cameron et al. (2011) that was discussed earlier in the chapter. It differs from critical theory (see Chapter 16) because its approach to social change is to seek empowerment and liberation through self-improvement and education rather than political action. In many European countries, it is not seen as a practical profession, and it has a higher status than social work. For example, in Germany, social pedagogy is taught in traditional universities, while social work is taught in the lowerstatus universities of applied sciences, although there is increasingly some diffusion between the two because of social work’s recognition in the English-speaking academic system. To take another example, in Poland social pedagogy has a historic position and social work is the innovation, and there is tension about whether social work should displace social pedagogy. In the UK, it is unclear that there is yet a politics between social pedagogy and social work, since social work is dominant and the main claim of social pedagogy seems to be its value position, which I consider in the next section.

Values issues The central value issue in macro practice is to manage the intrusion of the agency’s and practitioner’s objectives into the objectives of the collective or community that the practice is designed to help. There may also be differences among objectives espoused by various members of the community or collective. In individual practice, clients have the right to determine either the priorities, the problems to be dealt with or the solutions and aims of the work. These are often negotiated with them through creating a practice alliance, which also respects their rights to determine what happens as the work proceeds, as we see in the shared objectives (see Figure 1.7). Alternatively, there are clear responsibilities for the practitioner to intervene, for example to prevent child abuse or personal and social risks from mental illness, disability or ageing. In macro practice, practitioners have to manage what Banks (2003: 106) calls ‘parentalism’, the tendency on the part of the agency to want to control or even set the aims and methods that members of the community or collective will follow. We can often see this tendency in government policy. For example, social entrepreneurship sometimes seeks to get local communities to organize themselves to create effective businesses or to generate employment, when this would not be the desired method or priority of members of the community. Ideas such as capacity-building may seem insulting to members of the community (Banks, 2003) and impose professional or political ideas about what the community or its members should achieve, rather than members identifying what they should achieve. If you are concerned with community or social development, what are the boundaries of the community that you are developing? Do that community’s interests overlap or conflict with the interests of other

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communities that you are not concerned with? Are you sure that a reasonable range of interests within it are represented? And what constitutes development? Some people would see projects to provide work or additional housing as valuable, while others with a green perspective might see these as damaging to the environment. One of the dangers for social work agencies involved in community or social development is a focus on social welfare issues when the community may have other priorities, as the following case example shows.

Case example: A volunteering scheme for a housing project A settlement received government funding to promote volunteering in a housing project, recruiting unemployed young people as volunteers to visit a growing number of older people. This met government priorities in helping unemployed young people and the needs of older people that could not be met by employing social care staff. Local community representatives on the settle-

ment’s management committee objected to this project for two reasons. First, they did not see volunteering as helping young people into work. Second, they thought it was more important to find volunteers to help in the local school, which, because of poor standards, was threatened with merger with another school. They feared this would take local services out of the community.

Connected with the issue of conflicting priorities is the question of leadership. When does raising community members’ consciousness about the problems they face and the causes of those problems become setting the direction and focus of the community’s objectives? Government agencies have in the past criticized community work practitioners for encouraging local communities to protest about official services or policies, rather than do positive practical work (Loney, 1983). Burghardt (2014: 99) talks about ‘chutzpah’, the enthusiasm and self-confidence to motivate a group of people to believe that they can take action about problems they share and do something about them. When does having chutzpah as a source of encouragement become taking over the community’s rights to participative self-­management? On the other hand, when does encouraging participation become the practitioner avoiding professional responsibility? Banks (2003) suggests that dealing with such issues involves interprofessional and multiprofessional working that recognizes multiple accountabilities to many different groups in the community and among agencies involved with the community or collective. Working in this way allows practitioners to test out a variety of alternative perspectives on the role they and their agency are taking. Social pedagogy’s value position derives from its halting or ethos in which a respect for human dignity leads to a respect for place and the connections between human beings. The interpersonal use of self requires working to comprehend both individuals and their relationships and connections, holding a regard for them, accepting and valuing their otherness (Gardner, 2019: 34–5). This necessarily connects to a concern for social justice, since understanding and valuing people means seeing them as equals in the connections that they make

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and in the way in which professionals deal with them. The life world orientation describes how knowing, understanding and respecting the individual’s view of the world guides the balance of power in the practitioner’s relationships with clients and communities (Simpson, 2019).

Applications Macro/community work practice Macro practice aims to achieve lasting change that alters the economic, political and social environment so that people excluded by powerful interests in society from participating in the major decisions that affect their lives achieve an increasing influence and capacity to achieve their individual and collective life goals. Most macro practice works with communities, that is, groups of people who have shared interests in a particular social issue. Their shared interest sometimes derives from the fact that they live in the same locality.

PAUSE AND REFLECT  Communities and shared interests Note down some communities that you are involved with, both locality-based communities and those that are a community with a shared interest for other reasons. What shared macro aims do they want to achieve, and how does that fit the definition of macro practice?

Some suggestions I thought about the network for refugees and migrants that covers my area. It involves people providing services and support to refugees and migrants who are newly arrived in the country. Both newly arrived migrants and migrants who are already in the process of becoming established are entitled to membership. The network provides practical and personal help to individual migrants and their families. It also provides personal support to people who are appealing against immigration, housing and social security decisions, but it does not always advocate on their behalf. These services are not, however, macro services. The network selects a limited number of cases to advocate for, taking up cases that might make a point of principle that will benefit other migrants. It also uses its experience as the basis of public education to persuade other local people and organizations to be more accepting of migrants in the area and to persuade other public services to be more responsive to migrants’ needs. These aspects of the network are macro services: they aim to change, mostly in small ways, the way in which our society deals with migrants, so that new migrants can more easily settle and begin to develop a new life in the area. In addition, good experiences of understanding why people migrate and their many difficult experiences might help the general public to develop attitudes that are more accepting of social changes in their area.

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At times and in places when community work and macro practice have been valued by people in political power, social services agencies with a broad focus have often employed professional community workers and included elements of macro practice in their service. More recently, this has often been confined to specialist agencies working in areas where there is political support for considerable social development, for example in inner cities or where the closure of a major employer has led to economic difficulties for people in a city. Major social issues are often targeted through techniques such as activation practice with unemployed people, with the aim of helping them to adapt their skills and behaviour so that they are better fitted to current employment markets. This use of specialized community work is similar to the use of social development practice in developing countries, and can call on some social development techniques in the same way that social development theory interchanges with community work. Non-specialist practitioners occasionally include an element of community work in their practice as a special project, developing support groups, participation initiatives or community organizations that benefit particular groups of their clients. After initial positive experiences, however, such approaches have become entwined with the reform of unemployment benefits systems and have lost much of their community work emphasis, becoming primarily concerned with the compulsion, particularly of young people, to take up employment on potentially unfavourable terms (Lindsay & Mailand, 2004; Clasen & Clegg, 2006; Graversen & van Ours, 2009). The main social focuses of macro social work are: ●●

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small groups, which can bring together people who are experiencing shared problems in a particular locality, for example teenage offenders; families, parents or mothers who can be brought together to deal with pressures arising from care or community responsibilities, for example mothers with behaviourally disturbed children, or parents in an area where there is extensive teenage violence or drug-taking; areas where there are cultural issues, such as clashes between different ethnic groups, or where social cohesion is lacking because the culture has been lost after the closure of a local industry; areas where new communities are being formed, for example in renewed housing; issues that arise for particular work communities, such as health and safety issues, or particular jobs leading to social isolation, for example through shift work or isolated minority ethnic groups working in specialist restaurants; areas where there is concern about the environment, for example campaigning against new road, rail or airport infrastructure projects or the loss of local leisure environments through housing or industrial development; issues concerned with shared spiritual concerns, for example where there are isolated faith groups whose interests are excluded from schools, workplaces or community provision (van Wormer & Besthorn, 2007).

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Example text: Desai (2015) on social development in Asia Desai identifies the driver of social development in Asia as the history of ancient civilizations, religions and colonization in the contemporary context of rapid economic progress. Western industrialization took place within a context of liberal capitalism, individualism and the emergence of nation states and drew on the consumption of resources from colonized countries. Asian experience often challenges assumptions that these factors are necessary to industrialization, since it took place mainly in authoritarian states and collectivistic societies using development aid from colonial powers that controlled and exploited Asia’s economies. In particular, the state was an important source of economic development, together with influences from international organizations, rather than communities or social groups. The main elements of social development are economic development involving investment in poverty eradication, food security, people’s basic needs, particularly in health and education, environmental sustainability and social justice, in particular gender equality (see Chapter 17). Development systems, mainly state, civil society and regional organizations, influence, formulate and implement policies and plans. Such systems and policies are influenced by geographical and historical contexts, including religious and cultural factors, pre-­ colonial civilizations and political structures. Desai builds on Midgley’s (1995: 25) definition of social development as ‘a process of planned social change designed to promote the well-being of the population as a whole in conjunction with a dynamic process of economic development’. The aim is to link social and economic development. This is so that social welfare does not depend on drawing resources from economic growth. Instead, social programmes aim to enhance the capacity of people in poverty to participate in productive economies, rather than focusing on providing social services. The Western paradigm of economic development incorporates an ideology of secular humanism (see Chapter 13 for discussion of this idea applied to social work) incorporating an ideal of rational and scientific thought that supports economic liberalism, which emphasizes freedom to pursue individual economic interests and quantitative scientific evidence to formulate and evaluate objectives. Western modernist ideologies sought development of productive economies through industrialization, and this led to class stratification, social Darwinism and colonization as a way of obtaining and exploiting resources. While socialism criticized this, it also sought industrialization and economic and social development, but emphasized command by collective political structures, rather than individualism. Western and socialist modernist ideology saw limited industrialization as underdevelopment and economic growth as a favourable change, as developing economies mimicked Western history to evolve through a transitional phase towards becoming ‘modern’ developed economies. Modernization theories of development suggest that cultural and social ideas need to change to facilitate economic and social development, and claim that education and literacy work would overcome traditional attitudes, for example where men’s views or tribal interests dominate family decision-making. In addition, population control would reduce the pressures on the family and the community resources of large families. Social work became associated with this policy through the family planning project of the International Association of Schools of Social Work, initially to reduce women’s health problems but then to reduce population pressures that limited economic growth (Askeland & Payne, 2017: 19–20).

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Dependency theories of development argued that modernization theories perpetuated dependency on Western economic systems. This happened because less-­developed countries rely economically on exporting primary goods, such as food and natural products, while developed countries benefited from adding value through industry and services. Further development is not inhibited by traditional cultures but by social structures that maintain colonialism. Contemporary social development theory, therefore, proposes three critiques. The first sees industrialization as detaching traditional societies from their cultural roots. The second sees modernization as unsatisfactory, since it has not successfully ensured improvements in its target societies. Third, a critique of development suggests that efforts at improvement must respond to change, for example as variations in the social climate and in the variety of relationship patterns occur. Such changes mean that different distributions of opportunities and resources occur in families, and development must respond to that. Standardized approaches to development are therefore unhelpful. An alternative development model is needed because economic benefits from industrialization do not ‘trickle down’ to end poverty, liberal economic adjustment programmes have unacceptable human costs, social difficulties such as crime or pollution continue to spread in spite of or because of economic development, and democratization in many resource-poor countries suggests that people-centred models of development may be more worthwhile than purely economic development. Desai summarizes a paradigm for social development pursuing these ideas as follows: ●●

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Creating alliances through civil society organizations using alternative ideologies such as those of women, indigenous people and environmental movements. Basing development in postmodern ideologies that reject ‘grand narratives’ and instead focus on responding to underlying premises and motivations for development. Pursuing a postcolonial ideology that draws on knowledge and understanding of needs developed in former colonies. Multicultural perspectives endorsing diversity of communities, not only, as in Western perspectives (see Chapter 18), concerned with cultural, ethnic and language differences. Feminism contesting local power structures, seeking greater equity and participation for women, whose vision concentrates on social development based on human needs for equality, peace and development. Ecologism (or ecocentrism, see Chapter 15), seeing nature as a connected whole including human and non-human needs as combining to sustain nature. Human rights inherent in nature and necessary to living as a human being.

Thus, social development involves a participatory approach, enabling people to have direct access to decision-making and influence on economic, cultural, social and political processes affecting their lives. It emphasizes grassroots work and collective action, not allowing people to be marginalized and uses local people’s knowledge rather than bureaucratic expertise. It focuses on human development, aiming at human well-being, empowerment and agency, and justice and equity. Such approaches have been supported by human development policies of the international agencies, and in particular the United Nations.

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Desai (2015: 29–171) argues, using Asian examples, that a diversity of social development actions needs to be used, responding to the geographical, historical and political background in which they operate. The role of the state, regional institutions and civil society organizations needs to emerge from the particular society to enable relevant economic and social policy approaches to be developed. The resulting diversity focuses on: ●● ●● ●● ●● ●● ●●

poverty eradication; food security; health investment; education investment; gender equality; environmental sustainability.

Case example: Complex issues of social and economic well-being in Rwanda The village-based project Unugoroba w’Ababyeyi (parents’ evening forum) involved men and women in a regular meeting to discuss issues around family cohabitation. It originated from a women’s forum originally developed to respond to concerns about domestic violence, taking place in the evening to reduce conflicts with domestic responsibilities. As it developed, the topics covered were educating children on cultural values, so that they learned respectful and responsible behaviour in social situations,

work on developing savings and entrepreneurship, and the importance of formal and health education to improve well-being. While it was difficult to engage men, their participation was important in gaining broad commitment to these social innovations, and the local focus was found to be empowering for participants because it enabled them to organize advocacy in relation to government poverty reduction programmes. Source: Uwihangana, Hakizamungu and Bangwanubusa (2019).

Other writers, particularly Marxists, have suggested the importance of apocalyptic events to get development moving. For example, Lavalette and Ioakimidis (2011) collected studies of social welfare responses to natural disasters and civil wars; they call this ‘Social work in extremis’. They suggest that indigenous organizations create social structures that provide welfare support for affected populations. These actions are often separate from government responses or may oppose government provision tainted by involvement in conflicts. This can create alternative and sometimes original forms of social work. Midgley and Conley (2010a) extend these ideas by incorporating concepts of social investment and the role of social enterprise as ways of developing child welfare, mental health services and work with homeless people. Such innovations promote human scale achievements that support human rights.

Example text: Popple’s (2015) Analyzing community work Popple (2015) shows how macro practice emerges from current issues in communities at different times. I set out his analysis of theories in community work in Figure 10.3. Early community work is dominated by pluralist theories, which assume that interests in society can be

Radical/socialist theories: Recognize that communities’ interests conflict with economic interests represented by the State

Freire: Dominant social relations through ‘banking’ education system create culture of silence, requiring education for liberation

Feminist theories: Women’s personal experience reveals need for political links between community, home and workplace

Alinsky: organize people who share same self-interests Castells: capitalism’s interests linked to urbanisation, uses State to provide for citizens

Ethnic minority/anti-racist critique Western capitalism based on slavery and colonisation, perpetuated by development aid, with State repressing minority ethnic groups through racism Environmentalism/green critique Western economies dominate global policy, requiring affordable, renewable, resilient energy, transport, food and sustainable economic growth

Figure 10.3  Theories contributing to community work Source: Popple (2015: 57–92).

Gramsci: Popular-democratic struggle for hegemony by civil society, political parties, trade unions, churches, charities, cultural & community groups.

Foucault: power operates through people bell hooks: race, capitalism and gender interconnected Lukes: dimensions of power Sen: economic gains linked to political & social participation; plural identities

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Pluralist theories: Support and develop community groups representing diverse interests to the State

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Twentieth century theory

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represented by different groups. Community work seeks to develop and facilitate the involvement of groups to represent interests that may be under-represented in the present discourse. Radical and socialist theory argues that there is a consistent conflict between groups with economic power and oppressed groups have to struggle to gain influence. For community work, this means that simply developing and facilitating groups is insufficient, and economically disadvantaged groups need to be given priority. Feminist theories say that women have personal experiences of oppression in the community, the home and the workplace. The connections between these locations demonstrate that oppressions need a political response – ‘the personal is political’  – rather than simply developing and organizing in any single setting. This range of practice theories was subjected to critiques from ethnic minority groups and environmental interest groups; these theories did not adequately provide for their needs. In the case of minority ethnic groups, capitalist Western cultures oppressed minority ethnic cultures through racism built up by their history of slavery and colonialism, followed by the use of presentday postcolonial development aid to achieve economic, political and social domination of resource-poor countries and communities. The environmental critique also noted that Western economies dominate policy through cultural, economic, political and social globalization to promote unsustainable development. Both these critiques render traditional community and social development inappropriate. Community work needs to respond to the oppressed position of minority ethnic groups and populations, and the need for affordable, renewable, resilient resources of energy, transport and food to combat poverty and oppression. These critiques fed into a recasting of community work in the twenty-first century, Popple discusses these by drawing attention to influential social science writing that had an impact on community work thinking. Several of these writers are familiar from other parts of this book: Foucault’s (1980) analysis of power relations, Freire’s (1972) ideas on conscientization and liberating education, Gramsci’s thinking on cultural hegemony (Leonard, 1993; Ledwith, 2020), Lukes’s (2005 [1974]) scrutiny of political and social power and Sen’s (2001, 2009) ideas on justice as well as democratic political participation were all relevant to community work as to other social work concerns. These demonstrate the interlocking of social work and social science thinking in many fields. Alinsky (1969, 1971) was an American community organizer, Castells (1997) a sociologist who wrote about how society formed a network of interests, and bell hooks (1990) a feminist writer concerned with the intersections between race, capitalism and gender. As a result of these developments, Popple (2015: 93–113) identifies a range of models of the community work process, which I set out in Figure 10.4. The second column indicates the kind of strategy followed for each model with, in the third column, examples of the community organizations that might result. In addition to these models, Stepney (2018) makes a case for community social work. While this became an organizing feature of UK local government social work services during the 1980s, in which teams of social workers and associated care services were located locally and developed links with local organizations, Stepney promotes the ideology of involvement of social work provision with community connections as a good model of social work practice. This has connections with Popple’s (2015) ‘community care’ community work. In an earlier joint work, Stepney and Popple (2008: 107–31) developed an

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Model

Strategy

Examples of practice

Community care

Build self-help, social networks, voluntary services

Children’s play, community services for disabled or older people

Community organization

Coordination between welfare services

Local coordinating bodies, settlements

Community development

Helping groups build confidence and skills

Community centres, tenant groups, youth work

Community education

Equal and participative education

University of the Third Age, women’s and working-class education

Community action

Class-based, conflict-focused direct action

Campaigning on local issues, welfare rights, tenants’ action

Community economic development

Maintaining local business, social entrepreneurship

Community transport

Feminist community work

Improving women’s health and well-being

Domestic violence refuges, women’s health groups

Ethnic minority and antiracist community work

Running groups supporting minority ethnic group interests

Autonomous groups providing services, e.g. meals, cultural activities

Environmentalism

Enabling groups supporting eco and green issues

Campaigning, cooperative groups, food and fuel action/

Figure 10.4  Models of community work Source: Popple (2015: 93–113).

account of this practice, separating it from community work and community action. They argued that it formed a good basis for critical practice in social work, since engagement with and reference to the local community offered a source of critical analysis. An interesting feature of this account is that, although the work described here derives from Western community work, primarily in the UK, the areas of social concern addressed are similar to those addressed in Desai’s account, discussed as an example text in this chapter, of social development in Asia. We can see that similar social science ideas and social needs affect all disadvantaged communities wherever they are. Popple (2015: 135–43) sees community work as increasingly operating globally through international links between groups. Popple’s (2015) account of community work practice contains two elements: ●●

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Key values: equality and anti-discrimination, social justice, collective action, community empowerment and working and learning together. Important skills: critical understanding of the world, the professional use of self, communication, groupwork, organization and planning and research skills, teamwork.

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These values and skills connect closely with the kinds of values and skills that influence contemporary social work. Whereas the timescales and focus of community work may therefore make it difficult to combine everyday practice that incorporates both psychotherapeutic and community work, the value and skill requirements are closely aligned. This is one of the reasons why community work can be considered part of social cohesion practice, alongside many other practice theories. It also makes transfer between work roles with a community and psychological focus possible for practitioners. The final element in Popple’s (2015) account of community work covers the range of activities undertaken in practice. I have explained and reorganized this account in the following summary: ●● ●● ●●

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researching community needs; linking communities of interest and locality; resource development: helping groups decide on resources they need and find ways of getting them, including fund-raising; alliances and relationships: between groups and with other professionals and agencies; supporting representatives to official and commercial organizations; information development: building communications within communities and between organizations, and providing information services; setting up new groups: vision and structures; supporting existing groups: planning and taking actions, conflict resolution; working with children and youth groups; faith-based work; technology development, particularly information and communication technology, architectural and building technology.

In Popple’s (2015) account, therefore, we can see a clear development from theory and values to practice, and I set out this progression in process in Figure 10.5.

Theory

Models

Practice

Practice values

Practice skills

Practice actions

Figure 10.5  Community work theoretical process

 onclusion: using macro, social development and social C pedagogy ideas Most social workers will use macro practice from time to time in their work, setting up support groups or local organizations where they have identified important social issues affecting their work. Others may take this up as a specialization. Ideas of social entrepreneurship identify the importance of having a focus on innovation and sustainable financing through developing business alongside social objectives. Social activation emphasizes the importance of stimulating the energies of people who have been excluded from existing social opportunities,

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and social capital emphasizes how increasing the number and extent of people’s social networks can increase the human resources available to everyone in the community. ●●

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Social and community development provide a wide social focus for social workers’ interventions to help oppressed people, much more so than systems theory, which focuses on the interpersonal. Social development and social pedagogy have developed outside the conventional Western social work literature and offer insights drawn from alternative theoretical and practice perspectives. They confirm and promote the existing social order. These theories raise questions about how we should see ‘progress’ and ‘development’, which we often talk about unthinkingly as positives rather than recognizing the potential losses associated with them. Modernization theories also often assume that the social change they promote is always beneficial, whereas groups with differing interests may have various points of view or be in conflict. The detail of community work methods provides a useful codification of experience when dealing with community and social development.

The perspectives considered in the next four chapters incorporate these theories into a more critical perspective, considering whether the present social order is adequate to meet the needs of oppressed groups within society.

Additional resources Further reading Desai, M. (2015). Social development in Asia: Diversity and implications. Jaipur: Rawat. Patel, L. (2015). Social welfare and social development (2nd Ed.).Cape Town: Oxford University Press. Two perspectives on social development informed by up-to-date Asian and African theory. Midgley, M. & Conley, A. (Eds.) (2010). Social work and social development: Theories and skills for developmental social work. New York: Oxford University Press. A good account of social development theory and practice, mainly in resource-poor countries, with case studies. Eynaud, P., Laville, J.-L., Lucas dos Santos, L., Banerjee, S., Avelino, F. & Hulgård, L. (Eds.) (2019). Theory of social enterprise and pluralism: Social movements, solidarity economy, and the global south. New York: Routledge. Useful and well-theorized collection on social entrepreneurship particularly focused on the global south. Kummitha, R.  K. R. (2016). Social entrepreneurship: Working towards greater inclusiveness. New Delhi: Sage. In introduction to social entrepreneurship practice, with several extended examples.

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Popple, K. (2015). Analyzing community work: Theory and practice (2nd Ed.). Maidenhead: Open University Press. A well-theorized account of community work practice.

Journals Community Development Journal – Oxford University Press. Indian Journal of Social Work – Tata Institute of Social Sciences, Mumbai. Journal of Social Development in Africa – associated with the School of Social Work, Harare, Zimbabwe, this journal is now published online at http://www.ajol.info/index.php/jsda/ index. You can gain access to many African journals from African Journals Online (AJOL). Social Development Issues  – International Consortium for Social Development/Lyceum Books, Chicago.

Websites http://www.un.org/womenwatch/ The WomenWatch website of the United Nations Inter-Agency Network on Women and Gender Equality provides useful links to a wide range of social development issues concerning women. http://www.infed.org/index.htm, http://www.infed.org/biblio/b-socped.htm An informal education website, with useful resources on the history and nature of community work. The second page given here offers a well-informed account of social pedagogy. http://eprints.ioe.ac.uk/view/subjects/Y.html The government-funded and government-supported project to develop social pedagogy in UK children’s residential care provides for the first time good resources in English on this particular form of social pedagogy. The Thomas Coram Research Unit of the University of London Institute of Education provides a database of publications, which include several on social pedagogy and cover the findings and life of the project. This project also led to the setting up of a group of enthusiasts who operate a website at http://www.socialpedagogyuk. com/, and separately another group who support this work with an informative website at http://social-pedagogy.co.uk/index.htm. http://www.thewhocarestrust.org.uk/pages/social-pedagogy-what-is-it.html The good Who Cares? Trust briefing website aimed at young people and professionals who might come across this innovation. https://youtu.be/zJ2v2UdurCM An interesting discussion about decolonization in social work.

PART 3

REVIEWING EMPOWERMENT THEORIES This second group of theory chapters reviews social work practice theories whose main aim is to meet the IFSW objective to promote empowerment and liberation in the lives of the people that social workers serve. The previous chapter (10) covered practice using macro, social development and social pedagogy theories, which, while they have significant empowerment and liberation objectives, also contain significant social cohesion objectives. The final chapter of this group, on social justice, advocacy and empowerment, makes important contributions also to social change and development theories, and so leads on to the group of chapters ­concerned with the third IFSW objective. 11  Social construction: strengths and solutions

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12  Social construction: narrative practice314 13  Humanistic practice, existentialism and spirituality

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14  Social justice practice, empowerment and advocacy

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Social construction: strengths and solutions MAIN CONTRIBUTION Social construction contributes to social work the idea that social experiences and relationships set the agenda for what we do to manage our lives, resolve difficulties and make progress towards our aims. Shared expectations in society and ideas about the world built up in networks of social relationships influence how we can respond to difficulties. They also affect the direction of our search for opportunities and answers to those difficulties. Consequently, people’s talk and thinking about their lives forms and directs their actions. Strengths and solutions offer a forward-looking social construction of how to act on difficulties in our lives, rejecting problem-solving as a focus for individual help. They help clients and their families to recast apparent problems by looking for strengths in their present lives, allowing them to build positively for the future. A focus on building resilience is an important feature, and many of the ideas are being picked up in empowerment and critical theories.

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Strengths and solution perspectives share a positive forward-looking practice approach based on amplifying the strengths in clients’ lives. These perspectives come from social psychology and are all influenced by the impact on psychology of postmodernist, social construction ideas (see Chapter 3). Postmodernist thinking explores how power relations are expressed in the way people use language. This allows for ambiguity and disagreement in how people interpret the world, but may also seem bewilderingly circular in its ways of thinking. Concerns that postmodern perspectives lead to moral relativism (see Chapter 1) are countered by their emphasis on the alternatives that are open to people, given practitioners’ assistance. Clients face difficult realities, and social cohesion roles require practitioners to manage difficult behaviour and tackle serious social problems. Whether the focus on being positive allows for that is debated. In practice, sessions between clients and practitioners focus on positive planning for motivating activities as in vivo work between the sessions. 285

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Some evidence that a strengths perspective is effective in care (case) management and interpersonal practice with women subjected to domestic violence demonstrates the wide applicability of the approach, but research support for it as yet is weak.

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Deconstruction (drawn from the arts and literature) involves taking apart a situation through analysing its elements, and then exploring whose power has made those elements important. Discourse (drawn from sociological research) explores situations through examining the language used by the people involved. This enables practitioners to understand the different positions that people express or demonstrate about the situation. In turn, this process exposes the tensions and systems of mutual support that exist in responding to the situation. Exceptions are successful behaviours in people’s repertoires that practitioners amplify to overcome perceived problems in people’s lives. The miracle question helps clients to identify their objectives clearly. Scaling helps clients and practitioners to be specific about their aims and achievements.

THE DEBATE SUMMARY Social construction practices dealt with in this and the next chapter are significant implementations of the shared principles of alliance and rights. All of them focus strongly on involving clients in exploring their own worlds, understanding and participating in decisions and planning interventions. Three important areas of debate are as follows: ●●

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Positive psychologies used in strengths and solution practice value positives and possibilities. But do they neglect responding to clients’ concerns about problems and social work’s mandate to manage behaviour? Relying on linguistic interventions and changing people’s perspectives on their problems may make these approaches inappropriate for persistent and serious social problems and for busy agencies dealing with people with difficult, multiple problems. Emphasizing strengths can be a neoliberal agency policy that displaces service provision with demands that already deprived communities and families should provide caring resources rather than public agencies.

 ebating social construction strengths and solutions D practice Positives and problems as focuses Debate on strengths and solution perspectives counterposes the value of building non-­ judgementally on the positives and achievements in people’s lives with two critiques of this idea. Instead of concentrating on the deficits in clients’ social relationships or behaviour, you

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amplify and extend their advantages and offer alternative perspectives. In doing so, you reduce the importance of the deficit in people’s lives. A person with physical disabilities, for example, does not want to look at problems in their life that come from the disability; instead, they want to make their life a positive experience. These theories are a powerful source of the shared principle (see Figure 1.7) of working towards positive objectives. I deal here with two connected critiques of these ideas: ●●

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Being positive does not sufficiently recognize the reality, that clients and the people around them experience damaging problems. The social mandate for many social work agencies and for social work practice comes from demands for helping people to manage their behaviour appropriately.

Many people come to practitioners because of the negatives in their lives rather than the positives. Clients may find the unrelentingly positive focus of solution and strengths perspectives unrealistic because they refuse to acknowledge worries about the impact of serious problems in clients’ lives. Alternatively, clients may find these approaches disrespectful because they are always shifting the focus onto positives rather than accepting clients’ own perceptions of what is important. Clients may want the opportunity to explore and work on their problems (as in CBT) or to make sense of their family background or life experience (as in psychodynamic practice). The answer to this point is that the ethical requirement to secure clients’ informed consent to the way you want to work also means exploring alternative possibilities and gaining clients’ acceptance of your approach (Payne, 2011a: 50–6). The second point extends the same issue to social expectations of professional practitioners: social work agencies are mandated through policy and law to deal with social problems and difficult or disapproved-of behaviour. Focusing on positive possibilities may raise questions about whether social workers can achieve this social expectation by using ideas with a positive focus. Case example: Solution-focused questioned in child safeguarding This is an excerpt from a press comment on the ‘Baby P’ case in the UK, in which a partner of Baby P’s mother and his friend who was living with them violently killed an 18-month-old infant: It was this philosophy—Solution Focused Brief Therapy—which … [the] social services used in their dealings with the benighted mother of poor Baby P.  The fact that she was a shockingly bad mother, neglectful and prone to shacking up with violent maniacs, was thus largely ignored, and instead the people charged with the care of Baby P concentrated on what her mother sort of

hoped for, in a rather vague sense, in the future. What a fantastically stupid form of ‘therapy’. (Liddle, 2009) A television report about the same case included a more positive balancing comment: Andrew Turnell, an international expert in solution focused work in child protection, said … ‘Solution focused therapy provides tools that are like scalpels for a doctor, but they have to be used in the context of a risk assessment framework where everybody knows we’re talking about the safety of children.’ (BBC, 2010)

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I juxtapose these comments to show the gap that may arise between common-sense public expectations and competent professional uses of a theoretical idea in social work. Liddle is expressing the not unreasonable public expectation that, in an important area such as protecting children from violent adults, practitioners should give priority to the social order expectation that parents are not violent to their children or should focus on the need for the child’s living arrangements to change. Turnell, in contrast, makes the point that appropriate and specific training and professional support underlie competent practice, which must also take account of the social responsibilities and issues of risk and security in the lives of vulnerable people. The professional perspective is that solution work would build or amplify the capacity of Baby P’s mother to care for her children and the men’s ability to moderate their behaviour, and would not harp on about their difficulties. This approach, however, needs to take place within a safe, protective environment. Liddle’s account also illustrates how easy it is to caricature a theoretical concept without fully appreciating all its practice implications. All of this demonstrates how careful practitioners need to be in presenting their work to outside observers and how assiduous they need to be in implementing all the requirements of the theoretical models they use. The answer to such complaints about this and other social work theories is also contained in these comments. Liddle complains of the vagueness, the ‘sort of ’ character of the positives that the practitioner was working on. Turnell wants practice to have ‘scalpel-like precision’; the weakness in the services’ response comes from failing to achieve that. Where necessary, I cover later in the chapter the prescriptions contained in all these forms of practice for challenging present behaviour and assumptions. Turnell’s related point is that the service context in which the theory was being used means that its helpful aspects could only benefit clients when they had first been secured from the risks that led to the service’s involvement. This exchange reminds us of the general point about using theory, raised in Chapter 2, that we must use theory with an understanding of what the theory requires us to do, and within the social context and the mandate that our society and agency has been given. You start from the responsibility for safeguarding children and adults, and then use the theory accurately insofar as it furthers those aims.

Linguistic interventions in major problems This critical point connects to the points discussed earlier in this section, but focuses on the methods used in social construction practices: social work deals with serious matters in people’s lives, and these cannot be turned round by linguistic gymnastics. To think that implies a lack of respect for the real problems that clients face. Solution and narrative theory emerges from psychotherapy, which does not focus on the service-providing responsibilities of most social workers. Many agencies make plans according to legal, management and policy requirements, such as the requirement to create packages of care for people with long-term conditions so they can live safely at home. Busy practitioners have many service responsibilities, juggle insufficient resources in short timescales and do not have the time to use a therapeutic approach. There are three points against these criticisms. First, simply pursuing management or service priorities is a false economy, because you do not then explore how clients and their

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families see the issues, which is one of the assets of social construction theory; this then leads to dissatisfaction and complaints. Second, you fail to focus on clients’ priorities. Ethically, this is wrong: the service is for them and is not a rationing system for the agency and the society it serves. Practically, by ignoring clients’ priorities, you may fail to engage their participation. Third, your assessment may prove unsatisfactory because you have failed to get a complete picture of the situation. Again, social construction theory points to the possibility of many alternative ways of interpreting and constructing any situation, the events that led to it and the opportunities that might spring from it.

Case example: Putting the forms aside to get the story and find the strengths Gail was a social worker in a hospital. One of her main roles was arranging for the discharge of older people who had completed their treatment. She was often under pressure to free hospital facilities for other patients and meet clients’ wishes – they mostly wanted to go home as soon as possible, so this came from clients as well as hospital managers. In addition, she had to comply with complicated application processes and funding arrangements to get packages of services together. Like many practitioners, however, Gail found it more effective to start by asking about clients’ priorities. She brought the forms to the bedside and said, ‘I’m going to fill in these forms so that I can apply for ser-

vices for you, but I’m just going to put them aside for a while, so that I can get the whole picture from you. Would you start us off by telling me what the main thing on your mind is at the moment.’ Gail often found that the client’s main priority was a matter of family or home responsibilities rather than the treatment or care options. She would then ask the client to give her a picture of the whole situation and explain how the client came to be in the hospital. This led to a story that explained how the client saw the issues in the home situation. Finally, Gail asked what the client thought was most important about going home. This enabled Gail and the client to focus on the positives in the move and the client’s priorities.

As well as there being these difficulties connected with the mandate for social work, Gray (2011) summarizes a range of criticisms by stating that the focus on strengths in all these theories is poorly defined and empirically supported only by anecdotes and case studies rather than rigorous research. Presentations of solution practice overestimate the practical effect you can have in very deprived and excluded communities. Gray argues that this practice comes close to accepting the individualistic neoliberal perspective that self-help and mutual support will be enough to overcome even major social adversity. There is criticism that strengths-­ based practice is not clearly described, but some research on its methods in child welfare, community development, ageing and long-term care (Kondrat, 2014: 51), and with drug abusers, high-risk young people away from home, fathers improving their relationships with their children, and with young parents, in groupwork and in general well-being, has been positive (Blundo, Bolton & Lehmann, 2019). Rapp and Goscha’s (2012) work on community mental health case management is, moreover, significant. Research on solution-focused therapy is ‘equivocal’ in its outcomes (Corcoran & Pillai, 2009: 240), and the impact of these criticisms is heightened in situations where there are insufficient resources, professional supervision or skill in precisely implementing these theories.

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Strengths practice can support neoliberal withdrawal of services An agency focus on strengths practice can promote neoliberal austerity policies. This is because it enables agencies to give priority to looking for resources in clients, their families and communities before providing support and personal help, and this can lead to a shift of policy towards requiring clients and their families to provide resources before services are offered. This focus can lead to judgemental views of clients who are unable to provide resources. The counter to this is looking at building interpersonal social work with clients, using this to explore clients’ preferences and objectives. Such an approach enables a starting point of clients’ wishes to be diffused into interventions that give priority to looking for alternatives to agency service provision. For example, the English Department of Health and Social Care (2019) strengths-based practice handbook starts from the person’s knowledge and skills (which allow them to provide for themselves), moves on in order to their circle of support and community networks, universal services, targeted services, then to acute and critical services. The assessment framework of the associated legislation permits a range of services to be offered, but social care services are usually only offered if clients’ needs are assessed as ‘critical’, the implication being that this would only be after all the other resources have been identified and provided. A document contributing to this policy makes the priority given to avoiding state service provision clear: ‘The first of these [key components] is the fundamental concept which underpins the others. 1) RESILIENCE: The ability of an individual to be independent from the state, and or other institutional support…’ (Gollins et al., 2016: 38).

Major statements This chapter brings together interpretations for social work of two perspectives drawn from psychological therapies and ideas of social construction. They are recent developments, dating from the late twentieth and early twenty-first centuries, so many social workers still draw on the major statements made on these perspectives in psychology: de Shazer (1985) in solution-­focused work and the positive psychology of Seligman (2017 [2002], 2018 [1991]). Saleebey’s (2013) strengths-based practice is an important social work source for these ideas, in an edited collection of practice accounts rather than a theoretical text. Connected with strengths-based work is the idea of resilience, applied extensively by Walsh (2017) in family social work and by Greene’s (2012a) edited work covering a broad range of fields. In addition, Rapp and Goscha’s (2012) important statement of strengths-based ideas, which is supported by research, contains influential strengths-based research as an aspect of case management in mental health. Its most recent edition also reflects the recovery perspective in mental health, discussed in relation to humanistic practice in Chapter 13. Myers’s (2008) concise general interpretation of solution-focused social work is a useful introduction. Parton and O’Byrne’s (2000) constructive social work terminology, implying both its helpfulness and social construction theoretical sources, and Greene and Lee’s (2011) solution-oriented practice combine solution practice with other theoretical sources. Solution-focused psychotherapy has, however, directly influenced social work practice. I therefore use, as an example text in this chapter, Shennan’s (2014) thoughtful and comprehensive account, which, as it is from a social work practitioner, takes us on from psychotherapy.

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Wider theoretical perspectives The idea of building on people’s strengths as a way of overcoming their problems is intuitively attractive. Most ideas about helping, therefore, contain elements of looking for strengths that will allow people to make progress. Reviewing the practice theories in Part 2 of this book, however, we have often found that social work starts from people’s problems, and many of the approaches are concerned with detailed excavation of problems to identify things that can be changed. We saw this particularly in task-centred and CBT practice, and many other elements of practice theory. If you turn forward in this book to theory about social change and development, a lot of the ideas also start from the negative, that social structures and relationships in society are wrongly set up and need to be changed. Many of these approaches, then, start from a negative, and strengths and solution practice aim to turn this round. Within social psychology, strengths perspectives developed from Seligman’s ideas on positive psychology. He argues in Authentic Happiness (Seligman, 2017 [2002]) that people have a typical range of emotions, some being usually more positive and others being more negative. Your usual level of happiness generally builds on your childhood experiences and depends on your social circumstances; both of these you have little control over. But there are factors in your life that you can control, and generally if you can use your strengths and assets to make changes in life, you will become happier because you are fulfilling some of the possibilities within yourself that you are aware of but somehow have been held back from using. This is an important source of working with people’s strengths, because this theory, backed by a certain amount of research, says that having the chance to use the strengths you possess is inherently satisfying. In Learned Optimism, Seligman (2018 [1991]) shows that difficult life experiences, such as those that many social work clients have lived through, can lead you to ‘learned helplessness’, to believe that you cannot improve things in your life. But, he says, you can train yourself to think and act positively and get out of a pattern in which you believe you have no hope of making progress in your life. There is a considerable industry devoted to producing exercises and therapies to achieve this change, and it has been influential in business and management as a way of improving employee competence and motivation. This work has created a climate in which there has been a twenty-first-century interest in acting and thinking positively. Within social work, Saleebey’s (2013) strengths perspective has been the most influential set of ideas. Encouraging membership of and engagement with a community and resilience are important and so are dialogue and collaboration (Harms & Connolly, 2019: 121–3). Kisthardt (2013) sets out six main principles of practice: ●●

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Focus on people’s strengths, interests, desires, hope, dreams, aspirations, knowledge and capabilities, not on diagnoses, deficits and problems. Relationships with clients should be about collaboration, mutuality and partnership. Everyone can be resilient. Everyone has the right to try, succeed and fail. Helping activities should be carried out in naturally occurring community settings. The entire community has potential resources; use naturally occurring resources first.

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The ideas about growth connect with humanistic practice, which emphasizes everyone’s capacity and need to achieve personal fulfilment.

Case example: Strengths practice in UK adult social work An important example of how strengths practice may be taken up is the UK adult social care adoption of a strengths-based framework. The aim of this programme is to challenge a deficit or problem-based model of clients, proposing that they and their communities have resources and skills. The materials do not connect with the international literature on strengths-based practice, but focus on UK policy promoting knowledge and co-creation, values and ethics, experience, theory and methods, and skills (KcVETS – Baron & Stanley, 2019). Practitioners are expected to work collaboratively with clients and their families

to identify abilities and circumstances that will help them, rather than looking first at the problems that they have. The aims include: ●  identifying potential benefits and risks, activities or decisions for individuals and others; exploring and fully understanding the ●   consequences of these; ●  collaboratively identifying the best way to manage identified risks, maximize benefits and if appropriate reduce potential negative consequences (Colomina & Pereira, 2019: 25).

Social psychology in social work Social work has been aware of social psychology, social construction and postmodernism, but surprisingly there have been few direct and sustained transfers of perspective or research, at least until strengths, narrative and solution theory interpreted them in a new way. In this section, I point to some of the ideas that have come into social work from social psychology, and discuss why its influence has been muted. It studies how individuals constantly interact within the social groups they play a part in, as well as how relations within and between groups help to create and maintain people’s social identities. This includes ideas about how people behave in relation to, and therefore influence, others, and the effects of social factors such as stigma, stereotyping and ideology on behaviour in groups. Historic writing in sociology and social psychology, such as the work of Mead (1934), starts from how people construct their personal identity into a ‘self ’. They do this through interactions between their mind, with its rational thinking and emotional reactions, and the external social world that they experience. One important relevant area of social psychology considers the effects of communication, and therefore language and speech, on social interactions. Communication studies researches the use of language and other symbols in communication between human beings as individuals, within groups and more widely in organizations and social collectivities (Adler, Rodman & du Pre, 2019). Social workers use language to influence clients, which means that the communication processes through which they do so gives them power over clients. In addition, research and study on communication assists practitioners’ understanding of how they can use patterns of communication effectively. Thompson (2018a) emphasizes the importance of

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language as an aspect of culture. He shows how people’s use of language in communications contains symbols of their culture, as well as how poor communication across cultural boundaries may make social work practice difficult. He also includes a focus on written communication, for example in letters and mobile phone texting. Neurolinguistic programming (Angell, 2017) is a therapeutic practice that originated from the detailed study of the language interactions of therapists. It offers an understanding of how information received from the environment is processed through language and then organized by an individual during helping activities such as social work. Role theory explores the creation of roles as a process of constructing ourselves a place in social relations (Lyon, 1993). Structural-functional role theory assumes that people occupy positions in social structures. Each position has a role associated with it, and roles are the sets of expectations or behaviours associated with these positions in social structures. How we see our roles affects how well we manage change. Dramaturgical role theory (Goffman, 1968) sees roles as enactments of the social expectations attached to a social status. People pick up signs about others in social interactions, and we influence others’ views of us by managing the information they receive from us, through performances. Our performance is usually idealized so that it includes common social expectations. We emphasize in this way some aspects of our role and conceal others. Some behaviour also reflects role conflicts and ambiguities. Role theory is easy for clients to understand; it also does not criticize them in a personal way, so it contributes easily to intervention. Moreover, role theory takes in a social perspective on behaviour, making it a useful link between behavioural problems and the social environment.

PAUSE AND REFLECT  Criticizing social psychology’s contribution to social work Consider criticisms from other theoretical perspectives that may be made of this role analysis, and of the explanations that social psychology provides for Grace and her mother’s situation.

Case example: Grace caring for her mother Grace, a middle-aged woman, worked as a secretary, having been divorced from her husband. She had brought up her children successfully alone and her daughter had stayed at home with her. Her elderly mother, also alone, was blind and later had a fall in her home. The doctor to both families suggested that they should live together, so Grace could provide greater security for her mother. This arrangement became difficult and a social worker was asked to help. Using ideas from role theory helped to explain that there was role conflict between Grace’s working role and her role as a car-

ing daughter; both roles were important to her. This was both inter-role conflict, because the work and daughter roles conflicted, and intra-role conflict, because it appeared that the mother’s expectations about the role of a caring daughter conflicted with Grace’s and, indeed, those of the doctor and Grace’s daughter, who was still living at home. Looking more deeply into the situation, Grace was suffering from role ambiguity  – she understood and appreciated all these views of her role as daughter, so she was uncertain about how she should behave.

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Some suggestions The focus here is on role theory as an explanation. One weakness, however, is that, unlike other theories, it does not help us to intervene. Psychodynamic theory is a structural-­ functional theory and therefore resonates with role ideas. Psychodynamic practice would focus on the history of relations between the mother and daughter, and psychodynamic practitioners would use this to explore their changing roles. Crisis theory could be used to explore how the fall was a precipitating event that brought a sequence of life events to a head in the crisis. At this point, the conflict over Grace’s caring role could allow the strong differences in social attitudes to the caring role to be brought out and dealt with. Feminist theory would criticize the mother’s and the doctor’s assumptions about the role of women as carers. Social psychology focuses on social identity, so while it identifies the issue of women’s identities in this situation, it does so with a neutral stance, while feminism makes a more critical analysis of sexist assumptions about the role of women. This brief summary of alternative theoretical frameworks that might be applied to the same case shows how social psychological theories produce interesting analyses but fail to offer useful practice prescriptions or directions for practice. As a result, practice theory has not directly emerged from social psychology as a separate theory in its own right.

Social construction ideas The impact of social construction and postmodernist ideas in the 1990s was crucial in extending social work’s use of ideas from social psychology. In earlier chapters, we saw how these ideas propose that people understand the world around them from their experience the culture and history of their society. They do this through developing shared understandings and interpretations of the world as it affects them. Therefore, patterns of social relationships create shared social expectations about how people should behave in different social settings. Many practitioners find this theory attractive since it offers the possibility of achieving changes in behaviour by changing social structures around clients and, more importantly, by changing perceptions of and interactions about social expectations. Witkin (2017) argues that practice using social construction ideas helps to develop critical analyses of human rights practice, of cultural difference, enabling us to notice and respond to difference, to manage risk and to position strengths as an important perspective on social issues. It is important to understand the difference between social construction and individual constructions of the world. Kelly’s (1955) personal construct theory proposes that individuals manage their behaviour according to ‘constructs’ or pictures of the situation in their mind. Everyone constructs events differently from each other. Therefore, looking at and changing people’s constructs may help to change their behaviour. Figure 11.1a illustrates how personal constructs are the internal pictures of the world that people build up through their own perceptions, and shows how each personal construct differs from other people’s constructs. Looking at the diagram, you can see that the picture of the interview is reversed. Each person sees it differently because they have processed the information about what is going on in the interview from their own point of view. The study and therapeutic use of perceptions and interpretations of the world is often called constructivist and relates to cognitive therapies. Constructivist practice focuses on

Social construction: strengths and solutions 295 (a) Personal constructs are individual perspectives

(b) Social constructs correspond with shared social realities

Figure 11.1  Personal and social constructs compared

misperceptions and inappropriate thinking, which means that accurate perceptions are not well processed. This has recently extended into the use of neuroscience in therapy, as we saw in Chapter 7. Social construction differs from these ideas about personal constructs. Figure  11.1b illustrates social constructions. It shows that people build up shared pictures of the world. They do this through social interactions with each other, using language and creating shared ideas expressed in language. This social and linguistic process takes place in social and historical contexts. Through these interactions, they come to have the same sense of what is real in the social and cultural context that they share. Practice based on these ideas is often called constructionist. Practice focuses on how the shared picture has been built up and how the impact of such shared conceptions or the context in which they have their effects may be changed. Strictly speaking, then, constructivist theory is about how we process the reality around us through perceptions, through the way our brains work and through our rational thinking. Social psychological construction theory, on the other hand, is strictly about how we use language in our interactions with other people to create a shared understanding of reality. Not all writers, however, make this firm distinction between constructivist and constructionist ideas. This is because many people see these practices as interrelated because they are all concerned with constructions and how they may be changed. Three areas of social construction theory are important for social work (Payne, 1999a): ●● ●● ●●

the social construction of reality; claims-making in the formation of social problems; sociological work in social categories and social differences.

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The social construction of reality is an important theoretical source that we met in Chapter 1. It shows how shared social constructions contribute to socializing individuals into social groups and society. In this way, social ideas are so widely shared that they become a reality for the participants in that society. Social problems arise when a social group successfully claims, particularly using mass media, that a social issue is problematic and requires social and political action. The argument is that social problems are not themselves inherently problematic: rather, their problematic status is created by claims-making.

PAUSE AND REFLECT  Underlying claims of constructions about social problems Examine these two statements and consider what constructions of marriage and social stability underlie the claims about divorce.

Case example: Claims about divorce Here are two views about divorce:

A Bill that seeks to allow couples to divorce without having to blame each other for their marital breakdown ‘undermines the seriousness with which marriage and divorce are regarded’, the Bishop of Carlisle, the Rt Revd James Newcome, has said. (Becket, 2020) We owe all the wonderful aspects of modern marriage to one thing: divorce. Divorce means choice …

that two people do not have to remain bound to each other until the grave … Divorce means that human beings can determine the path their life will take … divorce is also the great equalizer, and the hallmark of a truly advanced society in terms of women’s rights. No woman can ever claim to feel ‘like property’ or ‘subjugated by men’ where are there are equitable divorce laws in place. (Bell, 2011)

Some suggestions The first view presented in the case example claims that divorce is a social problem, while the second claims it as a social benefit. Underlying the first claim are assumptions that marriage creates social stability and is desirable, and that effective divorce leads to instability and is undesirable. The second claim suggests that, on the contrary, the availability of divorce brings social benefits that enhance social stability. Claims-making in the formation of social problems is a special case of the social construction of reality. It shows how groups create social constructions about particular aspects of our social life. Work on human categories points out that many apparently physically determined human categories, such as men and women, become overlaid by social assumptions and behaviour.

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Research through detailed conversation analysis demonstrates that the assumptions of the people involved, or organizations and social structures, often create human categories (Jokinen et al., 1999; Karvinen et al., 1999; Hall et al., 2003). For example, Juhila (2003) points out that, in a social work relationship, it appears that only two roles are available  – social worker and client – and that these are asymmetrical in power. The social worker has institutional power drawn from professional knowledge and authority from being part of the agency, while the client controls access to personal information and family relationships. More complex relationships than this are possible, and different kinds of social work relationships might be imagined. Feminists, for example, seek greater equality (see Chapter 13). All this work draws attention to how analysing human interactions carefully gives access to a complex understanding of how identity and behaviour is created in social relations. Understanding this, practitioners can use similar interactions to change people’s perceptions and social constructions, and thus change their behaviour and social relationships. This possibility is the source of constructionist social work. The French philosopher Foucault has been an important influence on the development of these ideas (Chambon, Irving & Epstein, 1999). He uses the ideas of knowledge and power to explore ‘governmentality’ to show how processes and techniques in society enable the autonomy of individuals to be regulated according to a social morality (Powell, 2013). Thus, professions such as social work manage people’s behaviour through their techniques, for example, by surveillance and subsequently disciplining behaviour. Discourses in society allow for rules of behaviour to be specified.

Case example: Being old and vulnerable in the 2020 coronavirus pandemic During a coronavirus pandemic, the UK government instituted rules for ‘social distancing’ to reduce transmission between people of a dangerous and previously unknown virus. One of the requirements was for people who were considered particularly vulnerable to serious consequences of infection to ‘self-isolate’ themselves at home away from others. Categories defined as vulnerable included anyone over the age of 70 and people who suffered from serious pre-existing illnesses, such as heart, kidney and lung disease. This defined ‘old age’ as starting at

70, when there was a gradient of increasing vulnerability that increased with age, and applied social rules to people in these categories, which would be enforced by social disapproval and legal provisions. For example, all people in the ‘pre-existing conditions’ category received letters with instructions from the government. It was clear that people in both categories would be likely to receive less extensive treatment if they contracted the coronavirus. This is a very clear example of how behaviour is defined and controlled through social processes.

Foucault points to the body as an object of control and manipulation (Powell, 2013: 50). In the coronavirus case example, supposedly scientific classifications allow for systems of social control to operate on people’s bodies. The same is true of social problems: we saw that social construction ideas explore how social groups use the classification of a human activity

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or need as a social problem to exert management over people’s behaviours. For example, becoming older or having a long-term health condition entitles society to control where you go and what you do. Social work, and its theory and practices, is one of the mechanisms through which this is done. Résistance is a social response to power; this is a different usage of resistance to the discussion in Chapter 4 on psychodynamic theory. Wherever power is used, people may avoid getting involved or delay participation. In social work, clients may avoid participation that may be helpful, because they also find it interfering or controlling, and practitioners create strategies for dealing with involuntary participation. An example is the technology of motivational interviewing, a theory of practice that we looked at in Chapter 8, specifically designed to deal with this kind of resistance. Garrett (2018a: 178–81) explores Donzelot’s (1979) Foucauldian analysis of how society polices families by creating cultural and political policies that set the parameters by which people live in the smallest social units. Again, social work practice with children and families is part of this process. One of the important features of Foucault’s ideas, which he shares with writers such as Gramsci, is that power is widely diffused in societies and available to be taken up by collective action, through macro and psychotherapeutic practice and through critical understanding. This is one of the aims of construction practice. For example, Borden (2010b) brings together a range of practice approaches that seek to express and work on less obvious aspects of life. These include psychobiography, in which people are enabled to explore valuable aspects of their life experience so that they may connect internal emotional reactions to external realities that have affected their lives (Clark, 2010). Another possibility is the use of reminiscence and life story work to help people secure their personal identity as their life changes. This will help in enriching personal relationships between older or disabled people and their family carers (Gibson, 2011, 2018). Kemp’s (2010) research proposes that a better understanding of how people experience different geographical places and physical spaces in their lives may also be an important factor in practice. In all these examples, helping people to think in alternative ways about their experience of their lives and their environment makes it possible for practitioners to renew or redirect clients’ understanding of their lives and the opportunities that may be open to them in the future. Narrative theory in particular picks up these ideas and seeks to open up such alternatives and new directions (see Chapter 12).

Modernism and postmodernism in social work Many people argue, however, that traditional approaches to social work disparage the flexibility of thinking and practice implied by the focus on the availability of alternative interpretations, which is a feature of postmodern and social construction ideas. This is because social work has often been regarded as modernist because it represents the universal and timeless humanistic idea that people in an ordered society are responsible for others. Its methods have always assumed, again humanistically, that human beings can and should manage their lives using their rational minds, and that helping can and should use evidence-based practice, drawing on knowledge gained through positivist scientific methods (Payne, 2011a). In turn, they assume that the world can be known through observation and experiment. In addition,

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social work contends that human beings can be understood through research relying on rational analysis based on external observation (Brechin & Sidell, 2000). Because of its modernism, many of social work’s theories seek grand narratives, or overall perspectives that offer a strategy for collecting evidence that will eventually explain human life and the development of society in a general way. Postmodernism contests this view that the world and human beings may be understood rationally through evidence built up into one overall perspective of human society. It therefore disturbs the stability of some of the assumptions that have been held to underlie social work practice. Postmodernism and modernism are not, however, mutually exclusive alternative ways of thinking, because they coexist and interact, and both can benefit practitioners in undertaking social work. Moreover, the approach of postmodernism to social issues reflects the reality of a more complex and nuanced human society in a better way than a single, perhaps oversimplified, perspective can ever do. Postmodernism contains two elements: a set of ideas and a set of social trends emphasizing those ideas within social relations. Postmodernism does not cancel out modernism. Instead, the importance of postmodernism is that it sets up an opposition or discourse about modernist ideas. Its ideas say, ‘Modernist ideas are not the only way of looking at things; consider alternatives.’ The main implication of postmodernist thinking for social work practice is an assumption that practitioners can always find alternatives to any system of social thinking. Therefore, any social order, anything that says this is how the world is or how it should be cannot be taken for granted. Postmodernism is interpretivist (Brechin & Sidell, 2000). It points to how knowledge is biased by the decisions of researchers and practitioners to choose natural and social events to observe and investigate, and also biased by the way they choose to investigate and work on the issues that they identify. We met these ideas in Chapter 1.

Practice ideas from postmodernism: deconstruction and discourse Deconstruction and discourse are important practice ideas derived from postmodernism. They connect with the importance in all social work of understanding and interpreting communication of many different kinds. Deconstruction originates in the arts and literature (Bertens, 1995: Ch. 5). It starts from understanding a situation by taking it apart to see its elements more clearly. More than this, it implies self-reflexivity. What this means is that any communication contains a message relevant to a particular situation, and also a message or analysis about how communication and analysis are carried out in this setting, and also a message about the nature of the setting or social institutions within which the communication is occurring. Understanding the ways in which communications are carried out and their institutional context allows you to identify important aspects of social relationships, including the use of power between different social groups. Communication is important because deconstruction works by looking at how the people involved use language.

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Case example: Talking to children about death I worked in a hospice, a social institution that cares for people who are in the advanced stages of serious illnesses and people who are bereaved. This service is called palliative care. Many younger and middle-aged dying people have children, but they often do not talk to their children about their illness and impending death. Among the reasons for this is that intense efforts are made by healthcare professionals to cure their illness, and patients often maintain hope in the possibility of cure. It is also a social convention that parents protect their children from unpleasantness. As a result, they avoid telling their children about their illness until they are close to death, do not plan how their children will be cared for after their death and may refuse to allow children to go to the funeral of the parent who has died. Palliative care social workers often quite strongly advise parents in this position to be open about their illness and death, but family members often resist this advice. In pro-

moting openness in this way, the social workers are communicating an analysis of the situation that parents are often not familiar with in their ordinary social setting, because parents usually try to protect their children from the unpleasant aspects of life. This is also an unfamiliar view in healthcare organizations, such as hospitals, where the focus is on cure rather than planning for death. Practitioners are demonstrating that the hospice is a different kind of healthcare institution. Other patients at the hospice also communicate outside the social convention, demonstrating different kinds of communication and showing that this is a place where communication is different from what is conventional. For example, one patient told me that he watched and listened to how other people in the day centre explained their illness to other people. He said this helped him learn about alternative ways of talking to members of his family about his own illness and approaching death.

Such a failure to be open with children about their parents’ serious illness enables us to identify a power imbalance in relationships. Parents do not accord children the same rights to knowledge as adults, and this identifies children’s limited power in their social relationships with adults (Reith & Payne, 2009). This important personal and interpersonal decision is guided by social relationships and expectations. Views revealed in discussion with dying people and their families express attitudes about parental responsibility and childhood that are held within the culture of the people involved. Uncertainty in the public mind about these issues is often dramatized in radio and television programmes and discussions. Moreover, there is a clear discourse here. Discourses are social interactions, interactions between people and sometimes among groups of people (Fairclough, 1992). These interactions are expressed in language; they enable people in social groups and societies to build up a shared understanding of the meaning of pieces of behaviour. So people understand what dying may mean because other people explain it to them, or because they see coverage on television programmes, or because in discussing the world they gain an impression of what it is, or because they actually experience it happening to someone else. The language used in any discourse is important, but discourses may also include actions, discussion and writing because meaning is demonstrated by what people do as well as what they say and write. For example, parents talking about a relative’s death often go quiet when

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their children enter the room. The children get a picture of what is going on from this behaviour, but they may interpret their parents incorrectly. The child may come to think that they are to blame for a relative’s death, for example through being too noisy when the relative was ill at home. The idea of discourse allows us to rise above any particular interaction and ask about the social constructions and power relations represented within it. When I talk openly about the dying process with a client who is dying, I demonstrate a position in the cultural discourse about openness. The client may later talk with a relative who does not like to express emotions about dying. If the client then talks to a third person unconnected with their family, they might choose either position – openness or discretion – or some compromise. By looking at a succession of behaviours like this, the discourse and some of the power relations within it become clearer. How culturally free, for example, is the client to adopt my open position with someone who believes that it is socially wrong to talk about death? Having a spouse who prefers discretion may prevent both from adopting a more open position with another relative. By helping people to deconstruct discourses in their lives, social workers can give people greater power in their relationships with others. This is because giving people a broader experience of alternatives in social relationships offers them social capital; we met this concept in Chapter 8. Bourdieu (1977) emphasizes the importance of the capital held by individuals and groups within their fields (Smith, 2001: 137–9). This gives them power – the capacity to influence the fields they are involved in. Economic capital is the accumulation of resources that gives people and groups the financial power to achieve influence. Cultural capital is the capacity to understand and interpret the world around us in complex ways. People gain influence if they have secure and well-understood ideas about how to interpret the world, such as those offered by integration within a profession such as social work. Social capital is the power that we gain by having wide and supportive networks of relationships. Social science often focuses on economic capital, but postmodernism suggests that cultural and social capital can be just as important in giving people opportunities to gain power over their environment. An example of this is the man mentioned earlier, who learned from other patients in the hospice day centre how to discuss his death with his family members. He gained greater cultural and social capital because, through experiencing the hospice, he discovered alternative ways of interpreting how to manage the reality that a person is dying (cultural capital) and how to gain support without alienating family members who did not want to talk with him about his death (social capital).

Connections Strengths and solutions practice have two major links within social work thought: with psychological therapeutic approaches and with critical and feminist ideas. Within psychotherapeutic social work, they maintain the trend and the shared principles (see Figure 1.7) of defining and working on specific behaviours. They counter the focus in CBT and task-centred practice, however, from defining problematic behaviours towards looking for identifying future behavioural objectives. As a result, people who like the specificity of CBT often remain comfortable with solution practice even though it incorporates more flexible and interpretive

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techniques. Part of the reason is that research on solution-focused practice evaluates the model’s success in individual behavioural change and connects with other psychotherapeutic research trends. Another reason is that more interpretive ideas that nevertheless respect psychotherapeutic objectives make a useful addition to the practice options available in CBT. Similarly, by incorporating social construction ideas, strengths and solution ideas offer an important practice dimension for critical and feminist theory. This is because they formulate specific practice techniques that can be used in the more equal dialogue methods typical of these forms of practice. An example of the interconnections is Milner’s (2001) work with women subjected to domestic violence. Milner links solution-focused approaches with feminist thinking in discussing her work with young women who have been abused as children or in violent domestic relationships with men. Part of her approach in working with women is ‘serious gossip’. To do this, she shares with women clients important emotions about their experiences, as well as laughter and tears about events in their lives. She argues that women who have been abused in their lives often need a feeling of safety and control in their lives. They may blame themselves unrealistically for what has happened to them. They may also have been led to that self-blame by the way in which their abusers blame them for provocative or difficult behaviour. Often, they may accept too readily a diagnosis of depression from the mental health services. This leads to a discourse between practitioners and clients focused on reflexive discussion concerned with valuing yourself, and your self, for example as a carer or as a provider of emotional support in the family. It involves helping women to set realistic personal responsibility for, and in, their relationships, and to explore the uncertainties. This helps women to create resistance to oppression by subverting the problem, setting boundaries and relationship styles that resist oppressive or violent behaviour in their relationships.

The politics of solution and strengths practice Thus, the claims made by solution-focused practice differentiate it from other psychotherapies, while drawing on psychotherapeutic thinking in other traditions. In Figure 11.2, I summarize Myers’s (2008: Ch. 3) useful analysis of the contrasts between solution-focused and traditional social work theories. Solution-focused practitioners reject the focus on emotions and how problems have arisen from past experiences that is typical of psychodynamic practice. Solution-focused practice aligns its emphasis on looking at specific behaviours and competences from CBT-style interventions, the currently dominant therapeutic approach in clinical psychology. As we saw when examining the connections between these two traditions, however, it does not look backwards at antecedents as a way of changing behaviour, but concentrates on planning for objectives. The social construction emphasis of strengths and solution ideas on exploring how people interpret their experiences and on engaging clients’ participation situates it alongside some of the aims of humanistic and psychodynamic psychologies. However, because strengths and solution practice rejects practitioners’ expertise in understanding and interpreting

Social construction: strengths and solutions 303 Solution-focused practice

Traditional practice

Accept people’s experiences

Investigate ‘truth’

Search for solutions

Understand the causes or sources of problems

Focus on competences

Focus on the problems that people experience

Focus on what people want to talk about

Focus on past issues that are theorized as relevant

Focus on behaviour rather than emotions

Focus on emotions linked to past events

Avoid diagnosis, categorization and pathology

Analyse problems that are theorized as important

Be respectfully uncertain

Draw inferences based on theorized explanations

Avoid blame and focus on good attributes

Make normative assumptions about appropriate behaviour

The practitioner is the expert on techniques and processes

The practitioner makes sense of and ‘solves’ the problem

Figure 11.2  Myers’s differences between solution-focused and traditional social work Source: Myers (2008).

behaviours according to some existing therapeutic model of humanity, it also avoids looking at the broader emotional and holistic explorations that psychodynamic and humanistic psychologies propose.

Values issues I have suggested that these theories present three values issues to practitioners. First, in its social cohesion role, the social work profession is expected to enforce the accepted moral expectations of the people it works with (Payne, 1999b). This may be in tension with the openness of strengths and solution practice to pursuing clients’ hopes. Can strengths and solution practice be realistic in the context of the enforcement roles of social work agencies? The second issue is that the moral response to this may be refusing to blame people when they have no responsibility and are working to improve the situation. The third issue is that clients may not possess the political and social consciousness to take on critical practice objectives that seek social change and justice. Consequently, these methods may evade possibilities for achieving social change or removing or reducing social oppressions. Some writers suggest that postmodernist thinking therefore requires a moral and political relativism, which argues that nothing can be known or finally agreed. Not so: postmodernism instead asks us to seek out and examine alternative ways of seeing what we think we know and what we expect. Looking at possible alternatives allows us to test out how complete our present understanding is. Moreover, where we do find alternative explanations, it invites us to seek more complete understandings that allow us to see how several alternatives may be true (Fawcett, 2013).

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Case example: A disabled man’s allowance is withdrawn The mother of a disabled man in his twenties was angry at the withdrawal of a financial allowance that paid his expenses to visit her regularly in her home. His social worker’s practice focused on her concerns and on the psychological aspects of social work, thinking that the mother had made her son overdependent on her and was behaving irrationally because his dependence met her emotional needs. From this point of view, the son would benefit from greater independence. Ideas from the independent living movement for disabled people support this interpretation. However, from a family resilience point of view, both the man and his mother were strengthened by maintaining the contact

between them. A feminist theorist might suggest that the practitioner was viewing the mother’s strong emotional response negatively. Perhaps this was a paternalistic, rationalistic assumption that calmer rational thinking should dominate a relationship between a parent and a man in his twenties. Critical social work theory might emphasize the importance of public financial support for vulnerable and deprived groups such as disabled or bereaved people in the community. In this view, withdrawing the allowance created appropriate anger. A community activist might well value the continuing relationship between mother and adult son as evidence of good community and interpersonal links.

This example draws attention to two things. First, different people can look at the same situation in many different ways. Second, we should explore the evidence for the different interpretations of situations if we are to understand them in a more complex way. Social events and relationships, particularly in the view of narrative practice, are always complex, shaded by the social histories of the event and the relationships that are part of it. Understanding complex situations requires social workers to see them from alternative interpretations, as viewed by different actors in the situation. Moreover, far from rejecting concrete evidence, a complex, in-the-round understanding of the situation requires a greater attention to evidence and careful research. This is because it allows us to separate the different strands and varying points of view within the complexity and decide which are relevant and which are not. Otherwise, we work on a limited caricature of the situation. Rather than rejecting social order and social structure, postmodernism accepts that social order is valuable and necessary, but it asks us to understand the complexity and implications of the present social order and structure and of possible alternatives. Social workers need to examine different positions about the social order and how it is changing if they are to help their clients deal with a complex situation in which there may be many different competing attitudes to be resolved. Thus, it is important for social workers to explore debates and discourses about important issues in society, so that they can follow trends on issues of concern in social work, such as the role of the family. Examining these debates enables practitioners to understand who has power and influence in that discourse, both widely in society and between the individuals and family members they may be working with. This may enable clients and practitioners to pursue steps towards more critical social justice and change aims, building on the solution and strengths development they have achieved.

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Applications Strengths practice The strengths perspective underlies solution practice and can be used in virtually all practice approaches. I have broadened Rapp and Goscha’s (2014) summary of the main principles of strengths practice from their mental health focus as follows: ●● ●● ●● ●● ●● ●●

People with disabilities and facing issues in their lives can learn grow and change. Focus on individual strengths, not deficits. View the community as an oasis of resources. Clients are directors of the helping process. Worker–client relationships are primary and essential. The primary setting for our work is the community.

Pulla’s (2014) account emphasizes affirming people’s membership through citizenship of the society in which they live, giving them an entitlement to services and dignity and respect. Maintaining a dialogue with clients and their carers and collaboration with other professionals and services is important. The centrality of these issues has been learned from mental health practice, where leadership often resides with other professions and services, and failing to engage with them disadvantages clients. Moreover, in mental health the social exclusion and isolation of people with mental health problems and their carers is a major social work issue. It is more easily forgotten in other services, but is just as relevant to social work practice. Strengths-based practice (Pulla, 2014: 64), again adapted from a mental health perspective, includes the following ideas: ●● ●● ●● ●● ●●

●●

Emphasize the individual’s personhood. Value the lived experience of clients and carers. Convey empathy and compassion. Build partnerships and agree mutual goals with other professionals and services. Address marginality, stigma and disadvantage in clients’ social environment and relationships. Assist coping, resilience and hope.

Positive psychology can directly inform strengths-based practice through building ‘mental capital’ (Li & Miller, 2014) as part of the social capital, Bourdieu’s term for the networks of social relations that can enhance individualized helping efforts.

Example text: Shennan’s (2014) solution-focused practice Shennan’s account of solution-focused practice demonstrates how this mode of practice is more focused than the underlying principles of strengths practice. He sees it as based on: ●● ●● ●●

asking questions; listening carefully to the answers; saying back to the answers, making connections with them by echoing, repeating, summarizing, appreciating and identifying difficulties with them.

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You do this throughout the sessions, not just in summaries at the end. This implements the social construction idea that it is how you think about and talk about an issue that enables you to change how it affects you. A solution-focused practice session is not, as in task-centred practice (see Chapter 6), planning and rehearsing for tasks. It is a bit more like motivational interviewing (see Chapter 8) – actually working on the change that you are in the process of making. The content of your questioning, listening and saying back is formed by the basic assumption that there will always be something that the client wants to achieve that you can find to work on. Shennan’s three-stage solution-focused process, which I set out in Figure 11.3, aims to find that solution-focused something. It is repeated throughout your work with the client. In the ‘Commentary’ column, I provide a bit more explanation of what the process involves. An important point about this process is that you are doing the work of developing the questions and responding to them, so that they get the client thinking and working on the issues in their lives. Doing that work, your aim is to get the client working on thinking about their aims and ways of getting towards meeting them. If you have more than one session, they will be setting out on a programme of working towards their aims in between your sessions. So, in this form of practice, the client sets the solutions and does the work. Your role is enabling them to do that. Obviously, an important skill is being able to construct the questions. Shennan emphasizes getting straight to the point and focusing on specific aims as soon as possible. Use the client’s words in picking up their answers. You can use plurals, so that you always ask for more than one idea from the client. If you don’t get it, ask ‘What else?’ Get the client to focus on their life outside, rather than on coming to your agency and your work together. If you don’t get a useful response, ask the question another way. Try to shift the sequence of questions from the general to the specific: ‘Tell me more.’ Presented with a problem, ask how the client gets through it. Greene and Lee (2011) identify the classic questions that solution-focused practitioners use, which I summarize in Figure 11.4.

Commentary

Process Starting point

What the client want

Start with the client’s preferred end point

Describe the aims in concrete detail: how would you know? What will have changed?

Describe in detail what the client wants

Find out how the client will know when the aims are achieved and what difference will this make

During sessions, describe what’s been better

Describe progress made

Figure 11.3  Shennan’s solution-focused process Source: Shennan (2014: 18–28).

Use various techniques to help the client assess what progress they are making towards the aim

Social construction: strengths and solutions 307 Questions

Illustration

Comment

The miracle question

This might seem a strange question: if there were a miracle and this problem was solved overnight, how would you know the miracle had happened when you woke up in the morning?

Enables you to be precise about the change you are looking for – helps to clarify your goal

The time machine question

If you could travel in a time machine into the future, to a point when this problem had been solved, what would be better for you? What would people say about you that would tell you this problem had been solved?

Enables you to be precise about what the gains would be, individually and in relationships – a motivating factor

Outcome questions

If I met you in the street three months after our final session together – If I were a fly on the wall at your home or office for a day – If I made a video of you now and another one the day before our last session – • What would I notice that would be different about you or your situation? What would you tell me that showed that you no longer had this problem?

Clarifies the precise behaviours and situations you are aiming at

Follow-up questions

• What would have to happen to show that the miracle had started? • If a small part of the miracle had happened, what would you notice that was different? • When are the times that the miracle begins to happen? • What would need to happen for those times to occur more often?

Clarifies possible steps toward the goal

Relationship questions

• Who would be the first person to notice that something was different? • What would they notice? • What would it mean to them?

Connects the goals to improved relationships – a motivating factor

Figure 11.4  Useful solution-focused questions Sources: Greene and Lee (2011: 82–90) and Shennan (2014: 49–96).

Contracting As in all social work, you agree with the client on your aims and what you are going to do. The solution-focused approach to this is asking for clients’ hopes and the difference they hope to see as an outcome. Ask about their best hope, what they would see if it is useful, what or who would tell them about improvements, how the client would have changed and what the long-­ term effects might be. You may have to overcome two difficult responses. Clients are focused on their problems and may not expect much. In addition, their main response may be a variety of ‘don’t know’. But they are still with you, even with all their doubts and even if they are required to come by their school, the court or another agency. You have to take the agenda from their acceptance, even if it is half-hearted.

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Case example: Jacob after the divorce Eleven-year-old Jacob was sent to see a social worker by his school because of behaviour difficulties following his parents’ divorce. The answer about his hopes was: ‘I can’t see how talking to you will help.’ The

social worker picked this up directly: ‘What help do you want?’ The answer: ‘Get [the teacher] off my back.’ The follow-up: ‘What would being off your back look like?’ and she is already beginning to talk about his aims.

Another problem is talking about process. Examples are asking for explanations about how a problem built up, wanting advice or just wanting to talk. Your response to this is to ask about the outcome: how would you know this had been useful? Hopes may also be unrealistic, and this is what the critique we looked at earlier in the chapter refers to: someone with serious life problems just expresses a few vague idealistic aims. In response to this, you would ask about the underlying objective that is more concrete and achievable.

Case example: Ted’s mental health aims Ted hoped he would never have a recurrence of his long-standing depressive illness, ‘to never be depressed again’. His social worker drew attention to the lack of realism but asked for a more concrete aim: ‘You’ve really had so many bad times over so long, I can why you want

that, in fact anyone would. If you could think of one thing that would be better after three months without depression, what would it be?’ The answer was about not having his wife always nagging him to get going on improvements around the house.

As with Jacob’s case, this provided a specific agenda to work on about taking the initiative about improvements and responding to his wife’s anxieties.

Descriptions From this account of contracting, we can see the importance Shennan gives to helping clients to achieve clear concrete descriptions of two things: ●● ●●

their preferred future; instances during which they have experienced exceptions to their problems.

He carries on with this throughout the process. He also uses them even when he is mainly working on other aspects of his agency’s role, as solution-focused questioning can be used in all sorts of situations. Shennan (2014) identifies practice principles for working on descriptions. Here, you listen thoughtfully as clients talk about the problems they describe, and you use open questions to

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ask about what they are aiming for. You avoid being directive about what they should concentrate on or what they should do. Instead, you try to open up possibilities, using the subjunctive mood: ifs, mights and maybes. The idea of instances comes from the wider literature, which talks about exceptions. You try to elicit (see motivational interviewing in Chapter 8 for more on eliciting) descriptions of occasions when an issue goes well for them that usually goes badly. While you avoid interrupting their flow when they are talking about difficulties, you note down examples of occasions when they did not experience the problem. At a suitable point, ask them to describe what led up to this successful occasion. You ask how the client did that, what they did to help it along and anything else that helped, such as other people doing things. With this detail in mind, check whether they were pleased about what happened and whether they would like instances of that kind to continue. The description continues with the effects of what happened, and if it continued or became more common in their lives what other things might result.

Scaling and coping questions Scaling questions help clients to work on the level of their concerns and how much they have improved or could improve. We came across this in different forms in Chapters 7 and 8 on CBT and motivational interviewing. The approach here is to ask on a scale of 0–10 about how difficult a problem is for them. You might define 0 as the worst the problem has ever been or the worst that it might be and then ask for a description of the circumstances, while 10 would be the best it’s ever been or could be, with again a description of what that would be like. After defining the scale, you ask where the client is now. The aim is for them to be able to describe their own view. If you are using your own ratings, for risk of suicide or in child protection, for example, that is a separate matter. While Turnell and Edwards’s (1999) ‘signs of safety’ approach to child safeguarding builds on solution-focused practice and uses rating scales for assessment, in this case they are about the agency’s responsibilities, not solution-focused helping. Coping questions can sometimes be combined with scaling questions. The aim is to look for instances from current experience. You do this by building on the client’s descriptions of their difficulties and asking how they get through the experience, or how they stop it from getting worse. By doing this, you are expressing appreciation of and acknowledging what they have achieved and you are opening an agenda of whether this can be repeated. It also helps you to identify their preferred ways of dealing with problems. Asking coping questions allows you to identify possible instances that can be used to build towards solutions. In both cases, the aim is then to build understanding of the client’s view of their position. You can ask what tells them that they are at that point rather than another. What makes it a 3 rather than a 0? How has it changed? What’s the difference between how they were when they were referred or decided to come to your agency and your first interview? How has it changed since your last session?

A ‘bridge’ between instances and the preferred future As you work with clients on their descriptions, you next need to build a bridge from present experience and the possibilities identified in instances towards the preferred future that clients want to achieve. We have seen how scaling can help identify where clients are now with

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their problems. We can also look at where they can move to, and in follow-up sessions how far they have gone. Instances can be used to build a plan to move up the scale. You then follow up in later sessions using descriptions and scaling to identify how clients have moved in various ways towards their preferred solutions.

Typical structure of interventions Shennan (2014) sets out a typical first session structure. After introductions and explanations, and in particular looking at clients’ strengths, you start in as soon as possible with contracting, through developing the client’s detailed preferred future description. By describing coping, you can look for instances of this future structure that are already in place. Part of this may be scaling general progress and looking for any small signs of progress. In the closing stage, a summary of the session, using the client’s words, allows you to demonstrate how well you’ve listened, allows them to check your understanding and reinforces learning about existing progress and future possibilities. Generally, particularly with brief solution-focused work, there is not a homework-setting process, although you might help clients by suggesting what they might be noticing during the following period. If there are further sessions, they will become accustomed to how you look for descriptions of progress and instances in the intervening time. In their work on solution-oriented practice, Greene and Lee (2011) usefully identify examples of levels of noticing tasks that can be suggested, depending on how well they have been able to take on the solution-focused process (Figure 11.5).

Where clients can identify exceptions: ask them to continue doing those things that work and be prepared to report back on what happened

Example of an observational task: observe a defined aspect of the client’s situation and in the next session describe one thing that took place in that aspect of their situation which they want to continue to happen

A minimal task, where engagement is not accepted: congratulate the client on being prepared to attend and take part as the basis for moving on next time to deciding on appropriate actions

Figure 11.5  Levels of tasks in solution-oriented practice

Social construction: strengths and solutions

Subsequent sessions follow the general process of moving from the general to specific concrete descriptions and instances, and understanding the difference that progress has made. If things have not gone well in the intervening period, you would acknowledge this, appreciate any effort and progress, and look for instances. Eliciting difference, and particularly success in preventing things getting worse or achieving some instances of progress, leads on to a new contract for the future.

Conclusion: using strengths and solution ideas Strengths and solution ideas form a distinctive perspective on practice, as well as proposing some specific techniques. They have all been used with the full range of clients that social work practitioners work with; in addition, there is research validation of solution-focused practice in psychotherapy and strengths work in care management. However, there have been criticisms that it is overoptimistic to expect these psychological models to have an impact where severe adversity and social exclusion are affecting the surrounding community. These perspectives require a forward-looking focus on the positive outcomes that clients desire. They therefore connect with both the shared principles in Figure 1.7 and also research and aspirations in social work that emphasize enabling clients to be in control of the outcomes that they want to achieve. The practitioner is required to maintain a positive, forward-­looking approach rather than focusing on clients’ problems or deficits. In this way, the perspective connects with the social model of disability and citizenship models of practice, rather than focusing on problem-solving. Because these perspectives draw on postmodern social construction theory, they accept that people can change if their understanding of their social experience changes. There is criticism that this perspective does not recognize the responsibility of social work to maintain social cohesion and achieve mandated social objectives, such as changing criminal or disordered behaviour or getting people out of expensive hospitals and into more economical community facilities. Social work aims to achieve these social objectives, however, through a practice that is respectful of clients’ own objectives and acknowledges the need to engage people in making their own changes and incorporating their own objectives into wider social outcomes. Taking more time to manage work with clients appropriately and respectfully is more likely to engage them in using their strengths than jollying them along to meet the service’s targets. Important features of practice within this perspective, therefore, include: ●●

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drawing out people’s own experiences and their understanding of their lives and their objectives in working with the practitioner; maintaining a positive focus on the desired outcomes; using techniques that maintain clients’ forward-looking and positive objectives; working to identify personal strengths and enabling social niches in clients’ lives; identifying positive exceptions to patterns of life that people can amplify to develop their strengths; looking for clients’ own solutions by getting them to observe the successes in their lives;

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maintaining a forward impetus by working actively with clients in sessions to identify solutions and strengths, and setting forward-moving tasks that aim towards useful desired objectives.

Additional resources Further reading Rapp, C. A. & Goscha, R. J. (2012). The strengths model: A recovery-oriented approach to mental health services (3rd Ed.) New York: Oxford University Press. Saleebey, D. (Ed.) (2013). The strengths perspective in social work practice (5th Ed.) (Boston: Pearson). These two books provide different but complementary perspectives on strengths-based practice. Rapp and Goscha’s book focuses on mental health practice, while Saleebey’s edited book is an important source of useful ideas used in this model of practice within social work. Greene, G.  J. & Lee, M.  Y. (2011). Solution-oriented social work practice: An integrative approach to working with client strengths. New York: Oxford University Press. A useful account combining solution-focused and narrative perspectives in a social construction model of practice. Shennan, G. (2014). Solution-focused practice: Effective communication to facilitate change. London: Red Globe Press. A good practical textbook with useful examples of solution practice. Parton, N. & O’Byrne, P. (2000). Constructive social work: Towards a new practice. Basingstoke: Macmillan. This important book makes clear the social construction sources of strengths and solution perspectives.

Journals You can find articles on many of these perspectives in mainstream social work journals.

Websites https://www.scie.org.uk/strengths-based-approaches The strengths-based approaches website of the Social Care Institute for Excellence has many practical audio, print-based and video resources on strengths-based work in adult social care. https://www.youtube.com/watch?v=4JtWMzxY_vo A useful video introduction to strengths-based practice – how you can look at an older man not through his frailty or impending dementia, but through his life skills and experiences. By following YouTube links to other adult social care from Nottinghamshire County Council, you can watch other brief films that show you how strengths practice may be useful in carrying out everyday social work tasks.

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https://www.gov.uk/government/publications/strengths-based-social-work-practiceframework-and-handbook You can freely download materials from the UK government website on strengths-­based social work practice and its connected approach to asset-based practice. https://www.thinklocalactpersonal.org.uk/_assets/Resources/TLAP/BCC/ TLAPChangingSWCulture.pdf This UK local government website promotes social work using a community social work model (see Chapter 10), encouraging social workers to move beyond an outcomes-­based, meet the targets view of practice to engaging in relationship-based practice drawing on community and personal strengths. This freely downloadable document has a good account of the UK government approach to strengths-based practice. Important bases for solution-focused therapy are: ●● ●●

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The UK Association for Solution-Focused Practice – http://www.ukasfp.co.uk/ The Institute for Solution-Focused Therapy, Chicago, which is one among many internet promoters of the ideas of solution-focused therapy in the USA – http://www.solutionfocused.net/home.html The original source of solution-focused therapy, the Brief Family Therapy Center, Milwaukee, which has closed since the deaths of de Shazer and Berg; however, a legacy website provides some useful resources – http://www.sfbta.org/BFTC/Steve_de_Shazer_ Insoo_Kim_Burg.html The Kansas University School of Social Welfare (Saleebey’s original base), which has an extensive website with links to other sites that focus on his approach – http://www.socwel. ku.edu/strengths/index.shtml The Ohio strengths-based practice collaborative runs a useful Facebook site, to which people constantly add links to resources and publications – https://www.facebook.com/ groups/TheStrengthsBasedPracticeCollaborativeofOhio/ The Brisbane Institute of Strengths Based Practice takes in various forms of research and practice connected with strengths-based work – http://www.strengthsbasedpractice.com. au/index.htm

CHAPTER 12

Social construction: narrative practice MAIN CONTRIBUTION Narrative practice in social work enables people to explore and shape their understanding of the personal and social impact of issues in their lives. They identify themes within their lives by creating narratives that place events into a time sequence. Working with you on these narratives allows them to find different interpretations and alternative possibilities. Narrative practice draws on social construction theory to form a way of exploring how our talk and thinking about shared views of how the world affects our actions. It can enable people to redirect their understanding and response to social relationships and situations that they are involved with.

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Narrative practice is a form of social construction intervention allowing people to work on redirecting their lives, often in important intimate and family relations. By deconstructing clients’ accounts of sequences of events in their lives, in ways that externalize their problems, narratives allow you to co-construct with them a reframing of their past experiences and new possibilities for the future, and develop ideas about people and social structures that might help them. Although narrative practice is criticized as being too concerned with expressing individual feelings, it allows people to analyse and address social issues that have an impact on them and make connections between their personal experiences and wider cultural and social issues. Narrative work can also be practical because it improves relationships and enhances mutual respect between practitioner and client. Narrative social work is part of a wider ‘narrative turn’ in social thinking and a ‘descriptive turn’ in social science. Narrative practice contributes useful techniques to psychodynamic relationship-based practice, humanistic practice and dialogic practice in critical and feminist theories. The right to create our own narratives about our lives is an important human right.

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Practice involves listening to and enriching clients’ accounts of their lives, deconstructing them and questioning to identify possible alternative options for the future, and through conversations about change to share re-storying and re-membering to help clients see how to put those options into practice.

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Narrative is an ‘engaging account of events, over time, according to a plot or theme’ (Béres, 2014: 13). The account is organized by and represents the narrator’s thinking and understanding of both the event and its human and social context. Narratives select aspects of the event and use language, actions and images to represent the narrator’s conception of it. If you are aware of and analyse how the narrative is constructed, you can identify alternative constructions that provide the potential for change. Externalizing shifts a problem in the narrative to outside the person or the narrator. They can deal with it as something that affects them rather than stemming from their own behaviour or relationships. Frame, framing and reframing. A frame is an established way of thinking about and viewing events, experiences and situations. Narratives are framed by cultural and social expectations and our own and others’ representations of the content and form of an event, experience or situation. Framing a narrative constructs one way of looking at it, reframing a narrative reconstructs the event, experience or situation, enforcing or facilitating an alternative behavioural or social response to it. Re-membering involves recasting the characters who figure in a narrative to identify alternative roles for them or additional or alternative participants in the narrative. Re-storying or re-authoring involves recasting a narrative to reveal additional elements or alternative conceptions of it and enable consequent changes in behaviour or social relations.

THE DEBATE SUMMARY The main areas of debate about narrative practice in social work are: ●● ●●

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Is it too individualistic, so that it fails to deal with important social conflicts and inequalities? Is it too expressive, too concerned with exploring personal interpretations of the world rather than understanding and working with realities? Consequently, is it practical? Does it focus on intervening to take action to achieve clear aims? Or is it mainly concerned with expressing and understanding feelings and ideas?

Debate on narrative practice Is narrative practice too individualistic? The focus of narrative is stories of personal experience. Narrative practice emphasizes open-­ minded listening to the clients’ interpretations of important turning points in their lives. The clients and practitioners then work together to find alternative and potentially more

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satisfactory narratives that will form the basis of new directions in life. Working together on construction means that co-construction becomes an important, often-used concept, a forerunner of the idea of co-production in which practitioners and clients work together to create services within the practitioner’s mandate but also relevant to clients’ perceptions of their needs. Narrative practice permits a fuller exploration of clients’ experiences and the development of alternative perspectives, identifying the ambiguities in life experiences. It offers fewer structured guidelines for practice, however; indeed, this is one of its attractions for practitioners working with complex interpersonal difficulties. Baldwin (2013a) argues that a strong record of narrative analysis can contribute to knowledge development because it can form the basis of a flexible and deep understanding of people’s lives and problems. The technical understanding of the elements of narrative help to provide for consistent analysis of life experiences and factors that affect people’s behaviour and social relations (Drisko, 2011: 722–3; Carey, 2012: 173–84; Shaw & Holland, 2014: 147– 64). Techniques of document and linguistic analysis provide methods for producing empirical data from narratives. I discuss this further in the applications section later in the chapter. Even though narrative analysis and practice focuses on individual experience, it can still contribute to social workers’ thinking about difficult situations. Baldwin (2013a), for example, suggests that analysis of narrative in documents can help to make explicit strands in complex cases. Child protection, mental health difficulties and serious case reviews in community and residential care all present situations where there are different points of view and difficulties in interpreting hidden knowledge and interpretation, as the following case example indicates. Baldwin (2013a, b: 85–101) shows how once a narrative plot had emerged, it developed a trajectory in which actions and events were used to support the assumed outcome of the plot. Knowledge and participation by other professionals were all interpreted to fit with the pre-­ existing plot, and information was used to characterize the mother and other participants in ways that supported the narrative. Careful narrative analysis reveals how this process led to misunderstanding and injustice. Case example: A case of Munchausen’s syndrome by proxy Munchausen syndrome by proxy (MSbP) is a mental illness generating abuse of children, in which parents create or exaggerate children’s medical conditions as a way of gaining attention for themselves. In MSbP, parents’ accounts of events convince us of the possibility of illness and can be difficult to disentangle in a logical way. An American woman living in the UK had been accused of child abuse by MSbP during divorce proceedings in the USA, but was found not guilty in a criminal court. When she became pregnant in the UK, the local authority responsible for child safeguarding received inadequate information about the US proceedings and carried out

a brief investigation before deciding to place the child with foster parents soon after birth. In later care proceedings, information about the mother’s actions was misinterpreted and, believing the MSbP narrative, the local authority tried to gain the involvement of other professionals to make judgements consistent with its interpretation of the evidence. Eventually, the case went to the European Court of Human Rights before the narrative constructed was found to be untrue, but in the meantime the child was adopted and could not be reunited with the entirely innocent mother. Source: Baldwin (2013a, b).

Social construction: narrative practice

Is it so concerned with expression that it does not deal with realities? A significant debate around narrative practice is about its focus on expressing feelings and understandings about people’s lives, their life histories and experiences. Does this fail to confront people with external realities that they must grapple with if they want to tackle problems in those lives? There are two main answers to this point. One is that narrative practice aims to bring forward a fuller, more nuanced, richer understanding of a range of possible interpretations of those realities. This enables you to compare the present main narrative that people offer with deeper understandings of the factors that affect them. The second answer is that many people need and want to deal with the aftermath of demanding events in their lives, especially change and loss and anything that affects their personal identity, including their ethnicity, gender and sexuality. Narrative methods can help people work on these issues. Harms and Connolly (2019: 123–37) argue for the value of connecting individual stories with wider cultural context, in particular for Indigenous peoples (see Chapter 18) and other communities with strong social and cultural identities. Narrative gerontology, careful attention to critical life events in their social and cultural context, has been found helpful for research with older people. In practice, a narrative approach may help to connect older people’s experiences with their wider community’s collective historical narratives (Greene, 2012b: 211–12). Examining practice approaches, Harms and Connolly (2019: 130–1) point to how narratives can identify and explore hidden, ‘subjugated’ truths that give us a wider picture of the realities that are affecting people. Racist, sexist and other oppressive experiences can be challenged and replaced with a more balanced view of people’s personal and social identities.

Is it practical? Connected with the expressiveness issue, Sheedy (2013: 90–2) makes two critical points about narrative practice and social construction theory. The first is that construction and narrative approaches involve understanding better the choices we have made and changing the meanings that we attach to life experiences. This may release people to make changes in their behaviour and social relationships, but it does not tell them what changes need to be made. These are worked out by the client, possibly with the practitioner’s involvement. But the narrative method does not create them, so the social worker needs another practice method to intervene usefully, or the client is left on their own to make the choices about what to do. In similar vein, Greene (2012b) identifies a critique specifically about the idea of life review, which is used with older people and also with people who have been fostered or adopted. While there is some evidence that this may allow for the resolution and integration of past difficulties for older people, it may not have benefits for everyone. A more fully articulated conceptualization of life review and reminiscence, with clear purposes relevant to specific social work objectives, is needed (see also Gibson, 2018). Sheedy’s second point is that although narrative practice allows people to explore the social contexts of their life experience, it only proposes personal and interpersonal responses. It does not, therefore, propose interventions or actions to deal with social issues such as gender, power, inequality and poverty, but only the personal responses to such issues.

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Narrative practice, by encouraging listening and accepting clients’ life experience, may help, however, to improve interventions by enhancing relationships. But Howe (2009: 192–3) argues, looking at work with an older woman with dementia over a period, that listening to a life story and current experiences can enhance a relationship and allow for mutual respect in the constant renegotiations necessary in long-term work with people in need of support and services. Launer (2018) sees the practicality issue differently. He suggests that practitioners need to guard against imposing their own and their agency’s agendas on clients’ priorities. It is important to track closely nuances in the client’s language and follow their feedback, avoiding psychologizing or making interpretations that come from our assumptions about emotional reactions or stresses on clients. Looking for explanations or to change people is not always needed; sometimes it’s better to help them accept how they are. If clients present inappropriate or multiple problems, check with them how to handle an issue, either as part of a bigger problem or looking at each in turn.

Major statements The main source of narrative practice in social work is the work of family psychotherapists from Australia and New Zealand (White and Epston, 1990). They are associated with the Dulwich centre in Australia. White was a social worker and many social workers use their original writings. McLeod (1997) sees their major contribution as the idea of externalizing, which enables people to shift away from blaming themselves for problems in their lives by mapping the influence on their actions and thinking through a variety of other factors or people that affected these problems. This opens up a space for alternative ways of thinking about a problem. Another important concept is the idea of conversational maps, which is developed by Béres (2014). As we saw in Chapter 11, writers such as Parton and O’Byrne (2000) and Greene and Lee (2011) emphasize the social construction sources of narrative in the way that they bring it together with solution, strengths and related ideas. More recently, texts applying narrative ideas directly to social work include Baldwin’s (2013a), Béres’s (2014) and McTighe’s (2018) general texts and a collection edited by Burack-­ Weiss, Lawrence and Mijangos (2017a). In addition, Launer’s (2018) practical health and social care text, although its contribution is primarily to healthcare, offers useful practice guidance. None of these forms a comprehensive account of narrative practice theory, but all offer insights on practice and information drawn from important theoretical contributions. I have therefore constructed the applications section by drawing on the strengths of different texts, without emphasizing one single example text.

Wider theoretical perspectives The development of narrative practice is associated with a narrative turn in cultural and social studies during the 1980s and 1990s; that is, a shift towards thinking about narrative as an important focus of debate. This appeared first in cultural studies, especially literature, hence the use of literary analogies such as plot and genre. Everyday commentary on journalism and

Social construction: narrative practice

politics often refers to the narrative that an article or political initiative is trying to present. The assumption is that a consistent story will help people understand policy aims or people’s motivations more readily. Genre, the factors that we associate with past understandings of the type of narrative we are telling, sets boundaries around how we respond or creates expectations that redirect our thinking (Derrida, 1981). For example, does a client think that social workers expect to hear about problems or misery? Are they driven, therefore, to fall in with that expectation, or do they try to contradict or shift our expectations? The narrative turn is also connected to ideas within psychoanalysis. Schafer (1981) argues that psychoanalytic treatment (social work aspects of which I discussed in Chapters 4 and 5) involves dialogues between client and therapist that explore interpretations of autobiographical accounts, which produce and allow work on different versions of reality. An important perspective drawn from the narrative turn is an emphasis on time and sequencing in human accounts of our lives and social relations. Ricoeur (1981) suggests that all narratives connect events with a time when they occurred. At a deeper level, they also demonstrate the extent to which historicity is important to the person narrating the events in explaining and interpreting what took place. Do people see the weight of the past as very important in their current situation, or less so? This can influence how they act and make decisions, and might also affect how you help them. For example, you might help them to reduce the impact of the past on how they act in the present, or emphasize only certain parts of it. A plot makes sense of the sequence of events so that they are intelligible to others. Kermode (1981), discussing the sequencing of events in a narrative, points out that, in literature, how things are presented as part of a series of events reveals secrets about the psychology and experiences of the participants and the narrator. These secrets may not be apparent to them but are revealed to us, the audience, by how the narrative plays out. Thus, ideas about narrative connect with the psychoanalytic thinking that we can understand hidden psychological and social reactions to the world. Social construction and motivational interviewing similarly draw attention to how we use language and think about the world as important factors influencing our behaviour. As with historicity, therefore, people’s emplotment of a narrative, how they identify the important aspects of what happened and put them in a sequence, helps practitioners identify important hidden sources of their actions and behaviour. For example, you can see the emphases or gaps in their narratives and explore these further. The idea of narrative may also be connected to a more recent turn towards description in sociology. Savage (2009) argues that diverse types of sociological research have incorporated description as an important aspect of understanding. He argues that alongside efforts to explain social causation and analyse structural factors in social relations, which is a major part of sociological research, we must also understand what people can observe and describe. Then, we can assemble a range of narratives that help to understand social relations in a complex way, enabling us to achieve a richer exploration of social situations. The most crucial move towards social work from cultural and literary studies, however, is the influential work of the psychologist Jerome Bruner. In a classic paper, ‘Life as narrative’, Bruner (1987) points out that when people talk about their lives, they are both the person who

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lived that experience and also the person who narrates the story of it. The story is a construction, a picture of their mind’s view of events, not a clear recital of something given. It contains a fabula, a gist, leitmotif or point of view. Examples might be describing my life as dull, exciting, hard or sweet. The story also contains subjects, descriptions of material such as activities or events, which follow the fabula or demonstrate its instability. The story’s genre comprises a set of tokens of well-understood human plights. Using these tokens means we don’t have to set out anew the predicaments that everyone faces and knows about as we describe events in our lives. For example, we all know that marriage or cohabitation requires compromises in attitudes and behaviour, and this can be taken for granted in stories about marriage or which use a marriage analogy in describing other living together social situations. Every narrative must have agents, the people who act in the story, as well as actions, goals, settings, instruments and disturbances, all of which drive the drama by creating imbalances between these elements (Bruner, 1999). Bruner goes on to describe research in which people were invited to tell the stories of their lives, and as an example he compares the accounts given by four members of a family, using their life stories, because the setting and many of the actors and events in their different stories are the same and this allows for comparisons. How does each member of the family construct themselves from this related material? Some examples: they see places as home/safe/in themselves or as real world/threatening/outside. Some are actors, others more ‘done to’, and how and the extent to which they act varies during their lives. There is evidence that the language they use to describe themselves changes as they tell the story of their lives. Bruner argues that, while their language and their accounts may reflect their inner states, they also become habitual ways of representing themselves in the world, and the world as it affects them and their family. Social workers encounter these habitual ways as they do assessments or carry out interventions, but a non-involved observer might see the events described differently. This is why social workers are cautious about clients’ narratives about issues in their lives and try to cross-check them with other views. This puts a full understanding of the client’s narrative at the centre. Our testing out provides nuances and alternative understanding to explore with clients. Bruner distinguishes two modes of human thought dealing with understanding the world: one looks for logic and empirical proof, but the narrative form strives for coherence through being ‘lifelike’ in the experience of the people involved. In a later article, Bruner (1999) argues that in successful ageing, expressing our life stories as complex narratives is tantamount to a desire to live. Trouble-free, episodic stories do not put across a living entity. We may think about Bruner’s (1986: 11–12) example, quoted by Laszlo (1997), of the story ‘the king died, then the queen died’. The logical-empirical approach is to say that a connection between these successive events cannot be assumed, and more evidence is required to see if there is a link between them. But, hearing the story, it is human to think in narrative terms, about extreme grief, suicide or foul play. Thus, our lives seem more human if we can present or create for ourselves a diachronic picture of them; that is, an account in which events follow a sequence explained by the interaction of circumstances. There is less humanity in a life that is merely episodic, a set of disconnected events. The following case example shows how people like to make narratives that describe consistency in a series of life events.

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Case example: Diachronic narratives about a woman with dementia Jane had been an active member of groups in a community centre, renowned among members for her caustic wit. She was diagnosed with a form of dementia and admitted to a care home some way from her home. Jane had little functioning memory in her current life, and often became distressed because she thought she had nowhere to go and could not remember either the care home or her room in it. On other occasions she worried that she had to get to work or a meeting in a life long ago in her past. Members of the centre took it in turns to take her to group activities and other social occasions. They noticed she was less interested in visiting an attractive local park, but when they took her back to a park in her previous home area, she talked about how she had

walked her dog and played with her children there. She reacted to events in the care home with low mood or enjoyment, apparently without any consistency. Taking her to the centre’s community choir, however, always resulted in a positive mood, and she remembered the words of many of the favourite songs. People visiting her also noted sly comments on life and personalities in the care home. Among her visitors, there was a lot of comment on these examples of the ‘old Jane’ and the connections with her past life. To her social worker, this increased motivation and commitment to continuing to help Jane, because, despite her escalating disability, their narrative of these connections humanized her in her carers’ minds.

These ideas about narrative have developed into complex theories about how stories, particularly autobiographical stories, may be deconstructed, or taken apart and analysed. Social workers have become interested in these, because much of their work involves evaluating such narratives. In therapeutic settings, drawing on White and Epston’s (1990) work, deconstruction often helps to identify where people have been oppressed by others or by social pressures and to see where people have been able to take action and control events in their lives, or have been excluded, pushed around or have lost control.

Connections A variety of theoretical perspectives on social work call on ideas of narrative in their practice approaches. Witkin and Saleebey (2007), exploring humanistic and strengths ideas, propose a social work that achieves transformations through such methods as ‘en-voicing’ and ‘re-­ enchantment’. These techniques use different forms of talk, writing and art to explore ambiguity and uncertainty in knowledge. McTighe (2018) focuses on how people make meaning about events, and this also makes a direct connection with humanistic practice (see Chapter 13). People achieve meaning-making, in McTighe’s analysis, by ordering events in sequences by chronological time and by relationship and connections. He contends that this enables people to form schemas, ways of thinking about how different aspects of the world fit together. We came across schemas as a cognitive concept in CBT (see Chapter 7). In all these examples, helping people to think in alternative ways about their experience of their lives and their environment makes it possible for practitioners to renew or redirect clients’ understanding of their lives and the opportunities that may be open to them in the future. Narrative theory picks up these ideas and seeks to open up such alternatives and new directions.

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Thompson (2017: 198–212) points to the importance of language as an element in all social work practice. Language both expresses and constructs people’s experiences. This happens as part of the narrative turn, which is, therefore, connected with a ‘linguistic turn’ in cultural and social theory, which explores how use of language emerges from cultural history and experience. Thus, social work looks not only at behaviour and the social but also the linguistic as well as the narrative. We saw in Chapter 11 that practitioners may find it useful to deconstruct discourses in people’s communities or relationships that limit understanding or communicating about issues that are important to them. In Chapter 11, I gave the example of being open about death and dying. Other examples might be how we tackle ageing, or childcare practices in the family, or acceptance of mental health or sexual problems. Exploring narratives may help with deconstruction because it is a way of looking at where ideas in the community or family came from and may help to consider alternative ways of thinking or acting that the accepted approach in our usual discourses. In this way, narrative can help us to be creative. Also in Chapter 11, we looked at Milner’s (2001) use of the social construction elements of solution-focused practice in working with women who experienced domestic violence. She also discusses narrative approaches. Narrative discussion with abusing men is different from work with women (Milner, 2001: Ch. 4). They are rarely voluntary users of social work services, often resisting involvement in personal discussion until they become involuntary clients, for example as offenders or drug users. Male service users often have an internal dialectic (an unspoken tension reflecting competing responsibilities and social roles) about being dominant and controlling in their relationships and in their work settings. They need to find alternative ways of valuing themselves as men and in their relationships with women.

The politics of narrative practice The central issue in the politics of narrative practice is the focus we saw in looking at the debate about it, on the individual and personal, which seems to align it with expressive and interpretive therapies. People concerned with social change and social justice agendas view this emphasis as evading the importance and role of social change in social work. Its expressive elements also seem to reject the value of planned cognitive and behavioural change, espoused by CBT and task-centred practice. This puts it outside the strong empirical basis of psychological research. Narrative practice sees this differently: narrative allows you to explore the complexity and nuance of psychological reactions, which are perhaps oversimplified by cognitive and behavioural research. Narrative can also contribute to social change and social justice by putting the client’s voice at the centre of what we do. Being in control of narratives about our lives is enabling; it can be powerful. Burack-Weiss et  al. (2017a) argue that being able to put together stories allows people to experience the power of creating a story that expresses experiences, issues and possibilities in their lives. Narrative practice may, therefore, be challenging to power relations in people’s families and communities and in society more generally. Thus, the political import of narrative practice can be hidden: it may offer ways of working on social change and social justice while seeming innocuously concerned only with personal experience. This raises a practice question: we may not make the wider social consequences of narrative work clear enough for clients to give informed consent to using these techniques if they think they

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are only involved in personal work. I look at this issue in the final part of the next section, on values issues.

Values issues Narrative practice places value on human understanding and connections. Baldwin (2013a) argues that it is a recognized human right to express ourselves in narratives, that is, to be able to tell one’s story, and to express ourselves narratively, that is, not to be restricted to answering questions controlled by someone else. These human rights may be found in various declarations of human rights, for example, both the United Nations (1948) Universal Declaration of Human Rights and the European Union (2012) Charter of Fundamental Rights. Each allows various forms of freedom to express ourselves and defend ourselves from attack. The implication is that we have the right to tell our stories and have them heard. Many people in social workers’ client groups require help and advocacy to achieve this. The main rights that are relevant to practice are to help people express their narratives. Practitioners can facilitate people to lay out their stories, not to cut them off, not to be too busy to listen, not to control the expression of people’s stories by the questionnaires or assessment instruments we use, not to twist or misrepresent stories in the documents we create for our records. This helps to maintain the coherence and sequence of people’s stories. This may be particularly so if people find it hard to express their stories. For example, children or people with intellectual disabilities may not have the language or communication skills to express their stories fully. People may need opportunities to express themselves in play, in visual form or through mechanisms such as family sculpting. People with dementia may need help or interpretation by people familiar with their lives, so that the richness of their stories can be expressed. People who have been fostered or adopted may need the chance to collect information about disjointed parts of their lives. Others with disabilities or who have received medical treatment may also need help in making narratives about their lives.

Case example: The daughter of a mother who died of cervical cancer creates a diachronic narrative In the hospice where I worked, I was responsible for regulating access to care records. Lena was referred to me. Thirty years ago, her mother had died of cervical cancer at the hospice at the age of 30, shortly after coming to the country. Lena was a baby at the time. Her father, a recent immigrant to the country with poor language skills, had not been able to understand his wife’s illness and treatment. Lena, therefore, had little knowledge from him of what had happened to her mother. Now, she was considering becoming a mother herself, and I discov-

ered that she feared she might inherit a tendency to cervical cancer. Healthcare records are usually destroyed a short period after death, but fortunately the record had been kept for longitudinal research, and I was able to copy for her the only existing documents in the UK about her mother. I arranged a medical genetic consultation, which lifted her fears that she might inherit the same condition, and I was able to offer her a period alone in the hospice chapel to bring together her thoughts. She did not need further contact at that time.

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Although there are restrictions on allowing relatives to have access to patient records, agencies can exercise discretion in making information available about historical cases and in some other circumstances. Thinking about narrative, the anniversary and the fact that she had now arrived at the age when her mother died made a diachronic link for Lena between apparently separate episodes in the individual lives in this family. Her thoughts about becoming a mother herself led Lena to want to construct a narrative of her mother’s illness and death, making links with her own life. Our records, the genetic consultation and the time to think things through helped her to recreate her narrative. In this case example, we can see how people make connections for themselves to create a story that may motivate them to take action, but also may raise fears and anxieties. Why should we emphasize people’s rights to create and then communicate their stories? Béres (2014: 10–12) argues that one reason is to develop anti-oppressive and empowering practice (see Chapter 18). Many social work clients are not in control of how powerful people in their lives see their experience: they may be pushed around by events, by official agencies or by aggressive parents or spouses. By enabling them to see their own life stories in a new way, they are helped to take control of what is happening to them. This can combat the impact of stigma and secrecy. Bhadha (2017) describes how narrative practice helped people affected by HIV/AIDS in Kenya to gain mutual support by storytelling and listening workshops. Estey-Burtt (2013) shows how people affected by mental illness who lose control of how people see them can recover their own self, valuing their life even though biomedical views and social stigma devalues them, as the following case example shows.

Case example: Tony recovers and values his work history after a period of mental illness Tony moved to a new house, following retirement from teaching, and had a periodical reassessment of his mental health medication by a psychiatrist new to his circumstances. His depressive condition, known to be caused by chemical imbalances in his brain, had been stable for many years on this medication. Unfortunately, research had shown that long-term use of it might lead to damaging side effects, and the psychiatrist felt that changing the drug used was ethically necessary. Tony was plunged into serious depression, which led him to medicate his condition with excessive alcohol and attempted suicide, being rehospitalized for the first time for many years. Neighbours and people in his new social circle were

distressed and concerned about his disturbed behaviour. His wife, trying to cope with this, argued to the social worker in the mental health team that the long-term side effects of the original medication might be preferable. In fact, the team spent some time recalibrating the new medication so that it was effective with Tony. After more than a year, he was back to some semblance of his former personality. The social worker spent time with them both talking about Tony’s successful time as a teacher. Together with Tony’s wife, he planned a garden party for neighbours and friends to celebrate Tony’s recovery, inviting some of his former pupils to talk about how he had helped their careers and personal development.

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In this case example, we can see how narrative allowed first the social worker, then, by orchestrating a new perception of the client’s self, neighbours and other local contacts to leave behind a stigmatizing and limited view of the client’s problems. There is a freedom in being able to express openly something that people assume must be hidden. It can be expressed both to ourselves by formulating and sharing narratives and also through explanation and publication more widely to oppressive organizations or people. As we saw in the section on the politics of narrative practice, its expressive and individual character may conceal significant social change and social justice implications, and this can also raise values issues. Clients and family members may not realize the consequences of what appears to be mainly personal work. Moreover, agencies and practitioners may not be clear about social change outcomes of accepting and implementing narrative practice in their armoury of interventions. We saw in the connections section that critical and feminist practitioners have used narrative work to bring forward important social issues as they practise, and practitioners and agencies may not have understood and prepared for public and individual criticism and adverse political reactions to outcomes from narrative work. The power of clients’ experiences, when revealed, can stimulate social reactions, Examples of the importance of clients’ voices in disclosing and demanding response to social issues are the public response to child abuse in churches and other institutions, sexual exploitation of women and employment exploitation of migrants.

Applications A broad approach to narrative practice emphasizes encouraging people to tell their stories, listening carefully and helping them to review their past life in its cultural and social context. I start from this since it draws on listening and communication skills that are relevant to many social work situations. In the debate summary, however, we saw that simply allowing for storytelling and reminiscence may not be enough to help people make changes. I move on, therefore, to more detailed accounts of some of the theoretical constructions of writers on narrative practice intervention. Gibson and Heyman (2018) identify six stages of intervention, set out in Figure 12.1. In the section on practice concepts, I quoted Béres’s (2013: 13) definition of narrative as ‘an engaging account of events, over time, according to a plot or theme’. ‘Engaging’ implies that practitioners should try to help clients create a narrative that, by its language, plot and theme, is appealing and interesting to the narrator and listeners. This helps people, for

Re-author Define the problem

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Figure 12.1  Stages of narrative intervention Source: Adapted from Gibson and Heyman (2018: 357).

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example relatives and family members, to be prepared to engage with it. Beres’s definition also incorporates the elements of narrative that we found in the wider theoretical perspectives that I discussed earlier. Harms (2018) highlights how the basis of narrative practice must be listening to personal narratives, helping people find the right words and finding a sense of coherence in the story they create with those words. If they can achieve this, McTighe (2018) argues, narratives will form records of the meaning-making as people make sense of the world. The intervention stage of narrative practice, re-storying, develops conversations about the narrative that change the impact of the problem. You seek to change the client’s understanding of the impact of events in the narrative on themselves and their thinking about actions that they could take. Harms and Connolly (2019: 130) see these as the strategies and techniques for intervention.

Understanding and deconstructing narratives Harms (2018: 122–3) also sees the main starting approach of narrative practice as listening to and deconstructing the client’s narrative. You do this to identify and analyse talk that presents narratives so that you can use both the talk and the narratives to understand and then to intervene with a problem. McTighe (2018) suggests that the fundamental social work stance should be to be deeply curious about the mystery of the person, demonstrating that we are concerned to help them explore and understand themselves. In Figure 12.2, I set out a diagram of a conversation about a client’s narrative, based on White’s ideas, as interpreted by Béres (2014). The crosses are stylized representations of events in the landscape of a period in someone’s life. Of course, events sometimes crowd together or happen far apart, even though the diagram sets them out in a repeating pattern. Part of the landscape includes action, everything that happened and factors relevant to what happened. The actions are initiatives that clients or others involved took and skills that they brought into play. The problem is also part of this landscape. The wavy line represents the narrative as the actions unroll on the narrative’s course from the remote past to the future. The upper landscape includes actions and events that move towards the narrator’s identity, the consciousness or awareness that the narrator has of the significance of the events to their understanding of themselves. The upper, pecked, wavy line represents a potential alternative, or preferred, storyline. There might be many of these, including many hidden truths or truths that are subjugated by more powerful dominating narratives. The aim of intervention is re-storying, shifting the problem storyline towards the preferred alternative. You do this by getting the client to change their view of the actions and events in the narrative (re-authoring) and changing their perceptions of the people who figure in the story (re-membering). In the alternative storyline, I show a re-authored skill or initiative and a re-membered figure in the story. There may, of course, be several: more on this later. An absent but implicit conversation makes a bridge between the problem and preferred storyline. Here, you start from conversations about the problems, but encourage a shift towards the preferred storyline by helping the client to draw out more positive possibilities. Narrative practice starts from being able to analyse and deconstruct, that is, take apart, a narrative by looking at how it puts together the actions and the people involved. Baldwin (2013a) identifies seven features of narratives, set out in Figure 12.3. From this, looking at the

Social construction: narrative practice 327 Landscape of identity

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Figure 12.2  Conversational map of a narrative Sources: Redrawn from Béres (2014: 68, Figures 4.2 and 4.3) and White (2005: 12).

examples I give, we can see how thinking about how narrative helps us evaluate and think through how to react to what clients tell us. It also reminds us of the connections between narrative practice and the study of literature (Figure 12.3). Bearing in mind our understanding of narratives, we then need to use that understanding as we engage with the narrative as the client expresses it. Launer (2018: 27) presents narrative practice as having ‘conversations about change’. As with other forms of social construction practice and motivational interviewing, the focus is on aspects of talk that help us to formulate actions. He proposes seven elements to incorporate into this talk: ●●

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Conversations are not the vehicle for intervention, but an intervention in themselves. We attend to and build on the detail of the conversation, its language, form and non-verbal elements. Developing nuances and ambiguities in what is said builds a narrative inquiry. Curiosity within our shared narrative inquiry means setting aside assumptions and beliefs, starting from a position of ‘not knowing’. We avoid formulaic and structured questioning and become emotionally committed to the client by focusing on where the story is going, connecting with clients’ feelings and understanding. Contexts need to be part of the conversation. What previous conversations have constructed the pathway that led the client here? We ask questions that might connect with personal and family experience, school, work, and factors such as disability, migration or retirement. Learning that someone came from another country, you can ask about people and places: what is different about their lives then and now, how the move affected them, who helped them, who came with them, who and what they miss. Complexity is an increasingly important issue in social work. Launer (2018: 33–4) connects the narrative theory idea of ‘circular questioning’ to the systems theory idea of

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Emplotment is the thought-out arrangement of a story, describing how changes have taken place in a sequence, responding to the participants’ social and psychological drivers.

Did the offender go shoplifting to provide clothes for their family, to prove their daring to friends or in anger after drinking with other unsuccessful claimants for benefits?

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Characterization specifies convincingly the psychological attributes and social relations of participants as contributors to the sequence of the narrative.

Does a mother describe her child as badly behaved, mischievous or compliant? How does that affect and explain family relationships?

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Genres are understandings about how narratives may be categorized within an accepted framework.

Does a young person see their involvement in drug abuse as being led by others (a crime story) or promoting engagement with a close friend (a love story)?

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The perspective of the narrator in relation to the narrative sequence as expressed in the form of the narrative, and in the knowledge and analysis of the events.

Were they thrown about in a confusing whirlwind of events (affected by outside events), or did they want to build a new sexual relationship (a purposeful actor)?

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Rhetoric explores the author’s attitudes and analysis of the narrative sequence.

Is everyone against them (selfjustification), did they try and fail (morally worthy) or were they successful in supporting their family (achieving)?

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Authoring aims to achieve a particular attitude to or understanding of the narrative in the audience’s minds.

Does the father want to persuade you against taking their child into care, claim that the school is unfair in treatment of his child or to change your assessment of his parenting skills?

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The effects of understandings about the characteristics and aims of the people who consume the narrative.

Does the client fear prejudice through your racism, hope for sympathy because you are both women or think that social workers are not to be trusted?

Figure 12.3  Baldwin’s seven features of narrative Source: Baldwin (2013a: 13–23, with adaptations and addition of examples).

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‘feedback loops’ (see Chapter 9). To develop away from fixed ideas about someone’s assessment, or apparently unchangeable problems, pick up something in their responses and ask more about it, developing a more subtle and thoughtful range of possibilities. Challenge and creativity involves asking for a new perspective: would someone else look at that in a different way? That someone else might be a friend, relative or themselves at a different time of life.

Social construction: narrative practice 329 ●●

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Caution in pushing too far, or bombarding people with questions, can be avoided by monitoring your own feelings and pulling back if you are surprised or worried by a response. Care about the client and kindness towards them should guide how far you push on. Is this too much for them at this point?

It is obvious that good questioning is an important part of this process of narrative inquiry, because it creates openness in a conversation more successfully than being encouraging or reflective. Much of the skill of narrative practice is in forming good questions, and this, of course, is a skill you can apply in all social work. You avoid deviating into your own thoughts about a possible emotional reaction by saying apparently empathetic things, for example ‘That must have worried you.’ Instead, you stick with the story and expand on it with a question, such as ‘How did you feel about that?’ Sometimes ecomaps or genograms can help clients begin to explore which people or what factors are part of a situation that they are worried about, or what or who was involved in events in their history (Launer, 2018: 77–89). The process of questioning involves making a hypothesis based on the client’s previous comment, picking it up in a circular question to gain some richer complexity and remembering our curious, neutral, not knowing stance. The following case example illustrates this.

Case example: The questioning process Josie (including an element in her narrative about her daughter’s behaviour problems): My mother told me I shouldn’t encourage Maisie to argue about what is good for her. Social worker (hypothesizing that Josie found her mother’s attitudes relevant to her own worries about her daughter’s behaviour): What does your mother think about Maisie’s behaviour towards you? (circular: picks up one of the issues in the comment; seeks complexity by inviting movement into thinking about attitudes and relationships; neutral about Josie’s relationship with her mother) Josie: Well, I often think my mother is a bit traditional about how children are supposed to behave nowadays.

Social worker (hypothesizing that Maisie may get contradictory messages about her behaviour): How does your mother get on when she’s looking after Maisie? (circular: picks up the mother–granddaughter relationship aspect of Josie’s comment; seeks complexity to link attitudes with behaviour; neutral about attitudes to children’s behaviour) Josie: She mainly does lots of activities with her. Social worker (hypothesizing that the grandmother kept control of Maisie’s behaviour by using shared activity): What sorts of things do they do together? (circular: picks up the shared activities; seeks complexity to understand better the basis of relationships; neutral about different styles of behaviour management).

The hypotheses in this example may be partly right or wrong. It doesn’t matter, because they allow the focus of the conversation to expand from a criticism of Josie towards a broader discussion of relationships in the family. From this, both client and social worker build a richer picture of the narrative of grandmother–daughter–granddaughter relationships. This might in turn lead to Josie thinking anew about her mother’s attitudes to family behaviours and the ways she might respond to that.

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PAUSE AND REFLECT  Josie and Maisie Looking back at the previous case study, what other issues in Josie’s comments might you choose to pick up to create a circular question?

Some suggestions The first comment: you could ask how Josie felt about her mother’s strictures, in what ways her mother thought she encouraged Maisie to argue with her or what Josie thought about Maisie arguing with her. All of these could expand the conversation into both Josie’s and the social worker’s understanding of the attitudes and relationships in the situation. You can identify many other possibilities for developing complexity in the narrative in Josie’s other comments.

Intervention Harms (2018: 122–6) summarizes the main elements of intervention as externalizing the problem and then re-storying by connecting the client with a preferred story. Burack-Weiss, Lawrence and Mijangos (2017b: 248) suggest, citing Charon (2006), that the components of narrative competence are: ●● ●● ●●

attention to another person’s story; representation, sharing what that story evokes for you; affiliation, joining with the other person in empathy and common cause.

Roscoe (2019: 252) identifies externalizing questions that leave it open for clients to tell the story, situating the problem outside themselves. Examples are: ●● ●●

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How has {the problem} affected your life? rather than: What is {your} problem? How has {the problem} affected your relationships? rather than: What relationship problems have {you} had? How has {the problem} affected your view of yourself? rather than: Has the problem made {you} feel bad? In what ways are the {effects} helpful or unhelpful? rather than: What effects have {you} found difficult?

Béres (2014) creates conversational maps of the landscapes of the narrative in her interpretation of White and Epston’s (1990) work for practitioners. They help us to see how the externalizing and re-storying process works. In Figure 12.2, the map presented a landscape of events with the narrative wound through, and alternative and preferred narratives moved differently through the landscape of events. In Figure 12.4, she is looking at maps of the processes of helping people move on from identities that are hampering them in taking action to resolve their problems. The main aim is to externalize the problem, so that it is not part of the client’s identity; it is outside them. You work on problems or issues that have taken over clients’ identities so

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Figure 12.4.  Béres’s (2014) account of conversational maps Source: Adapted from Béres (2014: 29–45, amalgamating Figures 2.1, 2.2 and 2.3).

much that they are unable to make use of possibilities for change. For example, a mother may be so depressed that her low mood prevents her from working to improve her care of her child, or an older person may be anxious about building new relationships after a bereavement. The maps are a series of steps from a known and familiar starting position leading towards identifying things about the client’s situation that it is possible to know and that may be more positive. I lay out in Figure 12.4 a combination of maps of different kinds for you to refer to as I describe them. Instead of the events and timeline we met in Figure 12.2, these maps portray series of conversations from the present to intended outcomes. The starting point is a statement of the position now, describing the problem as the client experiences it. You ask ‘experience-near’ questions, to get clients to describe it in terms of vivid experiences. You can ask what colour or shape it is or what music it plays, or ask clients to draw a picture, or if it were a character in a film, who would it be? These are among the possibilities that allow clients to see the problem as something outside themselves. You then ask for information about how the problem affects them; be curious about when the problem comes around or how it acts. You are aiming for a rich or ‘thick’ description rather than statements like ‘I get depressed sometimes’ or ‘I am anxious meeting new people’. The next step is to build a description of the effects of the problem on the client and the people around them. Does it frighten them, make them anxious or angry? How does that happen, and how do they act as a result? Step three is to ask how they evaluate these effects. Do their feelings make them feel incapable of doing anything, or does the experience make them stronger? Good or bad, how do the effects of the problem help or obstruct them in caring for their children, managing their home?

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The fourth step is for clients to justify these evaluations. Is there evidence? Can they describe events or reactions by other people that show how the effects had these good or bad results? Issues that can be practically useful to raise and get people to create narratives about are: ●● ●● ●● ●● ●● ●●

The self: who am I and how did I get here? Artistic and spiritual experiences: art, dance, experiences of places, music, religion. Changes in health. Phases of family, life or work. Important cultural, ethnicity, identity and social issues. Important events, places, ways in which people have tried to improve their lives or help others. (developed from examples in Burack-Weiss et al., 2017a)

Building on these conversational maps of the problem that you are both working with, you can also develop very similar conversational maps that allow you to re-member and re-author the narrative. Re-authoring is about thinking how skills and experiences might be changed. It is about picking up skills and initiatives that clients have used in the past or imagining skills or initiatives that they can plan to try out. Re-membering is not about recalling things. It is about thinking how people around the client might behave differently in ways that might help them. In both cases, you go through the same series of steps, looking at each skill or initiative or person who might contribute differently to their identity.

Case example: Lacey externalizes, re-authors and re-members her disability experiences Lacey, in her mid-teens, had a genetic condition that meant she was becoming blind. Both she and her parents became increasingly anxious about how to cope with this. The parents tried to get Lacey to learn and practise using aids that would help her, and they accompanied her in social situations to assist her. She wanted more freedom and independence and felt ‘hemmed in’. Describing changes in her sight, she felt frustrated by being able to do less and less, talking of ‘looming darkness’. Externalizing, her social worker got her to talk about times when she felt the darkness was looming, and they discussed ‘rolling back’ the gloom. She had been quite sporty, but now could not see to play tennis or hockey. They talked about other activities that she had enjoyed, and, re-authoring, looked at whether she could take up swimming activities. Re-membering, they agreed that the

parents could take her to the local sports centre to enquire about how they can help her take part in water-based activities. As part of this, they found a kayaking club, which met at the swimming pool for training. The parents took her, but waited in the café while she participated. The family that led the kayaking club encouraged her to make friends and, once she was safetytrained, she learned to go out in pairs with some of her friends. This moved her away from relying on her parents’ help and felt more natural to her. Towards the end of the process, the club went away on a long weekend on a local river and camped overnight. The social worker led a conversation with Lacey and her parents about how this model of identifying an activity, the parents helping her to start and then finding a way of building up the activity through other participants worked for their daughter.

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Harms (2018: 125–6) proposes a process by which testimony drawn from personal narratives can be formulated into documents, blogs, vlogs and podcasts, which can document individual or shared experiences in ways that can help to transform individualized narrative practice to provide pathways to social transformation. Harms and Connolly (2019: 131) cite Denborough’s (2008: 75–9) use of drawing a ‘tree of life’ in groups of people who have shared problems coming from their life history. Individually, people can draw a tree of life, starting from the roots, branches of their experiences and fruits of various aspects of their lives. A group of children create a forest of trees to put on the wall, and explore when storms come. Certificates validate children’s contributions and what other special people have done for them. This is a form of re-membering. Burack-Weiss (2017) emphasizes how everyone’s life is multi-storied, with many different strands offering different ways of knowing about what happened to us. She argues that while narrative helps clients to influence what they work on, within their stories practitioners can identify and work on aspects that are relevant to their agency’s role and responsibilities, and the practitioner’s skills and experience. Clients can be helped to use narrative practice experience with you and your agency to work on other aspects of their lives elsewhere. In re-storying, an important process is to look for truths that are hidden but implied, and we saw an example of this in Figure 12.2 – creating a bridge between problem and preferred storylines. We can see through the conversation that there must be missing elements or people in the story because of their impact on what happens, but they are missing from the client’s current narrative. Hidden but implied factors often arise because of imbalances in power relations.

Case example: Hidden but implied partner abuse emerging in an assessment A school referred a teenage girl because of serious concerns about attendance at school and possible neglect, because her mother seemed to be lacking in organization and structure at home. The social worker visiting to make an assessment ­listened to the mother’s story of poverty and inability to provide food and clothing for the girl. The mother seemed perhaps depressed or lacking in energy, but her husband said there was no point in going to the doctor and she should ‘snap out of it’. The social worker asked about the husband, who ran his own apparently successful plumbing business. To the social worker, this did not add up, because a good income from the business suggested that the poverty was in some way unrealistic.

She asked the mother to talk about how the husband was involved in the family in the evenings. It seemed he made sure he was at home early in the evening and involved in family life. She tried to get a richer picture of how relationships worked in the family. Among the narratives of family life were how the father disagreed with the daughter using electronic devices; they were too expensive and the daughter should be doing more worthwhile things. As the picture developed, it became clear that the father restricted finance for any activity, managed the household budget very closely and did not allow the daughter to take part in activities outside the home, partly so that she did not need to buy expensive and fashionable clothes.

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From this narrative, it began to emerge that the wife’s expenditure and activities were also very tightly controlled by the husband’s constant presence and supervision of everything in the house. Eventually, the social worker reached the assessment that the husband’s behaviour was very coercive and controlling of family life. One of the reasons for his discouraging the wife from seeing the doctor was not wanting his wife’s attitudes to be influenced by an alternative view of appropriate family life.

In this summary, we can see how the social worker’s view of the issues in the family shifted. Narratives revealed damaging power imbalances within the family, allowing the social worker to recognize signs of abusive behaviour. A narrative approach might involve re-storying to help the mother and daughter accept the abusive nature of the husband’s behaviour and consider what their options might be to change the situation.

Towards the end of the process, the practitioner will naturally become decentred and not so important to the client, as the renewed story shifts their perceptions of the problem and enables them to cope on their own.

Conclusion: using narrative practice While it offers a coherent practice model, which can help people respond to demanding changes in their lives, narrative practice also offers useful techniques that can contribute to many other forms of practice. This is particularly so when you want to help people explore their experiences of social relationships and change and reveal what those experiences mean for them. McTighe’s (2018) account of narrative practice focused on meaning-making suggests some of the areas that might find narrative work most useful in helping people in the following areas: ●●

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Exploring issues of race and ethnicity in their lives, including how feelings of otherness, concerns about white privilege, internalized racism and the microaggressions they have experienced in their own or in others’ behaviour. Narrative work may help draw out and examine experiences that are difficult to tackle. Dealing with abuse, disaster, tragedy or trauma and their aftermath in their lives. Thinking through sexual identity, gender and sexual development issues. Changes in place, such as leaving home, leaving care, moving to a care home and migration experiences. Understanding grief and loss in their lives, not only as a result of death, but also as relationships or important places in their past have been lost, and as opportunities for emotional and personal growth have been lost. Evolutions in people’s sense of self or spirituality.

Many of these areas of life concern change and power in intimate relations. While people may start from feeling powerless in the face of change or difficulty, re-storying may help them to gain agency, the capacity to take control again of the direction of travel in their lives. This is one of the great assets of working with narrative.

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Additional resources Further reading Baldwin, C. (2013a). Narrative social work: Theory and application. Bristol: Policy Press. Béres, L. (2014). The narrative practitioner. London: Red Globe Press. Burack-Weiss, A., Lawrence, L. S. & Mijangos, L. B. (Eds.) (2017a). Narrative in social work practice: The power and possibility of story. New York: Columbia University Press. Launer, J. (2018). Narrative-based practice in health and social care: Conversations inviting change (2nd Ed.). Abingdon: Routledge. McTighe, J. P. (2018). Narrative theory in clinical social work practice. Cham: Springer. These five books all provide useful accounts of different aspects of narrative practice. White, M. & Epston, D. (1990). Narrative means to therapeutic ends. New York: Norton. White, M. (2007). Maps of Narrative Practice. New York: Norton. These are two of the available publications that provide access to the complex and stimulating analysis by the founders of this practice.

Websites http://www.theinstituteofnarrativetherapy.com/resources/ The Institute of Narrative Therapy resources page offers papers, videos and links to various specialized organizations. http://www.dulwichcentre.com.au/ The Dulwich Centre, Australia, is the workbase of White and Epston, important original thinkers in narrative therapy, and offers useful resources. It includes free access to downloadable videos. http://www.narrativetherapycentre.com/index_files/Page378.htm This useful introductory website is provided by the Narrative Therapy Centre, Toronto, Canada.

CHAPTER 13

Humanistic practice, existentialism and spirituality MAIN CONTRIBUTION The main contribution of humanistic and related practice to social work is its focus on enhancing individual personal development. The aim is to understand our personal identity in relation to others, not just to their identities but to the totality of who they are and the relationships they are part of. This becomes a way of empowering all aspects of our human creativity in support of human rights in human society.

MAIN POINTS ●●

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Humanism, existentialism and spirituality are different interpretations of important elements that are found in all human experience and social work. Many cultures see spiritual concerns as universal, and therefore as a significant factor in all helping activity, such as social work. Western societies often favour secularism, particularly in public services, as being a neutral position between different religious and spiritual beliefs, but this seems to reject spirituality and may be seen as hostile to people committed to a particular faith or belief. Understanding the spirituality of many minority ethnic groups in Western countries is important for an adequate appreciation of their social and personal needs. Symbolic interaction, phenomenological sociology, Laing’s view of mental illness, Rogers’s client- or person-centred practice, gestalt therapy, Gandhian social work and transactional analysis (TA) are all relevant ideas that focus in different ways on the human experience, social justice, and social and ecological sustainability.

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Self-actualization and self-fulfilment are social work objectives that are drawn from humanistic psychologies.

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Empathy, congruence, genuineness and unconditional positive regard of clients are the attributes of a practitioner in successful practice. Scripts and games are patterns of behaviour drawn from TA. Spiritual ideas of wholeness and connectedness contribute important human aims and values to social work. Meaning-making, an important aim of humanistic practice and work with people’s spirituality, is concerned with helping people make sense of how life experiences develop personal meaning and so influence their personal aims and development. The interaction of body, mind and spirit is an organizing concept in spiritual care. Decentralization, sustainability and interdependence are important social objectives in much Eastern thinking. Democracy and participation as elements of practice are influenced by humanistic psychologies. Dread and alienation in people’s lives, drawn from existential theory, have resonance for many clients and social workers. The TA metaphor of people having a parent, adult and child interacting internally and externally has also influenced social work.

THE DEBATE SUMMARY Debate about humanistic practice, existentialism and spirituality in social work revolves around two main issues: ●●

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Humanistic practice contains a conundrum at its heart. The central idea of humanism is to see human reason as the sole basis for human life, and therefore it might be the basis of empiricism in social work. Many empiricists, however, see the humanistic psychotherapies as promoting nebulous, sometimes almost mystical, personal responses relying on arts and the humanities, and valuing ideas and experiences rather than knowledge. These seem to reject technical and empirical methods of social work such as CBT and task-­ centred practice. Should these largely personal belief systems influence the work of a professional activity?

 ebate about humanistic practice, existentialism D and spirituality Humanism, empiricism and humanistic practice Humanism is widely accepted as a central value of social work. If you practise social work, it is necessary to believe that you can understand and overcome social problems by applying human reason and understanding. It is humanism’s view that human beings inevitably use reason in understanding the world and accepting this is crucial to being a social worker. Empiricists therefore think that humanism makes secular science basic to successful human and social development and to social work. Since humanism asserts the human capacity to manage the natural and social environments through observation, experimentation and rational analysis, you might think that humanism would support a technical social work or EBP.

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But humanism mainly influences social work through humanistic psychotherapeutic practice. This also draws on humanism, but its view of human helping does not accept the empirical, technical rational view of human understanding. Humanistic psychotherapies are open to a broad range of ideas, including the arts and spirituality as important elements of human experience. This openness appears to mean that humanistic practice goes against the contemporary emphasis in social work, discussed in Chapters 2 and 7, on EBP. Humanism values all human knowledge and creativity, and not just knowledge created by the limited research methods of EBP.  It also values shared human experience as the basis for human understanding, contrary to EBP’s emphasis on neutral external observation. Humanistic social work, therefore, sees CBT and EBP as too technical and agency practice as often too concerned with procedures rather than humanity. This critique reasserts the centre of social work as human beings’ capacity to improve themselves. Emphasizing the humanity of the objectives and ideals of social work is a counterposition that rejects overtechnical practice. It seeks to re-establish the focus of social work as empowering and liberating rather than problem-solving in character. Humanistic practice also questions solely social change views of social work. This is because it also focuses on exploring, understanding and coming to terms with human experience, rather than resisting adverse social forces, or demanding that all human development should move towards a rigid interpretation of equality and justice. The explicit use of humanistic psychotherapies has not developed strongly in social work. The one consistent element over several decades has been Rogers’s person-centred practice, with its thoughtful focus on personal empowerment with individual clients (Rogers, 1977). Person-centred practice was originally called client-centred practice, the terminology changing to emphasize the importance of liberated individuality rather than the client role. Current writing on client-centred, person-centred, personalized or service user-centred practice often refers to a focus on clients’ needs and wishes rather than agency priorities, and it is not connected with Rogers’s theory. Rogers’s influence has primarily been on the cognate field of counselling, where his approach is the source of a major stream of practice, equal in impact to that of CBT and solution-focused practices. TA is a good example of the reasons why humanistic theory is a fringe interest in social work. Influential in the 1980s, with its terminology of scripts and games, it is now regarded as a fringe psychotherapy. Its vogueishness means that many see it as giving superficial accounts of behaviour in a semi-humorous language. Perhaps this makes people feel that they are not being treated with respect when they are looking for a thoughtful analysis of behaviour. For some practitioners, on the other hand, its unportentous terms can help them to look at behaviour in a new, easily grasped way.

Personal belief and professional practice Humanistic practice, therefore, seems to value belief and experience as the basis of intervention and understanding, rather than concrete evidence. Is it a quack remedy, with an anything-­ goes philosophy? Does it value the social worker’s commitment to their beliefs rather than evidence of effectiveness? Could it lead to social workers influencing clients to believe what practitioners believe, rather than remaining professionally respectful of the client’s values and aims? These concerns arise around other aspects of practice: the therapeutic use of the arts, important philosophies and engagement with clients’ spirituality.

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Existentialism is an example of these concerns. Existential ideas have had periods of importance, but their source in a 1950s philosophical trend, occasionally revived, disconnects them from mainstream social work. Powerful ideas about ‘being’ and ‘dread’ speak to some practitioners, but for many it seems a quirky interest rather than a solid basis for practice. Similarly, some work on spirituality focuses on writers’ own Christian or Islamic faith. Alternatively, it draws on inspiration from less well-known religions that interest people because they seem exotic or out of the ordinary. This makes issues of spirituality seem to be a personal preference or an area of personal development rather than a professional responsibility in work with clients. Concerns about involvement with spirituality are reinforced because public agencies are required by many legal and administrative systems to have a secular stance. Cnaan et  al. (2002), Dunham, Furbey and Lownes (2009) and Part 4 of Crisp’s (2017a) edited collection explore the influence of religion on social work agencies and practice. In addition, the development of transpersonal psychotherapies emphasized the presence of spiritual and transcendent aspects of human life in much human experience and has been applied to social work (Canda & Smith, 2001). Transcendence is concerned with areas of life where we relate as humans to forces outside ourselves that we cannot readily perceive by rational means. Some of these trends are criticized because they seem to be rejecting rational, evidence-­ based practice with definable and quantifiable outcomes. Moreover, interest in Eastern religions, such as Daoism and Buddhism, suggests an exploration of the out-of-the-ordinary from personal interest, rather than it being a rational or thoughtful evaluation of ideas that are particularly relevant to practice in contemporary societies. Humanistic and related views of social work are therefore often a source of public criticism of social work for being vague and idealistic. They concern aspects of human experience that are important to many people, but their lack of clarity and the difficulty of forming clear targets and agreed explanations make these ideas hard to turn into an operational language of practice in a public profession. Because they seem insubstantial, they seem relevant only to the ‘worried well’ or searchers after personal meaning, rather than people with serious difficulties dealt with by many social workers. The origins of social work in the nineteenth century are associated with the shift of welfare provision from Christian churches to become part of the secular role of the state in the West. Humanistic practice, and concerns with ideas such as existentialism and spirituality, go against the shift towards secularism that is seen in public services in Western societies. Moreover, these historical sources seem to devalue in social work spiritual perspectives from other cultures, philosophies and religions. Humanistic ideas, existentialism and concern for people’s spirituality have, therefore, potential explanatory power in helping practitioners to understand clients and interventions, and in motivating clients. Nevertheless, they may not be widely accepted among the powerful groups in society that social workers seek to influence on behalf of their clients, and using them in social work practice may conflict with the secular culture and ideas that are influential in non-Western societies. Using them as part of social work may be an aspect of postcolonialism, in which the power of former colonial societies is maintained using culture and beliefs rather than economic or military power, adopting an interest in exotic indigenous ideas, without making connections to the culture from which they came.

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Answering this, some of the important research on the effectiveness of therapeutic relationships comes from the existential and humanistic practice tradition. Griffiths (2017), for example, analyses several studies to show that individualized personal engagement is necessary as the basis for all interventions. He also points out that in government programmes with the most difficult clients, such as sex offenders, thinking about people’s individual motivations and concerns is important in making a successful wide-ranging programme work. Averages and trends are just that: they don’t show what will work in every case. His analysis is a useful reminder of the evidence in Chapter 2, that positive or negative findings in research do not apply universally in services providing for human beings. All services need flexibility and responsiveness to individuality. Humanistic research also shows the importance of the skills and person of practitioners in their relationships with clients. It is the source of the research support for empathic and genuine relationships with clients, and attempts have been made to measure these elements. Although such relationships are not sufficient for therapy to be effective, they are necessary to therapeutic success. So, while they must be present for these techniques to be useful, they have to be part of the other activities that intervene effectively in clients’ behaviour or social circumstances.

Major statements Humanism and existentialism are systems of secular (non-religious) philosophical beliefs. I describe some important aspects of their principles that have influenced social work in the wider theoretical perspectives section. Unlike purely secular views, which reject religion, humanism is regarded as a spiritual system of beliefs. Its contribution echoes the role of spiritual thinking in social work, which is therefore also included in this chapter. Humanistic social work draws on humanistic psychologies and psychotherapies, which incorporate some humanist ideas. Again, I describe some of the important points in the applications section of this chapter. My own humanistic social work (Payne, 2011a), influenced by micro-sociology, and Lee et  al.’s (2009) integrative body–mind–spirit social work, based on Eastern philosophies, offer examples of practice interpretations of the spiritual elements contained in these ideas in systematic accounts of secular social work practice. I discuss these briefly below in the applications section of this chapter. Glassman’s (2009) humanistic groupwork represents contributions from ideas of democracy and human rights, demonstrating that humanistic practice is more than a secular spirituality, and I present it as an example text for this reason. Existentialism’s main texts from Krill (1978) and Thompson (1992) have recently been renewed by Griffiths’s (2017) wide-ranging practice account. Interest in existentialism and humanist thought has always, in his view, been present in social work, but the lack of a central theoretician and diversity of the field means that it links to many other theoretical positions, including relationship-­based work and important value positions such as selfdetermination and anti-­oppression. Because of its theoretically informed account of spirituality in practice, I have included a brief account of Holloway and Moss (2010), supplementing material on humanistic practice with theory that is concerned with these issues.

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Wider theoretical perspectives Humanism and existentialism are ways of looking at life that are based on well-established philosophies. Humanism believes in the capacity of conscious human beings to reason, make choices and act freely, uninfluenced by higher beings such as gods and religion or superstition. Humanism is different from humanitarianism, which is a philosophy of being humane and a practice of treating people with kindness because we value their humanity. Humanism, however, values human caring in social relationships as an essential aspect of humanity. It is also associated with democracy, because it believes in the capacity of human beings to value and help one another, thus restraining damaging pressures from our social environment and the natural world. Existentialism is concerned with the meaning for human beings of the fact that they exist, that we are human beings. It focuses on the capacity of people to gain the personal power to control their lives and change ideas governing how they live. Major streams of thought are based around the work of Büber, Kierkegaard and Sartre. Sartre’s work has had most impact on social work theory (Blom, 1994), particularly through Thompson’s (1992) book. Existentialism accepts that people are both subjects and objects; that is, they both act on and are affected by the environment. The environment often seems to contain absurd and alienating experiences and suffering, and existentialism speaks to us of their impact on people’s lives. Although social work is associated with secularization in some Western societies, welfare often remains connected to religious faith. This is because many individuals take up social work as a way of putting their faith into practice, and many social work agencies continue to be associated with or developed by churches and faith groups. In addition, social work with individuals often raises or deals with spiritual issues in people’s lives. Spirituality values a human search for meaning and purpose in life, seeing being human as integrating a wide variety of experiences into a whole personality. Many Eastern philosophies, including Zen Buddhism, Hinduism and Islam, have relationships with spirituality and some of the elements of humanism and existentialism. This is because they emphasize the process whereby human beings realize their capacity to enhance their own well-being through spiritual self-development. Similarly, African and Caribbean spiritual perspectives have had a considerable influence on what Martin and Martin (2002) call the ‘black helping tradition’ in social work in the USA and elsewhere. In this tradition, the spiritual self interacts with a racial self and a communal self. Similarly, Maori and Aboriginal spiritual beliefs have influenced practice ideas in New Zealand and Australia, and this has filtered into international practice, for example in the adoption of family group conferencing as a form of family and child participation in decision-­ making across the world (Marsh & Crow, 1997). Traditional caregiving in African tribes connected with black spirituality, which created a sense of the sacred and divine. This in turn gave African-American people a sense of dignity and self-worth as slaves in the nineteenth century; it has therefore been valued as a cultural tradition in Caribbean and north American communities who are of African origin. In particular, family relationships and child care were important sources of solidarity and maintained connections across the generations (Graham, 2002). Humanist and existential ideas also connect with green environmental political and social philosophies (George & Wilding, 1994; see also Chapter 16, which reviews the

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increasing importance of these ideas within social work). These emphasize the importance of human beings controlling their destructive capacities and living in harmony with their environments. Nevertheless, existentialism, as a contributor to some humanistic psychotherapeutic ideas, particularly relates to critical theory in its concern about alienation. Humanistic ideas, however, explain and approach alienation differently by exploring and understanding the experiences that connect alienation with wider life experiences, while critical theory interprets alienation as a social failure. Similarly, we can see relationships with feminist theories. This is because they focus on women’s shared experience in developing a consciousness of their oppressed social position (see Chapter 17). Both humanistic and feminist ideas favour participative self-development while recognizing the need to control the destruction that is implicit in existing social relationships.

Connections Humanistic social work developed from two groups of ideas, presented in Figure 13.1. The first group was interconnecting traditions of humanistic, transpersonal, constructivist and existential psychologies, all influencing each other. These led in turn to the second group of humanistic and existentialist psychotherapies. Broader sociological and social work thinking contributed to the interpretation of these as a humanistic social work. Much of this thinking was originally influenced by phenomenology, a philosophical and sociological system of thought. It emphasizes how our understanding of the world comes Phenomenology Phenomenological psychology

Existentialism

Social construction

Humanistic and transpersonal psychologies Group of connected psychologies

Phenomenological sociology

Existentialist psychologies

Microsociology

Constructivist psychologies

Humanistic psychotherapies

Existentialist psychotherapies

Other forms of social work

Group of connected psychotherapies

Humanistic social work

Figure 13.1  Ideas contributing to humanistic social work Source: Adapted from Payne (2011a: 9. Reprinted with permission from Oxford University Press).

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from the appearance of phenomena, such as objects or events, how we perceive them and how we process our perceptions in our thinking. This is affected by the phenomena themselves, of course, but how we see them can be just as or more important than reality in influencing how we act. Phenomenology connects with the interpretivist and social construction views of knowledge that we met in Chapters 1, 11 and 12, which say that what we know of the external world is interpreted through our perceptions and thoughts. Humanistic models of practice are based on the common idea that human beings are trying to make sense of the world they experience. We met this as an important idea in psychodynamic theory in Chapter 4 and in social construction ideas in Chapter 11 and 12. In addition, social workers are trying to help people gain the skills they need to explore themselves and the personal meanings they attach to the world they perceive, which in turn affect them. Humanistic models propose that people’s interpretations of their own selves are valid and worthwhile. The importance of spirituality in many cultures means that it is an important issue in understanding social work approaches in African and Eastern countries and in working with black and minority ethnic groups. Many ideas from spiritual perspectives in such cultures are consequently beginning to influence Western social work. Graham (2002), for example, presents aspects of African-centred world views as both a critique of Western social work theories and a way of understanding African-Caribbean people. We saw in Chapter 7 how mindfulness has been adapted in CBT as a behavioural technique, having been taken from Eastern meditation as a form of control of the self. Such practice is becoming increasingly mainstream in Western social work and counselling. It is questioned, however, for similar reasons that the impact of Western social work in Eastern and African practice is criticized: it does not connect well with the role of social work in Western welfare regimes. The potential interaction with ecological ideas is an example of this. We saw in Chapter 9 that ecological systems theory has been mainly concerned with intervening in social relations rather than, as humanistic and spirituality practices would suggest, harmonizing human relationships with the natural environment. This critique is part of the shift towards developing ecocentric and ecocritical theories of practice, as considered in Chapter 15. Well-known systems of practice and writers in social work and related fields implement these principles that are common to humanistic approaches, and their ideas have filtered into more general use. Examples are Laing’s (1965, 1971) views of mental health, Frankl’s (1964 [1946]) logotherapy, Rogers’s (1961) person-centred therapy, Gandhian theory from India (Kumar, 1995) and Berne’s (1961) TA. Different conceptions of spirituality and the arts are part of the connections of existentialist (Griffiths, 2017: 136–55) and humanistic practice (Payne, 2011a) with wider systems of thought in social work. Laing explicitly used existential ideas as well as psychoanalysis in his early work on theories of mental illness. He argued that we can understand schizophrenia as a person’s reaction to a bewildering or possibly damaging social environment. Disturbances in family communications lead to one family member being caught between conflicting demands from others, and the disturbed reactions are diagnosed as schizophrenia. Particularly in psychiatric settings, Laing’s work taught social workers to be cautious

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about medical diagnoses that fail to consider social and family factors as possible elements in the cause of problems. Frankl’s work (1964 [1946], 2011 [1948]) focuses on introspection about our life experience (1964 [1946]: 98) and people’s drive to find meaning even in the most painful and difficult circumstances. It thus expresses much of two basic points of humanistic practice. The first is looking inside ourselves through serious and organized reflection to understand others by comparison with our own experience. Introspection connects with the use of meditation (Keefe, 2017) and other Eastern philosophies in practice (Brandon, 1976, 2000; Lee et  al., 2009). The second basic point is the importance of achieving security with ourselves and others in relationship to ourselves and our lives, through searching for meaning in our life experiences. This has in turn influenced current conceptions of spirituality in therapeutic work. In social work, Krill (1978) and Thompson (1992, 2018b) use existential ideas explicitly to inform approaches emphasizing lived experience (Thompson, 2018b, citing Sartre, 2003), including emotional and intellectual reactions to human experience as the basis of practice. Goldstein (1984) tries to bring together cognitive and humanistic psychologies in an important forerunner of current interest in humanistic practice. In addition, humanistic groupwork developed in encounter groups and similar opportunities for self-expression. Rogers’s (1951, 1961) person-centred practice, and its three conditions of effective therapeutic relationships discussed earlier in the chapter, was also a decisive influence on humanistic practice in both psychology and social work. Rogers’s conditions are that clients should perceive that practitioners act as follows: ●●

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They are genuine and congruent in their therapeutic relationship (that is, what they say and do reflects their personality and real attitudes and is not put on to influence clients). They have unconditional positive regard for their clients. They empathize with clients’ views of the world.

Carkhuff and his associates (Truax & Carkhuff, 1967; Carkhuff & Berenson, 1977) adapted these ideas into a more general concept. Rogers’s ideas then become, first, honesty and genuineness; second, (non-possessive) warmth, respect and acceptance; and third, empathic understanding. Empirical work has confirmed that these are important elements in therapeutic relationships. Rogers’s work and many other ideas in humanistic psychology derive from Maslow’s concern for self-actualization and the attainment of human potential (Maslow, 1970). Another important thinker to influence social work was Gandhi, an Indian leader who formulated a philosophy of social development. His approach was committed to the welfare of untouchables (people of the lowest social caste), women and those living in rural areas (Muzumdar, 1964; Howard, 1971). Kumar (1995) summarizes the main points of Gandhi’s philosophy as follows: ●● ●● ●● ●●

There is a reliance on Vedic philosophy, an important basis of Hinduism. People are both interdependent and self-reliant. The spiritual is important in all worldly affairs. Faith in purity of means rather than achieving ends is important.

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Totality and holistic ideas are important, especially in relation to political independence. Social development, self-reliance and education should go with political independence, as such ideas are important in social development (see Chapter 8). Formal legal authority is disapproved of; interdependence and self-reliance are, as the previous point suggests, more important.

Gandhi proposed rural development based on cottage industries, physical labour rather than the use of machinery, a decentralization of power and social justice and the equitable distribution of wealth. Kumar (1995) argues that these romantic philosophies nevertheless connect with the social work values of promoting self-reliance, mutual help and personal and social development that rely on small, local groups rather than top-down direction. The process and means by which activities are carried out and the high value attached to collaboration and an avoidance of compulsion are also shared philosophies. Transactional analysis derives from the work of Eric Berne (1961, 1964). It is a humanistic therapy since its basic principles rely on the assumption that people are responsible, autonomous agents who have the energy and capacity to control their own lives and solve their own problems, being prevented from doing so only by left-over failings from early childhood behaviour patterns (Pitman, 1983). There are four elements of TA: structural, transactional, games and script analyses. Structural analysis proposes that our personality has three ego states, or ways of thinking about the world. These are associated with typical behaviour patterns. The parent state is a collection of attitudes typical of the sort of injunctions that a parent figure might give to a child and the sort of perceptions that a child might have of such a figure. The child state contains feelings and attitudes left over from childhood, typically rather self-centred, but also uncontrolled and potentially creative. The adult state manages, mostly rationally, the relationships between the ego states and between them and the outside world. These concepts are like the psychoanalytic structures of the superego, id and ego, but TA is less concerned with internal interactions among parts of the mind, drives and irrational responses. Transactional analysis is about how the ego states in one person interact with those in another. Transactions are exchanges between people’s ego states, which may be open or hidden, and problems arise when open and hidden messages involve different ego states or transactions. Games analysis is concerned with patterns of interaction and behaviour. People have three groups of emotional needs: ●● ●●

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stimulation, which they fulfil by artistic, leisure and work activities; recognition, which is met by receiving ‘strokes’, either non-verbal or verbal, positive or negative, from others (for example, a smile and a thank you or a scowl and a criticism, respectively); structure in life, particularly of time.

The pattern of strokes and life experiences that we get used to in childhood sets up our life position, which is how we feel about ourselves and others, and our general attitude to the world. There are four life positions (Harris, 1973): ●● ●●

I’m OK – you’re OK, when you feel good about yourself and others. I’m OK – you’re not OK, when you feel good about yourself but not about others.

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I’m not OK – you’re OK, when you feel bad about yourself and see others as more powerful and capable than yourself. I’m not OK – you’re not OK, when you are critical of both yourself and others.

Games are typical patterns of ulterior transactions that recur, reflect and promote damaging life positions. Social workers analyse games with clients, who can then understand and avoid them in favour of more satisfying interactions. Script analysis is concerned with seeing how transactions in the past have led to present life positions and games.

Recovery The recovery movement is the US term for what is also called the survivor or ex-patient movement. Such ideas were part of the mental health activism that influenced American mental health services during the 1980s and 1990s (Adame & Leitner, 2008). Many Western governments, including Ireland, New Zealand, the UK and the USA, developed policies favouring recovery in the twenty-first century (Watts & Higgins, 2017). The recovery movement contests ‘professional centrism’ (Watts & Higgins, 2017: ch. 4), which gives the greatest importance in recovery to medical, nursing and social treatment and care. This stance sees patients as developing illness and receiving treatment, with their condition improving or being cured. Future episodes of illness are seen as relapses, leading to the need for further professional interventions. By contrast, recovery perspectives focus on the whole life experiences of people with mental illnesses and social and community reactions to changes in their wellness and illness. The personal and social journeys of people with mental illnesses, and interventions that focus on them, are as important as illness and treatment. These conceptions place recovery as a relevant idea for guiding social work practice. Recovery from mental illness implies moving towards or achieving a mental state that someone prefers to their condition of illness, and looks back to past attainments. It contrasts, however, with the assumption in psychiatry in the early twentieth century that complete recovery (a preferred or favoured end state) from major or psychotic mental illness was not possible. Later experience and research found that individuals improved at least in the remission of symptoms and sometimes in decreased use of medication. Often, social disabilities also declined so that living independently and working became possible for many (McCranie, 2010: 473–4). Recovery thus became associated with improvements in at least some aspects of the quality of life. The recovery movement focused on an individual’s lived experience in accepting and overcoming social disabilities created by the condition (Deegan, 1988). This includes both short-term and longer-term disabling factors in the personal psychological reactions, social life and relationships of people who have experienced mental illness. These areas all form relevant locations for social work practice. This view of recovery from mental illness saw it as a process by which people gained personal experience of a new state and capacity to function in society. Recovery may nevertheless also connect with the experience of regaining something lost. Seeing recovery as a process through which people move contests a therapeutic or medical view of recovery as treatment coming from an external source leading to a cure. During the

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recovery process, people use their internal resources to acknowledge being socially disabled but nevertheless move towards achieving a new sense of self (Deegan, 1995). This might include ‘the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness’ (Anthony, 1993: 527). Leamy et  al.’s (2011) conceptual review of the literature isolates characteristics of the recovery journey from a wide range of literature. Recovery is an active, individual, gradual and non-linear process of trial and error, a journey in which there are stages and much struggle, multidimensional in the issues tackled. It is a life-changing but not curative process. Supportive and healing environments help recovery, but can occur without professional intervention. Five types of intervention are helpful: ●● ●● ●● ●● ●●

promoting connectedness; promoting hope and optimism about the future; promoting a positive sense of identity; identifying meaning in life and mental illness experiences; empowerment in achieving personal responsibility and control over life and focusing on strengths.

Tew et al.’s (2012) literature review of social factors in recovery from mental illness identifies the importance of working with families and communities. They suggest this forms a proactive agenda for mental health practice in social work. Frost et al.’s (2017) review of the literature attempts to make a helpful distinction between psychosocial intervention and rehabilitation aims in setting service requirements for an integrated recovery-oriented service: ●● ●●

Psychosocial interventions promote hope, recovery, self-agency and social inclusion. Rehabilitation interventions achieve improvements in daily functioning, working with the service user on restoration of skills and competencies and active community reconnection.

This recent professional analysis incorporates recovery movement ideas into service planning and management for both professional and user-led mental health services, and brings forward the importance of the social as an aspect of mental health care.

The politics of humanistic and related ideas We have seen that debates about humanistic practices centre on the importance they give to personal experience, including experience drawn from the arts and spirituality, as an important source of ideas. Brandon (1976, 2000), for example, offers Zen ideas and Daoism as useful contributions to social work. His is an intense and personal vision in which social workers should use all the elements of their personality to arrive at an authentic interrelationship with people in distress. Brandon seeks to approach people in extreme difficulties, contradicting the view that, as we saw in the debate section, humanistic practice is only for people suffering mild psychological disturbance. Work is directed towards self-understanding, enlightenment (the Zen concept is satori, a leap towards intuitive understanding) and self-growth for both

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the social worker and the client. An important idea is hindering, which connects with critical anti-oppressive ideas about social barriers getting in the way of people achieving social objectives in their lives. Hindering is focused less on social barriers and more on obstructions to people’s movement towards self-development, and enabling them to avoid the many features of their environments that were obstructing them. Brandon’s approach relies on personal charisma and sharing between clients and workers. Several writers, for example England (1986), argue that we should see social work as an artistic endeavour rather than an application of social science. Walter (2003), using theatrical ideas, argues for a sense of improvisation and for seeing interactions with clients as provisional rather than contractual. This means that practitioners should not start out by tying down in plans everything that they are going to do with clients, but rather should set out on a process and let it lead them into new aspects of the client’s needs as these emerge. Spirituality as an element of practice has experienced a resurgence in the twenty-first century (Crisp, 2017b; Canda and Furman, 2019) because of the following factors: ●●

●● ●●

●●

Religion and spirituality are integral parts of living in any society and are therefore relevant wherever social work is practised. There is a need to respond to ethnic and cultural minorities in Western societies. Political interest lies in the possibility of faith communities and churches making a stronger contribution to organized care and community services, thus contributing to social stability (Cnaan et al., 2002; Dunham et al., 2009; Crisp, 2017a: Pt 4). Criticism of materialism as a contrast to many people’s spirituality. This critique suggests that a consumerist tendency towards commodification in Western societies, that is, treating everything as though it is a good to be purchased in the economic system, is not desirable. There is a perceived need to rebalance this tendency with different ways of finding meaning in life.

Although spirituality is relevant to everyone, there remains the question of whether religion should be included in social work theory. A range of social work writing seeks to document religious or spiritual beliefs in particular cultures and ethnic groups so that practitioners not familiar with those cultures can understand them better, as part of becoming competent in dealing with cultural and religious issues (see Chapter 18 for more on this). Other writing seeks to extract useful ideas for practice from particular ethnic and cultural beliefs. Examples include Lee et al.’s (2009) body–mind–spirit practice, which uses ideas from Eastern philosophies, and is discussed in the applications section of this chapter. Awareness that issues of spirituality are important for many clients is an important contribution of the ideas presented in this chapter to practice theory in general. Focusing on spirituality allows practitioners to include in their practice the reality that a commitment to faith and a belief in a particular religion are important to many people they work with. Practitioners with a particular faith commitment may also wish to demonstrate that commitment in their practice, but social work theory in general requires openness to work with clients’ own religions. A theory constructed around a religious commitment, such as a practice theory of Christian, Hindu or Islamic social work, is ethically complex. This is because no system of

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religious thought is monolithic, so that even if clients shared their faith with the practitioner, it might involve imposing practitioners’ views on their clients. This would be more problematic if an evident faith perspective was not consonant with clients’ views. I discuss this issue in the section on values issues. There is a developing literature, however, on lessons that might be learned from religious or faith positions (for example, Crisp 2017a: Pt 3; Twikirize & Spitzer, 2019). This reflects a realization that Indigenist practice often includes responding to indigenous faith perspectives (Hart, 2019). Graham’s (2002) work on African-centred world views is a particularly well-­ worked-­out example of the applicability of non-Western spiritual ideas to social work. Graham’s approach draws on classical African intellectual traditions. It is also influenced by the civil rights and Pan-African movements, which seek a unification of African world views following the social fragmentation caused by the experience of slavery and colonialism. The approach used in relation to African intellectual and faith traditions is also applicable to systems of faith and belief in other ethnic groups. The emphasis is on identifying, analysing and celebrating what is special about being African through cultural symbols, rituals, art, music and literature, so as to revise the commonplace disparagement of Africa and its peoples. This would identify and affirm a distinctive African place within wider social theories and practices. The principles of an African-centred world view, in Graham’s (2002) analysis, are as follows: ●● ●● ●●

●●

All things, including people, animals and inanimate objects, are interconnected. Human beings are spiritual; that is, they are connected to others and to their creator. Individuals cannot be understood separately from their collective identity, particularly their twinlineal (that is, taking account of both their father’s and mother’s parentage) family trees. People’s lives and experiences are integral to their family and community histories and connections, and commonalities are more important than individuality. Mind, body and spirit are one, equal and interrelated. Each should be equally developed towards maat, a balanced sense of truth, right, harmony and order.

Much of this approach also has strong links with eco practice ideals. Thompson’s (1992) comprehensive assessment of the value of existentialist thought for social work practice is based on the ideas of Jean-Paul Sartre. A central notion here is being. Being-in-itself is mere existence. Being-for-itself is existence in which we are conscious and can therefore have potential, for example by making plans and decisions about how we want to be. Blom (2002) argues that, in this perspective, neither practitioner nor client can know each other in advance from the perspective of the other or from the basis of formal knowledge because there can be no prior expectations of how a human being might be. Practice relationships are a struggle between the experiences of two others outside themselves. Through this struggle between the different views of each other, we can take part with another person in social and personal transformation. But we cannot understand what is ‘inside’ them or how they would typically act, as psychological theories would propose. They have the free will to act, and our two conceptions of each other interact freely, allowing us to begin to gain external views of the other.

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Values issues Humanistic ideals fit well with many of the shared principles of social work (see Figure 1.7). This includes treating people as wholes, as being in interaction with their environment, of respecting their understanding and interpretation of their experience, and of seeing clients at the centre of what workers are doing. We see them in a wide range of social work theories discussed in this book, except for CBT. Two important values objectives are central to humanistic practice approaches. The first is the idea that practitioners have a responsibility for being genuinely concerned about and connecting with their clients, treating them with warmth and acceptance. The second is the importance of human rights as being integral to the humanity of every person; this leads to a consequent emphasis on human equality between practitioners and clients. The special importance of this value position is that many psychological approaches to practice emphasize individuality because it allows a clear ethical focus on individual clients and on clients’ consent to and, through self-determination, control of what takes place in practice. Individuality in psychological theories is instrumental: it is emphasized because it helps practice to be more effective. Humanistic practice, on the other hand, values individuality because this is fundamental to humanity, and this means that human rights are central to social work practice (Payne, 2011a). This is most clearly espoused in Ife’s (2012) account of rights-based practice. He argues for awareness of the contextual public and private, universal and personal aspects of rights to be linked in practice, so that responses to individual loss of rights can be understood in the social context of pressure on equality and rights. Spirituality raises a concern that workers might import their own values into practice. This requires looking for connections with other relevant views, an awareness of the social worker’s own spiritual beliefs and their commitment to avoid imposing it and to promote inclusiveness in practice (Hodge, 2003a, b; Osmo & Landau, 2003). Research and the development of assessment tools may also be helpful. An example is spiritual eco maps (Hodge & Williams, 2002) and spiritual life maps (Hodge & Limb, 2007). These provide visual ways of stimulating an exploration of, respectively, the client’s present faith and belief commitments and their religious life history.

Applications I draw the main practice elements of humanistic practice from my analysis of humanistic social work (Payne, 2011a). This starts from the principle of two accountabilities. One is responsibility to the social mandate for our work, derived from policy and law and enforced in our employment and professional responsibilities. This is balanced by an interpersonal accountability to clients, their families and communities, enforced through our compassion and our professional responsibility to achieve their informed consent to our shared activity. We also need to balance interpersonal work with clients and efforts at change in their social environments. Interpersonal work helps clients’ sense of self-efficacy. We met this concept in discussing motivational interviewing (Chapter 8), but it is relevant to many psychotherapeutic practice theories. It means to feel that you are

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effective in achieving personal change and to believe that they can be effective in influencing yourself and the environments in which you live and work. We balance this aspect of practice with the recognition that those environments are also engaged in continuing change, and we have to bring together that change with the personal changes that clients are making, so that the two reinforce each other. Humanistic practice must operate through interpersonal and social equality. This is because, as this practice sees the humanity of all human beings as equal, human rights are integral to humanism. Humanistic practice is therefore strongly committed to the shared principle of equality and respect (see Figure 1.7). This is implemented in humanistic practice because practitioners treat clients’ personal identity as being human in the same way as they are themselves. In addition, they seek to achieve equality of treatment between different social groups and between people within social groups by, for example, avoiding bullying and oppression in families, schools and workplaces. The commitment to equality also connects with Rogers’s (1961) emphasis on the practitioner being non-directive, non-judgemental and an active listener, using ‘accurate empathy’ and ‘authentic friendship’. Rogers also concentrates on the importance of the self seeking personal growth. There is an emphasis on the here and now rather than on the history of clients’ problems. Because of the belief in clients’ uniqueness, Rogers gives less emphasis than most problem-solving social work theories to the diagnosis and classification of conditions. Everyone is an individual in this view. Humanistic practice must also be flexible in the way that it responds to human beings, and prepared to engage with the complexity of everyone’s personal identity. We do not expect human beings and their relationships to operate in just one way; instead, we expect that all sorts of responses to situations are acceptable and workable. As with systems theory, we do not explain behaviour in a linear way, but accept that many different factors interact in all sorts of ways that we cannot fully understand. Caring and creativity are essential in humanistic practice. The term ‘caring’ is preferred to ‘helping’ because the latter implies that one person, the social worker, has both expertise and good intent, which reduces the freedom of the person being helped. Caring involves creating a caring environment that enables caring to take place. In this, there is a caregiver who is predisposed to caring and who performs acts with the client that have the behavioural qualities of caregiving. All this enables a caring relationship to unfold in which connections can develop between the cared-for person and the caregiver. This allows practitioners and clients to use creativity as part of the work that they do together, stretching the practice and generating additional connections between the participants, as well as empowering clients and the people around them to be creative in resolving the issues that they are facing. England (1986) extended his view of social work as art into a humanistic theory based around the ideas of coping and meaning. Self and spirituality are linked in their importance in humanistic practice. Personal development is an important human right, enabling people to move towards self-actualization. One aspect of this is the opportunity for everyone to build their personal identity, understanding the characteristics they share with others and the diversity of human beings, which strengthens their differences from others. Our identities are both internal and personal

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because they emerge from our nature and experience, and external and social, because they emerge from our interactions with others and the world around us. Our identity is a dialectic, an internal debate, between our experience of ourselves and our experiences of the world around us. Our spirituality develops from this dialectic: it is how we give meaning to our own existence and the existence of others in relationship to us. This idea of internal dialectic is secular, but it connects with spiritual ideas such as prayer and meditation. The importance of human rights and the value placed on the balance between our internal and external experiences make security and resilience important objectives in social work. This contrasts with the conventional view, which suggests that social work is often about assessing and managing risk. Humanistic practice aims to help people find ways of living that allow them to be secure in the decisions they have made and social situations they are part of, and help them to bounce back from adversity. Thus, humanistic practice rejects problem-­ solving as a social work objective because it sees problems as a natural part of the human condition. We should enhance people’s emotional and physical security and resilience, so that they can respond to the situations that life throws at them. In this way, humanistic practice offers a positive view of humanity and the human situations that people are part of, rather than focusing on the deficits in individuals and their social environment. Ideas about mindfulness, which we met in Chapter 7 and which draw on Buddhist thinking, are increasingly influencing a wide range of therapeutic practice. Lee et al.’s (2009) body– mind–spirit social work draws on three perspectives from Eastern thought: yin–yang and Daoist and Buddhist teachings. Its integrative view of change rejects the linear conception of change that is common in Western practice. The linear view proposes that you start from people’s problems, use knowledge to understand the causes of the problems and then use theoretical understanding to suggest a technique for change that removes the problems and achieves well-being. As part of this, clients’ active participation enables them to achieve greater control over their lives and problems. Eastern thought has a view of change that is different from Western thinking; reality is constantly changing and life is always in a state of becoming. No final state of well-being is therefore possible. Life and reality are in constant movement and exist in patterns that we can understand through a direct experience of their meaning rather than through rational analysis. Breaking things down into parts of concepts reduces our understanding of the balance and interdependence of the events in our lives. Balance, or the Buddhist ‘middle path’, implies not a compromise but an incorporation of different elements into a unified whole. In this context, we should, rather than trying to attain rational control, try to let go of our concern for transient socially based standards and desires, which limit us. Instead, we should connect with what would bring us inner harmony, which in turn incorporates the ‘wisdom and intelligence of nature’ (Lee et al., 2009: 25). Crisis intervention (Chapter 6) also used aspects of this idea from Chinese thinking. We should transcend our focus on the development of our self and our family and lose our attachment to worldly desires. The two important features of this approach to change that should not replace the Western view, but should complement it, are: ●● ●●

seeing balance as central; including spirituality in the conception of healthy change.

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Case example: Jabari’s unemployment Jabari was referred to a mental health service with depression resulting from unemployment. He had lost his job some months previously and had since made many unsuccessful applications for similar jobs. In his family, it was regarded as an important responsibility for men to be employed, and Jabari’s father was particularly critical of his failure to work. Although Jabari did voluntary work for a local charity teaching new migrants English, and had started to

take information technology classes at the local college, encouraged to do by his employment adviser as a useful contribution to his skills, his father did not feel that this was making a contribution to the family. Jabari found that he enjoyed the voluntary work and considered that he might train as a teacher. However, his father and brothers felt that this was not ‘man’s work’, and it would mean a long period before he could earn a good income again.

A conventional Western approach to this situation would be to concentrate on improving Jabari’s mood and working with the family to reduce the conflicts that might be contributing to his depression. The body–mind–spirit approach is to reject a single definition of man’s work and the role of employment in defining a personal contribution to a family. These views were keeping Jabari in a system of thought that prevented him from making progress. Working with Jabari and the family therefore had a focus on how family members were balancing different aspects of human contribution, rather than on trying to get them to adapt their behaviour. It recognized that Jabari’s ‘failure to contribute’ through working was not wrong or inadequate but something all family members needed to take into account in thinking about how the family functioned. Jabari’s changing his mind was not the only thing that was important, because all elements of his own and external states needed to change. Rather than wanting to get back to the previous balance, with Jabari working and making his contribution to the family as it was previously functioning, they all needed to accept the new situation. Being mindful of the present in this way, the family could transcend or rise above the difficulties within it, to recognize ways in which they could work effectively, including Jabari in a new way. In this way, people and our practice accept that ‘change is the rule, rather than the exception’ (p. 39), and that movement as change takes place when the forces affecting us allow us to develop and change. If we are mindful of what exists in the present, we can find ways of using this, accepting and going with the flow of change, using whatever strengths we have and being compassionate with others who are sharing the situation with us. Body–mind–spirit practice emphasizes the importance of interventions that use the body. Lee et al. (2009: 127–70) describe techniques that involve touch: well-known examples are the use of massage and acupressure points. They also recommend using rituals, such as taking time out of difficult periods of the day to drink tea or coffee. In this case, they emphasize the importance of setting aside time and going through a ritual of preparation and savouring the drink. This helps to create balance in a complex life and therefore greater tranquillity. Using physical processes in this way makes it possible to connect the body with the mind and spiritual growth: I deal with spiritual care in greater detail when discussing Holloway and Moss (2010) in the example text on spirituality and social work. It is also important to create

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a good balance between focusing on and actualizing our self and focusing on and actualizing others for whom we have responsibilities. This can often be important when we are helping those who are caring for older people or people with disabilities. Carers may concentrate so much on the quality of life of the person they are caring for that they fail to ensure they themselves remain healthy, develop their education or maintain their work skills, which will secure their quality of life in the long term after their period of caring responsibilities has ended.

Example text: Glassman’s (2009) humanistic groupwork Groups are places where individuals are valued and take mutual responsibility for each other, which creates a ‘pocket of humanistic egalitarian life’ (Glassman, 2009: 3) that enhances social and mental health. This account of groupwork derives from democratic and humanistic values, stating that differences among group members enrich everyone. It describes people’s: ●● ●● ●● ●● ●● ●● ●● ●●

inherent worth and equal right to opportunity; responsibility for and to one another, and the fact that they are socially interdependent; right to belong to and be included in emotionally and socially supportive systems; right to voice, to participation and to being heard; right to freedom of speech and self-expression; enrichment by others who are different from them; right to freedom of choice; right to question and challenge professionals.

Groups develop in a series of stages, and people’s behaviour and the themes of group interaction are consistent within the stages. Humanistic theory allows members to use groups’ development actively in pursuing their personal development. The stages are as follows: ●●

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We’re not in charge. Group members approach each other and the group with caution, uncertain about the group’s norms. The practitioner helps to identify common needs, interests and links between members, inviting mutual trust and support – a ‘partnership in mutual aid’ (p. 64). We are in charge. Some members attempt to impose their agenda or direction on the group, which produces resistance and conflict. The practitioner helps them understand that they are in the process of agreeing shared norms. We’re taking you on. Group members challenge the practitioner’s role and struggle with how to engage with or reject the practitioner’s help. The social worker helps them to explore their feelings about the practitioner and to remove barriers to using their potential contribution. Sanctuary. Members feel achievement and inclusiveness through working on power and authority, and feel a new caring, effectiveness and closeness. The social worker shares this feeling of engagement and helps the group to use the security they have created to work on real problems. This isn’t good any more. Group members do not want to take the risk of struggling with their problems, and feel disenchanted and angry with the group. The social worker demonstrates confidence in their capacity to work on problems and encourages them to explore rather than reject their negative feelings.

Humanistic practice, existentialism and spirituality 355 ●●

●●

We’re OK and able. By working through their ambivalence about whether the group can help them, the group’s members gain confidence that they can work out difficult problems. They choose from the various options that are available to them from the skills in the group. The practitioner helps them to enhance their capacity to clarify, focus, resolve conflicts and act. Just a little longer. Group members want to keep on with the security of the group, since it has been successful in helping them with their problems. However, they can now use their experience to manage more effectively on their own. The social worker helps them to separate from the group, valuing and confirming the helpful progress that has been made.

The objective of groupwork is to develop a democratic mutual aid system; processes for achieving this are set out in Figure 13.2. Practitioners help group members to express and simultaneously carry out (actualize) their purpose. This function is achieved by a range of practical techniques for getting the group to establish its goals, and for dealing with the conflicts and difficulties that arise in working on the goals. These are set out in Figure 13.2. Aims

Technique

Actions

Develop cohesion and emotional bonds between members

Facilitate collective participation

Foster valuing and accepting each other Scan the mood of all the group members Engage the group as a whole Establish group identity and cohesion

Modulate expression of feeling

Express feelings appropriately and respect differences

Prevent premature or overwhelming emotional disclosure Identify and universalize people’s stories

Facilitate processes of decision-making

Develop rules, leadership and followership, and goals

Check feelings and opinions Reweave a range of views as collective perceptions Help compromise and consensus to be developed

Process the here-and-now

Foster expression of feeling and democratic norms

Open up awareness and ownership of the group and its process Foster feelings of belonging, inclusion of others and being heard

Express feelings about the practitioner

Enable an understanding of and demystify the practitioner’s role

Ask the group to share their feelings about the practitioner Identify and respond to indirect expressions Own up to mistakes

Set goals

Enhance conscious ownership of the group, and crystallize cohesion and identity

When goals are questioned, reweave individual needs into common goals

Promote good and well-being

Identify and summarize individual feelings so that you can prevent dissatisfaction from being hidden and festering

Ask for and take part in rounds of reactions to the group’s experience, without comment or assessment

Figure 13.2  Developing the democratic mutual aid system Source: Glassman (2009: 103–27).

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In addition, social workers use several interpersonal skills in their practice to achieve these two purposes. These skills are as follows: ●●

●●

●● ●●

●●

Demanding work, directing, lending vision and support occurs where workers use their own commitment to move members forward when they are stuck. They do this by focusing their attention on acting and helping them to do so. All these techniques require workers to be active and positive, rather than reflective and neutral. Staying with feelings involves social workers acting as a model for expressing feelings positively, but also helping members to express their feelings when they are uncomfortable. Silence conveys respect and support for members who are struggling with difficulties. Exploration helps to involve members in free-flowing activity. Open-ended questions, curiosity and interest stimulate involvement. Identification involves pointing to repetitive patterns of behaviour and thinking in the group (Figure 13.3).

Aims

Technique

Actions

Role rehearsal

Experiment with new experiences

Imagine and play out alternative behaviours in new situations

Programming

Learn how to plan future change

The experience is one of generating, exploring and evaluating ideas for the group programme

Group reflective consideration

Clear up distortions in thinking

Recall events and how they affected people

Interpretation

Expand awareness of meaning

Identify alternative ideas about events

Feedback

Enhance feelings in relationships

Discuss ‘I perceive’ and ‘I feel’ about group events

Conflict resolution

Prevent conflict escalating

Identify when you feel there is conflict, fostering and modelling how to explore issues

Mending the group

Help the group rebuild after failures

Start a discussion of hurt feelings, exploring group members’ strengths and achievements

Confrontation

Face painful and divisive events

Stop the group, pointing out patterns of unhelpful behaviour and assisting in planning the change that is required

Data and facts

Increase knowledge and skills in finding it

Collect and share information, giving people experience of finding useful materials

Self-disclosure

Display your commitment to accepting group and human fallibility

Share feelings, limitations and vulnerabilities

Dealing with the unknown

Enable the group to overcome their inhibitions in handling an issue

Encourage the discussion of feelings and risks, helping members to explore them and supporting members if moving forward

Taking stock

Enable passage to new agendas

Help the group discuss salient themes and learning, and plan future ventures

Figure 13.3  Helping groups establish and work on group goals Source: Glassman (2009: 129–74).

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 xample text: Holloway and Moss (2010) on spirituality E and social work Holloway and Moss (2010) describe the historical relationship between religion, spirituality and social work as being tentative and at times hostile. In Figure 13.4, I have adapted their diagrams of these relationships to show some of the interactions with social work. All societies are simultaneously both secular (that is, people in that society do not believe in the existence of a god or higher being) and religious (that is, people in that society do believe in a higher being). Most people, however, regard spirituality as an element of being human. This comprises a sense of mystery and awe as they experience the world around them: ‘Wow: it’s amazing!’ Responding to that sense, people wish to see the meaning and purpose of those mysterious and awesome aspects of their world, their life and their place within that world and life: ‘Why and how is it amazing?’ These two elements form the main basis of spirituality, which is at the centre of Figure  13.4. Religions such as Buddhism, Christianity, Hinduism, Islam, Judaism and many more provide organized systems of thought about that mystery and meaning, as well as rituals that involve the worship of a higher being or beings who give that meaning and purpose to the world. Religion may be a part of some people’s spirituality, hence it is denoted in Figure 13.4 as an area within spirituality. The arrows show religion and spirituality extending people’s engagement with aspects of life that they perceive as the good and the dark side of life. Social work similarly interacts with the good and dark aspects of life, through its caring and helping roles that help towards empowerment and enlightenment, and its engagement with abuse, discrimination, exclusion and despair. Everyone experiences spiritual needs and distress, and various attempts and systems have been developed to asses and measure this (Hodge, 2001). These involve systematic ways of looking at how people decide on the meaning and purpose of their life and their actions

Mystery and awe

GOOD SIDE: Goodness, otherness, Wow! transcendence, beauty, etc. Social work caring and helping

Meaning and purpose Why?

Religion

Figure 13.4  Religion, spirituality and social work Source: Holloway and Moss (2010: 40–4).

DARK SIDE: Suffering, evil, meaninglessness, purposelessness Social work with exclusion, despair and discrimination

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within it. Spiritual assessment also explores whether people are able to transcend suffering and despair, building self-esteem and hope. It seeks to identify the beliefs that help individuals deal with problems in their lives, sometimes in particular focusing on religious beliefs. Evidence suggests that health and quality of life are enhanced by happiness, hope and positive feelings about our lives and experiences. Spiritual care seeks to achieve this by achieving: ●●

●●

●●

●●

●●

transcendence, a sense of purpose, hope, meaning and affirmation in life, sometimes in the face of oppression or difficulty; transformation, by enabling people to change their identity, enabling them to become self-­ affirming and able to deal with and prevent the difficulties in their lives; wholeness, by shaping people’s identity as a whole, integrating a focus on social structures as well as personal well-being; hope, by helping people to think about the opportunities available to them for improving the quality of their life in the future; resilience in the face of negative events, by developing skills in bouncing back from things that go wrong.

This is done through meaning-making, by searching for, expressing and sharing with others the meaning that people give to events in their lives, bringing together the past, the present and potential futures. Helping people to develop spiritual narratives enables them to see how the meaning of events has changed over time for them, and to reinforce beneficial changes. Spiritual care may be undertaken by individual practitioners, according to their commitment and expertise, or as part of a team that sometimes includes spiritual care specialists, such as chaplains. Many aspects of spirituality involve developing or enabling people to participate in spiritual and faith communities. Crisp (2017b: 4) suggests that responding to spirituality is most undertaken in particular fields of practice, including end-of-life care, bereavement, substance misuse, migration and mental health. As in personal construct theory (see Chapter 11), how social workers, clients and others around them attach meaning to events crucially affects how practitioners deal with them. The idea of making sense is a way of humanizing and interpreting clients as being worthwhile contributors to society.

Conclusion: using humanistic social work Social work practitioners use humanistic social work because it provides a principled approach to understanding human beings as wholes, which is more flexible, less deterministic and less judgemental than many psychological ideas used by social work. The interaction between clients’ perceptions and interpretations of the world and the reaction of the world to clients shows how situations arise in which clients’ apparently bizarre or bad behaviour is established or amplified by social processes. These ideas can be a useful way of explaining clients’ behaviour and problems without blaming clients, who are the victims of these social processes. Theories of humanistic social work emphasize that respect for whole persons and the common good are an essential part of effective practice and the value base of social work. Artistic and cultural understanding through metaphor, experience, revelation and faith are

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important parts of the lives of many people in all cultures and of all social workers themselves. Valuing spirituality and human fulfilment has always engaged a commitment among clients and social work practice ideas. Understanding and accepting the role of spirituality and the way in which people interpret social experience is essential to understanding many clients and to understanding the cultural experiences of minorities who may be oppressed or excluded in many societies. The technical rational and secular elements of social work have, however, often downplayed the importance of these elements of practice. Many practitioners therefore find that the humanistic and spiritual elements of practice provide a useful balance to the main rationalist thrust of social work practice.

Additional resources Further reading

Canda, E. R. & Furman, L. (2019). Spiritual diversity in social work practice: The heart of helping (3rd Ed.). New York: Oxford University Press. A leading American text on spirituality in social work. Crisp, B. R. (Ed.) (2017a). The Routledge handbook of religion, spirituality and social work. Abingdon: Routledge An important broad-ranging collection of papers on religion and spirituality in social work. Glassman, U. (2009). Group work: A humanistic and skills building approach. (2nd ed.). Los Angeles: Sage. An excellent account of humanistic groupwork incorporating humanist ideas. Cnaan, R. A., Boddie, S. C., Handy, F., Yancey, G. & Schneider, R. (2002). The invisible caring hand: American congregations and the provision of welfare. New York: New York University Press. Crisp, B. R. (2014). Social work and faith-based organizations. Abingdon: Routledge. Dunham, A., Furbey, R. & Lownes, V. (Eds.) (2009). Faith in the public realm: Controversies, policies and practices. Bristol: Policy Press. Three important texts from the USA, Australia and UK that demonstrate the role of religion in social policy and social work agencies. Ashencaen Crabtree, S., Husain, F. & Spalek, B. (2016). Islam and social work: Debating values, transforming practice (2nd Ed.). Bristol: Policy Press. Holloway, M. & Moss, B. (2010). Spirituality and social work. London: Red Globe Press. Useful texts covering spirituality and religion in social work practice. Payne, M. (2011). Humanistic social work: Core principles in practice. London: Red Globe Press. A general account of humanistic social work practice. Griffiths, M. (2017). The challenge of existential social work practice. London: Red Globe Press. Thompson, N. (1992). Existentialism and Social Work. Aldershot: Avebury. Two useful discussions of the theoretical and practical application of existentialist ideas to social work.

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Journals Journal of Religion and Spirituality in Social Work (formerly Social Thought) – Taylor & Francis. Social Work and Christianity – North American Association of Christians in Social Work. Journal of Humanistic Psychology – Sage. Although not a social work journal, this is the major international journal on humanistic practice. There are a variety of magazines on humanism. In the USA, The New Humanism is important; in the UK, the main source of information is New Humanist.

Websites http://www.youtube.com/watch?v=nd282Et6hy4 A short and informative video on existentialism and social work. https://youtu.be/90kRJjh-F80 A video of a guest lecture in 2012 on spiritual diversity in social work by the American academic, Edward R. Canda. The sound improves once the lecture starts. http://socialworkpodcast.blogspot.com/2007/02/existential-therapy.html A useful podcast discussion of existential social work practice. https://youtu.be/ZQSvSQDRB7o (UK: practitioner vlog, Jasmine Ama, 2017); https://youtu.be/VPnMRysTLKk (USA: academic talk; Sarah Curtis, 2016). Two fairly brief and not particularly engaging YouTube talks on religion, spirituality and social work; they might be useful to someone thinking about these topics for the first time. http://www.nacsw.org/ The website of the North American Association of Christians in Social Work, which contains useful information and bibliographies. http://thenewhumanism.wordpress.com/about/ The blog of the New Humanism magazine.

CHAPTER 14

Social justice practice, empowerment and advocacy MAIN CONTRIBUTION Social justice contributes two elements to social work practice. The first is interpersonal and psychological fairness. This element aims to help people achieve a sense that they are treated with justice in their personal lives and interpersonal relationships and that their social identities are appropriately recognized. More widely, the second element of social justice is concerned with justice between groups and within social institutions. Advocacy and empowerment practice underlies all social change and social justice practice. Advocacy aims to identify and represent the interests of disempowered clients to powerful individuals and in organizations to gain improved entitlements and rights. They enable social workers to construct help and alliances to overcome barriers to social justice in their social relationships and in the social structures that they are part of. Empowerment seeks to help clients gain powers of decision and action over their own lives. It does this by reducing the effect of social or personal blocks to exercising their existing power, increasing their capacity and self-confidence to use their power, and transferring power to people who lack it.

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Social justice is an important value in social work offering a sense of psychological fairness and equality among organizations in the social structure. Some approaches to justice compare present systems with an ideal, while other approaches aim for subjugated groups to achieve recognition and to improve justice in everyday actions. Fairness is a quality of individual human relationships, while justice is produced in social institutions and organizations. Liberal views of justice focus on individuals’ freedom of choice within a market and following fair procedures. Social justice views balance this with a concern for the fair distribution of social burdens and social benefits.

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Advocacy and empowerment are social democratic practices enabling people to overcome barriers in achieving their life objectives, to gain access to services and to improve services, contributing to practice a focus on social injustice. Advocacy and empowerment are also used in eco and green, critical, feminist and antidiscrimination theories of social change and development practice. Advocacy originates in legal skills and is a role for many caring professions. Advocacy represents people in two different ways: speaking for them, and interpreting and presenting them to those with power. Cause, or policy, advocacy promotes social change that benefits groups and their interests, whereas case advocacy seeks to establish individuals’ and families’ welfare rights. Advocacy on behalf of people with disabilities, particularly learning and physical disabilities and mental illness, was an impetus for the advocacy movement. Advocacy and empowerment are connected with self-help and individuals and communities participating in decisions that affect them. Empowerment aims to achieve the social justice objectives of social work, both in the way it is practised and in its aims. This is increasingly being implemented through advocacy practice. Normalization and social role valorization, which originate in and are related to advocacy movements for people with intellectual disabilities, seek positive environments for people living in residential settings. Empowerment theory emerged from the history of the struggle for equality by black people in America. Power cannot be given to people; practitioners must help them take it for themselves. There is evidence that group empowerment work with people from deprived communities can increase later citizen participation.

PRACTICE IDEAS ●● ●●

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Barriers or blocks may prevent people from achieving their social objectives. Normalization aims to create environments for people in residential and other care institutions that would be widely valued. Validation of people’s feelings and experiences is important.

THE DEBATE SUMMARY Debate about social justice as an objective of social work centres on the following issues: ●● ●● ●● ●●

Is social justice an appropriate and practical objective of a public service profession? Is social justice an aim rather than a value? What form or forms of justice are relevant to social work? Are advocacy and empowerment cohesion, liberation or social change objectives?

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Debate about social justice, advocacy and empowerment Can a public profession have social justice objectives? In many countries, social workers are public employees, and their duties include enforcing the law or carrying legal responsibilities for care. They are often responsible for managing the behaviour of people who are troublesome to the society in which they work, such as alcohol and drug users, and offenders. Can social workers, alongside such responsibilities, also pursue social justice when both clients and the public may perceive their primary role as enforcing the existing system? Their caring or therapeutic roles that facilitate social justice actions may be rejected by clients and their families or be given lower priority in the social mandate for their work. Of course, in their professional processes they can treat people with fairness, and they can seek equality and fairness of treatment for their clients and justice in social agencies. In this way, advocacy and empowerment are important expressions of social justice values. We have also seen that professionalization enhances the social status of the professionals, so developing a professional role is in some ways inconsistent with aiming at social equality. Another point about social justice is that deciding what is just is primarily a political matter, and should be left to democratic debate. But social work has never stood back from accepting that its existence and its purposes, like the existence of all social institutions and social purposes, are political, in the sense that interest groups might well form around different objectives. We saw in Chapter 1 that discourse around social objectives in society generally, within agencies and between practitioners and clients, always expresses political aims. Taking this view, social work should be seen as balancing different aspects of its social purposes and appropriately making the case for social justice as part of one of the few professions with a role in responding to social issues.

Is social justice an aim rather than a value? The IFSW Global Definition of Social Work (IFSW, 2014) identifies three objectives of social work, which form the division of practice theories in the book: social cohesion, empowerment and liberation, and social change and development. It separately identifies social justice as the first of social work’s central principles. Is this division between objectives and principles right? Would social justice be a better objective than social change and development, since it might be seen as a better defining purpose? Social change as an objective does not specify what change is directed towards. It could be all manner of things that social workers might disapprove of, such as, say, men controlling women’s lives, or people in poverty not being supported by welfare payments, or older people being neglected. Moreover, the other principles identified, ‘human rights, collective responsibility and respect for diversities’, also express what social change and development is designed to achieve, although they express it rather vaguely. It might be argued, then, that social justice should be an objective of social work rather than a value. One answer to this is that social justice is no better defined than social change, and I look at this issue next.

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What forms of justice are relevant to social work? The philosophical and social science debate about different forms and purposes of social justice means that it is unclear what pursuing social justice as a professional objective should mean. The most common social justice model is distributive, to ensure that resources are distributed between different social groups more equally. One of the important distributive issues that has engaged social workers’ interests is health inequality, since there is international and often national evidence that there are social determinants of health inequality (US Department of Health and Human Services, 2000; Commission on the Social Determinants of Health, 2008; Bywaters, McLeod & Napier, 2009; Marmot Review, 2010; Artiga & Hinton, 2018). Social work practice has also addressed inequalities due to disability, ethnicity, gender, mental health, poverty and sexuality; I review practice concerned with this in Chapter 18. These issues often raise concerns about whether affected groups are recognized in social discourse, a concern of Fraser’s (2008) view of social justice, or whether the processes of decision-­ making and service provision acknowledge and deal with needs that are outside the mainstream, a procedural view of social justice raised by Sen (2009). And should social work practice respond to broad justice issues or only with the groups whose problems are raised for social work agencies to deal with? Thus, there are a range of justice issues of concern, a range of possible approaches, and uncertainty about whether social work agencies should have responsibility for dealing with the justice issues raised and how social work as a professional practice might contribute. The debate here is between a view that limits the role of social work to responding to issues actually raised with social workers in their practice activity and a conception that social work should seek to right broader social injustices that may be the source of those issues of daily import. This tension is raised in debate about many of the social change theories that I review in Chapters 15–18. In this chapter, we are concerned with whether it has an impact on advocacy and empowerment practice. Because this practice may be used for social cohesion and liberation objectives in social work, how we look at social justice has an impact on wider objectives than social change, and we can ask whether advocacy and empowerment are appropriate roles for social work practice in personal and interpersonal care; I consider this next.

 re advocacy and empowerment social cohesion, liberation or social A change theories? Are advocacy and empowerment critical theories with social change aims, or are they practices whose main aims are improving the position of individuals, families and communities? Beckett and Horner (2016: 78–9) argue that advocating for a client’s or family’s needs only lends power to them; the advocate retains it. Similarly, carrying out needs assessments for providing a service places the power, to provide it and to decide what to provide with the social worker. The client becomes a supplicant. Practice mainly aimed at helping user groups (Braye, 2000), gives a lower priority to social change than critical practice theory demands. Leonardsen (2007), for example, argues that the crucial element of empowerment in individualistic practice is to help people develop a capacity to interpret the meaning of their situation and act upon it. Again, Eamon’s (2008) account of empowerment focuses on the effectiveness of CBT

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in empowering ‘vulnerable populations’. This justifies psychological intervention as empowerment only because such populations are the main focus of social work. Critical theorists argue, therefore, that empowerment and advocacy are not structural in their explanations of social and psychological issues and fail to seek social change outcomes (Rojek, 1986; Humphries, 1996). For example, critical views would say that offending among social groups of young offenders from minority ethnic groups in poor areas is produced by structures of inequality in society that have led to poor education services for them in areas of poor housing with few positive leisure facilities for young people and a background of endemic drug abuse. Empowering young black people in such areas to appreciate education or to realize the health and social disadvantages of drug misuse, and advocating for better work opportunities in such areas, are don’t overcome the way in which social attitudes and services continue to be organized to the disadvantage of young people in this position. Such views say that empowerment and advocacy ideas are inconsistent in helping clients because they raise understanding but do not enable them to act on the structural explanations of oppression that logically follow from this. Therefore, they do not empower but only demystify the effects and sources of oppression on people’s lives. Pease (2002) argues that empowerment theories are based on modernist ideas that power is held by dominant social groups, rather than the postmodernist conception that it is spread throughout social systems and is often available to be developed by vulnerable or excluded social groups. Empowerment practice, however, helps practitioners to think about social barriers to achieving their clients’ objectives and motivates them to deal with unfairness affecting their clients. It also encourages them to enable their clients to participate in the decisions affecting them and build their capacity to achieve what they want in life. Empowerment practice reflects a commitment to self-determination, client participation and the openness of practitioners and services to being influenced by their clients, what Beckett and Horner (2016: 80) call ‘power-sensitive’ practice. Because practitioners are usually not in a position to achieve social change in their agencies or in social policy, they can, by being power-sensitive, avoid oppressive actions in their practice and in how they implement their agency’s requirements. Ezell’s (1994) study found that most American social workers undertook some advocacy, mainly case-based and internal to their own agencies. Cause advocacy was carried out on a voluntary basis. Cnaan (1996) argues that American society is multilayered and incorporates both ruthless capitalism and complex systems for promoting welfare and independence through voluntary and community endeavour. This is true of many Western societies. Advocacy and empowerment might therefore be seen as social work contributions to this complex social picture. Moreover, not all clients can achieve a high degree of empowerment. Advocacy and empowerment fail to deal adequately with clients who are incapable of achieving power and control over their lives and those who need protection, since practitioners may disappoint or mislead them about the possibility of their own empowerment. Boehm and Staples (2002) found, in focus groups with clients, that different kinds of clients expected different forms of empowerment. They argue that one generalized theory of empowerment for all clients is insufficient. Very damaged, oppressed and institutionalized clients can achieve greater self-­ control and power through empowerment and advocacy, but this should not exclude

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therapeutic work for their benefit as well. Freddolino, Moxley and Hyduk (2004) make a similar argument about advocacy – that it should be used differently in different situations. If we accept that empowerment and advocacy do not aim for social change, they and the multicultural theories discussed in Chapter 18 lie between empowerment and liberation theories and social change theories. In the same way that macro, social development and pedagogy practice bridge the social cohesion and empowerment and liberation objectives of social work, so empowerment and advocacy incorporate objectives of both empowerment and social change social work, not fully adopting either view. Another issue, where social workers deal with individuals, is that empowering individuals may not extend to their wider community or networks. So empowered individuals may be taking power and resources from others in their oppressed environment, to the community’s disadvantage, rather than taking it from wider society. Where social and political resources are limited, empowerment may set oppressed or deprived groups against others rather than uniting them.

Major statements The most comprehensive account of social justice theory and practice in social work is Watts and Hodgson’s (2019) recent text. The political philosophy arguments of Rawls (1999), Fraser (2008) and Sen (2009) are influential. Empowerment ideas, of which Lee’s (2001) monumental account is still the most comprehensive presentation, are steadily being displaced in their importance by the concept of advocacy, an area in which theoretical work has flowered in the twenty-first century. Jansson’s (2020) important US texts see policy practice as an aspect of social work. Hoefer’s (2019) model is applicable to more local and case-based attempts to influence policy, and to practitioners who only occasionally use advocacy as part of more generalist practice. Dalrymple and Boylan’s (2013) and Wilks’s (2012) comprehensive theory-informed texts using British examples usefully bring together political and cause advocacy and interpersonal case advocacy. In the UK, advocacy has been a significant practice in work on children’s rights and work in the mental health field, particularly with people with intellectual disabilities. Specialist texts include Boylan and Dalrymple (2009) on children’s work, and Newbigging, Ridley, McKeown, Sadd, Machin et al.’s (2015) compendium on independent mental health advocacy. Donnison’s broad survey (2009) is useful, while the Brandons’ work (for example, Brandon 2000) was influential longer ago. Many now regard welfare rights advocacy in the social security and related systems as a specialist non-social work field, but social workers work every day giving information and advice in this area (Bateman, 2005).

Wider theoretical perspectives Ideas of justice and social justice I suggested in looking at debates about advocacy and empowerment practice that how we understand justice and social justice affects the extent to which we think that social workers should take it up in their practice. Justice forms part of the study of law and government and political philosophy, and social justice is also an aspect of the social sciences. We think of

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justice as the legal system adjudicating fairly between the interests of individuals, but what is ‘fair’? Social workers will often face disagreement about how to act fairly in their practice, or to support justice as part of their work. Sen (2009) makes a useful distinction when he describes fairness as a quality of individual human relationships, while justice is produced in institutions through procedures and social structures. Fraser’s (2008) recognition perspective challenges this view of justice. She argues that failures of recognition in societies mean that many subordinated groups cannot obtain justice through state or even international structures. If we do not recognize the identities of women or indigenous groups, they cannot obtain justice in their special position. And the identity of subordinated groups is sidelined by the interests of globalized economic systems, which exclude women and other important groups served by social workers. Participation is also invalidated as a strategy for subordinated groups because, rather than recognizing rights as citizens to service provision, they are treated as consumers by liberal economic thinking. According to Sen’s (2009) account of justice, there are two distinct approaches to thinking about justice. One approach starts by setting a standard of justice arrived at through debate and asks whether the institutions in a society meet this standard. This view connects with critical views in social work (see Chapter 16), which want to achieve social change by working positively towards a particular conception of social justice. The other approach is more pragmatic. It starts by looking at how justice works in a society, comparing it with what other societies do, and evaluates practically the extent to which the outcomes are fair. This sees social justice as a practical matter, aiming to reduce injustices. Sen emphasizes that this approach requires rationally thinking through issues that we come up against that seem to involve justice and arriving at a practical view about what we think is fair in the specific instances we are dealing with. An important part of this is having information that can inform our judgements about what is just. Sen (2009: 225–317) proposes that to do this we should examine the capabilities that are present in the institutional position and in the cultural and social possibilities offered by the lives of the people we are concerned with. Dealing with individual social work situations means that arguing through what is fair in situations that we face is often a helpful process for social workers. To do this we follow a strengths perspective (see Chapter 11) to look at the capabilities or strengths of the individuals, families, communities and social groups we are dealing with. We often need to consider the balance between a more positive, broader view of social justice and a more negative view of avoiding coercion or dealing with problems of justice. Two important twentieth-century views of justice, coming from a long history of debate, can be glimpsed in these competing ideas in the discourse around social justice within social work. They are as follows: ●●

Liberal views concentrate on the freedom of individuals from coercion. These views propose that a justice system should leave people free to make their own decisions as far as possible. Liberal thinking has influenced economics. Here, the term ‘liberal’ refers to liberating people from domination by others, supporting individuals’ autonomy to pursue their own interests and property rights. People would be freed from the confines of collective arrangements by institutions that impose norms limiting choice in their own lives. Such views reject attempts to reduce personal differences through trade unions, collective welfare provision and community cooperation. Instead, they favour people’s rights to

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pursue their individual interests. It is argued that people should be free to make choices for themselves in an open market, rather than having decisions limited by restrictions on how a market operates. These views of justice favour public choice policy, that social provision should be organized to leave people free to make their own choices about what expenditure and services contribute to their well-being. Social justice views, while accepting the importance of individual freedoms, balance this with a concern for the fair distribution of the burdens and benefits of society. These views connect well with the rational thinking-through approach to justice. We saw that these connect well with social work responsibilities, and they come in useful in advocacy and empowerment, as I explain in the last part of this chapter.

Social work is often ambivalent about these distinctions. This is because its values say that clients should, as far as possible, have freedom of choice and self-determination. Liberal views and public choice, however, assume that the best way of achieving this is leaving people free to operate in an economic market. For social workers, this is not satisfactory, because their clients are often suffering from poverty, which reduces their market power, or social divisions exclude them from some of the more attractive options. Social work clients, therefore, often don’t have freedom in economic markets, and public choice ideas don’t work well for them. Alternative ways of looking at justice are offered by religious and other traditions. Here are some examples. Christian denominations identify three types of justice: ●● ●● ●●

commutative justice, seeking equality and liberty for individuals (empowerment objectives); social justice, seeking the common good (social change and development objectives); distributive justice, seeking the distribution of social resources and burdens equally among individuals (social cohesion objectives) (Maguire, 2013: 31–6).

These ideas connect with the three objectives of social work and the political philosophies that inform them, which I considered in Chapter 1 (see Figure 1.6, and I have inserted a reminder of these in brackets). Palakkappillil (2013) considers a Gandhian perspective drawing on Hindu thinking. This seeks the attainment of a society that ensures everyone’s well-­ being through non-violent struggle, in which local communities were self-sufficient and self-ruling, resources were equally distributed, animals and the natural world were protected and oppressed people lifted up. We can see here how this might support social work concerned with ecological issues (which I examine in Chapter 16) as well as empowerment. In Islamic societies of the Middle East, the traditional view was of a circle of justice in which powerful rulers, or in modern times the state, enforced Islamic law and protected poor people, so that they supported the ruler or the state and accepted its paternalistic role (Thompson, 2013). In Latin America, decolonization led to social justice being represented in a ‘solidarity economy’, in which people in poverty were democratically engaged in the co-production of social policy (Esteves, 2013). By implication, unless the poorest were engaged in the process of deciding society’s rules, the system could not be described as just. This supports a social work concerned with participation and human rights. Even though many complex ideas about justice are available, social work’s development was primarily influenced by social justice discourse in the West. Lorenz’s (2013: 16–17) account of the development of Western ideas of social justice suggests that it became important as social bonds and relationships of traditional societies were changed by the industrial

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revolution of the eighteenth and nineteenth centuries alongside the development of liberal thought, with its individualistic view of justice. A more obvious differentiation between capital and labour became apparent. Utilitarianism sought the greatest good for the greatest number, but this was again to be achieved by liberal justice, by individuals being as free as possible to pursue their own interests, within an economic market as a fair way of distributing resources in industrialized urban societies. Roman Catholic debate in this period developed the concept of social justice, arguing that the ‘natural facts’ of personal difference in individuals’ genetic endowments gave the lie to the concepts of equality proposed in the American and French revolutions. This conservative concept of social justice added to the liberal political position on justice, which, we have seen, is one of the main traditions of justice, economics and politics. The role of the state in Catholic liberal thinking is to secure everyone’s different position within society, so this view supports inequality as a natural state. Greater awareness of poverty allied to a growing consciousness of social difference led to questioning of liberal political philosophy and capitalism as the basis for the distribution of resources and power. This generated social reform and social work in the nineteenth century. States became increasingly responsible for promoting social cohesion and social order by meeting a range of social needs. A three-way division of state social concern saw social reform and social work based on social research, which provided the evidence to inform social change and intervention. Citizenship became important in protecting people’s rights within the organizations of the state. These developments, however, operated within the context of the liberal conception of social justice, which requires individuals to be free to make their choices but only within established property rights. A social democratic position on justice emerged from these ideas. Citizenship rights to political participation and social provision mitigated the impact of economic liberalism. How power is shared and used, and mechanisms such as citizenship and human rights, thus become part of the basis for social work. The social democratic view of justice provided for Sen’s (2009) rational thinking-through approaches to justice. It requires social institutions to pick up important social issues, research them and then intervene through social activism and social work. Social work advocacy and empowerment are one of the ways of doing so. Among issues that have become important in recent decades are discrimination and oppression, the role of gender and most recently environmental issues. Chapters 15–18 in Part 4 of this book demonstrate how social work has assembled methods of intervention in each of these areas. We have already seen, however, that views such as Fraser’s (2008) perspective on justice questions whether existing political and transnational systems of justice can respond appropriately to issues such as this. Social work may have a role in securing justice in other ways than through existing justice systems, through advocacy and empowerment within and outside existing official systems of justice. The ferment of ideas also generated an alternative to the liberal and social democratic views of social justice. Based on the ideas of Hegel and Marx (Lorenz, 2013: 20), the socialist position argues that it is important to examine whether people’s needs are met by the divisions between capital and labour in the economy. If not, how can the inequalities created by those divisions be fair? Social justice in this view can only be achieved by redistributing the resources within society to meet people’s needs, and this can only be achieved by the state. Rawls’s (1999) important formulation of justice, influential on social policy and social work thinking, sought to resolve these issues. People concerned about both individual

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freedom and also equality in societies often support this way of looking at justice. This is because it argues for efforts to create fair social systems and provide for rights and opportunities, but rejects measures aiming for equalization that interfere assertively with individual freedom of action. His argument starts by bypassing an awareness of existing social class and divisions, so it starts from an ‘original position’ uninfluenced by knowledge of existing injustices. From this position, he proposes two principles. The first, equal liberty, says that everyone should have the most extensive possible set of individual freedoms and rights compatible with a similar system for all. The second, the difference principle, says that social and economic inequalities should be arranged so that they are to everyone’s advantage and attached to social positions that are open to all. This view accepts that social inequalities exist, for example because some people are intellectually or physically advantaged (the Roman Catholic ‘natural differences’), but that disadvantage should be compensated for by other benefits that equalize the position for everyone, especially the least disadvantaged. Furthermore, everyone should have equal access to opportunities to establish their position in society, for example to work, to political office and to participate in social relations such as marriage and having children. While this seems balanced, it is criticized, by critical or radical thinkers from the Left, because it fails to compensate for long-standing inequalities and injustices that are often inherent in social relations. Such long-standing inequality means that many people only have the superficial form of equal opportunities, because their life disadvantage excludes them from too many chances to improve their position in society.

PAUSE AND REFLECT   The complexity of different kinds of justice Consider what approach to justice might be best in the following case example about the decision to place Noelle in a foster care placement.

Case example: Deciding on a foster care placement Noelle, a 12-year old girl in care, had experienced a difficult foster care placement and had been returned to a children’s home. A new foster care placement was found, and a case conference was held to decide whether this would be an appropriate placement for Noelle. She had met the foster parents, visited their home and expressed her ambivalent views about it to her social worker, Sumi. In some ways, Noelle thought she would quite like to stay in residential care, fearing a further breakdown. Part of her feelings arose because she felt she was a ‘difficult child’; foster carers could not ‘cope with’ her. Sumi spent some time working with her on these feelings about her selfworth. Questions arose. Did Noelle have the self-confidence to put her views to the case conference? Should Sumi highlight the pos-

itives of the placement option alongside Noelle’s ambivalence to the conference? In some ways, this contested Noelle’s stated view. Should Sumi speak for Noelle’s view, even though she disagreed with it? Should the conference accept Noelle’s view? Was rejecting the placement fair to the foster carers, who had taken a lot of trouble? Were Noelle’s long-term interests met by accepting that she should stay in residential care? A question of distributive justice was whether it was fair to the local authority, whose taxpayers would pay the bill, and the private foster care agency, which bore the costs of finding and maintaining foster care placements, to pursue the more costly option of residential care, when a potentially successful foster care placement was rejected?

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Some suggestions One justice question is whether Noelle should be free from coercion, and, if so, whether ‘persuading her for her own good’ was a form of coercion or good social work interpersonal practice. Another issue is justice to different parties, such as the funders, the potential foster carers, the private foster care agency or whether only justice for the client is relevant. We can also see that ideas of justice do not help with people who have ambivalent feelings or where there are questions of resources: residential care is a scarce and expensive resource, and foster care placements are often not ideal but may be ‘good enough’. Looking at just arrangements for resolving the issues, is the formal process of representation at a case conference appropriate for this decision, or should the final choice be made by the children’s social care administration? And is the social worker an appropriate person to represent Noelle, or can she be left to express her views to what might be a difficult meeting? What advocacy achieves here is recognition for the complex range of factors that may need to be taken into account and that conventional structures for participation do not make possible. The outcome was that an independent children’s advocate was appointed to work with Noelle to represent her views at the discussion, and Noelle’s participation in the conference with representation helped her to accept a time-limited try-out, to see if it worked. A long-­ term placement resulted, and the process of participation in the decision-making helped Noelle, the foster carers and Sumi and her successors to work through several difficulties.

Social justice, social change and social work’s contemporary issues In Chapters 1–3, we saw that the IFSW Global Definition (IFSW, 2014) proclaims social justice as an important value of social work. This may have led to an increase in otherwise sparse discussion of social justice in social work writing or may simply be part of a trend to greater debate about social justice in the social sciences. Before the last ten years, there was little comment on social justice as having value in social work intervention; recently there has been more. The alternative political positions on social justice discussed in the previous subsection can be seen in ideas about social justice within social work practice. Where there is more commentary on these issues, the focus is on the professional duty to achieve an emancipatory practice that offers freedom and liberation from constraints for clients (Bell, 2018: 11–14), so the starting position is something like Rawls’s (1999) ‘original position’ that ignores historical injustice. One element of social justice in social work, therefore, becomes practical measures such as advocacy and individual and group empowerment to remove current injustices that affect individuals and groups in society. I examine these practices in this chapter. They are methods of intervention focused on the empowerment objectives of social work seeking personal liberation, which I reviewed in Chapters 11–13. Moreover, they can contribute to addressing social issues of current concern, around which I have suggested social work developments have recently clustered. That is why I present advocacy and empowerment as relevant both to the empowerment and to the social change objectives of social work practice theories reviewed in Part 4 of this book (see Figure 2.1). Chapters 15–18 thus focus on the contemporary issues and use advocacy and empowerment in concert with social action towards social change objective. One aim is to oppose and remove discrimination and oppression through anti-oppressive practice, and I consider this

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in Chapter 18. Jordan (2013: 241) notes that this concern is in some ways different from other ethical issues faced by social workers, which are often about human dignity and worth. Social justice, on the other hand, is about relations between individuals and groups in a society, how resources are distributed among them and access to ‘the protections of citizenship’. Modelling anti-oppressive practice in social work is nevertheless also an ethical requirement of practice activity in all matters. Clifford and Burke (2009: 123–46) argue that ideas of social justice and equality, and social injustice and inequality, are a product of a society’s assumptions and emerge from the social divisions that are created within that society. Doing something about them requires more than individual helping actions, therefore, and this always joins individual practice to social and political aims. Sheedy (2013: 34–6) argues that social work with individuals, in giving primacy to the uniqueness and worth of human beings, implies that social work has a social and ethical concern to treat people as equal citizens. This leads to a view that resources, including social work intervention, should therefore be distributed equally among people. Such a view inevitably leads to the politicization of social work as soon as we identify in our practice socially created inequalities that generate difficulties for individuals. These approaches are represented in eco, critical and feminist practices, discussed in Chapters 15–17. Watts and Hodgson (2019) identify four different perspectives on and approaches to social justice within social work, set out in Figure 14.1. To some extent, these approaches lead us to different practices, although there are considerable overlaps in objective and action, and we shall find them reappearing constantly in all the social change chapters in Part 4.

Perspective

Approach

Critical

Challenge and change economic, Social inequality and political and social structures that oppression. lead to inequality and oppression.

Activism, consciousnessraising, critical reflection, structural change.

Distributive

Fair provision of benefits and services.

Reform and develop policy and services.

Case and policy advocacy.

Social exclusion.

Anti-discriminatory and multi cultural practice.

Participatory Increase inclusion in decisionmaking and organizations. Autonomy and rights

Issue addressed

Ensure people’s human rights and Lack of dignity, freedom from oppression. respect and rights.

Practice

Anti-oppressive practice.

Figure 14.1  Social work approaches to social justice Source: Watts and Hodgson (2019).

Advocacy and empowerment as social justice practices I have suggested, then, that advocacy and empowerment practices, although in themselves meeting empowerment and liberation objectives, are also present in all social change practice theories. Advocacy has its origins, however, particularly in the legal field. There, ‘advocacy’ is the term applied to lawyers’ practice in the courts and elsewhere in representing their clients.

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In addition, advocacy is an explicit group of skills, with a literature base that forms an important element in legal training. Social workers might gain useful skills by pursuing similar skills training, but this is rarely actively done in social work education. Advocacy is also used as a skill and value objective in other professions, and so is not unique to social workers. For example, the UK professional code for nurses enjoins nurses to ‘act as an advocate for the vulnerable, challenging poor practice and discriminatory attitudes and behaviour relating to their care’ (Nursing and Midwifery Council, 2015: para. 3.4). The term ‘empowerment’ has a broad use in several disciplines. An important source is political science and political sociology, where the study of power is concerned with which political and social groups can achieve their outcomes against the wishes of other groups. The important sociologist Weber (Gerth & Mills, 1948) identified economic power and ideology as ways in which dominance is gained over some people or groups in society by others. These can include people with access to political power, people with access to opportunities in the economic market who gain socioeconomic power, and groups with a status deriving from honour and prestige. Marxist thinking proposes that socioeconomic power, which leads to the division of people into social classes, is the most important of these. More recent sociological thinking has emphasized that elites in society gain dominance over others by a variety of means (Mills, 1999 [1956]; Bottomore, 1993) and have established patterns of social relations that maintained their power, even though they could not always enforce their wishes. Gramsci’s ideas about hegemony, for example, propose that power can be sustained by dominant ideologies, or systems of belief. These become so subtly established in a society’s culture that most people assume it is right to comply with them (Ledwith, 2020). The Frankfurt School of sociologists, including Habermas, explore how power in societies was exercised by elites through social and ideological assumptions and forms of communication (Houston, 2013). The political philosopher Lukes (2005 [1974]), in an influential analysis, identifies three dimensions of power. The first two are direct influence over decisions and influence over which issues people see as important, which may lead to decisions not being taken. The third dimension is indirect influence, which shapes people’s preferences, for example through the media or advertising; this prevents issues even arising. The French philosopher, Foucault, points to how ‘juridical power’ is part of social structures that construct governmentality, how rules are applied within a society to discipline relatively powerless people through defining a positive and negative view of behaviour (Hodgson & Watts, 2017: 52–9). These developments in thinking suggest that people are constrained by discourses constructed by powerful groups in society, and dominance is often achieved through people’s lack of knowledge and understanding of their situation. A feminist analysis (Bradley, 2020) suggests, building on Lukes (2005 [1974]), that it is useful to distinguish between: ●● ●● ●●

visible power, in observable decision-making; hidden power, which sets, and may be revealed by, political and group agendas; invisible power, which shapes meaning, values and norms.

Hodgson and Watts (2017: 48–64) suggest that power is important to social workers because they often encounter clients who have little or no control over what happens to them, whereas other groups in society do not experience these constraints to the same extent, so that power seems unequally distributed. Powerful people can define the truth about aspects of society

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Tokenistic

Bureaucratic

Consumerist

Interpersonal

Superficial: claim of empowerment but no active follow-through

Focus on procedures complying with nonspecific statements

Focus on exercising choice in the market

Focus on changing personal attitudes and relationships

Structural Focus on changing social structures

Emancipatory Holistic: includes personal effects and structural change

Critical social work

Figure 14.2  Dominelli’s typology of empowerment Source: Dominelli (2012, with additions).

that social workers deal with, such as mental health. Empowerment, therefore, gaining or regaining power, may enable people to overcome social barriers in their lives by a better understanding of the limitations on their opportunities to take action. Sheedy (2013: 33) sees empowerment as an assertion of a social justice aim in social work. Teater (2014: 57–73) takes a more psychological and social construction approach to the idea, seeing the importance of empowerment to many people as gaining a sense of control over their lives and events that affect them. Empowerment practice gained traction through movements concerned with civil and consumer rights during the 1960s and 1970s. It became important in movements against discrimination on grounds of race, gender, disability and sexuality, which I discuss in Chapter 18. Used more widely, it has come to mean techniques for encouraging employee participation to achieve business objectives (Bloom, 2020), campaigns to enable communities to participate in  local issues (Craig & Mayo, 1995) and encouraging communities to become engaged in green issues (Blewitt, 2008). Gray and Webb (2013b: 101–2) argue that, although it is a key practice idea in critical social work, it is an ambivalent concept that may equally well contribute to neoliberal ideas of individuality and public choice. Perhaps a sign of this universal resonance is the Community Empowerment (Scotland) Act 2015. It makes provision for community participation in local decision-making, but reflects the same ambivalent status. Dominelli (2012) has developed a typology of empowerment, which identifies both empowerment and disempowering elements of this ambivalent concept, which I set out in Figure 14.2. This distinguishes between partial and holistic forms of empowerment, and we can see in her distinctions many of the issues that we identified in debates about different kinds of justice.

Connections Social justice, advocacy and empowerment ideas within social work I drew attention when discussing debate about social justice, advocacy and empowerment practice to discussion about whether they are only or mainly social change practices. The main role of social justice, empowerment and advocacy theory within the range of practice theories has been to incorporate into social work practice aspects of critical theories, without explicitly drawing on the Marxist roots of critical theory (see Chapter 15) or on ideas about anti-discrimination (see Chapter 18). Social justice is an inspirational idea, without any need to embrace Marxist ideologies. Because empowerment is an attractive, intuitive, widely used

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and positive idea, it has come to influence social work practice very broadly and is used independently of a critical theory underpinning it. Empowerment ideas offer practice techniques that rely on self-help, mutual assistance and participation in planning and managing services, as well as on the participation of clients and their carers in making decisions that affect them (Adams, 2008). Looking back at Dominelli’s typology, this conception treats empowerment and advocacy as interpersonal rather than emancipatory. Seen in this way, advocacy and empowerment are not necessarily aimed at social change, but many practitioners feel that advocacy and empowerment methods achieve social progress through individual and group learning and encourage participation in broader social movements, for example in organizations to support the informal carers of older or disabled people. Advocacy and empowerment practice is, therefore, included in community and social development and macro practice (see Chapter 10) as well as social change practices (see Chapters 15–18). In this way, it contributes to their objectives without necessarily adopting their theoretical position. For example, a group of women from a minority ethnic group might be helped in getting better resources for their families through a women’s group – a classic piece of interpersonal empowerment practice. This may give some of them the confidence to play a more active part in organizations campaigning for women’s rights – an emancipatory outcome. The work may also give the agency information to seek changes in the policy or welfare systems that disadvantage the women – a structural outcome. To carry out empowerment and advocacy work without planning for these further outcomes does not extend the possibilities towards critical social work, although it may be more acceptable to agencies that have been established to help individuals rather than wider groups.

Activism, policy, welfare rights and non-instructed advocacy From the 1970s onwards, advocacy has been incorporated into general social work practice in two ways. Case advocacy is provided by professionals to enhance people’s access to the provisions designed to benefit them. Cause, policy or systemic advocacy has sought to promote social change for the benefit of the social groups from which the clients come. In the USA, advocacy mainly refers to cause advocacy with the intention of changing legislation or policy on particular issues that affect social work client groups. This kind of policy practice (Jansson, 2020) is an identifiable stream of professional practice there. Baines, Tseris and Waugh (2018) make the connection between policy advocacy and activism on behalf of communities of interest and local communities. We saw when looking at macro and community work (Chapter 10) that community group activism was an important stream of work and it also forms a strong element of critical theory (Chapter 15). Early in its development, case advocacy was a supplementary service for clients with whom practitioners were working on behavioural or social issues. Freddolino, Moxley and Hyduk (2004) distinguish four types of advocacy service to clients: ●● ●● ●● ●●

protecting vulnerable people; creating support that enhances functioning; fostering identity and control; protecting and advancing claims or appeals.

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The first three of these are objectives within interpersonal practice. The last may be an aspect of practitioners’ administrative roles, such as completing applications for a service within the agency or with other agencies. Going further, case advocacy of this kind might involve acting on clients’ instructions in appeal processes or pressing their case with another agency in other ways. An important strand of practice lies in welfare rights, which is concerned with ensuring that clients benefiting from other welfare services receive their entitlements to that provision. This term initially focused on social security benefits but now has wider application. It is concerned with rights because, unlike many welfare services, such benefits are often founded on legal entitlements. The boundaries between welfare rights, with their legal implications, and helping practice in social work are blurred, since practitioners need relationship skills to work with people to understand their rights and help them to take up opportunities. Poverty and economic welfare are important aspects of many clients’ problems, and are the product of inequalities and social barriers in society. An effective response to these issues is integral to helping practice in social work, although specialized social security assessment and advocacy may require non-­ specialist social workers to refer clients elsewhere. Bateman’s (2005) account of the welfare rights advocacy skills needed for such work can be widely applied in social work. This includes interviewing methods and value principles such as those of social work, except that advocates only work following clients’ wishes and instructions. Skills such as assertiveness and negotiation are crucial here. A more critical perspective describes ‘systemic advocacy’ in two ways: first, as practice that develops a social movement involving and acting on behalf of the needs of a particular group of people (Dalrymple and Boylan, 2013: 3–4), and second, as the provision of a service to protect the rights and interests of a vulnerable client group, such as children (pp. 126–8) or disabled or older people. Although this kind of work is often seen by many practitioners as their personal responsibility, policy development and influence is a significant part of the work of many thirdsector agencies and government agencies, both local and central. Social workers are ideal candidates for these roles because of their broad social science background. Practitioners can then identify colleagues in these roles. Feeding clients’ experiences and needs to them is a form of policy practice that is available to people in ordinary social work roles. Advocacy of this kind, in which practitioners act only on clients’ instructions, following a legal model of distinguishing advocacy and the helping role, is the main characteristic distinguishing advocacy from other help. Boylan and Dalrymple (2009: 108–18) also identify a range of ‘non-instructed advocacy’ to implement empowerment and advocacy approaches, where the helping role predominates or agency constraints make it impossible to take up a full advocacy role. Practitioners often use these approaches alongside instructed advocacy, where this is possible. This requires giving priority to instructed advocacy, identifying clearly when only non-instructed advocacy is viable. Many of these ideas build on the experience of citizen and self-advocacy discussed in the next subsection. A difficult aspect of advocacy is the dual but related meanings of representation. Advocates represent, in the sense of acting and arguing for the interests of their clients. Philp (1979) uses the term ‘advocacy’, however, to imply the aspect of social work that represents, in the sense of interpreting or displaying clients’ value as human beings who are part of society to powerful groups in society. So advocacy can mean a service that argues

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clients’ views and needs, a set of skills or techniques for doing this and the interpretation of powerless people to powerful groups. Used in this sense, all social work is advocacy, because many social work actions are about interpreting misunderstood and undervalued social groups to wider society.

Citizen, self and peer advocacy as empowerment A different form of advocacy work, incorporating the other elements of advocacy services, grew up during the 1980s. It started as a process of increasing the capacity of people with mental illness or learning disabilities to manage their own lives and was connected with mental health patients’ or recovery movements: we looked at these developments in Chapter 13. Part of this development was a movement to give psychiatric patients assistance in achieving their civil rights within institutions and in leaving institutions where they may have been held by compulsion (Brandon, Brandon & Brandon, 1995). This movement has been particularly important in promoting the independence of people with all kinds of disabilities. One area of work lies in helping the families of people with disabilities to present the difficulties of both disabled people and the families caring for them. Empowerment here is not just about arguing for particular services to be provided or needs met. Bayley (1997) discusses, for example, how many people with intellectual disabilities suffer from a relationship ‘vacuum’ and need help in developing relationships in the main settings in which they live – their home, work and leisure settings. Self-advocacy, developing from services mainly for people with intellectual disabilities, involves helping people to gain the skills to speak for themselves. This takes place particularly in official planning processes, such as case conferences or individual programme planning meetings. It is a group activity, where people meet together to discuss their situation and use this support to present their personal difficulties and wishes within this context. Similarly, citizen advocacy involves volunteers in developing relationships with potentially isolated clients, understanding and representing their needs. Peer advocacy derives from self-help organizations in which people recovering from difficulties in their lives work together to represent individual needs. It is a short step from all these approaches to more general campaigning in the interests of the group represented. These originally separate forms of advocacy have become linked and have developed in cash for care or self-directed care provision. These policy terms refer to services in which, instead of professionals organizing packages of services, people are given ‘direct payments’ (the UK term) to buy their own care. Personalization policies have encouraged representative organizations for people with disabilities to take part in service planning and case management. User-led organizations are thus a recent outgrowth of practice that has emerged from advocacy ideas. Bowes and Sim (2006) show, in research on black and minority ethnic groups, that the success of involving oppressed groups depends on a responsive attitude among public authorities and on effective professional support. More recently, therefore, empowerment can be seen to have three aspects: ●● ●● ●●

recognition and awareness of the needs of particular groups; intervention and support, which may then raise self-awareness and critical consciousness; transforming choices into action (Albuquerque, Santos & Almeida, 2017: 90).

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Self-help and participation An important area of empowerment practice has been to assist the development of self-help and mutual aid groups (Gitterman & Shulman, 2005; Adams, 2008). Here, practitioners support groups of people sharing the same problems to come together to support one another. Many mutual aid groups form around particular health conditions or in the fields of mental health and addictions. During the twenty-first century, work with informal carers (caregivers in healthcare jargon) has been an important focus for this work. Mondros and Wilson (1994: 2–5) classify the theoretical work on these activities into four groups: ●● ●● ●● ●●

theoretical debate about the origins of social discontent; classifications of community organizations; descriptions of poor people’s campaigns for power; practice wisdom about organizing to help such groups.

Practice may be concerned with community development approaches or may be more therapeutic, encouraging people from vulnerable populations to support one another. Community development approaches connect with consumerism, which aims to promote opportunities for service consumers to criticize and complain about the services that do not suit their needs. Croft and Beresford (1994) argue that a participative approach is valuable because people want and have a right to be involved in decisions and actions taken in relation to them. Their involvement reflects the democratic value base of social work; it increases accountability, makes for more efficient services and helps to achieve social work goals. It also helps to challenge institutionalized discrimination. Croft and Beresford’s view of participatory practice has four elements: ●●

●●

●●

●●

empowerment, which involves challenging oppression and making it possible for people to take charge of matters that affect them; control for people in defining their own needs and having a say in decision-making and planning; equipping people with the personal resources to take power, by developing their confidence, self-esteem, assertiveness, expectations, knowledge and skills; organizing the agency to be open to participation.

PAUSE AND REFLECT  Barriers in Celia’s care decisions Consider a case example. What barriers exist for Celia, Joan and Joan’s husband to achieve what they want? What approaches might the social worker use to be effective and appropriate as Celia’s advocate and to empower other members of the family?

Case example: Should Celia’s social worker advocate on her behalf? Celia is a 15-year-old girl who has been looked after in a children’s home since her alcoholic mother separated from her father, a violent and abusive man who is mainly employed on sea-based oil plat-

forms around the world. Celia would like to live with her elder sister, Joan, who is married; Joan’s husband has convictions for dealing in drugs some time ago. However, their home appears stable and

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warm, and Celia enjoys visiting them. At a case review, the practitioner’s managers refuse to accept the risk of criticism if Celia lives with Joan and her husband. Celia asks her social worker to advocate on her behalf at the meeting. The social

worker is aware that this request for advocacy would be seen by her managers as being unable to act in Celia’s best interests, which may be contrary to her wishes. However, there is no alternative advocate.

Some suggestions In this case example, we can see many of the issues that practitioners face in trying to represent and advocate for the interests of their clients in agencies. This is particularly so when the agency has legal responsibilities for managing the client’s life beyond the general duty of care that any agency owes to someone for whom they provide a service. The practitioner’s agency responsibility for acting in the child’s best interests limits the possibility of being an instructed advocate. An empowerment approach suggests, however, that it might be possible to help Celia and Joan to work together, supporting each other to represent their position. The practitioner would be in a position to move in and out of the best interests and human rights advocacy roles.

User- and carer-led practice An important development of self-help and participation is the growth of user- and carer-led organizations. This has been a characteristic of organizations concerned with disabilities (Barnes & Mercer, 2006) and mental health problems. During the latter part of the twentieth century, organizations set up to help people with disabilities or health problems increasingly shifted from being the providers of services to being membership organizations led by people directly affected by the disability. Service-providing, and official, organizations often develop partnerships with user- or carer-led agencies. The concept of user-led innovation has also influenced design and technology, drawing on the experience of making computer technology user-friendly. The idea of the expert patient has developed in healthcare, particularly in the management of chronic conditions, where patients and caregivers often know more than professionals about the process of managing a disease as part of daily life (Tattersall, 2002). Official terminology refers to this as user-led self-management. Advocacy and empowerment theory provides a basis for practice in policy developments such as cash for care, direct payments and personalization, where user- and carer-led organizations have become important partners in professional practice. Thus, the idea of co-­production, in which service users and people in their social networks create appropriate services together with professionals, has been an important development (Hunter & Ritchie, 2007).

The politics of empowerment and advocacy Empowerment and advocacy have been available in social work for some time but did not come to the centre of thinking until the 1980s. Simon (1995) argues that empowerment is a long-standing ideal of American social work, and Ezell (1994) claims this for advocacy. This history is mainly in the arena of personal helping, rather than political and social change.

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Dalrymple and Boylan (2013: 21–45) identify a long history of advocacy within British social work, locating its beginnings in the late nineteenth-century settlement movement. This was a more socially critical development outside the official beginnings of social work in the Poor Law and the conservative ideology of charity societies. There are few recent separate developments of empowerment ideas, and the emphasis in theory development is increasingly on advocacy leading to both personal empowerment and empowerment for oppressed groups. In this way, advocacy and empowerment are important ways of implementing other social justice interventions. Recent texts (Wilks, 2012; Dalrymple & Boylan, 2013) link theory and practice in a range of settings, building skills and strategies for use in many client situations. Rees’s (1991) important analysis of the political role of empowerment in social work identifies five essential practice ideas within empowerment: ●●

●●

●●

●●

●●

Biography analyses clients’ experience and understanding of the world, allowing us to draw in a wide range of ideas. It places the present struggle in context, allows us to understand the continuity and coherence in people’s experience and helps to identify what prevents people from acting. Exploring a biography raises the potential of changing the way someone participates in future events. Power is potentially liberating as well as oppressive. Empowerment ideas view power as something that might be used positively; it is not, as in critical theory, mainly oppressive. Rees focuses on politics as understanding power as a way of obtaining resources and settling conflicts by using influence through power struggles. He also emphasizes how the use of language expresses power relations. We saw this was an issue in social construction theory (see Chapters 11 and 12). Political understanding needs to inform practice, observing both constraints and opportunities. Social work acts always involve either accepting or seeking to change an existing way of organizing power relations. We have seen that liberal political philosophy is an important strand of social justice thinking in which understanding human life is allied to the managerial control of agencies and social systems in the cause of efficiency and effectiveness. Setting this against the ideal of social justice shows how managerial purposes express different and more oppressive goals than the justice purposes of social work. Skills can empower. Gaining and using skills can be an important way of experiencing liberation. Interdependence of policy and practice must be established. This is contrary to convention, which regards the development of policy as lying outside the role of practitioners and their work with clients.

Gutiérrez, DeLois and Glenmaye (1995) have studied social workers’ views of empowerment in the USA. Their concepts include control over people’s lives, confidence in our ability to act over issues that are important to us, the ability to recognize or develop our own power to act, being aware of and having access to choices, and independence from others to make our own decisions and act on them. In another study, Gutiérrez (1995) finds that consciousness-­ raising groups increased the ethnic awareness of people from a minority group, which led them to change their way of understanding their problems and the way they might change their situation. This would be more likely to make them more politically active in ethnic

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minority issues. The research gives some support to the assumption that raising consciousness can lead to empowerment. Speer and Peterson (2000) have created a scale to measure how individuals analysed changes in their empowerment, covering cognitive factors, such as beliefs about how power was exercised, emotional factors, such as whether they felt they had influence in various situations, and behavioural factors, such as whether they had taken part in various forms of political influence. All this research demonstrates a movement towards providing empirical support for empowerment practice and raising its professional rather than ideological stance. Normalization or social role valorization (Wolfensberger, 1972, 1984; Race, 2003) is related to empowerment (Brown & Smith, 1992) and provides a theory focused on a particular client group – people with learning disabilities – although it may be more widely applied. It seeks to change healthcare and social work practice to encourage greater equality and participation for people with learning disabilities. Its approach is to offer people in residential settings valued social roles, such as helping others and participating in decision-making about their own lives, as well as a lifestyle as close as possible to those valued by people outside institutions. Normalization was an influential development in the residential care field (Sinclair, 1988). It is also used as a philosophy for people being reintegrated into the community from hospital or residential care. Ramon (1989) argues that it involves attempts to change attitudes among the general public and those professionals who are providing services, as well as those of people with disabilities and the organizations involved with them. Recent policy moves to focus on dignity as a human right in care services (Social Care Institute for Excellence, 2020) are an example of current developments in this area.

Values issues The main values issues that arise with empowerment and advocacy are concerns about people’s capacity to participate in social institutions and act and speak for themselves, and the problem of conflicting interests. Empowerment and advocacy theory recognizes that disabilities and an experience of long-term oppression generate social barriers. Consequently, people may not have and cannot develop the personal skills, emotional strength or resources of money and time to advocate for their own interests, even if this would ideally be the most empowering course of action. Wilks (2012: 67–88) raises a range of practical values issues that arise for practitioners. Clients may want to do something, but their intentions may not be in their best interests. Another example is where they may want to be represented by a member of their social circle, whose dominating personality may mean that they cannot accept the client’s instructions. The client’s wishes may also clash with the agency’s values, an example being an older person who wants their social worker to arrange for an African Caribbean employee to be removed from providing for their care. A further issue is representative and subscriptive advocacy (Wilks, 2012: 72–4). Subscriptive advocates are personally committed to the case they are making. The assumption of professional advocacy practice is that the social worker, as advocate, can adequately represent their client’s case, as lawyers do, without necessarily being committed to the client’s case.

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But the practitioner’s personal and professional experience may be so distant from the requirements of some minority groups, such as people from minority ethnic groups or disabled people, that clients feel the force of their case will not be properly represented; instead, they would prefer someone who genuinely identified with those interests. On the other hand, agencies may prefer their workers not to personally identify with cases they are making within the agency on their clients’ behalf, and tactically it may be better for the practitioner to present a neutral demeanour. A personally committed representative may be unacceptable to some outside agencies, for example a funder of healthcare, and a professionally neutral presentation of a case may be more acceptable.

PAUSE AND REFLECT  Conflicts of values in advocacy practice Look at the following case example and consider what you would have done.

Case example: Appeals against a healthcare funding decision A social worker in a voluntary organization, Jacky, referred a disabled client for assessment by a Clinical Commissioning Group (CCG), which funded a healthcare service. The assessment rejected provision of the service. Looking at the documents, Jacky felt there was a good case for appeal. She advised the family to do so, and suggested grounds that they might use. The appeal panel allowed the appeal. The manager of the service asked Jacky’s manager not to encourage and facilitate appeals in this way, because the CCG didn’t have enough funds to meet all the demands of the service. The suggestion was made that the voluntary organization’s funding might be in jeopardy

if the CCG had to cut back. Jacky argued that the right to appeal was available to the family in law and that it was a social worker’s professional duty to inform them of this. Her manager argued that she was really using the case to push forward her own views, so she was being a subscriptive advocate, whereas she didn’t have to do that if she wasn’t asked; she didn’t have to give them the bullets to fire. He also said that it damaged their agency’s relationship with the CCG, which might not be prepared to be helpful informally in other cases, and it was in any case more important that their agency (and Jacky’s job) was preserved for the benefit of all their clients.

Some suggestions This kind of value conflict is very common. You may think that this is because of the pressurized financial circumstances of twenty-first-century care services, but I have experienced many such conflicts personally, going right back to my early social work experience in the 1960s, when services were all expanding. One problem may be, as in this case, the shared managerial perspective that leads to Jacky’s manager’s failure to support her. If this is common in their relationships, it inhibits the social work approach to professional supervision in which the manager who takes resource decisions is better able to understand resource needs when they also supervise practitioners’ daily work. Managers of social work agencies need to be alert to the way in which this kind of conflict can damage good professional supervision.

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Good managerial and supervision training will make it clear to managers that in this kind of dispute their responsibility is to support their workers, while looking for longer-term improvements in relationships with interprofessional and agency colleagues. Another difficulty may be that in interprofessional and inter-agency relationships managers from other agencies are not aware of social workers’ professional responsibilities to act on behalf of their clients. For example, the advocacy responsibility of nurses is circumscribed to making professional arguments for resources to do an appropriate professional job, rather than supporting clients individually in cases against their employer. Issues such as this lead people to argue that advocacy services should be independent of service-providing agencies and their social workers. It is inevitable, however, that from time to time clients will ask social workers with whom they already have a relationship to act on their behalf. A longer-term approach to the issue is for social worker agencies to make clear in general, and gain acceptance in other agencies for, the professional expectations of social workers. Peer support from colleagues is also an important part of responding to such issues. Wilks (2012: 85–8) suggests principles for working with independent advocates, which I have adapted to identify practical ways of responding to some values issues in advocacy: ●● ●● ●●

●● ●●

●● ●●

Understand the limits of your skill and take an appropriate course of action. Don’t advocate when there may be conflicts of interest; find someone else. Be open about interests and concerns of your agency and your professional role with both clients and other advocates. Be open to appropriately involving different forms of advocacy. Work to develop advocacy knowledge and skill relevant to your usual working responsibilities. Find ways of getting clients’ and carers’ views valued and heard within your agency. Support and argue for the value of clients’ and carers’ views in services generally.

These last two points help to make the service environment easier for you to do advocacy work when required. In making the link between empowerment and social change objectives in social work, empowerment and advocacy theories demonstrate how the shared principles of critical practice and rights concerns may be incorporated into practice that is not fully critical in its objectives. If practitioners are, because of their work roles, unable to fully engage in critical practice, this provides them with theory that can facilitate some social change objectives within a practice that is more focused on social cohesion and empowerment objectives.

Applications Advocacy Advocacy practice operates within several overlapping dimensions (Wilks, 2012; Dalrymple & Boylan, 2013). You can usefully consider your approach to advocacy, often choosing a balance between contrasting activities. In Figure 14.3, I have set out nine sets of different dimensions from two important recent texts. Thinking through how you are going to approach advocacy in a case or in a broader situation helps you to be clear about your approach.

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Target Case

Only on behalf of specific clients

Issue

A specific issue

Individual

Clients’ needs and wishes

Internal

Insidethe agency

To change policy

Cause

Changes to organizations or procedures Systemic Collective needs and wishes Outside the agency

Collective External

Mandate Instructed

Only clients’ wishes

Only professional or agency decisions

Formal

Only formal decision-making bodies

Non-instructed

In other interventions

Informal

Only practitioners advocate

Passive

Participation Active

Clients participate

Mode of representation Instrumental

Information/advice

Clients’ expressing concerns/experiences

Enabling

Helping clients represent themselves

Voice

Express experiences/views

Speak for clients Change agencies/policy

Expressive Speaking for Persuasion

Figure 14.3  Dimensions of advocacy practice Sources: Dalrymple and Boylan (2013: 1–20) and Wilks (2012: 19–42).

The first set of dimensions is the target of the advocacy, balancing a focus on specific cases or issues, or an individual client’s needs and wishes against aims to change policy, organizations and procedures, meeting collective needs and wishes. Another choice is to advocate inside the agency or to other agencies. The second set of dimensions is about where you draw your mandate from. Instructed advocacy involves only advocating according to clients’ wishes, while non-instructed advocacy aims to meet your agency’s decisions or your own professional judgement. Sometimes advocacy is only with formal decision-making bodies, such as allocation meetings or case conferences. Advocacy may also be taken up opportunistically, as it arises with others. The third consideration is the extent of clients’ participation in the advocacy process; some processes only permit professionals to take part. The fourth group of dimensions is concerned with how you advocate. Do you merely give information and advice to help the client take issues up? Or are you mainly concerned to allow clients to

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express their concerns or experiences so that decisions are better informed by understanding their views. Is your approach to help clients represent themselves, or are you speaking for them? Some of these dimensions are not exact opposites, and nearly all permit you to work out a balance between the options with clients. For example, some clients may not feel confident to advocate for themselves at the outset, but participation may raise their level of confidence. Summarizing these dimensions, three main aspects of advocacy are important in applying a quite complex range of theory to practice: ●●

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Participation in decision-making, including the right and opportunity to choose alternatives, including the possibility of exit and the capacity not to use particular services or elements of them. Voice – the capacity to influence what services are provided and how this is done. Rights, which are entitlements to services or standards of provision based on enforceable legal and policy decisions (Boylan and Dalrymple, 2009; developing Hirschman, 1970).

Example text: Dalrymple and Boylan (2013) Dalrymple and Boylan start by discussing the dimensions of advocacy, demonstrating that there are many options. Their historical account of its development, and their contextualization of its role in current policy development, which I discussed in the sections on connections and politics in this chapter, seek to claim its central role in everything social workers do. From this, they derive four advocacy principles, and we can connect these with social justice and change perspectives set out in Figure 14.1: ●● ●●

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promoting equality, justice and social inclusion (critical and participatory perspectives); helping people to become aware of and exercise their rights (autonomy and rights perspectives); empowering people to speak for themselves or to have their voices heard within the system (participatory perspectives); enabling people to be involved in and influence decisions being made about their future (participatory perspectives).

While in Figure 14.1 we saw that, as part of social justice practice, advocacy is often associated with distributive perspectives, the main focus of Dalrymple and Boylan’s principles is on participation. Building on these principles, their account of advocacy practice places it into the stages of the social work process, incorporating a personalized, relationship element in its starting point and its examples; I have summarized this in Figure 14.4. This figure compares it with Wilks’s (2012) more problem-based account of the process. Wilks usefully emphasizes the importance of supervision, expert advice and peer support, although this is to some extent filling out Dalrymple and Boylan’s account of the planning process. He also treats the relationship with the client as mutual feedback, rather than Dalrymple and Boylan’s more relationship-­ based approach.

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Dalrymple & Boylan

Relationship

Assessment

Clients value trusting relationships as basic to advocacy

Relationships link agencies’ legal duties to clients’ needs and workers’ judgements

Problem analysis

Planning Planning allows client involvement and a structured approach

Information gathering

Action planning

Intervention Purposeful action to meet assessed needs and wishes

Negotiation Presenting a case

Evaluation and review Systematic, accountability for constructive service clients

Referral to further services Evaluation

Wilks Supervision Expert advice Peer support Feedback between worker and client

Figure 14.4  Models of the advocacy process Sources: Dalrymple and Boylan (2013) and Wilks (2012).

The skills required in this advocacy process are as follows: ●●

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Building trusting relationships with clients and others involved, so that you can build clear analyses of the key issues you need to take up and identify strengths and resources from both clients and other potential collaborators. Assessment, which involves an exchange between yourself and the others involved, especially clients, building on your analysis. Your assessment covers the nature of the problem, who it is a problem for, what organizations and individuals can best help with the problem, and how and why the problem is being created in clients’ lives. You might also look at who gains and who loses. The ‘pause and reflect’ activity at the end of this account of advocacy skills looks at the kind of issues you might explore when looking at an injustice in children’s social care provision for minority groups. It uses Hoefer’s (2019: 56–74) idea of creating a clear statement of the issue (an ‘understanding the issue’ statement) in an individual case or broader negotiation. Planning, again through communication with others involved, so that they do not sabotage the plan through ignorance or resentment at not being involved. Is your aim to get a better service or benefit, or achieve better outcomes from an existing service or benefit? An example might be making sure they are better organized or more appropriate to the client’s needs. You could also argue for something that would use resources better. Another important aspect might be obtaining and communicating better information to decision-makers. Interventions may be on behalf of individuals or family, a social or community group or to change policy. Wilks (2012: 113–58) distinguishes the skills of developing and presenting a case and of negotiation. You might do both at different times. For example, you might start with a negotiation with another agency or within your own organization, and if this fails move to an appeal. Or a decision-making process may raise issues that you can resolve through negotiation. ❍❍ Presenting a case starts from providing emotional support to clients, so that they can cope with the sometimes hostile or insensitive questioning they receive. Then you need to think about eligibility and criteria for the service or benefit, highlight risks and

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present alternative options, drawing attention to their limitations and then making a case for the positive benefits of the preferred option. ❍❍ Presenting a cause involves a community approach similar to that discussed in Chapter 10. You create links among potentially interested parties, building a coalition of support. The next stage is to gather evidence about needs and potential opportunities and undertake research about options and barriers to progress. Then you need to clarify and organize activities that lead towards your goals. ❍❍ Negotiating requires the same concern for care and support for the people involved that you provide when presenting a case. Exploring your clients’ needs and comparing them with the available resources, you may be able to identify creative solutions, understand agencies’ responsibilities and the resources that clients and those around them can contribute. Risks, rights and responsibilities of clients and other agencies involved can be identified. Your own skills need to include a balance between being too passive and not being clear about what is needed, and being too aggressive, or allowing clients to be too aggressive, for example by expressing anger or fear inappropriately during the negotiation. Open communication, creativity and flexibility about finding ways round difficulties but clarity about your objectives allows you to be assertive but not passive or aggressive. Try to avoid seeing the negotiation as a win–lose situation. Instead, try to behave as though you are jointly exploring the difficulties and possibilities of a situation and working towards a solution. Separate the people from the problem, for example by avoiding a concentration on how difficult a client has been in favour of emphasizing the realities of the strengths and resources that they can offer. Evaluation provides an opportunity to emphasize to clients and others what can be learned and the positive progress that can be made in developing services.

PAUSE AND REFLECT   Think about an ‘understanding the issue’ statement Think about who loses and gains in a situation by examining an ‘understanding the issue’ statement. An example of this that might be relevant in many social work agencies is: ‘Families with children of minority ethnicity in our area are more likely than families from the majority population to have their children investigated for child neglect and abuse.’ Thinking about this example statement, who might be gainers and losers in this situation?

Some suggestions The groups who lose will be obvious: these are the children and families who are unnecessarily investigated and who have their families disrupted by investigations and legal proceedings. There are others who may lose too, such as colleagues in the children’s social care teams who have an added workload of investigation and the added pressure of feeling that they may be involved in a racist policy. Resources for other children who might need investigation and

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help will also be tighter. In addition, pursuing the present situation might raise social tension in the area and lead to allegations of discrimination in children’s social work. The point about this account is that it is not just those individual families who are directly treated in an unjust manner who experience losses; there are often more general social losses as well, and identifying these may help you to devise useful advocacy interventions. Turning to the other side of this issue, it may be hard to see who gains from the situation in this example. Among those who might do so are groups in society who see the particular minorities in this community as inferior, incompetent, neglectful or lazy, or who have other racial stereotypes in their minds. Another group of gainers might be politicians or managers who are risk averse. They might fear that it will cause trouble for the agency if it investigates why more child abuse investigations are arising among minority ethnic groups. For example, they might fear accusations of racism in decision-making or, on the other hand, criticism for being politically correct because, instead of letting child care decisions go forward as they arise, they are planning to investigate the outcomes of an apparently racially motivated policy. So they gain from avoiding the issue, because they avoid the problems associated with it. It is easy to think that nobody gains from an unfair situation, but being clear that there will always be those who gain from injustice often helps to identify useful interventions or suitable targets for intervention using advocacy.

Empowerment within advocacy We have seen that advocacy can be an important part of empowerment. Wilks (2012: 99–103) identifies four elements of empowerment in advocacy processes: ●● ●● ●● ●●

developing clients’ self-confidence and skills; linking clients with networks of support; engaging with bigger policy and organizational issues; moving from passive to active roles, for example by undertaking shared tasks.

Practice with older adults illustrates how needs for empowerment and advocacy arise in all these areas with this client group (Soares, Rose & Feiger, 2011: 424–5). They stress, for example, the importance of focusing on clients’ loss of control in their lives and on finding ways of increasing their control over the decisions and actions affecting them. Practitioners should also reinforce people’s rights and ability to speak for themselves in decisions about their medication or location of care. Garvin (2011: 324–5), discussing groupwork with adults, usefully identifies important additional features of empowerment practice, which I have restated more broadly: ●● ●● ●● ●●

Consider the extent to which issues or problems are related to forms of oppression. Give clients significant influence over the process of your practice. Work on changing oppressive circumstances alongside any behavioural change efforts. Help people to achieve a critical consciousness to understand the forces that maintain oppressive social circumstances and whether these are at work in their own situations.

Rose and Black’s (1985) work, in which they describe a project promoting independent living for mentally ill people in the community, is a cornerstone of the theoretical

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development of empowerment and advocacy from a critical theory perspective. They based their approach explicitly on the work of Freire (1972), whose radical theory of education I discuss further in Chapter 16. Following Freire’s ideas, Rose and Black sought to empower people to become subjects (active in planning and developing their role and position) rather than objects (allowing others to dominate) in their lives, by involving them in the process of advocacy. Critical debate with clients entered the clients’ present subjective reality and explored objective reality with them. As a result, clients saw various situations in which their subjective reality limited their control over their environment. Clients were engaged in a transformation from dependence to interdependence, with collective networks of social support. Total autonomy was not considered desirable (or attainable for many people) – we are all to some extent interdependent. Rose and Black’s work was educational, using Freire’s ideas. All social exchanges were seen as having a political content because they either accepted or denied the present social order. By dialogue in a situation of trust, with people who behave authentically, clients engage in a praxis, acting and experiencing the reality that results from their actions; this in turn affects later actions. Praxis is not a synonym for practice experience; it involves recasting a practitioner’s perspective on social explanation because of an improved understanding of the social causation of what appear to be personal problems (see Chapter 16 for a more extensive discussion). In Rose and Black’s study, practitioners tried to get inside and understand clients’ reality. Clients’ history in the mental hospitals oppressed them through institutionalization, poverty and material deprivation, and they took these experiences into their view of the world. Self-­ expression was encouraged, helping clients to gain vitality and an acceptance of their own capacity and worth. The main treatment process was validation, which aimed to reconnect clients to their capacity for self-expression. This was done by trying to understand the reality of the clients’ own life history and rejecting their internalized judgements that they were incompetent. Clients became producer–participants in their lives rather than the passive consumers of services. In a later formulation, Rose (1990) identifies three principles of advocacy and empowerment practice: ●●

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Contextualization involves focusing on clients’ own understanding of their social being rather than on social workers’ assumptions or policies. This allows a dialogue to develop based on clients’ reality. In the dialogue, clients are enabled to express, elaborate and reflect upon their feelings and understandings about life. Empowerment is a process through which social workers support clients to identify the full range of possibilities that might meet clients’ needs. The work centres on helping clients to make decisions that will affect their lives. Collectivity focuses on reducing feelings of isolation and connecting clients to relationships. Experiencing this form of socialization produces stronger feelings of self-worth among clients. Similarly, an important principle of Moreau’s (1990) structural approach to social work, as well as of feminist social work, is to collectivize rather than personalize experience.

The assumption of empowerment practice is that practitioners lend their power to clients for a period to help them attain control over their lives and therefore permanently take power.

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To do this, practitioners need resources. Moreover, we should not mistake empowerment for enablement. Unlike enablement, empowerment is not limited to allowing or assisting people to take actions, but is aimed at relinquishing power and transferring it to others so that they can permanently control their lives. The role of empowerment is unclear when protection for clients or the security of the public is at issue. Ideas such as normalization and self-advocacy have often become associated with civil liberties perspectives that focus on the need to free people oppressed by assumptions about their dependence on care. However, it is not empowerment if you fail to provide the services that clients need. Case example: Moving into a mental health hostel Kevin was discharged from a mental hospital to hostel accommodation. This transfer was set up to offer him a great deal of freedom of action, but security was present via a system in which a social worker was on call. Jo, Kevin’s social worker, explained this, but Kevin did not understand what this meant, so he did not feel able to contact her when things went wrong. For example, Jo arranged to show him how to use local shops, but failed to check that Kevin’s social security allowance had arrived or

that he had provisions until it did. Kevin did not feel that he could raise these problems because the social worker had already been so helpful, so a later visitor found him unable to buy food or even make a hot drink. In supervision, Jo said she felt she had been giving him increased freedom in a normalized environment. Because he did not yet have the resources, skills and selfconfidence to use that freedom, however, he was not empowered by this freedom; just the opposite.

This case example illustrates the importance of not using the idea of empowerment to avoid responsibility for assessing and providing appropriate care and support. Gray and Bernstein (1994), describing a South African project to help ‘pavement people’ (that is, homeless people, who in hot climates are able to live permanently on the streets), argue that practical help is an essential part of responding to serious difficulties and that it becomes part of empowerment strategies where this is recognized. However, this is not the case if it just takes over clients’ responsibilities without making provision for the development of their self-­ confidence and life skills.

Example text: Lee’s (2001) empowerment approach Lee’s (2001) influential text is part of the historic stream of work founded by Solomon’s (1976) classic work Black empowerment emerging from the black community in the USA. Its starting point is social work’s aspiration for combining social justice with caring communities, engendering hope and power, particularly among black peoples. Although it emerged from work with ethnic minorities, empowerment practice listens to the voices and dreams of powerless groups, such as children and women. Lee focuses particularly on the international economic system as a contributor to poverty. Despite its being a clinical practice dealing with individuals and families, empowerment also seeks to be community-oriented. Three concepts are central to this:

Social justice practice, empowerment and advocacy ●● ●●

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391

developing a more positive and potent sense of self; constructing the knowledge and capacity that is needed to achieve a critical perspective on social and political realities; cultivating resources, strategies and competences to attain personal and collective goals.

Practitioners should try to create a sense of community with clients so that they may jointly challenge the contradictions arising from the vulnerability and oppression that is found within a society of the affluent and powerful. Individuals gain power from having a critical consciousness, in the Freirean sense, and a knowledge of structural inequalities and oppression. Transformation occurs when people can see alternatives to their present predicament as a result of consciousness-raising. This allows people to avoid self-blame for their problems, accept personal responsibility for trying to achieve change and work to enhance their effectiveness in making changes. The central practice method is working to achieve a sense of community within a group. Aspects of empowerment that connect with other perspectives on social work are as follows: ●●

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Empowerment is a biopsychosocial theory, employing ideas such as ego functioning from psychodynamic practice (see Chapter 4) and adaptation and coping from ecological practice (see Chapter 7). Construction and narrative approaches (see Chapters 11 and 12) make it clear that how people construe their situation is important. They also promote the idea that people can be co-­constructors of their environment. Cognitive theory focuses on helping people to remove false perceptions and beliefs (see Chapter 7). Feminist, interactionist and integrated approaches emphasize how workers may mediate between different social groups (see Chapter 17). Groupwork and community work approaches are central to Lee’s empowerment practice (see Chapter 10). Social work has a dual emphasis on individuals and their environments, removing both direct and indirect blocks to power. Its ethical basis requires action to respond to discrimination and a special focus on people suffering from oppression. Therefore, a mere understanding of oppression and treating all people the same are not sufficient. Oppression must be acted upon and oppressed peoples should be identified for action.

Lee’s vision of the empowerment that underlies practice is outlined in Figure  14.5. An essential requirement is to maintain a multifocal vision of the world, looking at different focuses in their lives that affect clients. These in turn guide the selection of practice methods. This multiple focus is considered important as it means that an understanding of the complexity of the factors affecting oppression can be incorporated into practice. Lee’s (2001) account of practice is set out in Figure 14.6. While Lee’s account specifically rejects the structural perspective of critical practice, she usefully emphasizes the importance of understanding the effect of global economic and social developments as an important element in people’s oppression; this represents a wider perspective than that of many social work practice theories. This is an example of how empowerment links, but does not fully

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Reviewing empowerment theories Multifocal vision

Description

Historical view of oppression

An understanding of the history and policy affecting oppressed groups

Ecological view

An understanding of individual adaptation/coping, ego functioning, cognitivebehavioural learning and power

‘Ethclass’ perspective

An appreciation of the relationships between class, poverty, power and oppression

Cultural/multicultural perspective

Attention to the norms, nuances and expectations of the client’s culture, and to potential diversity

Feminist perspective

Identification and conceptualization of women’s different ‘voice’ and limitless power

Global perspective

An awareness of global interdependence and social exclusion

Critical perspective

A critique of oppression and a linking of individual and social change

Figure 14.5  Lee’s empowerment vision

Empowerment principles

Source: Lee (2001).

All oppression destroys life and should be challenged Maintain a holistic vision of situations of oppression Assist people to empower themselves People who share commonalities need each other to attain empowerment Establish reciprocal relationships with clients Encourage clients to use their own words Focus on the person as victor, not victim Focus on social change

Empowerment practice

Prepare to enter the client’s world:

Work jointly on problems:

• ‘tune in’ to the client’s world • think what it might feel like

• client takes responsibility for empowerment • social worker empathy assists working jointly on problems • show awareness of threats of oppression • share reflection/consciousness of problem interactions and socioeconomic stresses • critical praxis on problems of oppression • identify personal/communal strengths

Enter and join forces: • ask for the client’s story • show the social worker’s commitment • mutual role definition

Mutual assessment: • share knowledge of community resources/issues • assess family, ego and narrative • assess empowerment: basic information, life transitions, physical/mental health, interpersonal patterns, the socioeconomic and physical environment, oppression, power and powerlessness, strengths

Problem definition and contracting, including: • client and worker tasks • multiple oppression in the contract

Leaving: • deal with feelings about ending • consider/consolidate gains • reunification with community • identify power gains

Evaluation: • ethno- and gender-sensitive, evaluation • research impact of oppression, strengths, language styles and concerns of minority experience • include data from reflection and participation • do not overvalue simple and measurable aims

Figure 14.6  Lee’s principles and practice of empowerment Source: Lee (2001).

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incorporate, empowerment and social change objectives in social work. Lee’s account of working jointly provides a helpful analysis of the skills and approaches of social workers. In addition, her ‘leaving’ task of reunification with the community, to which might be added family and other social networks, is a useful reminder of the need to connect the personal gains that have been made with the experience of the people who surround the client. Lee’s suggestions about focusing on measures of oppression in evaluation are also creative. The book then goes on to discuss group and community empowerment, using similar techniques. Case example: Choosing a new team leader A new team leader was being selected for a social work agency to supervise and manage a group of six practitioners working with different groups of clients. This team covered a large area of social housing with many social problems and some signs of active engagement from religious organizations trying to develop social change. The applicants were surprised to find that they were being questioned about their involvement in organizations outside their professional work. One had been on the committee of a welfare rights advocacy organization and was active in a local mental health association. In his interview, he

was asked about whether he saw his welfare rights involvement as being relevant to the mainly individual work of the team. He felt this was critical questioning fuelled by a concern that he would be a trouble-­maker if hired as an employee. He argued, defensively, that experience of advocacy was an important skill that he could bring to the team. He was surprised to be offered the job and immediately afterwards to become the agency’s representative on a community study project in the area, liaising with a variety of local community groups. The agency gained a great deal of credit in the community for his engagement.

 onclusion: using advocacy and empowerment theory C in social justice practice Advocacy and empowerment practice has been particularly well used in dealing with vulnerable and unjustly treated groups, including people with disabilities or learning disabilities, older people and children in public care. It therefore forms the practical core of meeting the social justice objective in social work. Empowerment and advocacy theories help practitioners because they draw attention to the possibility of seeing power positively. It is not wielded only by the rich and unaccountable, but can be made available within society for people to use. If you keep the possibility of empowerment in your mind and try to incorporate it into your objectives, you can often help clients develop greater control over their lives, at the same time increasing their skills in doing this for themselves in the future. Practices such as crisis intervention, task-centred practice, social pedagogy and social development, and humanistic, strengths, solution and constructionist practice all provide a theoretical basis for including this approach. Empowerment ideas also offer practitioners useful and practical ideas for including in their practice issues of oppression, critical thinking and joint working with clients. Some evidence supports the effectiveness of group methods that promote solidarity and

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consciousness-­raising. This is why empowerment has been seen as a valid conceptualization of the social work role in achieving liberation for well-being. Advocacy, both as a policy or systemic practice and on behalf of clients and vulnerable groups, is integral to many social work roles, and the development of advocacy skills and actions is a crucial element of helping many clients. Assessing your client for an appropriate package of care may be seen as an administrative function, but advocacy within the agency’s decision-making systems is also important. Many long-term care arrangements for children and adult client groups hold advocacy as being essential for practitioners representing their clients’ interests. Advocacy also requires skills in developing self- and citizen advocacy, and practitioners act as instructed advocates in advocacy services for vulnerable population groups. Advocacy is often the main focus of the practitioner’s tasks in task-centred practice, and is a supplementary role in therapeutic practice according to many models. Although it often contributes to critical practice ideas and ideals, we cannot see empowerment theory always as a critical practice; and it offers a useful way for many practitioners to think about all their work. Advocacy is an increasingly important role for social workers in all that they do and is, in these less deferential times, an increasingly important form of practice within social work agencies.

Additional resources Further reading Dalrymple, J. & Boylan, J. (2013). Effective advocacy in social work. London: Sage. Wilks, T. (2012). Advocacy and social work practice. Maidenhead: Open University Press. These two good general texts on advocacy social work practice reflect slightly different approaches. Dalrymple and Boylan, whose background is in work with children, integrate advocacy into general social work. Wilks, whose background is in adult work in mental health, on the other hand, sees advocacy as a separate practice that contributes to social work. Boylan and Dalrymple’s older book (2009) is still worthwhile for its more detailed analysis of children’s advocacy. Adams, M., Blumenfeld, W. J., Catalano, D. C. J., DeJong, K. ‘S’, Hackman, H. W., Hopkins, L. E., Love, B. J., Peters, M. L., Schlasko, D. & Zúñiga, X. (Eds.) (2018). Readings for diversity and social justice (4th Ed.). New York: Routledge. A useful and up-to-date comprehensive set of articles covering a wide range of social justice issues. Adams, R. (2008). Empowerment, participation and social work (4th Ed.). London: Red Globe Press. A good conceptual text on empowerment as a way of developing clients’ participation in the services and decisions that affect them. Bateman, N. (2005). Practising welfare rights. London: Routledge. A very extensive detailed practical guide to welfare rights advocacy.

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Lee, J. A. B. (2001). The empowerment approach to social work practice: Building the beloved community (2nd Ed.). New York: Columbia University Press. A well-established American text. Hoefer, R. (2019). Advocacy practice for social justice (4th Ed.). New York: Oxford University Press. Jansson, B. S. (2020). Social welfare policy and advocacy: Advancing social justice through eight policy sectors (2nd Ed.). Thousand Oaks, CA: Sage. Two useful American texts on policy practice. Mullender, A., Ward, D. & Fleming, J. (2013). Empowerment in action: Self-directed groupwork. London: Red Globe Press. A ground-breaking practical text on empowering groupwork. Newbigging, K., Ridley, J., McKeown, M., Sadd, J., Machin, K., Cruse, K. de la Haye, S., Able, L. & Poursanidou, K. (2015). Independent mental health advocacy: The right to be heard. London; Jessica Kingsley. A good guide to mental health advocacy in the UK, with useful research and practice information, which will be relevant even though the legal basis will change. Reisch, M. (Ed.) (2014). The Routledge international handbook of social justice. Abingdon: Routledge. An authoritative compendium of information about social justice. Watts, L. & Hodgson, D. (2019). Social justice theory and practice for social work: Critical and philosophical perspectives. Cham: Springer. A good account of social justice theory and practice in social work.

Websites https://www.scie.org.uk/care-act-2014/ This page of the Social Care Institute for Excellence (SCIE) website contains useful material on developing and commissioning advocacy resources, with practice and research information. http://www.actionforadvocacy.org.uk/index.jsp, http://www.siaa.org.uk/ The UK organization Action for Advocacy and the Scottish Independent Advocacy Alliance both have useful reports and documents covering several different client groups. http://www.justice.gov.uk/downloads/protecting-the-vulnerable/mca/ makingdecisions-­opg606-­1207.pdf/ A useful guidance booklet for independent mental capacity advocates, a legally mandated advocacy role often undertaken by social workers, is available from the UK Department of Justice. This contains useful information about advocacy roles. You can find useful information and link on children’s advocacy on the websites of: ●● ●●

Voices for America’s Children – http://www.voices.org/about and the UK organization Voice – http://www.voiceyp.org/

PART 4

REVIEWING SOCIAL CHANGE AND DEVELOPMENT THEORIES This fourth group of theory chapters reviews social work practice theories whose main aim is to meet the IFSW objective to promote social change and development. The previous chapter (14) covered social justice practice, advocacy and empowerment, which are also significant contributors to social change and development objectives, and are important in meeting social cohesion objectives. 15 Critical practice

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16 Eco practice

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17 Feminist practice

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18 Anti-oppressive, Indigenist and multicultural sensitivity practice

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CHAPTER 15

Critical practice MAIN CONTRIBUTION Critical practice helps social workers to avoid assuming that the way things are is the way they have to be. It offers critiques of and alternatives to a focus on social cohesion. Social change and social justice, it proposes, can only be achieved by significant changes to how society is arranged around us. Starting from this premise, practitioners can analyse and deal with the social factors that underlie the present problems they are grappling with, and with social barriers to the positive aims they are trying to achieve.

MAIN POINTS ●●

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Critical theory argues that social problems are created more by the structure of society and the cultural assumptions generated by dominant groups that oppress subordinate groups. Individual, psychological factors in people’s make-up are a less important source of people’s problems. It aims to free clients from the limitations imposed by the existing social order by using interventions that acknowledge the social source of people’s problems and avoid blaming and oppressing clients. Critical practice emerged in the late 1990s, reviving radical theory from the 1970s that had been strongly influenced by the Marxist emphasis on socioeconomic class as an explanation for the inequality of oppression. By incorporating feminist, anti-discrimination, empowerment, postmodernism and social construction ideas, contemporary critical practice incorporates a broader range of points of social criticism into its explanations than radical theory does. Critical practice draws on emancipatory and transformational political philosophy and rejects social work practice that accepts conservative, liberal, neoliberal or social democratic political philosophies of social policy. See Chapter 1 to review how these political philosophies link with the three views of social work objectives. Critical theory focuses on structural rather than personal or interpersonal explanations of social problems, and on inequality and oppression.

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Critical practice promotes consciousness-raising about social inequalities and political action and social change to combat cultural hegemony, through which powerful people maintain a social order that benefits them through influence via the media and education.

PRACTICE IDEAS ●●

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Praxis builds on people’s experience of oppression, injustice and inequality to inform an ideological understanding of how society works. It also strengthens our capacity to pursue social transformation. Dialogic practice, working with people in open dialogues, involves equal relationships in which views of social situations are exchanged and discussed. Conscientization – Freire’s term (see also Chapter 14) – is working to help people to understand and be able to criticize how social structures are implicated in their oppression. It also involves them in identifying and taking action over the practical consequences.

THE DEBATE SUMMARY Theoretical debates stem from a discourse, examined in Chapter 14, about whether a critical analysis of the basis of social justice can be central to social work practice. ●●

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Critical practice theory says that social work must include political and ideological aims, but many argue that this is impractical. Different critical theories have differing analysis of the relevant social issues. Is social work a form of social control, contrary to its claims to achieve ‘empowerment’? Is there empirical support for critical practice? Its broad social purposes make it difficult to derive prescriptions for interpersonal practice. Critical theory is weak in dealing with emotional and internal, personal and interpersonal issues. Conscientization relies on insights having motivational power. Critical theory accumulates demotivating criticisms without balancing positives. Social interests conflict, making creating alliances difficult.

Debate about critical practice  ritical practice says social work must include political C and ideological aims, but is it practical? Critical social work argues that many or most social problems come from the structure and organization of society, which lead to social injustice. To achieve social justice, therefore, social work should focus on changing society, aiming to eliminate the source of the difficulties. Individuals’ behaviour is a less important factor in the problems that social work seeks to tackle, but it is the focus of much social work activity.

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While many practitioners might accept this analysis that social work intervention is misdirected, most social work practice is with individuals distressed by the behavioural and interpersonal effects of these social problems. In addition, many social work agencies provide social care services to individuals and help people to deal with problems that affect them and their families. Action on social justice does not always fit with this service priority. Since most social work practitioners are employed by government agencies, their roles are limited by the legal and policy mandate given to their agencies. Opponents of critical theory claim that achieving broad social change towards a more socially just society is therefore difficult in the context of social work’s social mandate and professional roles. They give priority, therefore, to helping people meet immediate social needs and deal with distress, using critical social analysis to understand the position of these clients more fully and to support any personal activism that they undertake. Baines et al. (2018) see activism on behalf of oppressed communities as a key element in critical practice, and it can be a part of advocacy practice (see also Hoefer, 2019). Fenton (2019), however, accepts that this may make for difficulties in critical and radical practice in official social work practice. She presents a form of critical practice that goes beyond individualized work. It starts from a focus on relationship-building and emotional engagement, building trust with clients individually and in their social networks. The second step is a progression to building knowledge and critical thinking connecting individual situations that social workers are concerned with to broader social analysis to guide practice interventions that are not wholly focused on individuals’ needs. You follow this up with building the educational and professional resources that allow you to have the moral courage to accept the ethical responsibility to take actions that seek broader and political ends alongside the agency requirements on many official social workers.

Different critical theories vary in their analysis of social issues Some critical theory overtly uses Marxist and neo-Marxist theory to proclaim that all social work incorporates ideological and political objectives. Marxist theory is based on historical materialism, a historical analysis of how different economic systems affect the structure of society. In particular, the economic system creates class structures in contemporary society. Some social classes in capitalist societies are elite groups that maintain dominance over other social groups through controlling the economic system in ways that maintain their political and social ascendancy. Social problems are caused by conflict between social classes as working class people resist controls that damage their livelihood or create poverty. I look at Marxist views on capitalism later in the chapter in the section on ‘Wider theoretical perspectives’. Neo-­ Marxist theories are developments of these ideas, written after the death of Marx himself. Important neo-Marxist writers who have influenced social work include Gramsci (Ledwith, 2020: 163–216) and the Frankfurt School of sociologists, especially Habermas (1986[1971]). Critical theory says that if you reject this Marxist theory as an important contribution to social work analysis, you have not understood the full picture of how present social arrangements disadvantage and oppress people. That oppression causes or worsens the problems that practitioners work with because clients start from an economically and politically disadvantaged position in society. Other motivations for social work, such as religious commitment

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and problem-solving to help with personal and family change, need also to incorporate into practice a recognition that this oppression occurs. It feeds the problems that people face, and overcoming it is essential to any help that you offer. Some writers on critical social work theory claim a practice theory is only critical if it includes ideas derived from the Frankfurt School of writers, especially Habermas (1986 [1971]; Houston, 2013; Garrett, 2018a, b: 153–66). The ideas of the Frankfurt School are derived from Marxist theory but are significantly different and their work is specifically labelled critical. The main way they differ is their emphasis on hegemony, an issue Gramsci also stresses. It is the idea that dominant groups in society, as well as and often instead of maintaining their control by bullying or bribing people to comply, gain social acceptance for cultural and social ideas that support the present economic system. Consequently, everyone comes to accept that the present way of running the economy is natural, in which elites control most of the resources and lower social classes work for them. The way in which these cultural and social ideas are communicated in society, for example through the popular media, maintains the ascendancy of these dominating groups. So, to summarize, hegemony is maintaining social control by using indirect means such as ideas, philosophy and culture rather than direct means such as torture and violence. We met this idea when looking at empowerment in Chapter 14. Marxist and Frankfurt School critical and radical theory is based on a ‘grand narrative’ of how society is structured. It says that economic and social structures and social trends are realities that determine how society is organized. Determinist explanations emphasize that the social order has such a strong influence on our social relations that people cannot have much influence on social arrangements. But there are opposing views. We saw in Chapters 1, 2 and 11 that postmodern ideas claim that how people interpret reality in the context of their cultural and social history influences how they react to the circumstances and events that affect them. Postmodernism objects to grand narratives, and its inherent flexibility is inconsistent with the determinism of Marxist and Frankfurt School critical theory. Hermeneutics, the study of interpretation, connects with postmodern ideas. It claims that you can understand society and social relations by seeing how different groups of people put into words and then interpret others’ behaviour and actions. Critical theorists see poverty and inequality as self-­ evidently important in creating social problems, and criticize the postmodern concern with language and identity (Ferguson & Lavalette, 1999). Marxist and Frankfurt School critical theory and postmodern ideas are not wholly inconsistent. Because postmodernism questions all grand narratives, it rejects, as critical theory does, the grand narrative of psychodynamic ideas that people’s problems derive from their internal psychological conflicts and other psychological theories that overemphasize psychological sources for individuals’ problems. And both sets of ideas say that we should not take the present social order for granted. Some critical social work theory, therefore, picks up elements of postmodern social theory and hermeneutics.

Is social work a form of social control? Critical theory argues that social work is a significant form of social control. In this, it is allied to political and social elites in supporting the existing cultural, economic and social order.

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Critical theory is different from psychotherapeutic, problem-solving and empowerment views of social work because of its position that social work has, as part of its everyday practice, a social control function to promote conformity with what Pearson (1975: 129) calls ‘the binding obligations of civil society’. It is to everyone’s benefit that children are socialized into good behaviour, that offenders cannot run riot and that mentally ill people are not distressed. Social work potentially contributes a positive and helping element of social control. This can be added to interpersonal pressures from family and friends, created by the social order, towards reasonable behaviour, moral guidance by religion and belief, and authorized action by the police and other official bodies. But where and when should we be controlling? Critical social workers argue that we should challenge control by social workers, particularly those employed by the state, when it is exerted on behalf of the dominant interests of capitalist society. There are several problems with this position. First, it equates power with the social control of the individuals and small groups that practitioners work with. In addition, it fails to focus on important issues such as religious oppression and human rights abuses, including child and domestic abuse and, more broadly, torture and lack of political freedom to express views and vote accordingly. This may be because the texts come from Western countries where such rights are well accepted. But we cannot assume that this is true in many countries. In addition, individuals in many Western countries suffer from some abuses of this kind, and social workers provide valid and useful help in matters such as domestic violence. Critical theory thus seems to lack a sense of appropriate priorities: personal help is more urgent than changing the world. In one way, however, traditional radical theory has the advantage over contemporary critical concern for inequalities in that it focuses on structural inequalities, particularly of class and wealth. Concern with gender, race and other ‘-isms’ can be criticized for focusing on what are, in the radical perspective, secondary issues. Second, even if you accept that social work does contain significant elements of social control, it is a benign activity compared with the sorts of control that human rights charters are concerned with. Social workers are not usually imprisoning or torturing people, for example, and the control exerted by social work is balanced by positive help. Third, power cannot just be equated with social control, and it is not exercised just by elites or people who can use dominating physical power. Potentially, many sources of power exist, and many people can access at least some of these. Empowerment ideas, as we saw in Chapter 14, say that people can resist others applying power to them, and that they can gain power through cooperation with people who share their interests. Critical practice that includes postmodernist and construction ideas recognizes these other forms of power because it is partly about helping people to use them.

Empirical support for practice The ideological and political focus of critical theory means that it does not offer prescriptions for practice that can be tested empirically; its prescriptions derive from its belief and perspective. Against this, critical research identifies useful ways of understanding social factors that are only weakly represented in more psychological theories. Marxists would say that their method of investigation by historical analysis and debate is a legitimate form of study. More

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broadly, critical theory argues that positivist science (see Chapters 2 and 7 to review other issues about positivism) maintains the ruling hegemony. It does this by accepting and promoting the present social order, and is therefore biased in its methods of investigation in dealing with critical ideas. In this view, all theory represents ideological positions, often in support of an oppressive ruling class. Like many ideologies, critical theories define objections in their own terms and explain them away. Objections to critical theory are often taken to be representations of oppressive ideologies, and the same is said of other theories that have ideological elements. An example is psychodynamic theory: if you dispute psychodynamic ideas, your objections may be claimed to come from your unconscious fears or conflicts in looking at areas of thinking that are emotionally or psychologically difficult for you. So some people argue that, as with psychodynamic theory, critical theory requires you to be a believer, rather than relying on evidence to support its position.

 o critical theory’s social aims limit it in providing for interpersonal D practice? Many social work roles involve providing help for individuals and families with clear social needs. Critical theory leans towards collective action, and this tends to neglect clients’ immediate personal needs. It therefore creates a tension between helping and respecting people as individuals with personal and family needs, while also seeking collective social justice (Scourfield, 2002). This sometimes seems unethical, uncaring or impractical because it is not what the social services are set up to do, or because it provides only a partial explanation for the behaviour and events that social workers meet. However, making analyses and using broad social ideas can be useful in interpersonal practice, because these give you tools for thinking issues through in a way that does not take conventional thinking for granted. They also allow you to look at the broader issues that influence what happens to individuals. To critics from humanistic and psychodynamic approaches, however, the concentration on material and social issues and the promotion of services such as welfare rights advice ignores clients’ humanity and their emotional and personal problems. Instead, critical prescriptions come by deduction from the theory rather than being an inductive response to the problems that many clients present. So the theory risks failing by working from its own assumptions rather than those of the people served. It is one of the criticisms of EBP commentators and people who are concerned about client self-direction that critical theories arise from social workers’ assumptions about people’s positions, rather than from what clients themselves think. The critical response to this point is that when people’s consciousness is raised, they often become aware of alternatives to existing assumptions about society.

 ritical theory is weak in providing explanations of emotional C and psychological issues and prescribing in detail what you can do about them Leonard’s (1984) thoughtful development of a Marxist individual psychology tried to connect broad general explanations from social theory with an understanding of individual responses.

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It repays careful study. Critical theory often uses techniques from social construction that allow clients’ voices, especially marginalized and excluded voices, to be heard and responded to. Empowerment theory connects with participative and user-led approaches. In addition, a perspective that offers a coherent and engaging view of the world is useful in itself, even if it does not provide detailed help for practice. The incorporation of feminism into critical theory has also led to influence on important practice ideas of dialogue and consciousness-raising.

Conscientization or consciousness-raising relies on insight We saw in Chapter 4 that gaining insight does not necessarily lead to a change in people’s thinking and behaviour, because someone who gains insight into a problem may not have the skills or strength to change their thinking or behaviour. This is even more true with insight into how social pressures prevent change, because we may have less influence on social oppression than on our own thoughts and skills. Critical theory, in answer to this, argues that insight into psychological models of practice is concerned with changing attitudes and behaviour to align clients’ behaviour with the expectations that are present in the accepted social order. Improved self-awareness in psychodynamic and humanistic theories only aims to make people feel better and not to achieve the social change that critical theory seeks. Critical theory claims that conscientization avoids the problems of psychological insight therapies because the aim is not just understanding, but also an interaction of action and understanding others through praxis. Against this point, however, the critical theory argument here seems to want to replace bad practice in psychological therapies with good practice in critical practice. But there is good practice in psychological therapies, which involves helping people to use their insight effectively. The critical theory point bypasses this possibility. It is equally possible to imagine a poor critical practitioner who might not be able to link insight and action in critical practice.

 ritical theory accumulates problems and criticisms but this can C seem negative and demotivating (Rojek, Peacock & Collins, 1989) If you find that many things in the organization of society are wrong, you can appear very negative to your colleagues and to the people that you are seeking to influence. This conflicts with the shared principle of aiming for positive outcomes (see Figure 1.7). Critical theory can also seem to be a conspiracy theory: it often seems that every proposal from people with the power and resources to make it work is treated with suspicion, and that only oppressed people can make a valid contribution to social innovation. Critical practitioners see the downsides of every social innovation, rather than trying to make the good things work. The lesson here is to look for, promote and use the positives in critical thinking.

 he interests of the social groups involved in any issue often conflict, T making it difficult to organize alliances between them Some critical theories emphasize inadequate and oppressive environments and services as a better basis than individual psychology for explaining clients’ problems. At its worst, this can

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substitute blame for local environments and their occupants in general, rather than blame for the individual victim, as an explanation. This might lead social workers’ support for clients to be seen as being in opposition to the needs and interests of others in the same environment, since the needs and wishes of the poorest cannot always be aligned with those of all oppressed groups. Case example: The housing project for mentally ill people Kevin was a social worker on a project team to set up a scheme for supportive housing for recovering mentally ill people. The team worked closely with their clients in the area and their relatives, who supported setting

up the scheme. However, many other residents in the area came together in a campaign to stop the project because they said it would bring more difficult people into the area, which was already deprived.

Mentally ill people and local residents in this case example were both oppressed groups, but their interests were opposed. While this was so at least initially, effective social development or community work with all groups in the area achieved rapprochement.

Major statements Critical theory is actively debated, and there are several streams of thought. In Chapter 2, I noted texts on social work practice that focus on practitioners developing critical thinking (Jones-Devitt & Smith, 2007) that avoids taking for granted social or intellectual assumptions that may not be made explicit in accounts of theory. Gambrill’s (2019) and Rogers and Allen’s (2019) texts are examples of this approach to critical thinking. Such views reflect the reality that multiple perspectives on social situations demand constantly renewed inquiry into the ideas we are using. Rogers and Allen (2019) connect this with reflection and reflexivity, concepts and practices that we met in Chapter 3, while Gambrill (2019) is more concerned with rigorous inquiry. Social work is not just a social science; it requires practitioners to do things. Critical thinking and analysis must, therefore, lead to critical action. So what is critical action? Critical practice theory goes beyond critical thinking to incorporate social ideas that dispute commonplace assumptions about how societies, social relations and social institutions are currently ordered. Such a practice questions the current social order and seeks to replace it with alternatives. If your analysis of problems in life focuses on weaknesses in the present social order, rather than on clients’ personal failings, you will inevitably focus on changing that order, rather than on changing your clients’ behaviour. The three main current streams of work on critical practice theory are as follows: ●●

The first is eclectic, seeking to include a range of theoretical sources, which include Marxist, feminist, anti-oppressive and empowerment ideas. There is a current focus on social justice. The most extensive recent accounts of these ideas are contained in Allan, Briskman & Pease (2009) and in Fook (2016), which I use as an example text in this chapter.

Critical practice 407 ●●

●●

Mullaly’s (2007; Mullaly & Dupré, 2019) structural social work is the major statement of Marxist social work. I also present this as an example text. It is based in a Canadian theoretical tradition of which Moreau (1979, 1990) was a founder and Carniol an important representative (1992, 2010; Kennedy-Kish et al., 2017). The third influential group, mostly emanating from the north-west of England, represents the current iteration of radical social work, also with a Marxist base. It is associated with the journal Critical and Radical Social Work. An important element of its approach is an internationalist perspective, a view that awareness of and engagement with international social movements is an essential part of critical thinking. It is linked with the international Social Work Action Network (SWAN); see the ‘Additional resources’ for an Internet link. Related to this is a focus on economic and political globalization as a significant factor in the oppression of working-class people everywhere (Ferguson, Ioakimidis & Lavalette, 2018). Alongside collective volumes, the major text concerned with practice is by Ferguson and Woodward (2009). This is, however, primarily concerned with a political positioning of social work, rather than being a practice model, and therefore does not meet my criteria for being an example text.

Wider theoretical perspectives Overview of critical practice theory Critical practice uses ideas from several different sources, set out in Figure 15.1. Four main groups of social theory are relevant: Marxism and structural social theory; Frankfurt School critical social theory; feminism and the social model of disability, with their contribution to

Marxism Radical social work Structural theory Critical theory (Frankfurt School)

Anti-racism

Feminism Anti-discrimination Social model of disability Anti-oppression

Postmodernism

Critical social work Figure 15.1  Sources of critical practice theory

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anti-oppressive ideas; and postmodernism. Fook (2016: 19–23) notes that the context within which critical ideas have been taken up leads to variation in how they are seen. She contrasts the Australia, Canada, the UK and the USA where, respectively, social justice, structural, anti-­ discrimination and social construction ideas represent alternative focuses of critical practice. The emphases in each country also shift over time, as different currents of thought gain support. Critical theory emerged from radical views of social work, which, after a period of influence in the depression of the 1930s, regained significance in the 1970s. Radical practice lost influence as Marxism became discredited after two political changes: the collapse of communist regimes in Eastern Europe and Asia in the early 1990s, and the success of neoliberal and economic rationalist regimes, such as those led by Margaret Thatcher and Ronald Reagan in Western countries (de Maria, 1993). Although radical practice theory waned, social criticism deriving from radical thought is now more essential to social work than it was before its period of influence. Radical theory was criticized for not providing adequate accounts of interpersonal practice and migrated towards social democratic practice theories, such as empowerment and advocacy (see Chapter 14). This created a theoretical environment in which these ideas and also consciousness-­ raising in feminist practice re-established their influence. Lavalette’s (2011) contributors, reviewing early texts, point to the continuing importance of ideas about class and the use of community work as a technique promoting cooperative endeavour. Feminism and the social model of disability had both a direct and an indirect influence on critical social work through their impact on ideas on anti-oppression. I explore these ideas more in Chapters 17 and 18. The critical theory considered in this chapter is thus a significant element in the social justice objective in social work, and forms an overarching framework with important connections to feminist and anti-oppressive practice. Critical theory also informs some aspects of empowerment and advocacy and eco practice (see Chapters 14 and 16), and calls upon postmodernism (see Chapters 2, 11 and 12). All these ideas have led to the development of a perspective that emphasizes social change as a necessary requirement in achieving social justice. In Chapter 1, I briefly mentioned that such theories are strongly associated with a socialist political philosophy, and that their questioning of liberal or neoliberal political philosophies is crucial to understanding the aims and emphases of critical theories. Stark’s (2010) account of the main neoliberal ideas, which I summarize in Figure 15.2, helps us to understand their opposition to critical theory. Because Priority for the economy and markets

People’s freedom to pursue their own economic interests is fundamental to all other freedoms

The least possible activity of the state

The state interferes with our freedom to pursue our economic interests

Greater globalization

This maximizes efficient provision for people’s needs

Deregulation

Deregulation maximizes freedom in pursuing our own interests

Social policies and values are irrelevant

Provided we can pursue our own interests, we can achieve the maximum welfare for ourselves and therefore for all

Figure 15.2  Neoliberal principles Source: Stark (2010).

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they give absolute priority to economic welfare, they devalue collective or mutual provision as a limitation on people’s economic freedoms. Socialist ideas originate from the social theory of Marx and his followers. Marxist theory is, as we have seen, materialist; that is, it claims that the social organization of society arises from the economic system through which natural raw materials are converted to human use. As societies become more complex, economies have to accumulate capital, the resources needed to create goods on a large scale, for increasing numbers of people to consume. Some people – capitalists – are able to generate capital: they use it to set up industries that employ people as labour. Most people are working class: they do not have capital and can only take part in the economy by selling their labour to the capitalists. They thus become beholden to the capitalists, who gain control of the economy and society to support their financial interests. Politics and society are organized in the interests of the capitalists rather than people in the working class. Inequality is built into a capitalist system for two reasons: first, because their financial power means that capitalists gain more from the economy than working people; and second, because working people depend on capitalists for their livelihood so that they cannot assert their own wider social interests. The state and government depend on capitalist finance so also fall in with the interests of the capitalists’ financial power. A middle class develops, which consists of people who have jobs requiring education and advanced skills. These enable them to manage the economy and social structures in the interests of capitalists. Social workers are part of this middle class. Like healthcare or education workers, their role in a capitalist economic system is to facilitate a healthy and well-educated workforce and make the social system work smoothly, again ultimately in the interests of capital. For example, supporting women in their domestic and childcare roles is an important way in which children are developed into a compliant workforce, accepting the expectations of neoliberal capitalist economics (Bhattacharya, 2018). Among other things, by helping to support families, protect children and care for disabled and older people, social workers enable the economy to continue to produce effective workers who are not troubled by difficulties in their lives. Divorce, chaotic families with poor childcare and distress because disabled and older people are not well cared for would disturb the economically productive flow of life that benefits the capitalist political and economic system. Contemporary structural and critical social work theory is mainly a development of what Rojek (1986) calls the ‘contradictory’ view of social work. This is expressed most clearly in Corrigan and Leonard’s (1978) social work text. It sees social workers as agents of control on behalf of ruling elites who, at the same time, have some potential to undermine a society based on class and inequality. Social workers can achieve this by increasing the capacity of oppressed people to live their lives more satisfactorily, thus reducing control on behalf of capital and inequality. Social workers also offer some of the knowledge and power of the state to support this process. So although the state and social workers ultimately operate on behalf of capital and to the detriment of the working class, the contradiction in their role is that it helps to mitigate the ill-effects of the dominance of the interests of capital and to awaken working people to the oppression and inequality that is still affecting them. Because the contradiction in their social workers’ role between being both controlling and helping leads to other contradictions, people become more aware of inadequacies in the way

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in which society is organized. For example, through being helped to use play and education as a positive influence within their family life, people become aware that the broadcast and social media use entertainment to direct their interests away from the education and self-­ development that may lead them to question political and social assumptions. This awareness eventually contributes to wider social change. These ideas about social work are an example of the critical theory perspective that social problems and issues arise from the social structure of any society, and this in turn derives from the economic system; the cause is not individual problems or inadequacies. Inequality and injustice affecting social groups come from their positions in the social structure. Removing inequality and injustice is a major aim for social action, and analysing injustices affecting various groups is a significant part of socialist concern. This has led to perspectives that want to broaden the range of factors leading to inequality and injustice. Contemporary critical theory thus moves beyond the significance given to social class in traditional Marxist thought. Important among these perspectives have been feminist thought (Chapter 17) and anti-­ oppressive theory (Chapter 18), which focus on the oppression affecting particular social groups rather than thinking about social class directly. An important principle of socialist ideas is that the best way of organizing society is through cooperation and sharing in social structures that encourage equality rather than inequality. This influences the kind of help that critical practice offers: for example, it encourages groupwork and community action that stimulates mutual help and cooperation. Contemporary critical theories, in particular those of the Frankfurt School of social thought, Habermas (Houston, 2013; Garrett, 2018a, b: 153–66), Beck (Adam, Beck & van Loon, 2000) and Gramsci (Ledwith, 2020), go beyond Marxism. An important contribution of these writers is, as we have seen, to emphasize hegemony, how cultural and moral beliefs and structures are essential to how the present social order is maintained. Because social work is concerned with trying to influence people’s beliefs and perceptions about society, it is important to integrate these cultural aspects of society into practice. Allan’s (2003) analysis of the relationship between modernist and postmodern critical theories in particular emphasizes the importance to contemporary critical theory of analysing discourses through cultural and social relations. It sees power as being available to be used, rather than just oppressive, and as open to self-reflection and the reflexive creation of theory with clients. We saw in Chapter 14 that, although they contribute to and use empowerment and advocacy techniques, critical theorists attack these practice methods unless they are used within a structural and critical perspective.

Connections One of the most important uses of critical theory is as a broad theoretical framework within which empowerment, feminist and anti-discriminatory theory, and to some extent eco practice, can be positioned. Accounts of feminist and anti-discriminatory theory particularly rely upon critical theory as a generalized starting point, and assume critical practice as the basis for using their ideas. Critical theory mounts a significant critique of ‘traditional’ social work, in other words practice relying on psychological explanations of social problems and taking for granted a

Critical practice

priority to social cohesion. The main issues, which we have come across in considering practice theories with mainly social cohesion aims, reduce complex social problems to individual psychological ones. They ‘blame the victim’, making clients responsible for problems that have social origins. In doing so, they deflect attention away from social circumstances. We saw in Chapter 4 that psychodynamic theory, the main source of traditional social work, has been criticized for this. ●●

●●

●●

Related to this, ideas such as adaptation and fit in ecological systems theory (see Chapter 9) assume that it is desirable for people to adjust to the present social order rather than question and fight against the undesirable features of contemporary society. Traditional theory ‘privatizes’ people with social problems, for example by seeing the problems as confidential. This cuts clients off from others who would share that experience and possibly deal jointly with it, and can be culturally alien, for example in some African societies. Traditional theory strengthens and follows the oppressive social order of capitalist societies (partly from McIntyre, 1982).

Despite this critique, there are links between many critical theories and traditional social work. Webb (1981), writing originally about radical practice, identifies four main ones: ●● ●●

●●

●●

Both accept that society contributes to generating personal problems. In both, the relationship between people and society is transactional, reflexive or interactive, so that we can affect our social circumstances as they affect us. Both seek autonomy for clients. Traditional social work criticizes critical practice for ignoring it in pursuit of general social objectives, which may conflict with individual needs and wishes. Radicalism criticizes traditional social work for ignoring oppressive social constraints that force people to conform. Both value insight, as we have seen, so that clients can understand their circumstances in order to act on them. The purposes and means of action on insight are different, however, and each perspective contests the value of each other’s forms of action.

Critical practice also raises concerns about social work’s system of service provision. There are several major issues: ●●

●●

●●

Social control and the extent to which social work exercises it through the state on behalf of the ruling class. Critical theory is cautious of controlling activities. Professionalization and social work education that promotes the interests of the profession to the disadvantage of the interests of oppressed communities and individuals. Critical workers seek alliances with working-class and community organizations rather than professional groups. This contrasts with the emphasis on engaging with professional lobbying groups as a tactic that we met in some work on systems theory and empowerment (Chapters 10 and 14). Whether critical practice is possible in much social work. The critical focus on collective and political work may be impossible in state agencies and charities, because they are controlled on behalf of the ruling elites through the political system or the management bodies that socially represent the ruling elites, or in some societies colonial ideas.

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Critical practice is concerned with how the professionalization of social work disadvantages clients’ interests and leads social workers to become part of the state and social interests that oppress clients. It also seeks the profession’s development even where this is contrary to clients’ interests. Moreover, professionalization encourages an emphasis on the technical rather than the moral and political aspects of helping, separates social work from other related professions by emphasizing qualification and promotes professional hierarchies, thus incorporating inequalities (Mullaly & Keating, 1991). Illich et al. (1977) shows how professions are often established to act in their own interests rather than in the interests of those they serve. The role of social work education is an example of this process. Radicals argue that it trains students for ‘traditional’ social work, reinforcing social control, individual explanations of clients’ problems and conventional rather than critical interpretations of society (Cannan, 1972). Critical social work argues that practitioners should limit their professional status and education, which emphasize their social distance from, and cut them off from alliance with, clients. It is, however, concerned about deprofessionalization because of managerialism, which seeks to exert control over practitioners’ discretion to act on behalf of and engage with clients’ social and political interests. Carried to extremes, managerialism makes critical practice impossible. An important source of critical practice is the work of the radical South American educationalist, Paolo Freire (Leonard, 1993); we met his work in Chapter 3 on reflection and reflexivity and in Chapter 14 on empowerment and advocacy. Freire’s (1972) approach focuses on education with people whose communities are oppressed by poverty and powerlessness, so has many connections with social pedagogy. Such people are ‘objects’ who are acted upon, rather than having the freedom to act that people who are ‘subjects’ have. There is, however, a ‘fear of freedom’, which must be disposed of. This is done by education through involvement in a critical dialogue in groups where pure activism (trying to act without reflection and analysis) and pure verbalism (constantly talking about what to do without action) are merged in praxis. This involves acting on analyses of social situations and influencing the analysis by the experience and by the effects of the action.

The politics of critical theory The resurgence of critical practice from the 1990s onwards and the rehabilitation of radical social work in the twenty-first century reflects several factors. One is the climate of hostile public views about social work in the political–social–ideological arena of discourse (see Figure 1.8). Another factor is the recasting of radical ideas within social work, influenced by feminism, by concern about racism and wider oppressions, and finally by critical theory. Pease (2009), tracing the transformation of radical into critical social work, also notes the importance of concern about the technical rational ideology of EBP and managerialism. Bailey and Brake (1975, 1980) see radical practice as ‘essentially understanding the position of the oppressed in the context of the social and economic structure they live in’ (Bailey & Brake, 1975: 9). Practice focused on helping individuals and families is not rejected, only that which supports ruling-class hegemony. Lavalette (2011) also points to the relevance of racism, women’s issues, LGBT (lesbian, gay, bisexual and transgender) rights and the concern to enable service users’ voices to influence practice and service development. Lavalette and

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Ferguson (2007) and Lavalette and Ioakimidis (2011) also show that conceptualizations of social work emerge from experiences of disasters and political conflict that are different from practice in stable and developed economies. These conceptualizations often reflect significant attempts to change social structures. Lavalette and Ioakimidis’s argument is that extreme situations make clear the need for a radical transformation of social systems that is concealed by the stability of developed economies. A particularly important radical perspective, based on Freire’s work (1972; Brigham, 1977), developed in Latin America during the 1960s and 1970s. Liberation from the struggle to subsist is not a form of social action that stems from reform, maintaining society in a steady state; instead, it requires revolutionary change (Lusk, 1981) involving a substantial change to political and cultural systems of thought. For example, a stronger focus on environmental policies rather than economic growth as a political priority might remove many aspects of oppression that come from giving priority to success in economic markets. A related set of ideas came from liberation theology (see Chapter 10); this Latin-American interpretation of Christianity focused on supporting poor and oppressed populations rather than on the interests of rich capitalist elites. These views led to a reconceptualization of social work in Latin America (Costa, 1987) away from individual problem-solving and towards user-led mutual help projects. Conscientization is a crucial contribution to social work that has come from Freire’s ideas. It requires helping oppressed people to gain a critical consciousness of the social structures that are implicated in their oppression, including the impact of cultural hegemony. By this process, they become aware of their oppression rather than accepting it as inevitable. Through participation in dialogue and praxis, they can then take action to lose their fear of freedom and some of their powerlessness. The concept bears similarities to the concept of consciousness-raising in feminist practice.

Values issues Values debates about critical practice focus on claims that it sees social change as being more important than individual help and the relief of individual distress. This sets long-term objectives against short-term help. Another aspect of this is the unrealistic tendency to blame social factors for personal misbehaviour, which encourages offenders or people behaving badly to evade personal responsibility for their actions. This in turn leads to criticism of social workers as being ‘soft’ on crime and antisocial behaviour of all kinds by excusing it. The emphasis on long-term social change rather than immediate personal help was particularly characteristic of early presentations of radical social work, and is denied by current-­ day critical practitioners. Mullaly and Dupré (2019: 234–65), for example, propose that dealing with the personal consequences of oppression for individuals is a crucial element of critical practice. Conversely, oppressors need to be helped to understand and accept personal responsibility for oppressive behaviour, even though this is often not intentional because it comes from structural factors. By acting upon this acceptance of responsibility for their oppressive behaviour, people can move towards being less oppressive in their actions, even though a critical practitioner realizes that the structural sources of oppression render personal action inadequate to combat oppression widely in society.

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Applications De Maria (1992) sets out radical practice methods that have been largely adopted by critical practice. These are as follows: ●● ●●

●●

●●

●● ●● ●●

Social work action should be sensitive to the relevant social causes. Practice must be constantly tailored to the oppressive social situations that practitioners deal with. Practitioners should be alert to resisting claims that low-level gains, such as client empowerment, are problematic for powerful interests. For example, they may experience pressure to limit client empowerment because it makes the job of running the agency more difficult, as we saw in Chapter 14. Social work is concerned with inherent humanity, and no single political or theoretical position has a monopoly of the values that support such objectives. Critical thinking should lead to action, not merely hand-wringing about social concerns. It is important to preserve narratives about real life that explain and point up injustices. We should focus on things that are marginalized by conventional thinking.

The idea of praxis is an important aspect of all critical practice. It means that we must implement theories in practice, so that practice reflects on and alters the theory behind it. As we act, the ideas we use in acting find meaning in, and are therefore expressed by, what we do. They also change our view of ourselves as we experience the ideas in practice (Ronnby, 1992). This conception has many links with reflexivity and reflective practice, discussed in Chapter 3. Praxis argues that theory must come partly from ideas outside daily practice, otherwise it would be only a simple reflection of that practice, but it must not lie totally outside recognizable practice.

Case example: How praxis works After qualifying as a social worker, Kevin’s first long-term job was working in a service for children with emotional and behavioural difficulties and their parents, mostly using cognitive ­ behavioural and solution techniques. To broaden his experience, he then took a job with a family agency, working with children’s problems in a very deprived part of a major city. He worked with several families whose problems had their roots in poverty arising from the closure of several big industrial employers in the city. For many of the parents who had worked in these factories, their family problems arose from the sudden drop in their incomes and consequent family problems, the parents’ psychological reactions to unemployment and poverty, and diffi-

culty in providing for their children in the way they had expected. Kevin found that they resisted work on behaviour change with the children. The agency decided to approach this by working with the parents using groupwork, and Kevin used narrative ideas to allow groups of parents to describe and record their experiences in group writings and videos, and eventually in creating websites for them to express their experiences. Their joint exploration of what had happened made him aware of their anger at bankers and the owners and managers of the industrial companies, many of whom were still doing financially well out of their investments. Some of the parents shared literature about the economic and social

Critical practice

reasons for changes in industry, including ideas about globalization reducing the power of local economies to resist international financial trends. Kevin also had the experience of being with some of the families who, inspired by the international Occupy movement that had led demonstrations and the occupation of important financial centres, occupied the head offices of a local company. Eventually, Kevin moved on again to work as a manager in child safeguarding,

and his experiences led him to emphasize narrative techniques exploring families’ experiences of life. He also used the techniques to seek to distinguish clients for whom poverty and adverse life experiences had led to chaotic family lives from those in which behavioural difficulties were the main focus of work. He was then able to work with these groups in different ways, including sharing experience through groupwork to develop mutual support.

The importance of this case example is how listening, involvement in and acceptance of the experience of the families affected by industrial closures led Kevin to change his methods of work with them, and in turn his values and ideology of practice. He did not reject his previous practice experience or his responsibilities in child safeguarding work, but rebalanced his whole philosophy of practice.

Example text: Mullaly’s (2019) new structural social work The centrepiece of structural social work is oppression. This is so important to Mullaly’s theory that a major separate text (Mullaly & West, 2018) explores combating oppression in detail; I pick this up in Chapter 18. A distinctive feature of his analysis of oppression is the importance of confronting privilege. Mullaly and Dupré (2019: 2–28) begin by thinking about social work’s vision of its aims: ●●

●●

Conventional views of social work see its purpose as building consensus or cohesion in society by restoring breakdowns in relationships. But this fails to recognize conflicts of interest, oppressive relationships and power differentials that create damaging aspects of society. Progressive views of social work seek a fundamental change in the structure of society, creating social equality between groups and humanism in cooperative relations between individuals, so that universal human need is recognized and resources distributed to meet needs without denying others, people are treated with dignity, their human worth accepted rather than exploited and they are all equally able to develop their fullest potential.

Structural social work requires a progressive view, moving towards a social welfare system that works for full employment, environmental planning to prohibit exploitation of natural resources and movement against the concentration of economic assets in the hands of the few, narrowing differentials among different social groups. A social welfare state also seeks equality in living conditions, substituting public provision for insurance and promoting solidarity, so that political and economic power is widely spread and citizen participation is increased. Structural social work (like most Marxist and neo-Marxist theory) sees the present capitalist economic and social system as facing a succession of crises, requiring significant social transformation to achieve the progressive vision of the social welfare state. The capitalist state

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is not unchanging, and an important change in the last half of the twentieth century and the first part of the twenty-first is increasing globalization, so that national social welfare systems are less able to provide for the specific needs faced in that society. Ideology, ‘a consistent set of social, economic, and political beliefs’ (Mullaly and Dupré 2019: 65), underlies analysis of the state, social welfare and social work. Ideologies provide a way of explaining the main problems faced by society and of interpreting current events. There is a continuum of political ideologies, from the political left, seeking radical change, to the right, holding conservative or reactionary values. Ideologies on the left accept greater state intervention in society, while those on the right seek less state intervention. Within the discipline of social work, there are many microtheories of practice reflecting a range of ideologies, but these exist within the framework provided by a paradigm, a taken-for-granted way of understanding how facts and methods fit together and what they mean. Social work’s paradigms describe and explain the relationship between the scientific thought of the discipline and the dominant ideologies in society. Mullaly and Dupré (2019: 65–194) identify a range of paradigms that reflect the ideologies of accepted political positions. These include neo-­conservative, liberal and neoliberal, social democratic, Marxist, feminist, anti-racist and postmodern ideas. Each has different views of humanity, society, the state, social justice and social change. Mullaly and Dupré’s (2019: 196–294) structural social work is based on a reconstructed socialist ideology, focused on responding to oppression and privilege. They identify aspects of conventional socialism that require development, and I set these out in Figure 15.3. We can

Deconstruct (rethink):

Reconstruct:

Class emphasis Gender neutrality Colour neutrality State support of dominating relationships Normalcy assumption Sexual division of labour Family forms Capitalism and patriarchy Dominant Eurocentric culture

Oppressed groups’ voices Eliminate gender exclusion Eliminate middle-class white priorities Politics of difference seeking social equality Examine categories of exclusion Break down private/public role separation Value multiple family forms Socialism/feminism complementary Celebrate cultural difference

Retain and develop traditions

Developed traditions

Socialism’s modernism Social justice, emancipation, equality Materialist philosophy Essentialism, totalizing thinking

Postmodern liberation, flexibility Respecting difference, diversity, inclusion Critical postmodernism Avoid fragmentation

Challenge Present situation evolved and is inevitable Traditional socialism

Figure 15.3  Reconstructing socialism Source: Mullaly and Dupré (2019: 196–9).

Change What an elite made, can be unmade Reconstructed socialism

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see that the reconstruction takes place by rethinking a wide range of issues, such as class, gender, disability, the sexual division of labour, family forms and culture. The focus shows up weaknesses in conventional socialist thinking, it does not refer to conservative, consensus-­ based thinking. Instead, traditional socialist ideas are developed in a more inclusive direction. Some traditional thinking in labour movements, for example, devalues women’s membership and accepts the idea that men should have primacy in the public spheres of paid work, the market and political roles in the state. Reconstructed socialism breaks down these divisions and wants to see men and women with equal roles in both private and public spheres. Another example wants to include postmodernist flexibility in thinking about social beliefs and respect for diversity and inclusion in ideas of justice and equality. We should therefore not just accept that the economic system is as it is, but look for alternative economies in non-profit social enterprise or green instead of fossil-fuel industries. And while we can achieve social justice by using human rights legislation to gain wins for, say, disabled people, we should also be seeking to include disabled people in every social organisation, and find ways in which disabled people can participate equally in sport and every other field of endeavour. Structural social work aims to change the structures of society that accept social problems as inevitable. The target structures are: ●● ●● ●● ●●

social institutions, such as the law, schools, workplaces; social processes, such as social work, teaching; social practices, such as leisure, shopping; social relationships such as family, marriage.

Oppression is the source of social problems in social structures and privilege. Oppression is systematic disadvantage and privilege is systematic advantage experienced by people because they are members of a group or category of person. We all experience restrictions in our lives, perhaps because we did not try hard enough, and we all experience advantages, because we have earned them by working for them. The crucial point about oppression is that we lose out simply because we are black or female or disabled or in some other category. Similarly, we are privileged in education or family life because of a category that we belong to, but we did nothing to justify our inclusion in it. I say ‘justify’ because our privilege is a matter of injustice to other people. Case example: The disability and youth groups in a community centre A community centre had started as a youth centre and the committee now wanted to broaden its work. It was suggested that a group for local disabled people would be helpful. The organizers of the youth group argued against this, saying that it would inhibit the young people from boisterous activity, from ‘letting off steam’, because they would have to be careful of noise and restrict their activities so that disabled people would not be injured by sports

activity. The organizers of the disability group suggested an experiment for the two groups to meet. It was found that the members of the disability group enjoyed meeting the other young people socially. In addition, two disability group members, including one in a wheelchair, volunteered to work with the youth groups, which led to the setting up of a youth group for physically handicapped and able-bodied young people together.

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This case example highlights some myths that lead to oppression. The first is to assume that resources are scarce, and people often feel this when they have struggled to set up a service. Sometimes it is hard to see that a resource we have worked for now gives us a privilege. Exploring possible options might help to see how they could be shared. There was also stereotyping both about the nature of a youth group and also of disabled people. Oppression often arises around assumptions about the identity of a group of people. These assumptions were shown up by events as they progressed. The protesters had not realized that both groups might gain from the change. Practitioners in social work will be constantly working with situations in which ‘structural violence’ occurs, in other words damage to people and their lives arising from structural inequalities. As a result, their clients will be affected by the oppressive myths found in the housing, retail, employment, education, healthcare and criminal justice systems. One example many practitioners accept is that people from working-class families, offenders and mentally ill people smoke heavily as a response to the stresses in their lives. Accepting this fails to acknowledge that advertising and media representations of smoking, acting on behalf of elites that make profits from tobacco, emphasize its benefits in managing stress, rather than making clear the health problems that smoking gives rise to. Since oppression is an important part of Chapter 18, I have not covered Mullaly and Dupré’s account of it in detail and set out their striking account of privilege in Figure 15.4. Privilege

Examples

Class privilege

I don’t worry about going hungry or being homeless; I’m sure that my children will be well-treated at school; Unlike poor people, I can take advantage of tax breaks and shopping deals.

White privilege

I can be sure if I am contacted by the authorities or the police that I have not been singled out because of my ethnicity; I can be sure that make-up and bandages will match my skin colour.

Male privilege

I’m praised for spending time with my children, cooking and doing household chores; Employers will never ask about my plans to have children; I can express emotions without being seen as irrational.

Heterosexual privilege

I won’t be blamed for spreading HIV/AIDS; I can be affectionate in public without being ridiculed or attacked; I don’t have to struggle with ‘coming out’.

Traditional family privilege

My children don’t have to answer questions about parents’ arrangements; The authorities and neighbours will not question my family arrangements; I can take it for granted that people will treat me as normal.

Non-disability privilege

People will not assume I’m incapable of a sex life; People won’t stare at me in public; When I want to travel, I can assume that I can access public transport.

Young adult and middle-age privilege

I’m not seen as a burden on the economy and society; People will not assume I’m lonely and useless; People will not assume I’m incapable of a sex life.

Figure 15.4  Examples of privilege Source: Mullaly and Dupré (2019: 279–83).

Critical practice

How should social workers respond to privilege, including their own? An egalitarian strategy seeks to makes changes, for example to their agencies and agency policies, and how people around them behave, to include people who are oppressed and help them achieve equal positions. At the same time, they also avoid taking advantage of their own privileges. But this is not easy, because society awards privileges without privileged people even trying. So a further strategy is a ‘standpoint’ strategy, in which you take a critical position about processes that award privileges and take for granted privileged processes. This strategy is based on the idea that privilege happens because people don’t understand that it’s happening, so it’s important to draw attention to the process, to call it out so that understanding about what is happening increases. This also helps to stop your privilege getting in the way of your relationships with the people you work with. Taking a standpoint position also validates the experiences of people who are oppressed and values them, helping them to see the worth of their category and appreciate it. Taking up these positions against privilege can lead you to take up some of the following actions: Reclaiming the language of oppression and privilege. You avoid a treatment or psychotherapeutic description of what you do, and reclaim social change. Be clear with people that racism and sexism are not done by bad people, but because the structures of society take white and heterosexual privilege for granted. ●● Acknowledge that oppression and privilege exist, and explain to clients and in reports how they are affecting the present situation. If clients describe it, name it; if it’s affecting the situation you are analysing in your assessment, show what’s happening. ●● Pay attention to research and literature, such as novels, stories or other media, that illustrate and analyse oppression and privilege. ●● Learn and be prepared to listen within your work for oppression and privilege, exploring people’s experience of it. ●● Take little risks by being open about it: ❍❍ Make a noise about it: oppression and privilege depend on silence – ‘What’s going on here?’ ❍❍ Find ways of not taking the path of least resistance – ‘Why don’t we try out …?’ ❍❍ Dare to make people uncomfortable, including yourself – ‘I don’t think we should be having this conversation’ ❍❍ Openly choose and model alternatives – ‘I wonder if we could …’ ❍❍ Openly promote change in systems that support oppression and privilege – ‘Hey, we don’t need to do that’ ❍❍ Make oppression and privilege part of the agenda – ‘Could the team have a space every week to talk about examples?’ So far, we have been examining the analysis of oppression that informs structural social work practice. I have summarized the main points of Mullaly’s account of practice in Figure 15.5. Mullaly divides practice into two elements: working within and against the system, and working outside and against the system, the latter focusing on political action. An important aspect of practice is the analysis that the personal is political, a concept often claimed by feminist theory and practice. This idea proposes that practitioners should understand that every practice action contains implied political objectives, and that it is helpful to clients to understand how their present apparently personal troubles connect with ●●

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political and structural forces. The aim is to reduce feelings of guilt and blame. Structural social work does not, however, negate personal responsibility: it is not acceptable to say ‘society made me do it’ or ‘it’s all a capitalist plot’. Irresponsible or bad behaviour is not acceptable, but we do not blame people or say that everything about them is bad because they are affected by oppressive factors in society. In addition to the interpersonal practice guidance offered in Figure  15.5, Mullaly and Dupré (2019: 325–8) point to the practice implications of taking structural approaches to practice in mainstream agencies. Various approaches facilitate continuing practice in this situation: ●● ●● ●●

Be clear about the ‘control and pacification features’ of mainstream agencies. Find structural ways of challenging oppression by the agency. Protect yourself and your colleagues from reprisals.

PAUSE AND REFLECT  Structural challenge in your agency Identify ways in which you could achieve each of these means of facilitating structural practice in your agency, ideally sharing these in discussion with others.

Some suggestions Among the techniques I have seen practitioners use are seeking solutions that reflect people’s realities and do not blame individuals. Practitioners have included these alternative views in case recordings, have developed information leaflets describing clients’ rights and entitlements to services, have formed groups with colleagues with similar views and have been tactful and constructive rather than attacking. They have sought to be practitioners who provide solutions, not problems. Working outside the organization includes: ●●

●●

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●●

an awareness of the alternative services and organizations that can help clients in different ways, and making referrals to them; being involved in and involving clients in social movements and coalition-building that aim for social change; participation in trade unions and professional associations that work on achieving beneficial social change, rather than merely supporting self-interest; encouraging an awareness among practitioners, clients and carers of debates in electoral politics and opportunities to be engaged in politics; this includes encouraging mutual support groups to be aware of and involved in policy development, sometimes using social media and other informal means of communication; supporting the revitalization and development of the public sector as a socially progressive force;

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Elements

Actions

Intrapsychic and interpersonal work

• Counteract the damaging effects of oppression • Build strengths for individual and collective action against oppression

• Counsel on psychological effects • Enable people to be agents of their own change • Engage critical reflection on the effects of existing social arrangements • Set up groups with people in similar situations to develop political awareness, self-define a new identitt and develop confidence to assert a more

Empowerment

• Reduce alienation and sense of powerlessness • Help people gain greater control in their lives

• Remember that practitioners cannot empower others, only assist in self-empowerment • Engage in mutual problem-solving with the client • Avoid exploiting the helping process for your own benefit (e.g. being seen as a kind or supportive person) • Facilitate the voices of clients being heard

Consciousnessraising (conscientization)

• Understand dehumanizing social structures • Aim to alter social conditions • Base this on the client’s situation and experiences • This is part of, and not a substitution for, support, services, advocacy, referrals and improving immediate lives

• Help people gain insight into their circumstances with a view to changing these • Increase self-confidence and assertiveness • Provide information and education about structural issues • Use dialogue, mutual learning and critical questioning • Show personal and social empathy; reflect back the personal experience and link it to social factors • Engage structural empathy … and ask where these factors come from • Open a dialogue on the social functions of oppressive actions

Normalization

• Clients’ experiences are not unique… • … and are a logical outcome of oppression

• Provide information that others are similarly affected • Link client with others in the same situation

Collectivism

• People are social beings, dependent on others

• Form groups of people with similar experiences • Refer to groups or helping organizations in the community

Redefining

• Redefine assumptions that problems come from individual, family or subcultural defects

• Employ critical questioning, dialectical humour, metaphors, storytelling, checking inferences, mental imagery, persuasion and use of silence to identify alternative explanations

Dialogical relationships

• Participants in social work are equal participants • Practitioners are not experts, professionals or therapists

• Share case-recording so that clients contribute to the records of their lives • Involve clients in decisions affecting them • Get clients’ feedback on services • Provide information on agency roles and clients’ rights • Reduce social distance by self-disclosure, casual dress and explaining your actions

authentic identity

Figure 15.5  Structural social work practice Source: Mullaly and Dupré (2019: 299–35).

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developing discourses that are critical of the dominant social order; emphasizing human rights to recognize that everyone has a shared interest in having their needs for health, autonomy and well-being met. Ife (2012) would argue that there is also a concern for others to have similar rights met.

Example text: Fook’s (2016) critical approach to practice Fook argues that a critical tradition in social work divides work on the social from practice with the interpersonal. There is, however, no complete divide between structural and interpersonal: domination is experienced personally. Postmodern and poststructural ideas offer the possibility of incorporating multiple perspectives into our practice. Critical theory allows us to incorporate reflective and interactive ways of knowing, and to recognize connections between structural oppression and the possibilities for both personal and social change. Structural approaches can lead to domination by managerialism and ‘top-down’ approaches to dealing with identified social issues, rather than listening and responding to people’s stories. Current contexts of practice present us with globalization, which compresses the world, breaking down boundaries and fragmenting ethnic and other identities. Both technology and economic changes play their part in this. For social work, this means that professional skill, knowledge and autonomy are devalued. There are, however, creative professional possibilities in these changes: ●● ●● ●●

recreate our professional identity as social workers; work for inclusivity for marginalized and excluded people; work to understand the intersecting contexts and complexity, to help identify and work on contradictions and tensions in practice.

Fook’s approach to social work concentrates on rethinking our ideas about practice in four different ways.

Knowing Critical practice questions both what we know and how we know it. Modernist ideas see knowledge as having achieved the status of objective understanding; that is, being widely seen as validated. Professions maintain their social position by their generation and dissemination of such accepted knowledge. Critical reflection allows us to apply knowledge from a wide range of sources, including clients and their communities. We should use a variety of ways of knowing and sources of knowledge, being inclusive in the range of people we involve in developing our knowledge.

Power: who has power and how they use it This is important because power is often seen as a commodity, something that someone or some group has, instead of something that can be shared. Following from this, we tend to see groups as opposed to one another: if we think one thing, then someone who thinks something different is an enemy. We should accept, however, that differences exist and try to account for contradictions in our thinking, and then get other people to see the contradictions in the way

Critical practice 423

they are behaving. There can be no assumptions about what is empowering to individuals: their reactions may vary.

Discourse, language and narrative The Marxist concept of ideology sees it as a system of beliefs that has been institutionalized as part of the way in which a society or part of a society operates. This system interacts with the theories, explanations, behaviour and practical consequences related to the beliefs. In turn, the beliefs, behaviour and theories all affect and support one another. This way of seeing ideology leads to several problems. Different explanations are, according to a person’s ideology, seen as true or false. Your behaviour is similarly seen as directional: it always works in favour of one point of view rather than another. There is also a rational superstructure of ideas (an assumption that all ideas have to fit into an entirely consistent and rational pattern) and a lack of plurality (an assumption that multiple perspectives can coexist, or that ideas may be ambiguous) or contradiction (an assumption that ideas may have elements within them that contradict each other) in thinking; in this way, inconsistencies are ironed out. Postmodern discourse views about understanding, however, run counter to these views. They suggest, calling particularly on Foucault’s work, that understanding is constructed by social practices, particular forms of subjectivity and the power relations inherent in knowledge. Language is not seen as neutral but as colouring how we think and what we know. The narrative that we tell about something chooses between possible alternatives so that our communications convince others that what we say is true. If we can rethink it, a different interpretation may become true.

Identity and difference Critical theories question the traditional idea of a set, continuous self and identity. Part of this has to do with language. For example, we tend to think of things as dichotomies: what we are and what we are not. If I say that I am a quiet, studious person, it excludes the possibility of being a lively, socially active person. Critical ideas suggest that we can change and be contradictory and multiple – many things at once. We should see ourselves as whole people who can develop more complexity and diversity. Figure 15.6 is my representation of the important elements of Fook’s critical practice. Each element converts one of the ‘new ways of thinking’ into a practice, and has connections with solution practice, discussed in Chapter 11. Contextual practice (that is, working on the family, community and social environment rather than directly on the client’s behaviour) draws on the empowerment and advocacy approaches discussed in Chapter 14. By emphasizing ‘unsettling’ dominant discourses, Fook emphasizes how critical theory is an important source of the shared principle of disrupting current social assumptions through critical practice (see Figure 1.7). An overarching practice approach relevant to much critical practice is the poststructuralist idea of deconstruction, which we met in Chapter 11. Fook’s book provides a critical theory analysis of this idea, showing how you can use deconstruction in work with clients. This is particularly important in disrupting current assumptions throughout, but especially in

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New ways of knowing

Power

Unsettle dominant discourses • Deconstruct • Resist • Challenge • Reconstruct

Conceptualization and assessment of the problem

Discourse, language, narrative Identity, difference

• Clients’ perspectives and story • Other players’ perspectives • Interpretation and enactment in the practice context

Narrative strategies • Uncover the narrative • Externalize the problem narrative • Shift to empowering narratives • Create an audience

Contextual practice • Positionality, resist dominant cultural contexts • Reconstruct roles and identities • Challenge dichotomies and dilemmas • Critical case management • Advocacy

Figure 15.6  Fook’s critical practice Source: Fook (2016: 117–97).

understanding clients’ situations and empowering them. The main sequence of practice action is as follows: ●●

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Deconstruction may, for example, tease out the range of individual and social factors that influence what is happening to the client. Resistance involves thinking out ways in which events are pushing clients to go against their own beliefs. For example, changes in social security or employment policy may give priority to a single parent getting a job rather than caring for a young child. Challenge involves finding positive ways of disagreeing with unhelpful pressure, for example by identifying positive progress in the social relationships made by a mentally ill person to contest demands that their behaviour be managed by increased medication. Reconstruction may, for example, involve planning a new pattern of life that combines the preferred aims of the client with demands for compliance with external demands.

The ideas of resistance and challenge derive from radical theory. Critical practice also has similarities with cognitive practice (Chapter 7) because it suggests that we should not be misled by irrational ways of thinking. Critical practice differs, however, because it emphasizes particular areas of irrational thinking (misunderstanding about discourses of dominance) and flexibility, and focuses on change in a particular direction (towards reconstructing relationships that enhance clients’ understanding and use of power). These again connect more closely to radical thinking.

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Critical practice also rejects the authoritative ‘therapist’ practitioner that is implied by cognitive theories in favour of a more complex relationship between social worker and client that reflects the ambiguities of their relationships, both between themselves and in the networks of relationships in the practitioner’s agency and in the client’s social environment. For example, feminist ideas have been criticized for assuming that women always have shared interests, whereas women in good jobs have few shared interests with new migrants living in poverty. We may, however, seek equality and shared experience with clients while realizing that this is not always possible or helpful (White, 1995). I take this point further when I discuss White’s (2006) work in Chapter 17. In these ways, critical practice directly picks up and uses empowerment and feminist theory (see Chapters 14 and 17), but it has a different view of them. Empowerment presents several difficulties, which we have already seen in Chapter 14. Practitioners cannot empower people; they must help them empower themselves. Moreover, empowering one person or group may disempower others. Empowerment may also be diluted to mere enablement, particularly where, as in anti-oppressive theory (Chapter 18), there are too many target groups for empowerment. In this situation, addressing all of them will mean that none of them is addressed adequately. An ambiguous relationship between empowerment and self-help illustrates this problem. It is empowering to help yourself, but it is not empowering to be forced to do so when you do not have the resources. Consequently, Fook emphasizes the importance of not trying to empower people unrealistically. The final three aspects of critical practice – problem conceptualization and assessment, narrative strategies and contextual practice – focus on interpersonal practice and, with contextual practice, also on macro practice and an involvement in social work agencies and social work education. While she continues to use the deconstruction–reconstruction model throughout, Fook incorporates a range of practices through using narrative and other social construction approaches.

Conclusion: using critical social work Practitioners use critical social work to offer a framework of practice that enables them: ●●

●●

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●●

●●

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to practise in ways that emphasize social change objectives rather than, or as well as, social cohesion and empowerment; to become aware of and avoid oppressive systems in society where they blame and victimize clients, particularly in their own agencies and their own practice; to provide a theoretical framework emphasizing social justice and equality in their practice in interpersonal work as well as in advocacy; to keep in mind alternative ways of exploring, assessing and acting in social situations that do not take for granted the current social order, particularly where this is oppressive to their clients and the communities they are working with; to have a critique of individualistic, psychological practice techniques, which assist them to think critically; to provide a broad framework in which they can incorporate the ideas of feminist and anti-discriminatory practice.

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In these and similar ways, the availability of critical practice avoids social work staying with the status quo. In addition, as with social construction, humanistic and empowerment theories, critical practice remains positive about the possibilities for change, despite barriers and social resistances that make both personal and social change difficult. The difficulty for many practitioners is that the strong analysis of barriers and social oppression in these theories can seem too negative to maintain their positive motivation in practice. Because of this, practitioners often feel they have to focus on their interpersonal work, rather than find ways of building a more critical practice. To respond to this, alliances with colleagues both locally and more widely are an important part of maintaining a balance between interpersonal and critical practice.

Additional resources Further reading

Fook, J. (2016). Social work: A critical approach to practice (3rd Ed.). London: Sage. Mullaly, B. (R. P.) & Dupré, M. (2019). The new structural social work: Ideology, theory and practice. (4th Ed.). Don Mills: Oxford University Press. Webb, S. A. (Ed.) (2019). The Routledge handbook of critical social work. Abingdon: Routledge. Important critical practice texts. Ferguson, I., Ioakimidis, V. & Lavalette, M. (2018). Global social work in a political context: Radical perspectives. Bristol: Policy Press. Lavalette, M. (Ed.) (2011). Radical social work today: Social work at the crossroads. Bristol: Policy Press. Accounts drawing on radical social work. Fenton, J. (2019). Social work for lazy radicals: Relationship building, critical thinking and courage in practice. London: Red Globe. An original and thoughtful view of critical practice, drawing on a wide range of literature. Robb, M., Montgomery, H. & Thomson, R. (Eds.) (2019). Critical practice with children and young people (2nd Ed.). Bristol: Policy Press. Rogowski, S. (2013). Critical social work with children and families: Theory, context and practice. Bristol: Policy Press. Two books reflecting attempts to apply critical practice theory to work with children and young people, in view of the difficulties that this area of practice may seem authoritarian and unsusceptible to critical practice.

Journals Critical and Radical Social Work  – Policy Press; see https://policy.bristoluniversitypress. co.uk/journals/critical-and-radical-social-work Journal of Progressive Human Services  – Taylor and Francis; see http://www.tandfonline. com/toc/wphs20/current

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Websites https://ojs.scholarsportal.info/windsor/index.php/csw The internet journal Critical Social Work, with a long-standing record of raising critical social work issues. http://socialworkfuture.org The website of Social Work Action Network, an international campaigning network of social workers, originally formed in the UK around dissatisfaction about globalizing and managerialist tendencies in social work. The major organization for critical and radical social workers.

CHAPTER 16

Eco practice MAIN CONTRIBUTION Eco practice aims to confront environmental injustice by strengthening people’s capacity to respond to and understand environmental hardship and transition. By working with people and communities around ecological crises and disasters, it makes connections between the natural and social worlds. This is because it moves beyond ecological systems theory’s (see Chapter 9) ideas of adaptation and fit applied in interpersonal practice, towards a focus on environmental justice working through collective action. Eco social work is a social change and development practice because of its concern with the fair distribution of the burdens and benefits of life and social relationships.

MAIN POINTS ●●

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Eco practice helps people confront environmental injustice and transition, and builds awareness of and resilience to environmental disaster, hardship and transition. It is a new practice theory, without agreed practice models, but urges practitioners to include concerns about the environment in their practice, seeking both policy change and interpersonal help with the impacts of environmental change. Ethical and spiritual elements of eco practice equate human rights to well-being and sustainable natural environments. Rejecting neoliberal and globalizing economic systems, eco practice seeks alternative economic structures that offer collective solidarity and seek the public good in a partnership between civil society, the state, families and social groups. Targets for eco practice are issues of local importance and environmental policy issues. Holistic individual and family practice promotes participation, positive use of natural resources and self-consciousness about lifestyles. Interpersonal practice focuses on environmental degradation and hardship, resilience to environmental disasters and seeking sustainability through connectedness between human life and the natural world.

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PRACTICE IDEAS ●●

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Environmental degradation, deterioration of infrastructure and facilities affecting individual, family and community fulfilment. Environmental hardship, lack of resources creating difficulties for individuals, communities, families and social groups. Environmental transition, linking environmental to economic and social changes through a series of stages to shift to a new social settlement, including a concern for holistic well-­ being, de-growth strategies, low consumption of natural resources and a collective economy.

THE DEBATE SUMMARY The debate about eco practice coalesces around three issues: ●●

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Different formulations of eco practice present a confusing array of overlapping conceptions. There is no single recognized practice model, though ecological systems theory (see Chapter 9) is challenged. Accounts of eco practice urge social workers towards environmental activism, for ideological or political reasons, but ways of including eco issues in practice are underdeveloped. Practice prescriptions primarily seek widespread policy and social change in areas of social concern not strongly associated with social work, often drawing on social development practice, and are hard to connect to everyday social work in many countries.

Debate about eco practice Conceptions of eco practice Ecological systems theory (see Chapter 9) is the best-known practice theory to use some ecological terminology, but contemporary writers are agreed that it is not an eco practice theory. This is because it is concerned primarily with the social rather than natural environment. Ideas such as the person-in-environment, fit and adaptation in interpersonal relationships are important, rather than, as with eco practice, human interaction with the natural environment. I suggested in Payne (2002) and Chapter 9 that ecological systems theory allowed American social work to incorporate its traditional individualized person-in-environment therapeutic approach to social work into the social perspective of systems theory. Derezotes’s (2017) account of ecopsychology is an updated version of ecological systems theory, integrating concern with human and local ecosystems and spiritual implications of concern for the environment with systems practice. The more recent interest in chaos and complexity systems ideas reviewed in Chapter 9, on the other hand, has built on a sense of impending environmental disaster and is more relevant to twenty-first-century eco practice. Eco practice theory, while aiming for social work engagement in environmental disasters, does not integrate chaos and complexity into prescriptions for social work.

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Case example: Youth unemployment in ecosystems and eco-critical practice Matthies and Närhi (2018: 206–10) review the alternative approaches to youth unemployment of ecological systems and ecocritical practices. Ecological systems theory proposes a comprehensive programme of individual and family support for young people. It involves community organizations in helping them and their participation in local projects. An eco-­critical project

facilitates the young people to think through the future of work, the effects of climate change, the prospects of work in  local nature-based projects, social entrepreneurship and a local exchange economy, as well as traditional work. Based on this, they can make better decisions individually for the future and work collectively to build future opportunities of employment.

As it is a relatively new, twenty-first-century theoretical position, how to understand eco practice remains an important area of debate. The earliest formulation is a form of macro or social action practice, originally described as eco-critical, because it criticized the limited ecological content of ecological systems theory and sought better awareness of the social risks of environmental crises in social work practice (Matthies, Närhi & Ward, 2001). Eco-critical practice (Närhi & Matthies, 2001) referred to the inclusion of environmental issues and concerns about place in well-being primarily as a form of macro practice or social pedagogy. This shows social work picking up important debate in the political–social–ideological arena (see Figure 1.8) and beginning to incorporate it into practice theory. By the time of Närhi’s (2004) PhD thesis, she was describing it as ecosocial, while maintaining the theoretical critique of ecological systems theory. In their account of the development of eco theory, Närhi and Matthies (2016; Matthies & Närhi, 2018) link the distinction to the tension between the ideas of two founding mothers of American social work, Jane Addams and Mary Richmond. Addams worked in a settlement and took a social change and justice perspective, while Richmond worked in casework agencies and took a social cohesion perspective. Närhi and Matthies argue that the eco-critical and ecological systems distinction is in the same tradition. In the present book, I have situated eco practice within social change aims in social work and systems theory within social cohesion aims. The division between macro and casework views in the early twentieth century, however, did not derive from environmental concerns – which were not current at the time. Eco practice cannot, therefore, trace an inheritance in direct line from Addams’s tradition within American theory. Rather, eco practice derives from an attempt to promote a social work role that responds to contemporary environmental concerns. These concerns are set out in Figure 16.1, in which a circle shows the main issues in public debate identified by Gray, Coates and Hetherington (2013b: 13–16). Debate on these issues is increasingly influenced by a sense of impending environmental disaster. This shared sense also affects the thinking within social work identified by Mary (2008). Her analysis reflects concerns about the social sustainability of the present direction of society, the need for a global awareness of the issues to be raised within social work, the connections with spiritual ideals among clients and practitioners, and the risks of social chaos and complexity.

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Pollution

Toxic materials & waste

Climate change

Environmental concerns Natural destruction

Natural disasters & traumatic events

Species extinction Complexity & chaos Impending environmental disaster

Global awareness Spirituality Sustainability

Figure 16.1  Eco concerns in social work Sources: Mary (2008) and Gray, Coates and Hetherington (2013b: 13–16).

Närhi and Matthies (2016: 32) distinguish six types of eco practice in response to these issues, as follows. In this account, I explain that we may now simplify these differences: ●●

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Ecological social work, emphasizing sustainable development that comes from reciprocal relationships between the environment and human well-being (associated with Coates, 2003). Environmental social work, seeking a conception of social work practice that includes sustainable development (associated with Gray, Coates & Hetherington, 2013a, b).

To simplify, we should see environmental social work as a more recent formulation that includes ecological social work. Both primarily see sustainable development as essential to social work’s concern for human well-being, in view of a widespread perception that environmental difficulties of all kinds are increasing. ●●

Deep ecological social work, focusing on environmental justice by displacing humans from the central position in the relations between nature (associated particularly with Besthorn, 2003, 2011, 2013; van Wormer & Besthorn, 2017: 243–97).

Deep ecology is a slightly mystical concern for the environment, based on a value position that equates human well-being and environmental good, and I discuss it in the section on values.

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Eco-spiritual social work, emphasizing spiritualities, particularly among Indigenous peoples (see Chapter 18), who see humans as part of nature and sometimes as responsible for guardianship of nature, flora and fauna.

This conceptualization picks up the link between many spiritualities (see Chapter 13) that link human well-being with forms of spirituality that include respect for the environment. Such commitments are a characteristic of many spiritualities, but are particularly associated with Indigenous spiritualities. While concern for animals and nature may seem distant from the interpersonal focus of much social work, pets provide crucial relationships for some isolated people or people with mental health problems, and the use of companion animals in healthcare is a commonplace example of how animals may be important in interpersonal and social contexts. ●●

Green social work, proposing interventions that change social and political structures to give equal priority to protecting the environment and assuring human well-being (associated with Dominelli, 2012).

Dominelli’s green social work includes internationalist activism on environmental issues allied to a concern for the consequences of environmental disasters for human well-being. She develops the contemporary interest in environmental activism as a location for critical practice. ●●

Social ecological social work, combining ecological systems and ecocritical social work to seek social transitions through empowerment, macro and critical social work interventions.

Närhi and Matthies (2016) are arguing here that a balanced approach to eco practice requires both ecological systems and their own long-standing formulation, ecocritical practice. In Matthies and Närhi (2017), they invoke the concept of transition as the basis for this conception of practice. This seeks to present a complex account of social change as a model of social work that includes social justice considerations. Environmental transition is conceived as connecting with economic and social transitions so that each influences the others to achieve a new social settlement; that is, a widely accepted way of living, including holistic well-being, de-growth strategies, low consumption of natural resources and a collective economy. Practice responds to the impact on individuals, families, groups and communities of environmental hardship and disasters by re-establishing a post-disaster lifestyle that moves towards that new social settlement (Matthies, 2017). Rantamäki and Kattilakoskli (2017) propose a series of steps in transition through which local policy may move towards such as social settlement, and I summarize these in Figure 16.2. The intention is that early stages are likely to be more easily accepted, and therefore implemented in an agency, locality or community, and later stages can then be built on them. Nevertheless, elements from all the stages might easily be taken up out of order if it fits with developments in a locality. In addition to these forms of eco practice, Coates and Gray (2019) refer to an ‘ecocentric’ turn in social work and society. This rejects solutions that adapt the present economic system to improve environmental sustainability. Industrialization and technical fixes to resolve

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Decent quality of life for all

Fairness and equity

Recognize local needs and resources

Consider special local characteristics everywhere

Participation and partnership

Care for environment

Thought for the future

Engage diverse local resources

Individual and communal relationship with environment

Meet current needs sustainably

Figure 16.2  Steps in local environmental transition Source: Rantamäki and Kaittilakoskli (2017: 185).

problems are inadequate; major social change that involves a different way of life is required. The ecocentric turn seeks to facilitate people’s well-being during a transition to greater interdependence and communal shared responsibility. To include these varying aspects of the move towards incorporating concern for and action on the environment in social work, I have referred to them all as eco practice. The agreed basis of such practice is: ●● ●●

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awareness of the impact of human activity on the global environment; that social justice requires environmental justice in the use of natural resources and between human well-being and the natural environment; developing sustainable human life that does not damage the natural environment; human well-being developed in ways that are interdependent with the natural environment; social transition towards economic, political and social systems in human well-being alongside respect for the natural environment.

Spiritual elements of eco practice that see human need as equal in importance to the needs of the natural environment and flora and fauna are as yet less well developed and a lower priority for some practitioners. They may, however, be important in particular communities or families, for example in Indigenous or migrant communities building on cultural traditions that are close to the environment.

Urging social work to include environmental activism Social action on environmental and green issues is an important area of twenty-first-century activism, and this has filtered into social work. Brueckner and Ross (2020) argue that many areas of concern for communities and individuals have connections with environmental issues, so that you resolve eco issues while working on other things. Conversely, working on eco issues can sometime be an instrument for helping with other areas of clients’ concerns. The following case example is an example of health concerns that connected with an environmental issue and led to both policy and groupwork.

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Case example: Pollution concerns for urban families Hazel was a young single parent living with her daughter, Paula, in an apartment in a busy town. Paula experienced health problems from childhood, including very serious asthma. The social worker attached to the respiratory clinic of the local hospital included Hazel in a group of mothers with a range of similar conditions, which met weekly for education in managing their children’s difficulties. Several of the mothers were worried about whether pollution was causing or worsening their children’s difficulties.

Some were interested in supporting control of the use of large transport vehicles in the city centre and became involved in lobbying for policy change with the planning authorities. Hazel thought this was too much for her, but became attached to several other mothers who arranged time as a group in  local parks. As this idea developed, they arranged a group holiday in the countryside for their children, and then applied for funding from a charity supporting regular trips into the country during school holidays.

The next case example illustrates the alternative direction of travel, in which picking up opportunities for involvement in nature and the environment benefited a young man with intellectual disabilities to manage changes in his life.

Case example: Joe’s work in the community farm Joe was a young man with intellectual disabilities, making the transition from school to adulthood. He had enjoyed involvement in the school garden, growing vegetables, and had helped to care for small animals in the classroom, including taking home a guinea pig during the school holidays on several occasions. His move to a community education centre on leaving school removed this opportunity. Working on his care plan, constructed with Joe, his advocate and his parents, included picking up on this school interest. His social worker introduced him to a local garden centre project working with disa-

bled young people, but he found he did not have enough practical things to do to interest him. His support worker suggested he might think about a community farm, which was a bit further away and less well known to Joe and his parents. They were anxious about this because it involved working with larger animals than he had experienced previously, including sheep and horses, but with the support worker’s encouragement he was able to take this on, and enjoyed the greater degree of physical activity required. He also found the group of workers and volunteers at the farm more congenial.

While eco concerns are present in many communities, they are often not a strong priority for the social work services that people want. Two texts reviewing social work published in East Africa (Spitzer, Twkirize & Wairire, 2014; Twikirize & Spitzer, 2019), for example, deal extensively with cultural identity, poverty reduction and women’s issues. It may be possible, nevertheless, to include some environmental concerns into work on issues of priority to the community, as the next case example illustrates.

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Case example: Housing repairs issues and the local environment Social workers in a local advice centre in an estate including a good deal of poorquality social housing dealt with constant requests from residents for advocacy about slow and inadequate repairs, and tried to encourage peer advocacy both to help individuals and to raise the level of competence in the community to deal with these issues with the housing provider. They involved a local community centre in this work. As the housing group got involved in the community centre, they met a group of eco activists who were campaigning to improve the urban environ-

ment in the town. They encouraged the housing group to work on improving the green space around their apartment blocks. Doing this helped the housing advocacy group in several ways. First, they could achieve some positive improvement in the housing estate, they saw this benefiting their children and they provided a programme of activity to engage young men in the area. Second, it assisted their advocacy to be seen by the housing provider to be making an improvement in the estate, and to be working positively rather than ‘just complaining too much’.

Disconnection from daily practice The focus on global issues and economic and social policy is central to many of the widely used texts. An important stimulus of concern is the work of the international social work organizations. In the early twenty-first century, these shifted their policy interests towards global issues (Askeland & Payne, 2017: 26–30), including a Global Agenda for Social Work and Social Development (International Association of Schools of Social Work, International Federation of Social Workers & International Council on Social Welfare, 2012). This responded to increasing concerns about environmental issues, stimulated also by global economic difficulties after 2008 (Truell & Jones, n.d.). Eco issues were among the main concerns, two of the four pillars of the Agenda being: ‘promoting sustainable communities and environmentally sensitive development’ and ‘promoting wellbeing through sustainable human relationships’ (Truell & Jones, n.d.: 7). Many writers have dealt with environmental issues as matters for policy advocacy or for developing professional and public interest, rather than as concerns to be addressed with individuals, families and communities in daily practice. For example, looking at Dominelli’s (2012: 25) approaches to green social work, summarized in Figure  16.6, there is little direct concern with criminality, education or health, all important issues to many people living in poverty or under environmental pressure, and to social work. There is also no direct focus on abuse, caring, security or ageing, all matters of concern in the work of many social workers. Many of these issues would be addressed as part of working on the broader social issues raised by green social work. The direct concerns of everyday social work, however, are not in the foreground of the objectives of green social work. Rather, work on them is an instrument for tackling the wider issues addressed by such theories, and progress on green issues has the potential to make a strong contribution to the relevance of social work to public debate on environmental problems (Truell & Jones, n.d.). Many writers in the main eco practice texts, however, seek to adduce ways in which environmental issues can be brought forward in everyday practice, and I review some of this material in the applications section in this chapter.

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Major statements Early works created interest in eco approaches. An ecocritical perspective (Matthies, Närhi & Ward, 2001; Närhi, 2004) deriving from Finnish and German literature promoted a structural, participative and preventive approach to community social action as an alternative to American ecological systems theory. A critique by Coates (2003) of 1990s social work theory on ecology, and a review of historical and philosophical sources on ecological concerns, is an influential early forerunner of environmental social work. He focuses on promoting environmental awareness and global consciousness as important adjuncts of social justice. An American text (Mary, 2008) emphasizing environmental sustainability also picks up cultural and spirituality issues in thinking about the ‘web of life’. Three recent influential collections of articles (Gray, Coates & Etherington, 2013a; McKinnon & Alston, 2016; Matthies & Närhi, 2017) provide a range of accounts of policy and practice relevant mainly to environmental sustainability and ecosocial transition. The only comprehensive single-author statement of ecological theory to achieve widespread prominence in Dominelli’s (2012) Green social work, offering a social change perspective, and I discuss this as the example text in the applications section of this chapter.

Wider theoretical perspectives Eco practice has close relationships with other social justice and change perspectives. Feminist, critical, anti-discriminatory and multicultural identity practices all have elements that make connections with it. Examples include: ●●

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Ecofeminist movements, which see environmental and gender injustices included in a constellation of intersecting social concerns created within capitalist and economic liberalism, and connected with an industrialized, urbanized model of economic developments (Gaard, 2019). Conservative white men concerned with economic and business development are an important source of climate denial, devaluing nature as they devalue women (MacGregor, 2017). One critique is that ‘the environment’ in environmental social movements is sometimes portrayed as a single phenomenon, rather than as a range of local issues with different meanings within the population, and women’s social constructions of important environmental issues are devalued and stereotyped. Critical practice has a long-standing concern with the poor physical environment of working-class housing. Working-class movements have similarly supported access for urban working-class people to the countryside to combat some of the health issues. Pollution and health inequalities have been associated with environmental degradation owing to industrialization and urbanization, which is also relevant to social justice.

Cultural and ethnic diversity provides opportunities for creating a richer social environment, but it is often treated in a divisive and excluding way. Promoting social inclusion by proactively encouraging people to become engaged in mutual help and community involvement makes the best use of human and cultural resources in any community. Boeck, McCullogh and Ward (2001) propose that any eco approach to social inclusion should incorporate both

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the British emphasis on the redistribution of resources and the French tradition of focusing on social capital, including the ways in which relationships can exclude social groups. Although primarily seeking significant social change, eco practice recognizes the strengths offered to stressed environments by individual community, and family responses to environmental difficulties. It also acknowledges the stress caused to individuals, families and communities by environmental change and disaster. Consequently, because environmentalism is a widely supported ideology, many people are committed to it separately from their social work roles, and practitioners might easily use its precepts alongside other practice theories. As the debate section of this chapter makes clear, an essential issue in understanding eco practice theory is its distinction from ecological systems theory. Practitioners need clarity about their position on these distinctions.

Connections Different forms of eco practice Reviewing conceptions of eco practice in this chapter’s debate section, I identified different approaches to practice. Coates (2003) outlines the basic ecological ideas used in social work, set out in Figure 16.3. The idea of ‘the importance of becoming’ means seeing possibilities in situations that we are dealing with – what realist theory (see Chapter 2) calls emergent properties – rather than only what exists now. It also connects eco concerns with spirituality because Indigenous population groups place a concern with indigenous spirituality alongside a concern for the guardianship of nature. Looking at this analysis points up the ways in which ecological theory focuses on social connections and positive engagements between the environment and individuals

Develop caring communities Build activities benefiting the common good

Integration and connectedness

Promote active partnerships

The wisdom of natural things

Build capacity in individuals and communities

The importance of becoming

Help decentralized, localized decision-making

Maintaining diversity

Promote community health and social resilience

Relationship in community

Promote environmental and social justice Reduce human and ecological stress, grief and loss Use natural methods of healing and spirituality

Figure 16.3  Basic ecological concepts and social work practice implications Source: Coates (2003).

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and their communities. This sense of the positive aspects of connectedness is also important to feminist theory (see Chapter 17). Liberal or neoliberal economic policy gives priority to economic rather than social development and writing on eco practice makes connections with concerns about the environmental sustainability of such policies. Chapter 10 shows that theory about macro practice and social development tried to get to grips with some environmental concerns by including social development in civic, economic and political development. Approaches such as Dominelli’s (2012) green social work connect the global concerns of the ecological critique of modern industrialized and urbanized society to social work practice. Eco practice, however, seeks alternative economic structures, seeking collective and participative economic growth.

The politics of eco practice Eco practice is a recent development in social work thinking, and it has not been a substantial part of the politics of social work theory. A tight group of writers based in or with connections to Australia, Canada and Finland are the main protagonists. They are also involved with critical theory debate and with connections to writing about social construction and in countries where concerns about Indigenous peoples have an important influence on social work thinking.

Values issues Coates and Gray (2019) argue that an ecocentric turn in social science and social work thinking requires a change in the values of the profession, as well as in wider society. Conventional environmental consciousness builds on a rationalist view of environmental sustainability. It suggests that the answer to environmental problems lies in large-scale changes, for example in modes of power generation, whereas energy conservation and the more effective use of energy can also be developed in alternative economies through local support and individual and family action. Besthorn (2003, 2011, 2013; van Wormer & Besthorn, 2017) identifies the radical ecology of Naess (2008) as an important ethical position about the eco issues that have influenced this ecocentric turn in social work. Deep ecology decentres human beings, placing them within the whole of nature. If you do this, you cannot see the survival of human beings as more important than the survival of animals or of the natural environment. Good stewardship of the environment is not only for the benefit of humans, but also for the environment itself and other species within it, which must be viewed equally with human beings. Eight principles of deep ecology (Naess, 2008: 111–4) describe this approach: ●●

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The flourishing of both human and non-human life has inherent value, independent of whether non-human life is useful to human beings. The richness and diversity of all life-forms have value in themselves and contribute to the flourishing of life.

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Human beings have no right to reduce this richness and diversity, except to satisfy vital needs. Human interference with the non-human world is excessive and worsening. Policy must be changed to allow economic, technological and ideological structures to create a joyful experience of interconnectedness. The ideological change required is to appreciate the value of life in its different forms, rather than increasingly high standards of living. People who subscribe to these views have an obligation directly and indirectly to participate in attempts to make the necessary change.

This set of value statements provides a basis for taking up concerns identified within the social work literature. They also justify the incorporation of environmental activism in social work responses. Brueckner and Ross (2020) present a similar position. They argue that social work cannot be concerned only with justice and well-being for human beings. Eco-values of love, non-­ violence and justice are as relevant to the environment, and its flora and fauna. There is also a public interest in effective government, which includes both activism and social work, to maintain nonviolent respect for all living things. Ross (2020) argues that a ‘love ethic’ is an essential part of a social work that is empathetic, compassionate and nonviolent; this is linked to Gandhi’s conception of the importance of nonviolence in achieving social justice, which we noted in Chapter 14. To be concerned with these factors in interpersonal relationships with human beings means that we must in justice and equality also be concerned with them in relationships with the environment and nature. Peeters (2017) connects eco practice with the idea of a ‘commons’ as an alternative economic system. Contemporary societies require a diverse range of economic systems, and this permits less environmentally destructive options, in which human cooperation and interdependence would be valuable. He argues that an important ethical objective of social work is to achieve solidarity, working towards the public good, in partnership with the state, civil society and families and communities. This could offer an economic and social context, more favourable to and respectful of the natural environment.

Application Collective eco practice Discussing the debates about and the politics of eco practice, I noted application is an important issue for eco practice. Two targets for practice are: ●●

Issues of local importance, where environmental impacts of industrialization and urbanization have effects on individual, family and community well-being. Practice is place-based, so that approaches to people’s well-being responds to the ecological, economic and social needs of local communities (Rantamäki & Kattilakosli, 2017). Case examples include food aid (Kortetmäki & Silvasti, 2017; Gamble, 2017; Leskošek & Zidar, 2017), gardens, leisure and recreation (Shepard, 2013, 2017; Leskošek & Zidar, 2017), health (Boetto, 2016), ocean and marine resources (Taylor, 2013), pollution and risk associated with mineral

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extraction (Ranta-Tyrkkö & Jojo, 2017), scarce water resources, (Stehlik, 2013; Alston, Whittenberry & Western, 2016b; Gamble, 2017), slum housing (Ranta-Tyrkkö & Das, 2016) and transport (Shepard, 2017). Broad environmental policy issues, where people are affected by global or at least widespread concerns. Case examples include climate disasters (Tester, 2013; Alston, 2017) and renewable energy (Rambaree, 2017), both deriving from climate change.

A variety of methods are proposed for dealing with issues such as this. Many involve small-­ scale group and community interventions, encouraging individuals to find common cause with others affected by similar issues. This adopts macro practice, social development and social pedagogy methods (see Chapter 10) and empowerment and cause advocacy (see Chapter 14).

Holistic practice with individuals and families Närhi and Matthies (2001), an early source for ecocritical practice, identified characteristics of eco practice as: ●●

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holistic analysis, drawing on the needs of the global environment and including environmental impact analysis of the social area in which the social workers are operating; this will also involve citizens in planning and social action relevant to their interests and needs; promoting the positive use of natural resources and self-consciousness about lifestyles that are respectful of environmental resources; concern for the social environment and cooperative networks through which services are provided, especially schools and health and social care agencies; ‘adventure pedagogy’, which develops specific networks to promote life opportunities for people; Matthies et al. (2001) refer to young people, but it is possible to imagine such practice extended to disabled people, people with mental illness and older people. networking and social support systems to work with disabled, mentally ill and learning-­ disabled people and with older people.

Holistic practice meant that people’s entire life context, and not merely their social relationships, should be the focus of attention. Practical environmental and green projects, and shared living and workshop projects for young people all enhance people’s self-understanding of political and social relationships and develop social self-consciousness and concern for the environment. Current thinking encourages non-sustainable lifestyles based on employment that increasingly does not exist because of globalizing social forces benefiting capital- and pollution-­intensive industries. Moreover, sedentary lifestyles have been unhealthy, using highly manufactured foods and encouraging smoking. People should be helped to develop more inspiring, diverse and stimulating environments than the gloomy and excluding housing living conditions they are often given. Boetto’s (2016) account of practice interventions proposes a range of useful eco practice interventions for everyday social work, and I summarize these in Figure 16.4. These points are primarily about practice with individuals and families, but similar points and examples may also be applied to groupwork and macro practice. The main emphasis in her suggestions

Eco practice

Engagement stage First interview in a natural setting Reception and interview with natural elements Sounds, pictures, videos of natural scenes Promote sustainability in available information

Assessment stage Can health issues be improved by contact with the natural environment? Expand client’s and family’s activities in the natural environment Consider interaction with animals Does poor environment lead to health problems? Are support networks adequate and connected to natural environment? Are individual and family issues related to environmental degradation or hardship?

Examples

Intervention stage

Adequate healthy and nutritious food? Increased fuel or power costs? Cooling, heating, insulation adequate? Environmental hazards near to home, school or work? Environmentally friendly household appliances?

Opportunities for improving health/well-being through natural environment Can you improve health by improving the physical environment? Consider alternative economies in education, leisure and work Consider energy and insulation costs Develop awareness, provide information and prepare for environmental disasters

Examples

Evaluation and review stage

Interaction with the outdoors Useful eco-therapies Work on social isolation and support networks Consider interaction with animals Can you remove environmental hazards?

How did we use the natural environment? Can we do better? Did we and can we promote sustainability of the natural environment? Did we and can we improve individual, family and community resilience to environmental disasters, degradation and hardship? Did we and can we improve access to information and other resources to address environmental decline, disasters and alternative economies?

Figure 16.4  Boetto’s eco practice strategies Source: Boetto (2016: 63–74).

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about eco practice is to maintain your own awareness of where you can include environmental and sustainability issues in everything that you do. If you achieve this, it is quite easy to include at least some element of eco practice into many situations you deal with. Important ways of doing this include the concepts of: ●● ●● ●●

●● ●● ●● ●●

environmental degradation in the places where clients live; environmental hardship affecting them or their families and communities; working on resilience to environmental disasters such as fires, flooding or food pressures; thinking about energy, food and fuel conservation and poverty; thinking about social networks and connectedness; looking for alternative economic options; working on gains in health and well-being that can be achieved through involvement with the natural environment and animals.

The increasing experience of environmental disasters and political conflict associated with social change and pressures can provide the basis for active work in the recovery phases, as people have gained experience of solidarity and cooperation during disasters and their immediate aftermath (Ramon, 2008; Lavalette & Ioakimidis, 2011; Alston, Hazeleger & Hargreaves, 2016a). It often leads to creative possibilities to traditional services, and community and Indigenous responses can sometimes offer new ideas for intervention. The following case example is an example of the way that local communities trust and use traditional models, rather than official provision, following economic, environmental or political disasters.

Case example: Traditional fostering for children ‘dropping out’ of families in social conflict During a period of social conflict in East Africa, a local group of widowed women came together to develop shared funding for each other in an alternative economy. After a serious political conflict led to many children being orphaned and living on the streets, the women’s group became aware of their difficult situation. The women’s group worked together to provide traditional fostering for younger children who were being exploited by older children to take part in criminal activities. This picked up a cultural expectation that local families took in children who needed care, rather

than expecting families under stress to do so. They formed foot patrols to find children being exploited and took them into their homes, supporting each other to do so. Later, they staged drama and concerts to highlight the children’s problems in neighbouring towns, and this led to further children being identified in a more consistent manner. Their record of self-care and active concern meant that official systems came to identify trusted carers through the women’s work. Source: Luwangula, Twikirize and Twesigye (2019).

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Example text: Dominelli’s (2012) green social work Dominelli’s starting point is social crises and disasters. Unequal distribution of power and resources means that inequalities are structured into all social relations. Faced, therefore, with a social disaster, such as poverty or industrial pollution, or an environmental disaster, such as an extreme weather event, there is social injustice because some people have less control of their environments and fewer resources to respond to disaster than others. People are interdependent with social, cultural, economic and physical environments, all of which contribute to their personal and social identities. Green practice intervenes both to protect these environments and also to enhance people’s identity and well-being, mitigating or eradicating the environmental injustice. Dominelli’s definition of green social work is long and complex, and I have divided it into two of its aspects: ●● ●●

the elements of green social work, presented in Figure 16.4; its approach to practice, presented in Figure 16.5.

These elements start from seeing human beings as interdependent with each other, with social groups and institutions and with the physical environment. You cannot deal with individuals without taking up these interdependencies and you cannot deal with social issues in groups, communities and in social action without also being concerned with their human consequences. Four elements of these interdependencies are significant, and how each plays out has an impact on all the others. For example, the social organization of relationships affects flora and fauna in their physical habitats. If the organization of social relationships ignores the

Social organization of relationships

Flora and fauna in their physical habitats

People’s interdependencies

Interpersonal behaviours undermining well-being of humans and the environment

Figure 16.5  The elements of green social work Source: Dominelli (2012: 25).

Socioeconomic and physical environmental crises

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significance of those habitats for the survival of flora and fauna, people will live in degraded environments and will lose access to sources of food and other resources. Crises in socioeconomic and physical environments similarly have an impact on interpersonal behaviours that undermine human and environmental well-being. For example, fiscal crises (crises that arise from problems with government and official financial systems) that reduce expenditure on welfare and social services increase poverty. This has an impact on the quality and range of food that poorer people can buy, reducing the age at which people start to become disabled as they grow older, and eventually the length of their lives.

PAUSE AND REFLECT  The impacts of the elements on each other I have given two examples of the impacts of elements on each other, because of people’s interdependencies. To understand better the interactions of all the five elements with each other, take each element in turn and identify your own examples of interactions with the other four elements.

Some suggestions You could look at how socio economic and environmental crises affect flora and fauna, people’s interdependence and the social organization of their relationships. The green social work practice approaches propose the areas of people’s lives on which it is most productive to focus. For example, if you are asked to help a young family to improve their quality of life, you might help them to look at ways of reducing their dependence on expensive but convenient unhealthy mass-produced food and passive sources of entertainment. To do this, you could work towards the shared purchasing of locally produced healthy food and facilitate learning about family participation in cooking and eating fresh ingredients. This would contribute to working on exploitative production and consumption, eliminating poverty and using natural resources better.

PAUSE AND REFLECT  Shifting your approach towards green aims Think about at least two recent situations in which you were involved. How could you have included one or more of the green approaches in what you were working on?

Some suggestions If you are working with several families in the same poor environment, you could have picked up improving solidarity by encouraging groupwork among parents, or got them to work together to tidy local shared spaces or to develop regular children’s activities in the local park.

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Question exploitative production and consumption

Tackle structures distributing power and resources unequally

Eliminate poverty and oppressive ‘isms’

Promote global interdependency and solidarity in social relations

Use natural resources for all, not people with privilege

Protect the flora and fauna

Figure 16.6  Green social work practice approaches Source: Dominelli (2012: 25).

This might enable them to gain the connections they need to work collectively to argue for better resources for their local community, or to protect it from public expenditure cuts (Figure 16.6). Social workers’ professional position is damaged by reductions to publicly funded expenditure on poor people, so that they are unable to focus resources and time on their clients’ interests. Priorities are redirected so individuals and groups have to compete for limited resources, or participate in making priority decisions when they should be demanding increased resources. Finance is organized through banks or funds in which decisions are imposed, rather than shared, instead of more involving and participative institutions. The principles of green social work emerge from this position: ●● ●● ●●

●●

●●

respect living things together with social-cultural and physical environments; develop empowering relationships between people and their environments; advocate for embedding the social in economic activity, especially where it aims to address poverty; question development focused on industrialization, over-urbanization and over-­ consumption as the basis for social progress; promote social and environmental justice.

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Practitioners seek to include these principles in practice activities, and in everything they do, they seek the following three perspectives. These three important perspectives inform green practice. Holistic, sustainable practice means building co-production with clients and local organizations, with collective action enabling people to build resilience and that world view being incorporated into your joint actions. It is important to nurture both people and their environments, not seeing environment as just the social background to work with individuals. It is also necessary to build capacity in communities around clients to provide democratic spaces for collective work. ●●

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Dominelli contrasts a ‘big society’ response (this refers to a UK political initiative in the period 2010–15), which assumes that there are shared interests between wider society, with the capacity to deal with oppressed people and others living in poverty. Often, however, there are barriers to their participation. For example, they may not have the resources to benefit from new technology or renewable energy schemes, unless practical support, charity and business beneficence or state intervention helps them to overcome their exclusion. Social work may sometimes be able to make or organize interventions or promote collective action to overcome these barriers. Resilience needs to be reconceptualized from improving personal or family capacities to understanding and interacting with three dimensions. Practitioners need to evaluate the nature of the change affecting the person, family or community, the nature of their response and the direction of the outcome. These are: ❍❍ the nature of the change: whether it comes from inside the person, family or community, or from outside, and whether it is gradual or a shock; ❍❍ the nature of the person’s response: whether it is internal or external, and is to adapt to the change, to evolve in a new way or to transform; ❍❍ the direction of the resilience: whether it is towards thriving, surviving or failing. Alternative world views influence people’s responses to environmental issues. People are influenced by family, community, national society and international influences. They interact with physical environments and infrastructures, social and cultural norms, political and economic forces and spirituality, faith, affiliation and values. Practice, therefore, is built on these influences on a person’s agency; that is, their capacity to influence externalities, reflexivity about the influences on them, power relations and the resources and strengths present in their lives.

Dominelli identifies a range of areas where this occurs and suggests alternative structures to help individuals and communities aim for in each case. I summarize these in Figure 16.5. The overall approach to each of these areas is: ●●

●● ●● ●● ●●

reduce personal and environmental potential for jeopardizing health, both physical and mental health; modify hazards; decrease vulnerability to hazards and increase resilience; improve preparedness for future disasters and crises; prevent and mitigate disasters (Figure 16.7).

Eco practice 447 Issue

Why is this an issue?

Practice possibilities

Industrialization and urbanization

Capitalism gains economic efficiencies, but urban infrastructure destroys natural habitats, competition is dehumanizing and offers poor housing, employment and social provision for people in poverty.

• De-urbanize cities with parks, allotments.

Industrial pollution and environmental degradation

Climate change, renewable energy

Giving priority to economic over civic and social development generates both industrial accidents and continuing degradation, for individuals, families and communities to deal with. This raises issues of environmental justice, since oppressed people affected by poverty are most likely to lose opportunities and resources as a result.

Other eco issues have led to climate change, with increasing risk of serious climate disasters, and movements to enhance renewable energy.Environmental injustice and racism often means that oppressed and poor peoplerequire inclusion in efforts to respond to climate issues and reducing their risk.

• Develop microfinance to allow people to control employment locally. • Use social enterprise to return resources to the locality. • Redefine resilience to create thriving sustainable community and other relations. • Care for people affected and their carers. • Develop social capital, support networks through local projects, e.g. clean-ups. • Work on mental health consequences of degraded environments. • Seek to distribute environmental risks and benefits fairly. • Facilitate local participation in environmental decisions. • Use local community cultural traditions, knowledge and ways of life. • Recognize and support ability of people and communities to make successful choices.

Environmental crises, social conflict and mass migration

Environmental crises often led to serious incidents, recurrent events such as famine, social conflict and movements of people, including international on in-country migration,to reduce risk and find security.

• Disaster interventions need to be holistic and inclusive of all faith and social groups. • Encourage collective work to reduce risks. • Support planning and preventive work. • Ensure consistent organization of immediate responses and volunteers. • Mediate between groups where conflict is a risk or arises, respecting the full range of interests and concerns. • Take special care of children and adults, e.g. older, disabled or mentally ill people.

Natural disasters and marginalization

Emergency aid is needed, but is often extended, in part because political action to resolve contentious issues is avoided. As a result, people are marginalized by not being involved in preventive preparation for disasters and planning to avoid disasters fails. Consequently, people are unable to build basic competences, and make use of opportunities for learning, and this does not prepare them for secure work and community life.

• Preventive work to develop resilience and minimize danger. • Support during emergencies. • Help with rebuilding lives. • Balance protecting the environment with increasing standards of living. • Co-produce knowledge and skill to increase future sustainability. • Build reciprocation in caring for other people and the environment.

Scarce natural resources and intercountry conflict resolution

Conflicts over resources can be inflated because of the importance of place to people and needs for suitable living space. Shortages of housing, employment, water and the need for renewable energy to replace non-renewable and environmentally damaging fossil fuels arise.

Figure 16.7  Issues and objectives for green social work Source: Dominelli (2012: 42–170).

• Involve the caring triangle of social work, family and community, and employer and business responsibility for social consequences. • Emphasize human rights to engage responsibility from different sources of power.

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Conclusion: using eco practice theory Eco practice is a twenty-first-century development responding to political and social debate about environmental concerns and disasters. Its focus is environmental justice: fair treatment of different communities, individuals and groups affected by environmental hardship. While this has connections to critical theory, and environmental activism is an important social movement, many of the ideas available in eco practice theory involve awareness of issues such as sustainability and require inclusion of the natural environment in interpersonal practice. Eco practice seeks incorporation in all practice. Its social justice processes involve adopting Matthies and Närhi’s analysis of social transition, to shift agency practice and structures towards promoting environmental justice through combating environmental hardship. By focusing on environmental disasters and degradation, eco practice aims to make a role for social work in responding to disasters and emergencies, and to direct that response towards a new form of collective economy, one that connects working for human well-being with sustaining the natural environment.

Additional resources Further reading

Dominelli, L. (2012). Green social work: From environmental crises to environmental justice. Cambridge: Polity. Gray, M., Coates, J. & Hetherington, T. (Eds.) (2013a). Environmental social work. Abingdon: Routledge. Matthies, A.-L. & Närhi, K. (Eds.) (2017). The ecosocial transition of societies: The contribution of social work and social policy. Abingdon: Routledge. McKinnon, J. & Alston, M. (Eds.) (2016). Ecological social work: Towards sustainability. London: Red Globe Press. These four books are the major current texts in this field, offering a variety of perspectives and case studies from around the world. For practice theory, McKinnon and Alton’s edited collection is perhaps pre-eminent because many of the authors provide both case studies and analysis of practice interventions. A more theoretically complex analysis is contained in the contributions in Matthies and Närhi’s book.

Websites https://jyx.jyu.fi/bitstream/handle/123456789/13326/9513918343.pdf Kati Närhi’s (2004) PhD thesis on the Finnish ecocritical and ecosocial approach at an early stage; it is available on the Internet.

CHAPTER 17

Feminist practice MAIN CONTRIBUTION Feminist practice focuses on explaining and responding to the oppressed position of women in many societies. This is important because, in most societies, women are the main clients of social work, and most social workers and social care workers are women. Feminist perspectives, therefore, help everyone – not only women – to understand how their social role and position is worked out in society; in particular, they allow the female majority of social workers and their clients to practise in solidarity with each others’ world views. Feminist practice contributes practice methods and skills in collaborative dialogue and groupwork that can be used to achieve a consciousness of issues that affect women in their social relations within societies. These can also be applied more widely.

MAIN POINTS ●●

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Feminist thinking has experienced several waves of development. It concerns how, in many aspects of life, women and their social relations are dominated by social relations based on men’s assumptions. Alternative feminist perspectives highlight different ways in which oppression may affect women. Critiques of feminism in social work question whether using it excludes men and risks limiting feminist practice to issues of concern to women rather than offering a practice theory that may be widely applied. Pro-feminist practice by men is appropriate. In social work, feminist thinking has raised concern for women’s conditions, developed a women-centred practice, focused on women’s distinctive voice and identity and celebrated women’s diversity. Specifically, feminist practice focuses concern on women’s experiences and roles in socialization and children’s well-being, their role in the reproduction or development of social and economic systems, and the importance of reconstructing private relationships on a more equal footing.

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Feminist practice seeks commonalities between female practitioners and the women they work with, and takes place in a dialogic, egalitarian relationship. This has been an important contribution to critical theory. Postmodern feminism explores complex diversities in gender relationships and stresses gender fluidity rather than binary divisions such as male/female sexuality. The ethics of care position emphasizes the feminist view that caring derives from interpersonal connections within relationships, rather than from rational, planned service provision, and a feminist virtue ethics stresses the development of virtues in a community context to provide support in resisting oppressive power relations.

PRACTICE IDEAS ●●

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Consciousness-raising (connected to the critical practice of conscientization; see Chapter 16) is a strategy for stimulating awareness and change. Reflexivity was first used as a research tool and subsequently adapted as an element of practice. Dialogue is a process through which different perceptions are described and connected or opposed to each other demonstrating egalitarian relationships. It acts as the vehicle of a practice that values and empowers women and all clients. Social and personal identity and the social processes by which it is formed and changes are important in creating and intervening in diverse relationships. The ethics of care position argues that women’s caring arises from connectedness.

THE DEBATE SUMMARY Three areas of debate are sometimes raised around feminist practice: ●● ●● ●●

Does focusing on feminist practice exclude men and issues that affect men? Does feminist practice make women’s issues a ghetto? Are women’s issues a special interest rather than a broad practice theory?

Debate about feminist practice Debates about feminist theory reflect attitudes towards women and feminism, in particular existing gender inequalities. Feminism asserts that women are oppressed by social structures and relationships in a society that privileges men and male views of social priorities, excluding and devaluing women and women’s views of society. This leads to the oppression of women, particularly those with little social or economic power. Since that oppression derives from inequalities arising from gender divisions, it is important to understand how the experience of this oppression makes it difficult for women to achieve their aspirations and attain well-being. It also makes it difficult to intervene to challenge and change that oppression.

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Does feminist practice exclude men and men’s issues? One criticism of explicitly using feminist theory is that focusing on women’s issues excludes equally important concerns that mainly affect men, including criminal violence and exploitation in employment that is different in nature from women’s oppression in these situations. And does a feminist theory exclude men from using it? It might also fail to examine the effect of gender divisions on men’s problems. In addition, a focus on women’s issues may exclude men’s participation. While a feminist criticism of many societies is that women are assumed to take on caring roles and the management of social relationships in families and more widely, there has been no concerted attempt in social work to engage men in family and social care. But there is evidence that if a caring role is required of them, particularly in intimate relationships, they do perform it. This has been shown, for example, in Parker’s (1993) study of men’s care for wives affected by severe disability and Fisher’s (1994) discussion of men’s caring role in community care services generally. By concentrating on women, the critics say, feminist ideas fail to pick up important opportunities to change gender relations and roles for the benefit of both sexes. Against this point of view, feminist theory points to evidence of widespread gender inequality and the consequences of the exploitation of and violence towards women, as well as the neglect of their needs. Recognizing this, some men support women’s movements and engage in pro-feminist theorization. Pease (2016), for example, suggests that men should act to take responsibility for their own and for other men’s sexism, and both women and men working with men should develop an analysis of how masculinity is formed and may be changed to treat women with justice. All people benefit from equality, so men benefit from feminist thinking and action that leads to equality. A diversity of masculinities is possible, and men can model alternative behaviours and work to develop pro-feminist work in individual, group and community interventions. This is important especially when dealing with men who are dominating and violent in their relations with women. Using feminist theory is useful because most social work involves women working with other women; feminist ideas inform this majority practice. In addition, in most societies, women are significantly more affected by poverty and many other social disadvantages than men are. Against these points, women may be the main clients of social work only in particular welfare systems. Some of the Nordic welfare systems, where social work is associated with the social security system, generate social work with men more easily, since men are referred for social work when seeking financial benefits. Moreover, there is evidence that men fail to seek healthcare and may delay medical intervention when their health would benefit from it. The focus on women clients may therefore be a product of patriarchal assumptions in service provision rather than a characteristic of social work practice. The focus on women might also be a product of preference or comfort among women practitioners for working with the female members of families rather than the male. For both men and women practitioners, women may be more accessible to work within the home, while male family members need to be sought out in other settings. This is possibly also true for men, since male practitioners might feel more able to influence women because men are accustomed to dominate and control women. The organization of social services in the daytime, involving domestic visiting, family care issues such as childcare and care for frail older people, generates a focus on women, given current social assumptions.

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Does feminist practice put women’s issues in a ghetto? Another problem with the explicit use of feminist ideas is that it places women’s issues into a ghetto as an area of special interest, rather than gaining credence for feminist analysis more widely. Orme (2003) argues that feminist caution about pursing the path of creating extensive feminist models of general practice renders feminism invisible and its critique of how social agencies operate ineffective. If it were more present, both sexes would benefit from its insights. The priorities of feminist social work may be justified, however, because the history of social work and its role in surveillance on behalf of a patriarchal welfare state means that women remain socially oppressed and social work does little to alter that, and contributes to it. Resistance to feminism lies in the refusal of male institutions, including marriage, employment and social work agencies and education, to give up their power. This is the other side of seeing feminist ideas as a matter of special interest rather than a general critique of social ideas and practice. The social relationships that are critically analysed by feminists do not change, even though feminist ideas are not directly contested in social work. For example, there have been continuing criticisms of the lack of women in senior positions in social work organizations in proportion to the number of women in the organization, and, in universities, of women’s lack of influence over and leadership in academic work. Reactions have often been defensive, and no theoretical analysis justifying these inequalities is presented by the opponents of feminism. Discrimination against women continues to be commonplace in the workplace and in welfare provision, and women are disadvantaged economically and socially everywhere, especially in resource-poor countries. There is thus clearly an issue to be addressed by a profession that tries to help people in this position.

Can feminist theory offer a broad theory of practice? Connected with these areas of debate, another question is whether feminist practice can be used with issues other than those that particularly affect women. Services for women affected by domestic violence, for example, can easily be understood as a location for feminist practice. You can argue, though, that there is no reason why a feminist approach would be helpful with, say, intellectual and physical disability or mental health problems, where both sexes are affected, or with crime or drug abuse, where men are the main group affected. A further issue in recent years is whether feminism limits anti-oppressive practice to just one area of oppression, since recent social work theory development concentrates more on anti-oppressive practice in several areas, incorporating rather than forwarding feminist thinking. There are several arguments against these points. First, where women are affected by any of these issues, their experience may be different, and that difference may construct the position of women in society. Practice, therefore, will need to help women make sense of their experiences of these issues in a different way; moreover, that sense-making will contribute to broader understanding for practitioners of how the issues affect everyone in society. Second, following from that, better understanding of all social issues and practice to respond to those issues comes from appreciating the range of perspectives, which includes a feminist view and women’s views. Third, a feminist analysis can offer insights that inform practice in any area, whether women are the practitioners, the clients or affected by the issue. Gorey et al. (2002), cited by Milliken (2017: 197–8), review comparisons of feminist with other forms of practice.

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They show that feminist practice characteristically addresses the importance of gender, unequal resource allocation, tries to eliminate false dichotomies, works on rethinking power relations and offers a strengths perspective. Its clients appeared to ‘do better’ than clients experiencing other kinds of intervention. This suggests that commitment to feminist perspectives is not inappropriate for any kind of practice,and might well be helpful to men’s practice. All this indicates that feminism is still important to many women and to social work, and should not be subordinated to critical or anti-oppressive practice.

Major statements Many texts about feminist practice reflect the ideology of feminist thinking and so are collective works. Examples are two recent influential collections (Wendt & Moulding, 2016; Butler-­ Mokoro & Grant, 2018). Dominelli’s (2002a) Feminist social work theory and practice is a rare contribution in that it provides a coherent account of a structural perspective on feminist theory that has application to practice. Earlier statements have been provided by Dominelli and McCleod (1989), Hanmer and Statham’s (1999) Women and social work and the edited text by Bricker-Jenkins, Hooyman & Gottlieb (1991). These give extended theoretical analyses, useful explanations of issues of concern to women in social work and very useful accounts of practice, respectively, but they do not incorporate more recent developments in postmodern feminist thinking. Other early edited collections (Burden & Gottlieb, 1987; van den Bergh, 1995) reflect a range of perspectives on practice issues. White’s (2006) account of feminist social work is based on evidence collected from interviews with feminist women, this approach representing feminist styles of research and analysis. It gives a sense of collective endeavour to create theory by two means: first, inclusively through dialogue, the external process in which women debate issues in relationships of equality; and secondly, through dialectic, the internal process through which people argue out in their minds opposing and different ideas to form the basis of their decisions, thoughts or actions. Because White exemplifies feminist thinking in this way, and presents a practical account of what it is like to practise using feminist ideas, I use it as the example text in this chapter.

Wider theoretical perspectives Historical perspective Feminism has a history stretching back for more than a hundred years, and I set out some frequently debated ‘waves’ of development of feminist thinking in Figure  17.1. I have also included the idea that there was a phase of postfeminism, during which it was assumed that the main aims of feminism had been achieved. You can analyse this backlash as a postfeminist era, in which assumptions that equality is an unachievable false goal replace social movements aiming to free women from social domination by men and male assumptions. This view proposes that feminism has spoiled many female advantages and preferences, for example, being free to use female attractiveness to men to gain social advantages, or being able to prefer being a full-time mother rather than working.

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Waves

Objectives and characteristics

Period

First wave

Political and legal rights to vote and to own and inherit property.

Nineteenth century to 1930s

Second wave

Inequalities of opportunity in work, political influence and the public sphere, connected with attitudes towards woman in the private sphere, e.g. in family and interpersonal relationships.

1960s onwards

Third wave

Postmodern feminism focused on personal and social identity, inclusivity, representing and valuing complexities and differences in women’s experiences. Challenging cultural, political and social power structures subordinating women. Understanding intersectionality and making links with other oppressions e.g. race, disability.

1990s onwards

Post-feminism

The idea that the objectives of feminism have been achieved and further activism is not required.

1990s

Fourth wave

Representation of women’s issues and experiences through Internet and social media, asserting bodily autonomy or challenging, in the public arena, misogyny, oppression, sexism and violence against women.

2010s

Figure 17.1  Waves of development in feminist thinking Sources: McLaughlin (2003), Milliken (2017: 193), Foster (2018a), and Wendt (2019).

McLaughlin (2003: 47–69) suggests that the wave analysis does not clearly provide for an important element in feminist thinking, standpoint theory. This argues that different groups vary in their knowledge and understanding about society, providing them with alternative points of view (standpoints) on social issues. Some standpoints have better evidence to support them and can therefore be more appropriately applied in practice and in dealing with the world. Women’s position in societies is in opposition to that of men, who often operate with an abstract idea of masculinity, while women can draw on concrete experiences of the social structures that oppress women. This places them in a better position to achieve a more realistic understanding of oppressive social structures, although they may need to use consciousness-­ raising to gain access to their experiences, which may be hidden by oppressive social assumptions.

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Alternative feminist perspectives Since the 1960s, within feminism, alternative perspectives have emerged to explain the inequalities between men and women. There are various depictions of these, again debated, but I try to distinguish the main ideas represented in the social work literature in Figure 17.2. While there are overlaps between different forms of feminist theory, they also criticize each other. Liberal feminism is criticized for ignoring real differences in the interests and experiences of men and women. In addition, promoting equal opportunities – the main prescription of liberal feminist theories  – is ineffective in furthering women’s equality, since opportunities do not always lead to fair outcomes if other aspects of inequality do not allow

Orientation

Main emphasis

Practice implications

Liberal or equal rights

Improve equal rights, especially in workplaces and family responsibilities.

Change women’s position with equal opportunities law and change gender assumptions by shifting social conventions in family and work, and alter socialization so children do not grow up accepting gender inequalities.

Radical, lesbian and cultural

Challenge patriarchy, aspects of social systems that give men power and privilege.

Value and celebrate differences between men and women. Promotes separate women’s structures within existing organizations and women’s own social structures.

Marxist or Socialist

Women’s inequality comes from class structure and women’s role in capitalism to reproduce the workforce.

Aim for equality in domestic tasks and childcare and intersection of women’s with other forms of oppression, e.g. ethnicity, disability. Analyse and seek alternative ways to mee diverse interests.

Black or multiracial

Women’s oppression is heightened by black and minority ethnic heritage and status.

Connect with other campaigns for social justice, recognize diverse experiences of different groups. Link to family experience of slavery and historic family patterns in African and other minority ethnic heritages.

Postmodern, including queer theory

Complex social relations create social constructions of gender, and surveillance and discipline in men’s interests.

Transnational, Women affected by postcolonial exploitation across national borders, in colonies, postcolonial cultural domination and legacy of slavery.

Challenge rather than accept categorization. Avoid surveillance and discipline in women’s social roles, e.g control of sexuality, child development, youth offending, restrictions on liberty and opportunities for older and disabled people. Identify, challenge and prevent cultural legacies, e.g. childcare culture and transnational exploitation, child abduction, domestic slavery, female genital mutilation, online sexual abuse, trafficking women for sexual exploitation.

Figure 17.2  Feminist theoretical orientations Sources: Hill Collins (1986), Sands and Nuccio (1992), Dominelli (2002a), and Foster (2018b).

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women to make use of the opportunities. Radical feminism is criticized for focusing on gender differences and the common experiences of women, ignoring the diversity of interests among women. Emphasizing gender difference may play down women’s capacity to achieve social change and may trap them in a ‘victimized’ role. Socialist feminism is criticized by radical feminists because it mainly limits its analysis of power relations between men and women to economic power and misses, for example, male violence. Others say that the socialist focus on class and economic oppression offers inadequate explanations of patriarchy. As with all postmodern perspectives, postmodern feminism may be criticized for emphasizing the relativity of social understanding, in the same way as postmodernism is criticized more generally for moral relativity (see Chapter 11). This is integral to feminist thought, since it sees gender as socially constructed assumptions, rather than depending on the sexual identity of women. However, postmodern ideas emphasize how language creates different social perspectives and categories. It thus implies that ‘woman’ is not a single category, and diffuses the focus on women’s exploitation and oppression (Forcey & Nash, 1998). Some feminists, therefore, have been concerned that the influence of postmodernism has damagingly reduced the feminist focus on men’s oppressive power (Fawcett & Featherstone, 2000). Others, however, argue that it enables practitioners to understand complex gender and other relations.

Connections Three strands of feminist thinking identified by Orme (2013: 91) are: ●● ●● ●●

shared values and synergies between feminism and social work; practice theories providing prescriptions for practice with women and men; using feminist perspectives to understand gender in social work practice.

A well-developed feminist social work analysis exists. In a paper that was influential in initiating feminist debate in social work, Sands and Nuccio (1992) emphasize the importance of problematizing social and gender categories. This means avoiding taking for granted assumptions about social categories and the characteristics of people who are categorized in various ways. For example, we should not assume that women are natural carers for children and men are not natural carers merely because women have the biological role of having babies. Why should there be a simple either/or distinction? Taylor and Daly’s (1995) collection considers the historical development of women’s role as being subservient to men in general social conventions, the law, medical practice and religion, which have had a considerable influence on the development of social work. This identifies many areas in which gender categories are taken for granted. Van den Bergh’s (1995) collection examines issues of importance to women that have influenced feminist practice, including peace, social justice and violence against women. Domestic violence is a good example. Conventional attitudes often assume that women who ask for police help and later change their minds about prosecuting a violent male partner thereby waste police time. Feminist thinking recognizes the many social pressures that lead women to accept even a violent relationship. Examples of these pressures are the views of other family members, conventional assumptions about the importance of sustaining a marriage for the children’s sake, the sense of failure in an important relationship and the financial power that men sometimes have in a marriage. An important way of moving towards a

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position of justice for women in violent relationships is, however, to help them make decisions that take dealing with these factors into account.

Feminist and critical practice theory Feminism has been an important contributor to critical practice, as we saw in Chapter 15. This is because it is an important critique of taken-for-granted social attitudes in its questions about how gendered social assumptions affect relationships and social institutions. It is impossible to conceive of current-day critical practice without incorporating a feminist perspective. Feminism is also a significant contributor to critical practice theory. For example, Fook (2016), a major contributor to critical theory, states that feminism has been a major influence on her. Feminist ideas are, however, woven within her work rather than being explicitly identified. Healy (2000) sees feminism as going beyond critical practice. This is because it is open to a wider range of explanations of oppression than class and racial divisions are. In addition, it gives priority to interpersonal and personal experience as an expression of oppression and a contributor to social change. For example, a Marxist explanation of racial oppression claims that it arises from the need of capitalist societies to maintain an impoverished population available to take low-grade jobs. Feminism, however, would look additionally at how economic pressures on poor families make it difficult for women to facilitate their children’s education and interpersonal skills. Thus, the feminist view does not exclude the issues of socioeconomic class, but looks at more complex explanations of interpersonal and social relationships. Feminism is prepared to look at the interactions between different forms of oppression, rather than giving priority to one system of social oppression. On the other hand, Fook (2016) also sees feminism as part of critical practice because it refuses to take the present social order for granted. Much of Fook’s material on feminist social work particularly emphasizes the way in which gender difference and power are linked. Social and physical difference may become associated with the use of power in complex ways. For example, people may too readily give up making choices that might be open to them because they do not go far enough to deal with difficult relationships or issues. They might happily accept and value professional expertise or the help they receive, and might also enter into a dialogue in which they question particular things that do not suit them.

Case example: Money and power in a family relationship An older woman in a residential care home valued the care given her and appreciated her sister’s frequent visits to take her out. However, the sister also managed the resident’s money and was very careful with it. In one incident among many, the sister was slow to replace expensive batteries in the resident’s hearing aid, thus isolating her socially. The resident would not question this, because she did not want to upset her main support. When the care home manager raised concern about this at a review, the social worker got the sisters to discuss

this on the basis that small things are important when life is restricted by being in residential care. More broadly, having this incident questioned might mean that the sister would be more thoughtful about their different attitudes to money in the future. The social worker also thought about whether this behaviour might have been financial abuse of a vulnerable person. She judged that action might have been needed to protect the resident from misuse of her money if the sister had not shifted her stance.

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One of the important aspects of postmodern feminism, to which we now turn, is an awareness of the diversity of behaviour – the view that women are always oppressed and never the oppressor is not always true.

Feminism and postmodernism Sands and Nuccio (1992) and Healy (2000: 46–55) discuss some of the ideas that postmodern feminism contributes to social work, both focusing on poststructural theory. Poststructuralism, a set of theories of French origin, contests logocentrism – the idea that there is a single, fixed, logical social order that can be identified as reality. This connects with other postmodern ideas that question the possibility of understanding the world according to linear explanations of cause and effect. Consequently, there will be a wide diversity of social forms and behaviours. One of the important areas of postmodern feminism is that it addresses complexities and ambiguities in women’s lives (Healy, 2000: 42; Orme, 2013: 90). Orme’s (2003) criticism of some social work for people with long-term conditions is that it sets up a ‘male’ system for assessing need and allocating care services that relies on routinization and checklists. Generally, feminist thinking sees managerialist and rational systems as characteristic of male thinking and relationships, attributing less structured approaches to setting up systems as being more characteristic of female experience and thinking. First, this only partly represents the possibilities in the situation. Formalizing decision-making helps to permit greater equity and social justice in the provision of services, although it may dehumanize the way in which services are provided (Orme, 2003; Payne, 2009c). Second, formalized decision-making may also mean that people in more senior roles in care agencies, more often men than women, manage these ‘male’ decision-making processes to allocate inadequate resources, leaving female relatives or less powerful practitioners and carers to manage the human consequences of this lack of resources. Caring continues to be needed even if resources are inadequate, and there is evidence of both men and women accepting and negotiating caring roles in a complex interplay of relationships. Postmodern feminist theory acknowledges and seeks to understand this diversity and the multiple discourses that exist. It is criticized by structuralist writers such as Dominelli, however, because this emphasis on diversity makes it less easy to gain solidarity for political and social action to improve resources. Sands and Nuccio (1992) identify feminist thought that emphasizes positionality or both/and. Here, while engaging in social action for better resources, practitioners emphasize and document the universal experience of women in providing caring, and promote men’s support for the need for social change, while in other situations practitioners value and recognize diversity. Feminist thinking also gives an important role to identity and its sources in people’s social experience. People’s sense of themselves derives from myriad social relationships and the institutional and personal influences upon them (Jenkins, 2008). It is thus constructed in the social and historical period that they experience. Exploring the factors that create someone’s identity and how this relates to group membership is an essential part of postmodern feminism (Sands, 1996). It is also relevant to ethnic and cultural sensitivity (Chapter 18), because

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an important aspect of social identity is national identity and the factors that create it or may be assumed because of it. Postmodern feminism particularly focuses on the deconstruction of these sorts of discourses about women in society. The approach tries to destabilize conventional behaviour and assumptions, and to provide openings for alternative and diverse interpretations. So, looking at issues of identity, it questions whether people have a single, stable and perhaps developing identity throughout life. Instead, adopting alternative understandings of social experiences might enable people to reconsider and change the main identity that they assume. An example is women who fall in with conventional assumptions about women’s roles in marriage and playing a major role in raising a family but then, on divorce, find a strong lesbian identity. This change does not reject a woman’s identity as the ‘mother of a family’ but is not a development of heterosexual identity; it is a complete change of conception of the woman’s self. Another example is that postmodern feminist thinking contests language that, by moderating and managing the impression of behaviour, denies domestic and sexual violence against women and children (Healy, 2000: 40).

Case example: The man who ‘tapped’ his wife A practitioner interviewed a man to question his violence towards his wife. He started by describing the event as ‘I tapped her one’ (hit or slapped her lightly once), whereas the police account that had led him to be imprisoned was of a public argument in the front garden of

their house. Getting the man to describe what happened in detail, the practitioner eventually got him to describe injuries such as grazes, cuts and bleeding, aggression such as shouting, and how he had knocked her down and pushed her over a fence.

Here, by challenging a vague and moderating presentation of the event, the practitioner highlighted the reality of gender violence. Another example of language use in particular discourses that needs to be questioned to achieve destabilization is describing the sexual abuse of children as expressions of affection. Another important area is reassessing the cultural characteristics of the ‘feminine body’ (Healy, 2000: 49–51); the French poststructuralist writer Cixous has been influential on social work writing in this area (Sands & Nuccio, 1992; Healy, 2000). Women’s bodies are not simply physical objects; instead, their physical character and their differences from male bodies are interwoven with cultural assumptions, expectations and language. Social assumptions about what is a good or attractive in a woman’s body vary between cultures, and different presentations of a body incur social assumptions. For example, a rounded, fleshy female body might be regarded as maternal, warm and comforting, or as representing overindulgence or lack of control in eating. In another culture or class, however, the rounded fleshy body might be regarded as an ideal of sexuality. Postmodern feminism attaches a high value to diversity and women’s individual choice. Social workers might be concerned about obesity leading to ill health or early death in clients, for example, without recognizing the emotional needs met by eating. They may also fail to

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recognize the consequences of poverty and assumptions about the role of women in families, which may cause a woman to eat poor food, which in turn may lead to obesity, while giving the better quality food to her children and male partner. For similar reasons, feminism is also important in anti-oppressive perspectives, because gender divisions are important sources of social oppression. In addition, oppression arising from gender divisions may magnify the experiences of oppression felt by black and ethnic minority women.

Other interactions with theory There has been concern about the way in which women’s socialization is inconsistent with male definitions of management. For example, a female manager might give importance to mutual trust and support in her relationships with team members, and accept flexibility in their working hours to facilitate childcare. A male manager, on the other hand, might emphasize clarity of instructions and reporting in his relationships and encourage long working hours to complete tasks, seeing family commitments as antagonistic to meeting work objectives. Patriarchy means that male assumptions about what is good management practice prevail in organizations. This means that women do not attain senior roles in agencies consistent with their representation among social workers generally; they are also sometimes unhappy about the way in which authority and power are exercised within social work. Some writers (Coulshed, Mullender & McGlade, 2013) have developed distinctively feminist approaches to social work management as a consequence. We saw, examining standpoint theory in the section on wider theoretical perspectives, that an important method for developing a feminist standpoint is consciousness-raising, usually achieved by forming groups to share experiences and provide mutual support. Longres and McCleod (1980) relate consciousness-raising to the conscientization of Freire (1972), which connects directly to critical practice. We saw in Chapter 15 that feminist thinking has had a strong influence on critical theory and is a relevant perspective in many of the theories presented in this book. Similarly, in social work, it is argued that goal- and task-oriented practice, as well as positivist demands for scientific or evidence-based practice, are male-defined priorities that use male language and a male way of thinking (Collins, 1986; Fawcett et al., 2000). Walker (1994), however, points to the gains achieved by the scientific method and argues that the uses to which it has been put should be the target for criticism. Moreover, the ethics of care position argues that caring is devalued by patriarchal societies because it is associated with women. Parton (2003) argues that the focus of social construction theory on plurality of knowledge and voice connects to this view by accepting alternative narratives and possibilities in practice. Many complexities are presented by work with men, since gender relationships are unlike many other forms of oppression and discrimination (Christie, 2006). This is because men and women are in close relationships, while many oppressed groups, such as gay and lesbian people and people in ethnic minorities, often live much of their social life in separated social groups (Milner, 2004). Thus, feminist practice may give low priority to working with men, for example by working with the victims of domestic violence rather than male perpetrators. People concerned with anti-discrimination will, however, find it easier to identify the benefits

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of adjusting oppressive relationships and actions for all parties involved. I explore this more fully in Chapter 18. Pro-feminist ideas have therefore been generated to help in working to make sexual stereotypes more explicit. This may be helpful in practice aimed at reducing violence and sexual exploitation, as well as in social work education to see clearly where oppressive assumptions about male–female relationships require different ways of working (Cavanagh & Cree, 1996). Work with men and boys seeks to remove any damaging effects of their socialization into conventional male behaviour. In addition, it aims to reduce their tendency to become isolated because of the expectation that men do not need help or support, as well as their tendency towards aggression and violence (van Elst, 1994). Social conflict that adversely affects women justifies special attention to working with men to resolve issues of masculinity that cause problems for the men involved or more widely. Working to change men may, however, be criticized if it leads to working with men as an instrument to achieve improvements for women, unless it also benefits the men involved. Otherwise, our practice may subject men to change for general social benefit rather than their own. Pro-feminist work with men, therefore, needs to understand the benefits both for the men involved as well as for women and wider society. As part of this, it needs to generate informed consent by the men for interventions in their lives. We saw in discussing ‘alternative feminist perspectives’ that Foster (2018b: 51–2) draws attention to connections with ‘queer theory’, LGTBQI+ issues and gender fluidity. Furthermore, lesbian preferences were an issue in radical feminist thinking, which seeks to disrupt conventional assumptions about gender relations and therefore also about sexuality. Foster argues that sexuality has not been central to social work, but that it has been used to pathologize women. In feminist thinking, it has been connected to exploration of boundary-crossing and transgressive behaviour. Butler’s work suggests that making a binary distinction between male and female in both gender and sexuality is false, and a range of sexual identities and sexualities is possible (Featherstone & Green, 2013). Rowntree (2016) argues that exploring how heterosexuality has been constructed as the dominant form of sexuality helps feminists to understand better the position of women. Heterosexuality, for example, controls access to social institutions such as marriage and conventional social relations.

The politics of feminist social work Feminist social work theory emerged out of the commitment of women social workers to wider feminist movements in Western societies in the 1970s. It became associated with the radical social work movements of the 1960s and early 1970s, but its earliest writings came from a broader, more liberal tradition in response to general movements to improve civil and human rights. During the 1970s, academic work and radical theory on women’s caring roles influenced professional thinking. Conversely, feminist movements affected counselling approaches to women’s well-being and health. There was also campaigning around issues affecting women, particularly violence, rape and prostitution. Orme (2009) identifies four main areas of feminist social work:

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Women’s conditions – with women sharing the experience of oppression and discrimination in many areas of life, and professionals being disadvantaged in pursuing their work and professional advancement. Women-centred practice – where the focus is on identifying women’s particular needs and responding to them. Women’s different voice – women experience the world differently, and have views that are different from those of men, particularly in matters of social and moral concern. Working with diversity – because of their shared experience of oppression, women were able to identify, value and respond to many different sorts of social diversity. This is an important source of the feminist contribution to anti-oppressive and critical practice.

Domestic or intimate partner violence and other violence towards women has been at the centre of much feminist writing on social work (Wendt, 2009, 2016; Wendt & Zannattino, 2015; Buchanan & Jamieson, 2016). Other important areas are kin family work and child protection, where feminist perspectives offer a significant critique of patriarchal views on motherhood, child well-being and child safeguarding (Scourfield, 2006; Buchanan, 2016; Johnson & Espinoza, 2018). Feminist writing also presents perspectives relevant to a wide range of issues faced by social workers, for example, in mental health (Moulding, 2016; Mirick, 2018), disability (Fawcett, 2016; Slayter, 2018), work with older people (Chonody & Teater, 2016; Grant and Holak, 2018), exploring whiteness and ethnicity reflexively (Tedmanson & Fejo-King, 2016), work with refugees, homelessness (Wendt & Moulding, 2016), healthcare more generally and crime (Butler-Mokoro & Grant, 2018). We saw in Chapter 10 that working with women’s issues was important in social development practice. This is for two reasons. First, women play an important role in managing poverty in resource-­deprived countries and in particular are important entrepreneurs in developing sources of income and achieving practical development in communities in deprived communities. Second, women are often severely affected by gender discrimination and marginalization in resource-poor countries and a focus on empowering them and securing their human rights is an important priority (Bayisenge, 2014; Omona, 2014; Twikirize, 2014; Chilwalo, Zulu & Mwale, 2019; Okech & Danikuu, 2019).

Case example: Rural older women in Uganda A study of rural older women in Uganda found that they suffered cumulative disadvantages throughout their lives. They lacked formal education, partly because of their parents’ poverty but partly because they were unvalued and forced to care for younger children. In the poorest households, they were forced into early marriage and pregnancy. Care for children and grandchildren led them into a lifetime of caring roles. Despite their experience, they were unable because of cultural expectations to do any better in educating their own daughters. Because they lacked

education, they depended for income on cultivating food crops in subsistence farming. Through experiencing women’s groups, they were able to share work on communal gardens, improving productivity and community relationships. Social work needed to be aware of the accumulation of disadvantages building on each other to intervene successfully in helping older women’s contributions to families and communities in later life, rather than just repeating the process of forcing them into caring roles. Source: Tusasiirwe (2019).

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While such experience may seem extreme in Western nations, older women anywhere could probably tell similar stories of losing out on opportunities during their lives, and being forced into caring roles to the disadvantage of their own personal development. Scourfield (2006), exploring child welfare practice, notes that since in many settings social work operates individualistically, and childcare takes place in a patriarchal society, carried out by women, child protection work will inevitably involve a scrutiny of mothering, rather than of issues of child poverty and poor nutrition. Feminists propose a rebalancing of the way in which we think about such issues. Callahan (1996), for example, suggests concentrating on: ●● ●● ●● ●●

women’s experience of childcare as a central aspect of understanding work with children; families and the female role within them as crucial elements of childcare; reproduction as an element of society that is as important as economic production; relationships that need to be reconstructed to see the connection between private relationships, between spouses and between women and children, so that they interact with public definitions of what is appropriate and are then enforced in family relationships.

Values issues Commonalities An important value position in feminist practice is that women share important commonalities; that is, they have shared experiences as victims of oppression by a patriarchal society that privileges men’s ways of thinking and living. This is a source of identity for women and a basis for building relationships between practitioners and clients, enabling women to support each other (Orme, 2009). It may, however, be another situation in which women’s diversity is a factor. For example, many social workers do not share the same experience of poverty and difficult experiences in the labour market as many of the women they work with, but they may share the experience of sexual bullying (Penketh, 2011).

Dialogic practice We have seen that an important tenet of feminist social work theory is having a dialogic relationship between practitioners and clients. What would dialogue consist of? An aspect of dialogic practice is to see dialogue between participants in a social situation as always being open-ended (Healy, 2000: 51–5). It is important to avoid defining the required outcomes in advance, or allowing people with institutionalized power, often men, to close off the debate before the participants in the situation have been able to engage adequately with different points of view. The following case example illustrates how a practitioner refused to let the husband’s assumptions limit the range of family issues explored in an assessment, while not completely excluding the male perspective that he represented.

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Case example: Dealing with all the issues in an assessment Jackie was carrying out an assessment of a family referred because the daughter Nichole was presenting behaviour problems at school; there had previously been concern about the physical abuse of younger children in the family. Naomi, the mother of two of Jacob’s children, was talking with Jackie about the difficulty of integrating two of Jacob’s older children from his previous relationships

into the family. Jacob, however, wanted the conversation to focus on Nichole and her difficult behaviour at home as well as at school. Jackie managed to maintain a more complete dialogue, which included Naomi’s thinking, by stopping the conversation and getting them to agree to look at each child in turn and list the positives and negatives about each one.

Feminism, the ethics of care and virtue ethics The idea of the ethics of care is an important example of the alternative cultural expression that women’s thinking and actions represents. It argues that women have a distinctive approach to care relationships in society that comes from their relationships and social experience. That experience and the consequent understanding of care in a different way from men’s understanding does not, therefore, emerge from economic oppression, as standpoint theory would suggest, but from the differences between women’s and men’s experience. Sansfaçon (2016: 43–51) also argues that a feminist virtue ethics may be identified. She argues that social structures that subjugate women can be contested by cultivating individual virtues that allow a community to increase resistance to oppressive power relationships. An example is the #MeToo movement, in which solidarity among women allowed an international campaign against sexual harassment and sexual assault to develop from several notorious incidents. It would support both social workers in their workplace to protest against such impositions, and also give confidence to clients in similar circumstances. Gilligan’s work (1982) contributing to the ethics of care position has been influential in social work and related professions (Koggel & Orme, 2010, 2011). Gilligan shows that women and men have different modes of reasoning about moral questions, including the nature of caring (Rhodes, 1985). The conception of caring contained in the ethics of care proposes that women experience caring attitudes and caring behaviour as coming from the connections between people. Men, on the other hand, provide caring because of a commitment to duty, responsibility and social expectations. Davis (1985) applies this to social work, arguing that female voices, both generally and in social work, have been suppressed in favour of a male positivist perspective; this is therefore about both gender and the approach to understanding knowledge. Such a perspective argues for alternative ways of defining social work and its knowledge base, and for ensuring that agencies are not managed to exclude women and their perspectives.

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PAUSE AND REFLECT  Mr Jones’s attitudes This example of Hilda, an informal carer for Mr Jones, offers a picture of how feminist thinking offers a new perspective on these traditional social work debates. It uses an ethics of care analysis of gratitude that has been proposed by Mullin (2011). Looking at the situation presented to the social worker in this case example, how do you evaluate the different points of view? What actions would you take?

Case example: Hilda, Mr Jones, gratitude and caring labour Mr Jones was a disabled man, aged 86. Hilda, aged 62, his major carer, was his daughter-­ in-­ law, whose husband, Mr Jones’s son, had died. Hilda began to experience heart failure and had to reduce the amount of activity in her busy life. Mr Jones had been a miner and had strong socialist beliefs, having been involved through his trade union in important strikes and working-class campaigns during his working lifetime. A social worker was asked to carry out an assessment to decide on an appropriate package of care to meet his increasing needs.

The social worker came upon a hidden tension between Hilda and Mr Jones. Mr Jones felt that, as his deceased son’s wife, Hilda had a duty to the family to care for her father-in-law, and he took everything she did for granted. Hilda, on the other hand, had formed a new relationship and wanted to get on with her life, feeling tied by her responsibility for Mr Jones. She was willing to be to some degree supportive, but felt he should show how much he appreciated her help in his relationships with her. Mr Jones felt that asking for the help of social services was an abandonment of her duty.

Some suggestions The practitioner thought that the tensions stemmed partly from a generational difference in attitudes to the role of women. She thought that Mr Jones seemed to feel that caring in families should be natural and had not seen that it was usually an imposition by men on women’s aspirations. By listening carefully to Hilda, the social worker was able to empathize with and respect her sense of frustration at not being able to move on in her life, which had arisen from social restrictions because of the gendered expectations that came from her former marriage. Hilda found the social worker’s empathy respectful and supportive. However, it seemed to Mr Jones that these two women were ‘ganging up’ on him. Mullin (2011), in her thoughtful ethics of care analysis of gratitude in caring relationships, contributes to our thinking here. She points out that women are usually more able and willing to express gratitude than men. This, she suggests, arises partly from what research has identified as a traditional male identity that conflates gratitude with indebtedness and dependency on others, which men are often brought up to avoid. Women, on the other hand, equate gratitude with a process of building connections between the cared-for person and the carer. The tension between Hilda and Mr Jones partly expresses his fear or rejection of a feeling of being dependent. However, it also expresses Hilda’s lessening respect for him. For example, because she is focusing on her current life priorities, she is neglecting to respect his contribution to his family through a hard and difficult work life, his political and social contribution to his community and more widely his socialist commitment. The practitioner is allied with this, because

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she is focusing on Mr Jones’s current care needs, rather than viewing his life holistically and incorporating a rounded view of his personal identity. In a later intervention between them, the practitioner presented the argument that Mr Jones’s socialist views should lead him to accept social services care because it was his right to receive it, both as a citizen and as someone who had contributed through taxes to providing services. This statement tried to use a recognition of and respect for his whole identity to balance his fear of dependency. Mr Jones replied that, if so, Hilda’s expectation (and by implication the social worker’s view too) that he ‘should grovel to be cared for in his old age’ was wrong. Mullin (2011: 118) argues that gratitude is justified by good-quality care provision and respect for the cared-for person; I have suggested that the tension found by the practitioner reveals what Mr Jones experienced as a lack of respect. Consequently, the quality of care was inappropriate for Mr Jones’s psychological needs, because it rejected an important part of his feelings – his belief in the duty of women in his family to provide care – and this meant he was unable to feel and express gratitude. There is a further point too. Mr Jones also felt that his socialist world view and contributions to society through his work and campaigning life had been largely dismissed by the society and the state, as socialist ideas and trade unionism had recently lost their influence in society. Mullin (2011) argues that an essential element of working with caring relationships is to understand and work with the personal responses, attitudes and needs of both the cared-­ for person and the carer in a connected relationship, recognizing how these have been shaped by social hierarchies and public debate. The ethics of care view takes a feminist view that caring is about the connections between people, and feminist social work requires a thoughtful analysis of the connection itself and both sides of it. The practitioner needed to spend more time exploring feelings in this relationship before she could successfully interweave formal caring services with Hilda’s caring help.

Applications Feminist practice In Figure 17.3, I set out some general ideas about appropriate feminist practice strategies, and these still reflect the ambitions of many feminist practitioners. Healy’s (2000: 51–5) principles of postmodern feminist practice support many elements of critical practice: ●●

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Focus on social practices rather than social identities, so that we do not assume one single identity associated with a range of factors, but seek the complexities of the different factors that affect people’s identities. For example, looking back at the case study on Hilda and Mr Jones, it was important not to see Hilda’s identity as that of an informal carer and Mr Jones’s identity as that of a dependent older person in need of care services. Looking at their relationship and social expectations in a more rounded way, we can identify caring practices and conventions in family social relationships that contributed to forming the conflicts between them. Promote an open-ended dialogue rather than trying to define the required outcomes too closely.

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Feminist principles Commonalities Dialogue Empathy Partnership Feminist practice prescriptions Perceptions of caring Experience an essential focus Practices, not identities Individualization liberates

Feminist gender perspectives Male/female views of care Male/female power relations Local, not universal, context Local, not universal, meaning

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Developing feminist practice principles Socialization Privilege & oppression Diversity Intersectionality Social identities Gender fluidity

Figure 17.3  Traditional and developing feminist practice strategies Sources: van den Bergh (1995), Healy (2000), Orme (2009), Shepard and Dziengel (2016), and Livingstone (2018).

Shepard and Dziengel (2016), reviewing twenty-first-century American developments, identify the consistent themes of feminist practice as empowerment, relationship-building, contextual analysis and social change. Ideas about feminist practice emphases have been developing. Concerns about caring in all areas of practice remain, for example in working with adults requiring care services and childcare provision. Developments in thinking about mothering and child well-being in the context of the impact of attachment theory (see Chapter 5) have led to a focus on socialization, with critical theory being also concerned about women’s role in the social reproduction of social classes and the workforce. Social reproduction theory (Bhattacharya, 2018) is a development of Marxist ideas that women, by their involvement in childcare, other caring roles and education, play an important role in reproducing a workforce that is suitable for a neoliberal capitalist economic system. Attempts to create critical practice theory in child safeguarding work, discussed in Chapter 15, have also influenced these developments. Johnson and Espinoza (2018) maintain the priority in child welfare services is the permanence and security of the child’s living arrangements, together with safety and well-being for the child. Women are usually expected to fulfil mothering roles whatever the pressures on them. But in relational-cultural theory, it is important to intervene around how dominance and subordination affects them and how this affects their connectedness to other supports in the mothering role. Factors that may affect this are their identity as women and mothers, and others’ views of that identity and role, including their ethnicity and migrant status. The way mental health issues and poverty affect them and their living arrangements is also relevant, as women may experience the impact of these more strongly than men in the family and social network. Consequently, their connectedness and support may be strongly affected by these issues. Dumbrill (2017) suggests that feminist practice will involve clarity about the parent’s, child’s and worker’s perspective on the child protection situation, engaging closely with the family to understand how experience in the family is affected by their experience of life. These different perspectives need to be merged in a holistic understanding, guarding against oppression in professional interventions and

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retaining the tentativeness of our early understandings. Be prepared to change your view as you understand more. In addition, contemporary issues include an increasing concern with diversity and intersectionality. This is because feminist practice theory reflects critical theory in shifting its concerns to a widening range of oppressed groups, so that oppression affecting women has been subsumed into a wider concern with diversity and responsiveness to multicultural populations. This has been so particularly in the USA, where there has been a retreat from specific development of feminist theory and practice focused on women (Shepard & Dziengel, 2016; Livingstone, 2018). Shepard and Dziengel (2016: 24–7) review changes in American social work education and research that shows a decline in publication about feminist and women’s issues in favour of research on the needs of indigenous populations and cultural and ethnic competence. I look further at these issues in Chapter 18. An emphasis on EBP favours research on specific therapeutic interventions rather than ideologically informed practice such as feminism. Also, a clinical focus in North American social work encourages practice concerned with individual psychologies in a systems context rather than a politically informed context (Shepard and Dziengel, 2016: 28–32). Finally, an increased focus on gender fluidity, while it connects with traditional feminist concern with identity, also shifts practice away from a singular concern with women. All these developments are nevertheless presaged in Orme’s (2009: 71) assessment of the main contributions of feminist theory to practice. She suggests that it highlights and therefore allows responses to: ●● ●●

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The use or misuse of power between men and women. Ethics of care issues about privileging (male) rational, logical ways of responding to people, as against focusing on (female) ways of promoting the connectedness and relationships between people, including between practitioners and clients. The ways in which caring is positive, or may be demeaning, unhelpful and oppressive in relationships. We can see that this now also includes how we respond critically to mothering, child well-being, attachment and socialization. The ways in which identity is connected with oppression, because identifying people with particular groups may make it easy to ignore or devalue their experience and contribution to social solidarity. Thus, while the traditional feminist model sought to enable people to explore their individual identity, present concerns reflect an openness to a range of gender identities. The need to shift individualization from constraining us, by failing to connect with the diversity in people’s lives, towards liberating us, by offering opportunities to respond to people’s specific needs. People’s personal, individual and private experiences as being important in thinking about and taking action, including political action, on the social issues that those experiences reveal. The way in which empathy allows people to express their needs and wishes.

Many of these points are expressed in a coherent account of feminist practice in White’s (2006) text, which also makes clear how they may be implemented in the face of the pressures of current agency and social constraints.

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Example text: White’s (2006) The state of feminist social work White started from a sense of unease that current theory and practice were not incorporating feminist ideas and activism. She experienced four tensions between feminist social work theory and the experience of being a feminist social worker: ●●

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Theory assumed that a feminist identity was an unproblematic base from which to launch a feminist practice, whereas experience suggested that feminist identities were fluid, fragile or, for some people some of the time, non-existent. Theory assumed that the commonality of experience between women practitioners and clients was the basis for a non-hierarchical, non-oppressive, egalitarian practice, whereas experience suggested that gender might not be a basis for egalitarian relationships – such relationships might not even be possible at all. I looked at these concerns in the ‘values issues’ section. Theory assumed that the goal of egalitarian relationships was empowerment, whereas in practice it was unclear what empowerment was, as we saw in Chapter 14. Theory played down or avoided the statutory basis or legal mandate for social work, whereas statutory and legal responsibilities and powers in practice constrained feminist practice.

Creating a feminist social work identity for the practitioner is the basis of feminist practice, and early writing assumed that a feminist social work identity is rooted in an eclectic approach, accepting that diverse perspectives should be included in an open-ended practice. Most views of feminism share a questioning of assumptions that women’s social roles are mainly domestic and concerned with child-rearing, and that it is acceptable for women to take low-paid, low-status roles in the workplace. Thus, a feminist social work practice identity might build on that agreement. However, the diversity in the positions of women across the world suggests that although this may be a reasonable position for middle-class women in developed Western countries, the standpoint of a working-class woman or a woman in extreme poverty in sub-Saharan Africa means that a shared identity might be impossible. Therefore, some feminist theory has argued for the importance of hearing and valuing alternative and suppressed voices, showing how black, disabled or lesbian women experience the world differently from many other women. This might be used to challenge and refine mainstream feminist understanding, so that a united feminist identity includes valuing difference while also sharing some common experience and goals as women. In contrast to attempts to broaden a unified but eclectic feminist social work identity in this way, some have argued, calling on postmodern ideas, that it is important to emphasize how power, diversity and difference are diffused throughout society and among women; a non-oppressive feminist approach would value and acknowledge a kaleidoscope of experience and perspective. Nevertheless, women characteristically think of women, feminism and gender as an important aspect of any analysis of a social situation and perspective, in spite of a diverse range of splintered identities that derive from different experiences. Is this eclectic feminist identity enough to form the basis of a feminist social work practice that advocates egalitarian relationships and empowerment?

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Seeking egalitarian working relationships between practitioners and clients is a fundamental practice objective of feminist social work. The aim is to minimize power differentials and develop a woman-centred practice that respects and values women and affirms their particular experiences. Building woman-to-woman relationships, rooted in shared experience, is more important than competing specific tasks or agency objectives.

Case example: Feminist woman-centred practice with an older man and woman Alice was the care manager for an older man, Joel, who was in need of social care services because of his increasing frailty. His main carer, Karina, was his wife of 40 years, and as he had become more frail, their relationship had deteriorated. She felt that he had become hectoring and demanding of her time for his care, rather than giving her the freedom to pursue her own interests, as she had done when they were both at work. Because Alice’s assessment at the outset was mainly of Joel’s needs, she focused on his problems. The agency’s policy was that services should not be organized on the assumption that a wife would take on a caring role. However, Alice found that it was in practice hard not to build the routine services round the main role of a spouse who was able and willing to take on many caring responsibilities as a normal extension of married life. For example, meals services were not required because Karina cooked for her husband, but this was also a burden on her when Joel could make little contribution to buying and preparing food. In thinking this, Alice was identifying the reality that the attempt to make the position of men and women equal through this agency policy did not fully work, because everyday assumptions about husband–wife relationships hindered full equality. Indeed, many clients and their spouses wanted to continue in that caring relationship. Because Alice saw that Karina was getting very tired and that there were tensions in the relationship, she suggested that she should undertake the separate assessment of carers’ needs that law and agency procedure said should go alongside Joel’s

assessment, and offered to do this over a cup of coffee in a local café. Alice and Karina met in the café a few days later. This took their relationship outside the formal interview setting (implementing a feminist practice), even though it was clear that Alice was fulfilling an official task. It also allowed Karina to talk over some of the tensions in the way Joel’s changing behaviour was affecting her. They spent some time teasing out the feeling of responsibility and duty that Karina experienced, alongside her feelings that she did not want her marriage to develop in this way, although at the same time she recognized that her husband’s frailty made this necessary. Although Alice did not have similar responsibilities in her life, she demonstrated a shared analysis of what was going on by recognizing and expressing the tension that lay behind some of Karina’s concerns. Their plans included Alice accepting the responsibility for pushing Joel to accept an involvement in creative activities at a local day centre, with Karina supporting this suggestion rather than having to take the lead in persuading Joel. This would give Karina some time free from the constraints of Joel’s dependence. Alice also wrote into the carers’ assessment the need for a regular monthly meeting between Karina and herself to think through Karina’s feelings and possibly plan other activities for Karina. Over a period, additional support services were required for Joel, and these were planned first between Alice and Karina so that Karina was strongly engaged in the planning, rather than having to resist or just accept if plans were made directly with Joel first.

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PAUSE AND REFLECT  Is Alice and Karina’s work a ‘feminist conspiracy’? In planning together and focusing on Karina’s needs as a carer, Alice and Karina were creating a more egalitarian relationship, which gave Karina more power in the situation and met some of her needs. This joint planning process also used a task-centred technique of sharing the tasks, rather than the practitioner working out tasks that would help the client. It accepted Karina’s neglected needs as being just as important in the social work role as the task of carrying out Joel’s assessment and service provision. A less feminist approach might not give the priority that Alice did to Karina’s needs. However, Joel is the client. Is his world view being neglected through this feminist focus?

Some suggestions Answering this question, it is important not to see an opposition between meeting Karina’s needs more fully and meeting Joel’s needs (in feminist terms this is not an either/or but an and also situation). Enabling Karina to express and explore the tensions in her attitudes, and helping to meet her needs as a full-time carer, allowed her to take on the caring role successfully, while understanding and responding to some of her ambivalence about it. An effective relationship grew up between practitioner and carer, which would benefit Joel. It also permitted a strategy for starting his day care, which reduced the risk that his tense relationship with Karina would be worsened – also a benefit for him. The practitioner therefore did not damage the outcomes she achieved for him, but she achieved them in ways that benefited Karina, and permitted Alice to engage in an egalitarian approach to her work. She also complied with the legal requirement to assess and respond to carers’ needs. Returning to White’s account, the empowerment of women is a major objective of practice in the eclectic feminist position, and is intended to transform the position and capacity of women to achieve equality in their social roles and positions. However, empowerment has a range of meanings. In many state agencies, and elsewhere, it is a synonym for enabling clients to participate in decisions that affect them rather than gaining significant influence over their own lives. It may also be taken, in agencies, to mean clients gaining control over services rather than over their own life experience. Neoliberal theory sees empowerment in almost the opposite way, as freeing people from interference by the state or from a dependence on the state and its services. Feminist theory sees empowerment as an outcome of egalitarian services and practice, since it validates women’s life experience and enables women to seek their own objectives instead of or alongside agency objectives; they thus gain greater control over their lives and the services that are provided. One of the problems is that this conception of power is individualistic: it may lead to women having greater influence in their interpersonal relationship, but does not change the way in which society routinely excludes women from power. This is particularly an issue where feminist practice takes place in agencies, particularly state agencies, where hierarchical power structures accept men’s dominance of decisions and social relations. Significant empowerment for women may be obstructed by such structures, even if

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empowerment is possible in organizations such as women’s organizations that provide refuge from domestic violence. In state agencies, or in agencies where men’s perspectives are dominant, conceptions of empowerment may privilege male hierarchical understandings of power relations and ideas of empowerment that do not seek to transform women’s positions. In addition, feminist writing about social work is often based on experience in student placements and specialized agencies rather than mainstream state agencies. It is doubtful, then, that feminist practice is transferable to such agencies. Feminist writing also often conflates ends and means when considering social work. Feminist literature assumes that practitioners are sufficiently autonomous to be able to adopt a feminist identity and use feminist methods in practice, whereas a common experience is that state agents shape the means by which feminist practitioners can operate, because it sets ends that exclude feminist objectives. Possible practice options are to: ●●

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transcend agency limits by finding spaces within agencies to practise using feminist ideas and your feminist identity; transform social work by shifting it outside the state apparatus, allowing feminist practice to develop without restriction; accept that feminist practice is antithetical to state social work and not to seek to practise feminist ideas outside state agencies.

One possibility is to focus on anti-discriminatory practice (see Chapter 18), which may be more easily assimilated in state practice than a practice that seeks liberation for women. A significant question is whether the regimes in social work agencies can be adapted or developed to form an appropriate environment for feminist practice. Practice is not just an individualized atomistic function directly connected to social work’s legal and social policy mandate; that mandate is carried out through agencies. Similarly, agencies are not just organizations within which social work is carried out, as, by fulfilling their legal and social responsibilities, they contribute to creating the social work that practitioners do. We saw, when discussing Figure 1.5, that the interactions between managers and practitioners within agencies form an important arena in which social work is created. Two important conceptions of the relationship between social work and agency exist: ●●

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Bureau-professional regimes are regimes in which practitioners’ professional roles provide flexibility and discretion within a bureaucratic organizational structure. These assume that there is a constantly changing balance in our practice between the agency’s requirements of us, political power and our professional skills and values, used with judgement and flexibility. While political power creates the policy that generates those requirements, it is balanced by creative responses in situations that are too complex to be dealt with through rules-based practice. In the latter part of the twentieth century, agencies became larger (for example, through the creation of large generic agencies with wide service responsibilities) and more politically important (for example, as concern grew about child safeguarding and serving a growing population of older people). As a result, the impact of agency controls became more important. Managerialist regimes, also called new public management (Clarke & Newman, 1997), were initially a political response to the perception, particularly among neoliberal

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thinkers, that comprehensive welfare states were unaffordable. To manage the expenditure, managerialist regimes set objectives, using numerical measures and financial controls to assert control over local services. They also aimed to decentralize management so that each unit of the organization was, like a small business, required to meet its objectives. Concern for equal provision across decentralized units, however, reduces the possibility of flexibility to respond to local circumstances and needs. All these factors reduce the professional discretion of practitioners in the bureau-professional balance. Legalism enhances the detailed use of law and regulation as a way of specifying practice on behalf of powerful state interests, using detailed policy and practice guidance. Controlling procedures and, with the greater availability of computer technology, the documentation and surveillance of professional actions tends to deprofessionalize practice and reduce opportunities to practise creatively using feminist ideas. Managerialism reshapes bureau-professionalism by subordinating professional concerns to budgetary and management efficiency, and by colonizing professional concerns. Being a good professional, then, requires loyalty to the quality of service aims, which seems professional and reasonable but excludes the kind of interpersonal objectives that feminist theory would propose. These managerial changes reshape what practitioners seek to do in their interpersonal relationships with clients. This is not a simple process in which feminist practices are dominated by management, but it does reshape the negotiation between politicians, managers and practitioners. An important way in which feminists have sought to influence this negotiation is by getting more women into management jobs. This can have two effects: it incorporates women’s ideas into the agency and political debate, but it may also lead to a form of management that is more respectful and enabling of practice that achieves feminist objectives. Social work education has also been affected by these changes in organization because, internationally, higher education has become a more managed regime concerned with costs and economic development, rather than being a site for developing individualized academic concerns. In addition, agency managements have achieved a greater control of curricula and teaching methods as part of the process of inculcating political, managerial and legalistic control into professional practice. Examining the different identities that women might adopt, and the theoretical concepts that they might identify with, White explores three areas: ●●

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Identification with issues about social division – practitioners inconsistently identified with terms such as equal opportunities, anti-discriminatory practice and anti-oppressive practice. However, none used terms referring to gender, feminism or women, suggesting that general terms were more widely used in day-to-day work. Women’s interests – practitioners identified with terms that focused on including women’s interests in their practice concerns. However, they mainly applied general anti-discriminatory or anti-oppressive practice to work with women, rather than putting this into a specific form of practice. Feminism  – women saw identification with feminism as potentially problematic. Four stances were taken here. A small group identified themselves as feminist and valued their

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identification with a specific school of thought. Some saw themselves as feminist with reservations, seeing feminism as validating the importance of valuing women’s perspectives in their practice, while not associating themselves with the radical connotations of the term. Others saw themselves as not being feminist but drew on feminist principles in their practice. Another group saw themselves as not being feminist at all, either because their life experience had not made this a major priority for them or because they thought that feminism did not adequately address the different position of working-class women. White’s (2006) research also looks at women practitioners’ experiences of important issues in feminist thinking. On the possibility of egalitarian relationships and empowerment with clients, they recognized that there was some shared experience that could enhance practice, particularly in groupwork. However, most felt that equal relationships were not possible because of power differences associated with their professional role or the agency’s function. Similarly, in relationships with students, practitioners recognized shared experiences and often found it easier to build good working relationships with female and male students, but felt that students had to find their own way in dealing with inequality and oppression. Most saw empowering women clients as a crucial aspect of their professional role, mainly seeing empowerment as facilitating participation and partnership. Many women valued managerialism because of the clarity it injected into clients’ rights and their responsibilities, making their work more organized. However, they disliked the focus on financial assessment and the shortage of resources that led to rationing rather than an open-minded offering of service. Another difficulty was the way in which a focus on a ‘core business’ (treating the social work agency as a business organization, focused on financial efficiency rather than caring priorities) meant several things: that related helping was less easy to offer; that possibilities of taking up collective work using groupwork, preventive work and counselling roles were closed down; and that the approach led to a loss of discretion. Finally, computerization took up time and limited creative possibilities in practice. Practitioners accommodated these difficulties in various ways and raised various challenges to them. It was to some extent possible, particularly in local teams, to negotiate over discretion and flexibility, and to change attitudes to oppression and the position of women; it was, however, more difficult to influence wider departments. It was also difficult to influence sexist attitudes in other work settings, such as those that involved the police or senior doctors. Voluntary, non-profit organizations were valued because they could be more radical than official agencies, could accept a referral of work outside the agency’s core business and were more flexible and friendly towards women’s issues. Engagement in wider campaigns was difficult for many because of lack of energy outside their main work and family roles. They were ambivalent about taking on management roles because of a commitment to practice and because they were unable to accommodate to or change management attitudes based on male conceptions of the role.

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Conclusion: using feminist theory in practice It is clear from White’s (2006) research that using feminist ideas in practice is problematic for women, and this is probably also the case for men. Feminist theory has been criticized as a perspective because its limited focus and priority for women’s issues, its marginalized position in specialized agencies and its limited research base mean that it is hard to apply generally. Feminist theory has, however, changed thinking about gender roles and relationships in relation to social policy and welfare services. It has raised awareness of the importance of women’s shared experiences in working with other women, particularly those in oppressed situations. Increasingly, it explores more fluid gender identities, and offers a way of examining critically the role of women in social reproduction and child safeguarding. The main features of feminist practice are as follows: ●●

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Feminist practice creates dialogical, egalitarian relations. This requires an open approach to creating a debate about possibilities with clients, rather than a questioning style of interpersonal practice. So, instead of constantly asking questions from a checklist, opening a discussion allows clients and their carers to raise issues and express their opinions, rather than sticking to the agency’s agenda. This does not mean that feminist practitioners are unchallenging: they constantly seek to unsettle conventional gender-based assumptions, implementing the shared principle of critical practice (see Figure 1.7). It focuses on fluid personal identity, particularly women’s identities. This requires helping clients to clarify and pursue important personal objectives that strengthen them as women and enables them to explore more openly more personally satisfying identities. Feminist practice values diversity among women and men and the relations between them, validating a wide variety of non-exploitative relationships in clients’ lives. It also seeks opportunities to use groups to promote an awareness and understanding of oppression, as well as strategies to respond to it. This is the traditional approach of ‘consciousness-­raising’ – more broadly, it reflects a social pedagogical approach of increasing women’s understanding and awareness through using learning opportunities and gaining experience of a wide range of social relations..

Additional resources Further reading

Butler-Mokoro, S. & Grant, L. (Eds.) (2018). Feminist perspective on social work practice: The intersecting lives of women in the 21st century. New York: Oxford University Press. Wendt, S. & Moulding, N. (Ed.) (2016). Contemporary feminisms in social work practice. Abingdon: Routledge. Two recent and wide-ranging collections of articles on feminist theory and practice. Dominelli, L. (2002a). Feminist social work theory and practice. London: Red Globe Press. This is the only comprehensive social work text offering a feminist model of social work practice – its position is socialist feminist.

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Freedberg, S. (2008). Relational theory for social work practice: A feminist perspective. London: Routledge. This book provides a good account of feminist theory applied to a psychodynamic model of interpersonal social work practice and also reflects increasing interest. White, V. (2006). The state of feminist social work. London: Routledge. Good theoretical analysis and research on feminist practice.

Journal AFFILIA: Journal of Women and Social Work – Sage; see https://journals.sagepub.com/home/ aff

Websites For up-to-date general information about issues of concern to women, relevant news and links, see, from the USA, the Feminist Majority Foundation http://feminist.org/ and the National Organization for Women https://now.org, and from the UK, the Fawcett Society https://www.fawcettsociety.org.uk and the feminism pages from The Guardian http://www. guardian.co.uk/world/feminism The University of California Berkeley Library has good links for academic work and campaigning. https://guides.lib.berkeley.edu/c.php?g=4417&p=15647

CHAPTER 18

Anti-oppressive, Indigenist and multicultural sensitivity practice MAIN CONTRIBUTION Ideas on anti-oppressive, Indigenist and multicultural sensitivity practice help practitioners to understand cultural and ethnic barriers, conflicts and differences in societies. This enables them to practise in ways that respect people’s individual and social identities and respond to oppression by dominant social groups, and changes in agency organization pursuing such oppression also develops practice. Cultural and ethnic differences have important consequences for people’s personal development and social experience, and these ideas help agencies and practitioners to incorporate these factors into their practice.

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Anti-oppressive practice focuses on combating the oppressive effects of discrimination, in which powerful groups in society maintain power by creating negative stereotypes. Antioppressive practice seeks particularly to combat the exclusion of some social groups from social equality, from full participation as citizens and from social justice. Anti-­oppressive practice may be distinguished from anti-discriminatory practice because it concentrates on processes of oppression and exclusion rather than on the discrimination itself, but the two terms are often used interchangeably. Multicultural sensitivity approaches, which include ideas such as cultural competence and cultural diversity, promote responses to the cultural and ethnic diversity that is found in societies. Anti-oppressive and multicultural sensitivity practice both emerge from widespread concern about racism and ethnic conflict. Multiculturalism affirms ethnic diversity and aims to improve societies by valuing their many different cultural contributions. 477

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Racism comprises ideologies and social processes that discriminate on the grounds of assumed differences in ethnicity and culture between racial groups. All human beings are of the same biological race, so using ‘race’ and similar terms to refer to ethnicity is incorrect. Some writers therefore enclose such terms in quotation marks to show that it is not a valid descriptive and analytical term. Talking about race is, however, a widely accepted usage, and I do not use quotation marks. Alternative anti-racist perspectives are assimilation, liberal and cultural pluralism, structuralism and black perspectives. Anti-discriminatory practice combats discrimination on grounds of race, gender, disability, sexuality and age. Bringing such issues together draws on an overarching explanation that discrimination comes from social structures rather than individual or group processes. Anti-discriminatory practice may be distinguished from anti-oppressive practice because it concentrates on preventing and combating discrimination, rather than working on the oppression that may result from it. However, the two terms are often used interchangeably (see the first bullet point). Including in one practice oppression or discrimination on multiple grounds of race, gender, disability, sexual orientation and age may be criticized. First, it may not reflect the views of those who experience a particular form of discrimination, and second, it may not help to set practice priorities between different forms of discrimination. Personal, cultural and social factors are all relevant to discrimination. Where there is a focus on language and culture as a basis for reducing discrimination, there have been accusations of political correctness. The theory of anti-oppressive and anti-discriminatory practice focuses on structural explanations of discrimination, while multicultural sensitivity approaches focus on the role of cultural and ethnic differences in stimulating discrimination.

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Discrimination and oppression are important aspects of people’s experience of social relations and should therefore be a focus of social work practice. Indigenist practice focuses on appropriate responses to groups who self-identify as Indigenous peoples within a wider society. A focus on people’s personal identity and the way in which ethnicity and cultural experience constructs identity is also relevant to social work practice. The idea of sensitivity to or competence in dealing with social and cultural difference can be an important part of practice. Taking a black and oppressed people’s perspective can be a guiding factor in practice.

THE DEBATE SUMMARY Three main areas of debate in this area concern: ●●

Differences between anti-oppression and multicultural sensitivity as practices.

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Language issues include conflicts between neoliberal thinking on political correctness and appropriate responses to discrimination, oppression and the position of Indigenous peoples. Is the main concern diversity, particularly of culture, or social division?

 ebate on anti-oppressive, Indigenist and multicultural D sensitivity practice Anti-oppression and multicultural sensitivity practice These areas of theory emerged from growing concern during the 1980s about ethnic conflict in many Western societies. Debates within social work and broader social movements raised the need for and possibility of practice that responds to ethnic and cultural division. I discuss what brought this about more fully later in the chapter. Figure 18.1 represents some of the relationships and oppositions in this group of theories. The starting point  – concern about racism and ethnic conflict  – generated a range of approaches to understanding these issues. I have identified four. Pluralism argues that where there are several ethnic groups in a community, people in general and professional practitioners, such as social workers, need to respond to conflicts that arise from that plurality. Two responses are: ●● ●●

cultural competence, to be competent to deal with cultural differences between them; multiculturalism, to accept and value contributions to the community by people from the different cultures.

Cultural competence

Racism and ethnic conflicts

Pluralism

Multiculturalism

Structural approaches

Critical race theory

Intersectionality

Anti-discrimination

Anti-oppression

Black perspectives Indigenous peoples

Approaches to racism & ethnic conflict

Indigenist practice

Social work responses

Extended social work responses

Figure 18.1  The development of theories and practices from racial conflicts

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These approaches are connected. Both claim that differences in culture are the main issue, denying racism as a concern. Structural approaches to race issues derive from the structural analyses discussed in Chapter 15. These propose that race issues are explained by the form of social institutions, processes, practices and relationships established in societies. Structural accounts of race conflicts propose anti-discrimination practice. In the USA, particularly, the ideas of critical race theory have also influenced social work. Black perspectives emphasize the importance of black people’s voices in understanding and interpreting issues about race and ethnicity, and also contribute to anti-discrimination. Both anti-oppressive and multiculturalism approaches include elements of pluralist, structural and black perspectives. Indigenist approaches come from the self-identification by Indigenous minorities in specific territories of distinctive identities deriving from historical links with pre-colonial or pre-­ settler groups and their oppression by majorities (Hart, 2019). An Indigenist practice developed in response, including elements of all the other approaches. These concerns broadened to incorporate wider forms of social exclusion and discrimination against other social groups. Anti-oppressive theories take a primarily social change view, while multiculturalism approaches emphasize empowerment objectives. Multicultural ideas leading to cultural competence or sensitivity practice do not focus on oppression and privilege as issues. Their main aim is to help people build upon positive aspects of cultural and other differences in society. Intersectionality says that where people experience more than one form of oppression, they interact in unpredictable ways; an analysis we also found in feminist practice (Chapter 17). Thinking about intersections means that we cannot therefore give priority to one form of oppression: race, for example, does not trump ageism or disability. Neither do oppressions accumulate, so that the more you have the more oppressed you are. Instead, it is important to explore how they interact in each instance, because the social circumstances and personal experiences of the people affected will have varying effects (Murphy et al., 2009). Consequently, it is the process of exploring intersections that enables us to better understand the complexities of interacting oppressions. This is because by fuller understanding of experience we can better adapt our practice to the holistic impact of oppression (Hill Collins & Bilge: 31–62). The main source of debate between anti-oppressive and multicultural sensitivity practice is that these terms imply different views about the origin of discrimination, which leads to different views about how to tackle it. Anti-oppressive practice takes the position that much of the problem arises because of a conflict or tension between the interests of social groups whose members have social identities linked to devalued characteristics. Because they have little choice about this, for example, being black in a white society or female in a patriarchal society, the response should be to deal with the conflicts of interest through social change. Multicultural sensitivity views, and related ideas such as cultural competence and cultural awareness, argue that the main problem is in our ability to understand and value the social identities that are linked to devalued characteristics. Accordingly, we should educate people to value diversities in society and improve relationships between different social groups, with the aim of reducing the impact, and removing the sources, of misunderstanding and conflict. Practitioners would do this by understanding the implications arising from the different

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cultures associated with different ethnicities and increasing their competence in responding more appropriately to those cultural differences, so that interventions were more appropriate to the different cultures. Both views are concerned about how we use language. Anti-oppressive and anti-­ discriminatory practices often take a social construction view about our use of language (see Chapter 11): if we avoid using devaluing language, we can create a new narrative about the differences that are of concern to us. Multicultural sensitivity views argue that we should use courteous language that respects people’s differences. Language has changed in several aspects of life to avoid terms that have become stigmatizing or disrespectful. For example, in British law, people with learning disabilities were once described in legal terms such as ‘idiots’ or ‘feeble-minded’, and the study of intellectual disability is still called ‘defectology’ in some Eastern European countries. Professions involved with people moved to talking about ‘mental handicap’, and there have been further shifts to a use of ‘learning disabilities’ and the healthcare terminology ‘intellectual disabilities’. Concern about discrimination, oppression and a lack of cultural competence leads people to be sensitive about how language is used. Practitioners often feel that they have to keep up with the latest changes in language in order to remain respectful. In turn, different terms proliferate and come to be associated with views expressed in the debate. Case example: Confusion about the nature of Nia’s disability Nia’s parents knew that she had been slow to develop, but were confused when a doctor they consulted described her as having ‘intellectual disabilities’. They said to their social worker, ‘We never expected her to be an intellectual.’ They were used to the social worker and education staff talking about ‘learning difficulties’ and had accepted this: ‘It seems to mean that

she will be able to learn, even if not as much as other children.’ The social worker explained that ‘intellectual disabilities’ was the internationally accepted technical term in healthcare for the same thing and meant that Nia was less good at using her thought processes. This would also have an effect on other aspects of her life.

This is an example of the consequences for clients of the different approaches of the range of professions working with clients and their families.

Language issues Overconcern with language use is sometimes called political correctness, and there has been significant conflict about how this issue affects social work, among other walks of life. Philpot (1999) points out that political correctness is often used indiscriminately as a term of abuse, with very little meaning or in jokes that criticize anti-discrimination practices. Using the term reflects a conservative political view that rejects underlying structural explanations for racial and other discrimination. Fairclough (2003), reviewing the issue, argues that social construction ideas sought to achieve political change by trying to promote the correct use of language. This led to accusations of political correctness, aiming to change cultural attitudes rather than

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social institutions, law or policy. Attempts to change social behaviour and structure by changing the use of language was new and was experienced as an arrogant personal attack rather than a valid way of achieving social change. Moreover, Fairclough argues, the campaigners did not campaign strategically, but presented the changes as a matter of justice requiring immediate and practicable action over language use. This meant that they did not establish the case fully or work to change social institutions before the backlash emerged. Dent (1999) argues that effective service provision is a more important focus of anti-discrimination than language use or procedural caution, although these may disguise inadequacies in service provision. While most people agree that sensitive language is an appropriate courtesy, complaining about political correctness often reveals hidden prejudice because it is a soft target for what would otherwise be unacceptable attacks on anti-discriminatory practice. Practitioners need similarly to consider whether focusing only on multicultural sensitivity may be avoiding the issue of prejudice. Some sensitivity views, however, acknowledge that abusive language is oppressive. Another language issue is the distinction between discrimination and oppression. The word discrimination may have positive connotations: it means the capacity to draw distinctions between people or things with discernment and good judgement. Used negatively, however, discrimination means putting individuals and identifiable groups into categories according to personal characteristics that people often devalue, treating them less well than other people or groups with valued characteristics. Oppression, on the other hand, sees discrimination as part of the use of social power by the dominant social groups in a society. The point of making a distinction between anti-discriminatory and anti-oppressive practice is that oppression always arises because of the misuse of social power, while discrimination might result from misunderstanding or conflict in social relationships. Similarly, talking about disadvantage affecting social groups is also criticized, because it underplays the use of social power that has created the disadvantage.

PAUSE AND REFLECT  Thinking about issues of culture and oppression Consider what issues of culture and oppression might be at work in the following situation.

Case example: Gang fights in the social housing scheme Police and social workers were concerned that two gangs of teenagers, the Rams and the Goats, had established different territories in a social housing scheme. This had led to street fighting and knife attacks on young people from the other part of the scheme who strayed into the wrong territory. In conferences about this issue, police officers saw this as mainly about territory for the distribution of illegal drugs. Social workers saw some of the conflict as stem-

ming from a large group of migrants from the Caribbean in the Goats’ area: the name Goats had originally come from a favourite dish of these families, goat stew, which had appeared in  local shops when this ethnic group became significant customers. People from the Indigenous white population often talked about the way the Caribbean men were taking jobs away from skilled white workers because they would accept lower wages for semi-skilled work.

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Some suggestions Part of the source of gang violence might have stemmed from racist stereotypes about migrants ‘taking work away’ from Indigenous people, although there is little evidence that this happens in most advanced economies. Other sources of the drug abuse might also be explored: there might be alienation, for example, because of poor opportunity for education and social mobility. It is often necessary to explore a range of social conflicts before arriving at a view about which social issues to tackle. There is debate about multiculturalism. This concept affirms cultural diversity, allowing individuals to keep much that is distinctive about their cultural traditions. It also works to integrate diverse cultural traditions into society, thus avoiding a single, dominant culture (Sanders, 1978). The difficulty with this is that the variety of cultures available in a diverse community or nation may lead to only a partial understanding of each. It might also lead to a lack of commitment to any cultural or religious identity. For example, schools successively teaching the features of several religions may not adequately support each child in a commitment to the religion that their parents would prefer.

Case example: Celebrating cultural diversity in residential care Children in a group of private sector children’s residential care homes were encouraged to celebrate the festivals of Diwali (Hindu/Jain), Christmas (Christian), Passover (Jewish) and Ramadan (Islamic), which were relevant to some of the children in the home. However, there was no education about their importance in differ-

ent cultural and historical contexts, and no attempt to ensure that children from different backgrounds realized the significance of a particular festival for their own cultural heritage. As a result, many of the children merely saw the celebrations as a disconnected series of occasional celebrations, rather like birthday parties.

Because multicultural policies may lead to this kind of disconnected treatment of important cultural or religious events, people may enjoy the exoticism of a cultural idea that is new to them, or find it distasteful, without thinking about its implications for their personal system of thought or for practice within existing social structures. Another example is the debate about adopting elements or procedures of Islamic sharia law into Western legal systems. To do so may seem respectful to the traditions of important ethnic and religious minorities in society, but the ideas may also conflict with important tenets of the majority religion and culture. Thus, multiculturalism finds itself valuing and respecting alternative cultures, but resisting their acceptance into established legal or cultural traditions. This can seem ambivalent or dismissive of the importance of all the traditions that are represented in the society.

Indigenist practice and Indigenous peoples Indigenist practice is a recent development emerging from social movements of people descended from populations living in countries where the dominant population group derives from past colonial settlement. Examples include the original populations before colonial

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settlement of Aotearoa/New Zealand, Australia, Canada and the USA. There are also countries where there are significant ethnic minorities, often in specific regions, whose cultural history is devalued by the majority population; an example is the Sami peoples of northern Europe. The term might easily be applied to parts of Cornish, Irish, Scottish and Welsh populations in the UK, and many countries might identify similar historic or other devalued local groups. A more diffuse but often stigmatized population group is the Roma people present in many European countries. Indigenous movements have ties to geographic regions, distinctive language, culture and beliefs, social, political and economic systems and want to maintain or build links to historic environments and cultures to form a distinctive community of people. Identifying Indigenous minorities in this way is often disputed for political reasons, since it may threaten majority economic, political and social settlements. Activist campaigning for social justice to such oppressed groups, however, is an important political movement. An aspect of that justice is advocacy for the voice of Indigenous groups to be respected, for participation in decision-­ making, respect for cultural mores in general and in helping and other services and equal provision of social work and other services. The terms ‘Indigenist’ and ‘Indigenous’ are capitalized to reflect their equivalence to words describing regional populations such as American, Asian or European. Demonstrating explicit respect for Indigenous groups and their concerns is sometimes represented as politically correct by critics. That is, conservative critics reject valuing Indigenous populations because they do not accept the structural implications of doing so. An important aspect of Indigenist practice is identifying and using Indigenous and traditional concepts as part of practice and a questioning of conventional approaches where they do not accord with Indigenous cultures. For example, Ney, Kinewesquao and Maloney (2015) describe a family that experienced both a family group decision-making process and a traditional process. While the family group process sought to engage the family in collaborative work and focused on family strengths, it was experienced as unsupportive compared with the well-understood traditional process. As we noted in Chapter 13, Indigenous concepts often call on traditional spirituality.

Diversity or social division? ‘Diversity’ is a recent term, connected with multiculturalism because it refers to the reality that most countries and regions have a wide range of groups with identifiable cultural and social characteristics that distinguish them from the majority population. Using this term is sometimes criticized as a euphemism, hiding the fact that such groups are discriminated against or oppressed. Promoting diversity suffers from the same problems as multiculturalism in that it says we value what minorities offer us without proposing practice that assists them to overcome their social disadvantage. As with political correctness, there is a risk that talking about diversity underplays the importance of social structural explanations of social division in creating discrimination and social conflict.

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Major statements There has been a ferment of publication in this field in the twenty-first century. As we saw in discussing feminist practice, the major anti-discrimination statements build on Thompson’s (2016) introductory text Anti-discriminatory practice, now in its sixth edition. Okitikpi and Aymer (2010) covers similar ground. On anti-oppressive practice, Dalrymple and Burke (2006) offer an account of practice related to social work responsibilities in welfare states from a UK source, focusing on legal and professional responsibilities. Morgaine and Capous-­ Desyllas (2015) cover a broader range of practice issues from a US source, but with some global perspective, so I use it as an example text later in the chapter. Nzira and Williams’s (2009) account of anti-oppressive practice is useful for its linking of health and social care settings and interesting practical material on identities. Mullaly and West (2018) provide a structural account with less of a practice emphasis, building on Mullaly’s analysis of oppression and privilege in critical practice (see Chapter 15 for more detailed coverage). Baines’s (2017a, b, c) long-standing edited collection from Canadian sources provides an account focused on social justice with a strong critical theory analysis but also much material on practice implications. Dominelli’s (2002b) now-ageing text on anti-oppressive practice is more theoretically comprehensive and more internationally focused than Thompson’s, and builds on her work in anti-racism, an area for which her introductory text Anti-racist social work (2017) remains well used and has recently been updated to include contemporary issues such as Islamophobia. Lavalette and Penketh’s (2014) edited collection is good on social policy on race and its implications for social work. Cocker and Hafford-Letchfield’s (2014) edited text emphasizes theoretical analysis. Esquao and Strega’s (2015) edited text focuses on child welfare, an important aspect of practice for both anti-racist and anti-oppressive thinking, because of its implications for respecting alternative cultural and minority ethnic group child-rearing practices and because of its importance to social work agencies’ responsibilities across the world. Devore and Schlesinger’s (1999) Ethnic-sensitive social work practice remains an important statement of sensitivity practice. Another contribution is from O’Hagan (2001), who offers a British research-based discussion of cultural competency – the idea that practitioners should gain competence in understanding and dealing with people from different cultures. Williams and Graham’s (2016) edited collection contains the best critical analysis of diversity issues. Accounts by Marsiglia and Kulis (2015) and Sisneros et al. (2008) are examples of attempts to incorporate a critical and structural analysis of oppression that have been informed by multicultural sensibilities into prescriptions of practice. Sisneros et al.’s (2008) account is used as an example text illustrating this trend.

Wider theoretical perspectives A variety of terms are used in this field (Harrison & Burke, 2014), and I deal first with anti-­ racism, going on to discuss some contemporary ideas about racism. Following this, I consider some perspectives on diversity and multiculturalism. Then I move on to oppression and discrimination.

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Anti-racism The first term to emerge was ‘anti-racism’. This refers to attempts to combat racial prejudice. Later, anti-discriminatory and anti-oppressive practice emerged to broaden the scope of concern about discrimination, taking in other common grounds for discrimination such as gender, disability, sexuality and age. To the proponents of action on these broader issues, referring only to anti-racism may seem to prioritize racial discrimination above other kinds of discrimination. In addition, individuals or interest groups sometimes dispute the idea of rolling up their concerns about, for example, disability or sexuality into these omnibus terms because they see the source of discrimination against them as being more specific. Some people also question the implication of anti-oppressive practice that the issue and the focus of practice should be not discriminatory attitudes but the social oppression that results. Sometimes, part of the reason for these doubts is political dissent from the idea of oppression because of its association with critical or radical political and social opinion. Anti-discriminatory practice derives from the sociological and psychological study of the processes by which some social groups and individuals devalue particular characteristics and discriminate against others on these grounds in social relations (Dominelli 2002b). Anti-oppressive practice looks at how everyday experience is formed by multiple oppressions in individual experiences and social arrangements. Resistance to those oppressions is part of that experience. In this context, social work is not just neutral and caring, but while helping individuals it also looks for ways of transforming society so that people do not have to experience oppression and build resistances. Social work does this by creating alliances and working alongside other related social movements. It draws its inspiration from the struggles of marginalized social groups that it sees and participates with. Participation with clients is necessary, but we should avoid this being co-opted into supporting the status quo. To do this we need to use critical reflection to sustain a focus on achieving social justice (Baines, 2017a). It is important to understand that anti-oppressive practice takes place at a time in which neoliberal, globalizing economics leads to a restructuring of the agency context in which universal provision is being replaced by targeted social programmes and new public management that leaves only residual social provision. It is helpful to retain a vision of holistic, preventive, proactive services to resist fragmentation of services and participatory democracy and the narrowing of social work skills (Baines, 2017b). Multicultural sensitivity practice, on the other hand, is built on the study of cultures and their interaction with behaviour and relationships in societies. This practice overlaps with anti-oppressive practice, but they have different primary aims: anti-oppressive practice intends to transform social structures to achieve greater equality and social justice, while multicultural sensitivity practice intends to manage and respond effectively to the conflicts in individual, group and community social relationships. An important source of ideas is research and commentary on the social issues concerned with race and ethnicity. Feminist theory and work on disability and sexuality are also contributors. Anti-oppressive practice brings together these areas of concern into an overarching theory and practice covering any people inappropriately discriminated against or oppressed. Multicultural sensitivity focuses more on ethnicity, race and spirituality, although it is increasingly applied to other social divisions where sensitivity is required. Devore and Schlesinger

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(1999) point out that many minority ethnic groups do not accept the association with wider oppressions that is implied by adopting anti-oppressive practice, since there are particular factors involved in the oppression of black and minority ethnic groups, particularly slavery in the USA. Other groups included in anti-oppressive practice theory often feel similarly – that oppression on the grounds of gender, disability, sexuality or age stems from different sources and requires a range of responses. However, the main thrust of anti-oppression theory derives from critical social science analysis (see Chapter 15) rather than the views of oppressed people themselves. This view holds that oppression comes from inequalities that are part of the structure of societies as a result of the power of the ruling elites. Because of this, anti-­ oppression theory argues that excluded groups are affected by similar social processes.

Anti-racist perspectives Racism is a range of ideologies and social processes that discriminate against others using assumptions of different racial membership (Solomos, 2003: 11). Thus, if you are of a different racial group from the client you are working with, you regard them as ‘other’ than yourself. Experiencing someone as ‘other’ affects both you and them: you may experience confusion and hostility; they may experience dehumanization and humiliation (Essed, 2020). Or you may both be fearful of those feelings. If, to do successful social work, you want to respect and value the other person, this may adversely affect your practice. Figure 18.2 identifies several perspectives in anti-racism, which you can extend to apply to most oppressed groups. Most are similar to the feminist perspectives identified in Chapter 17. The interaction and role of each are debated, and in the next two parts of this section, I look at some of the issues that have been raised for social work. Dominelli (2018) identifies personal and structural racism as elements of such processes and ideologies. In addition to the personal consequences of racism for your practice, therefore, broad social issues arise from racism in any society. Solomos (2020) discusses two distinct intellectual traditions. One reflects the social responses in the USA in the aftermath of slavery, and issues of whiteness leading to concern about the racism of white supremacist

Perspective

Explanation

Assimilation

Migrants or minorities will assimilate to the majority culture and lifestyle

Liberal pluralism

All groups should co-exist, and equal opportunities, but not necessarily equal outcomes, are assured by legal and administrative means

Cultural pluralism

There is a focus on diversity: all groups should co-exist, maintaining their cultural traditions

Structuralist/ critical perspective

Ethnic and cultural divisions are strengthened by economic and cultural domination by elite groups

Black perspectives

Black and minority ethnic groups develop particular perspectives on societies because of their history and experience

Figure 18.2  Anti-racist perspectives Sources: Ely and Denney (1987), Jenkins (1988), Denney (1991), Gould (1994), Sisneros et  al. (2008: 5–6), and Dominelli (2018).

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thinking. This is less evident in Europe, where the focus is more on the consequences of colonial histories and the resulting attitudes to racial minorities who have come from colonies. Racism has been a worldwide phenomenon throughout history (Bowser, 1995) and affects different societies differently; it is constantly developing. Contemporary research, for example, looks at mobilization: which issues mobilize activism and policy development in different countries? One issue is nationalism and ethno-nationalism: to what extent is our ethnic identity connected with our national identity? There are also transnational mobilizations: movements associated with religious and spiritual identities such as Islam and Islamophobia, for example. Evidence from social science shifted conventional norms from nineteenth-century assumptions that white people are biologically superior to black ‘races’ towards a focus on discriminatory behaviour that is a consequence of feelings or attitudes of cultural superiority. Reviewing the history of racist ideas, Banton (1987) showed that, in colonial times, different racial types, often associated with skin colour, were distinguished. In the nineteenth century, these types became connected with evolutionary ideas in biology, so that different types were related to different evolutionary lines of development. This became associated with social status, and more successful and dominant societies claimed superiority over others. As races came into contact with one another, superiority and inferiority became associated with class positions in societies where different races were in contact. There was then a movement away from assumptions that biological differences between races (which do not exist biologically in human beings) justified superiority on the grounds of cultural and social differences. Globalizing social change from 1980 onwards accentuated this (Pilkington, 2003). As global travel and communication became quicker and more comprehensive, migration because of disasters and wars became more widespread, and cultures and ethnic groups came into contact more extensively. Significant minority groups with different physical appearances and cultures formed in many countries. Countries dealt with this in different ways, and sometimes these responses contained contradictions. For example, the USA has a history as a welcoming nation, a significant receiver of immigrants, but has contentious race relations partly because of its history as a location of slave economies. Another example: some European nations have accepted or encouraged migration to maintain their economies in the face of declining birth rates, while at the same time receiving increased ethnically and religiously diverse migration as a result of wars and international disasters. This has produced increased xenophobia, and struggles over perceived public benefits, rights and contributions to the nation. Documentation of immigrant status and social contribution in all countries thus became an important area of struggle (Joseph, 2020). This affects professionals such as social workers because as public officials they may be required to enforce immigrant status and cultural behaviour, for example in matters of childcare or mental healthcare. Such enforcement of public requirement or social expectations may conflict with social work values of openness and acceptance. Many countries, in their own way, face problems of conflict between different ethnic and cultural groups. We have seen that Indigenous people have formed social movements in response to oppression from settler populations. Difficulties have often arisen because of an inward migration by other powerful ethnic groups and a record of oppression and conflict, as in O’Hagan’s (2001) example of Northern Ireland; another example might be Israel/Palestine.

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Diversity and multiculturalism Responding to such situations has often led to an emphasis on respect for ethnic diversity or multiculturalism (Isajiw, 1997) and, in social work, to approaches involving sensitivity and cultural competence. Multiculturalism refers to attempts to incorporate groups different from the dominant population into a nation or community by valuing their cultural contribution to the whole and emphasizing the value of diversity and pluralism (Rex, 1997). Multiculturalism both accepts and encourages participation in the dominant culture and the maintenance of some ethnic and religious traditions from the minority culture, but it opposes social separatism. The idea was particularly influential at the time of campaigns opposing social policies based on a separation of ethnic and cultural groups. Examples include the American civil rights movement, South African apartheid and, in Canada, Australia and New Zealand, concern about the rights and cultural identity of, respectively, the ‘first nation’, Aboriginal and Maori populations. These concerns pressed social workers and their agencies to make services more appropriate and responsive. Much of the literature focuses on culture, but a significant element of cultural diversity arises from religious and spiritual diversity. There has as a result been growing interest in understanding different religious and spiritual experiences (see Chapter 13). Rising concern with the impact of Islam in international conflicts has also affected this (Ashencaen Crabtree, Hussein & Spalek, 2016). Inequalities in housing provision and employment markets were the first focus of concern about racial discrimination; it became associated with discrimination in all large organizations, often using the idea of institutional racism. This proposes that indirect discrimination arises within organizations because established patterns of social relations privilege majority ethnic groups. Mullaly and West (2018) propose that practice should focus on privilege in cultural aspects of life, individual experiences and structural levels. This is because it intersects with many other aspects of oppression, being internalized into people’s sense of identity. Such privilege is part of the structure of organizations such as the police, health and social care agencies, schools and government bodies in societies, and the assumptions of their workforces, managers and political leadership. As social institutions, organizations may become oppressive because they are ‘institutionally racist’ in their ordinary functioning, and members of the organization may not be aware of this. For example, a social work agency may place a strong emphasis on confidentiality as a principle of practice – it is part of many social work codes of ethics or practice. To some minority ethnic groups, however, this may exclude family, community or religious groups from participating in active involvement in making family or community decisions. This is an expectation in many African and Asian countries, so just assuming Western social work values are relevant to African and Asian agencies may be inappropriate and social work conventions will need to be reconstructed. It also means that where minorities come from other countries to Western countries, people’s traditional problem-­ solving models may not work when social work agencies become involved in a family or community, so that people may be excluded or exclude themselves from getting appropriate help, or social workers cannot help them appropriately. Minority groups may be excluded from the main economic and social systems, and may become concentrated in economically and socially deprived geographical communities that are eventually associated with that minority. Consequently, minority ethnic groups become

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associated with the economic and social problems of deprived communities. Cultural representations, through the media, literature and films, also connect deprivation with minorities. Because of its knowledge base in social science, social work was among the first professions to develop an awareness of these issues and incorporate anti-oppressive and sensitivity practice into its corpus of knowledge and skills. Assimilation assumes that migrants to a new country will assimilate to the culture and lifestyle of that country. Where there is a native population and dominant incomers, assimilation will be to the incomers. This demonstrates that the power of the dominant culture, rather than who was present first, is at issue, and we have seen that this has been an issue in Indigenist movements. Small (1989) suggests that immigrants start by identifying with the culture and lifestyle of their country of origin and then substitute the new country’s culture and way of life. Isajiw (1997) refers to an interweaving of minority and majority social structures, cultures and identities, leading to reciprocity between the minority group and the majority society, both of which gain economically and culturally. In gender, disability, sexuality, age or other discrimination, assimilation views assume that different groups can adapt to a society that includes these differences. An important issue with assimilation perspectives is that they assume a cultural deficit, with the minority’s original culture not developing the skills and knowledge to cope with the new environment. This may assume that the minority culture is deficient. For example, people might think that childcare skills are lacking, or that the oppression of female members of Muslim families is inappropriate in a Western society. As a result, services may pathologize black people (Singh, 1992), an example of blaming the victim. In this way, the power to define the culturally acceptable behaviour of the minority community as a problem is used to remove oppression from the agenda on the grounds of this behaviour, so that agencies do not recognize this aspect of the problem. Most anti-racist approaches are structuralist; see, for example, Dominelli’s (2018) anti-­ racist practice. Multicultural sensitivity and black perspectives often include elements of explanation from structural perspectives, but focus on cultural and social domination rather than economic and class analysis. Consequently, structural theorists often regard them as providing inadequate accounts of racism. One aspect of sensitivity is to emphasize black people’s contribution to the history of social work (Carlton-LaNey, 1994, 2001; Martin & Martin, 1995). These may have been hidden by racist assumptions, which devalue such contributions. Views from black perspectives propose that practitioners should be sensitive to black perspectives and experiences of the world, and sensitive in their attempts to adapt the skills of conventional practice to this perspective. Practice methods can contribute to this. For example, Martin (1995) shows how a process of exploring the oral history of an individual in family and community contexts can include black and community perspectives in professional assessment. Graham (2007) argues, however, that we must be careful to avoid assuming that black people’s lives involve only struggle and reaction to white oppression: black perspectives offer creative and original views of the world. Efforts should be made to develop and make use of social science information about black people, which responds to the understandings that black people have about the world (Robinson, 1995). We should avoid assuming that there is only one minority culture or that each group has a single culture, but explore the range of views in each case (Gross, 1995).

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Case example: Views of Muslim youth on integration and adaptation A study of Muslim youth in Scotland used a series of informal conversations using prompts, an example of Robinson’s (1995) use of social science methodologies to enable black perspectives to emerge. Young Muslims were critical of many aspects of the Muslim institutions they were involved with because of failure to engage with their experiences, but were also concerned about perceptions of Islam

in wider society. While proud of their Muslim heritage, they also had important connections with the majority community. They saw social workers and similar professionals who took the trouble to engage with and understand their experiences and voice as potential advocates and helpers in overcoming the conflicts of identity that they experienced. Source: Robinson and Gardee (2016).

In the USA, critical race theory (CRT; Delgado & Stefancic, 2017) incorporates both multicultural and oppression perspectives, and, starting from its base in legal studies, has been influential in professional education (Abrams & Moio, 2009). Arising from the American civil rights movement of the 1970s, it particularly emphasizes the role of legal interventions to correct racial oppression. It criticizes ‘colour-blind’ policies and practice, because trying to treat people of all ethnicities as the same evades the reality that some ethnic groups are historically oppressed and need additional support to take up opportunities so they can realize their potential. CRT also emphasizes black people’s perspectives and issues of white supremacy, important in the USA, and criticizes a focus on cultural competence as a way of dealing with racism, because cultural competence fails to deal with structural oppression. Marxist analysis proposes that CRT does not sufficiently recognize structural oppression in neoliberal economies (Cole, 2017).

Discrimination and oppression Anti-oppressive approaches to social work developed in the late 1980s and 1990s because of policy concerns in Western democratic states. These arose partly from serious social conflict, such as the inner city riots in the UK in the early 1980s, which were largely ascribed to alienation among young black people, similar riots and a high level of crime among black people in the USA, and conflict in Germany, Italy and Balkan countries over refugees from Middle Eastern countries and in France over refugees from North Africa. Official responses to this were largely socially liberal. That is, they focused on reducing inequalities and marginalization by policies and practice that promoted social inclusion (Barry & Hallett, 1998). Anti-­ oppressive practice also springs from the concerns of critical theory about groups of people within societies who suffer from inequality and consequent injustice. Critical theory sees the problem as one of social structures rather than one of individual or group problems or disadvantages. As I described earlier in this chapter, discrimination involves treating individuals or groups with identifiable characteristics less well than people and groups that are not identified as having those characteristics because those characteristics are devalued. An important

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strand in thinking about anti-discriminatory work comes from the influence of feminist thinking (see Chapter 17). The oppression of black women, where racism and sexism may intersect, has led to an approach that is distinctive from broader feminist perspectives. An important wider debate that has relevance to social work is the issue of the role of psychoanalysis and its approach to women (see Chapter 4). Other influences on anti-discriminatory thought have been lesbian and gay rights work, and ideas on disability, mental illness, learning disabilities and social gerontology’s concern with the social and structural implications of ageing and ageism (Phillipson, 1982; Dannefer & Phillipson, 2010; Ayalon & Tesch-Römer, 2018). Many of these factors interrelate (for example, age, gender and sexuality, King, Almack & Jones, 2019; age and ethnicity, Torres, 2019), so that problems occurring where two or more aspects of identity lead to social oppression may be magnified, or may lead to conflicts in response and attitude. Theoretical approaches in relation to other oppressed groups are less well developed, but it is possible to position them within these perspectives. Normalization and social role valorization (Wolfensberger, 1972, 1984; Race, 2003; see Chapter 14) take, in many ways, an assimilationist position. This is because this approach seeks to include people with learning disabilities as far as possible into ‘ordinary life’ (Towell, 1988), so that their social roles can be, as far as possible, equivalent to those that are widely valued in society. However, this also has elements of a perspectives position, because it seeks to take up and promote disabled people’s own perspectives on their situation. A social model of disability view (Oliver, 2009) is a pluralist position with structural elements arguing that medical models concentrate on disabled people’s impairment. Instead, we must recognize that social definitions of what is normal lead to society being organized in ways that create disability. For example, if there were no steps in buildings, a person with a walking impairment would not be disabled. Society should be changed so that all groups can coexist on an equal basis. The recognition of ‘communities’ among disabled people suggests the possibility of a perspectives position as well. One example is a Deaf community of people born deaf whose language and culture derives from sign language – the capitalization of ‘D’ in ‘Deaf ’ denotes participation in that community. A political economy of ageing view (Phillipson, 1982) is mainly structuralist. It argues that assumptions about ageing derive from the exclusion of older people from the labour market, making them economically and socially dependent. A disabled living view (Morris, 1993) is related to perspectives positions. It argues that disabled individuals and communities should direct and manage the services designed to support them towards independence. More recently, citizenship practice with older people has stressed the importance of emphasizing the rights of older people and people with dementia to participate in and contribute to society through as many normal processes as possible (Marshall & Tibbs, 2006; Payne, 2011b; 2017a). Matthies (2010) argues that social work values promote participation and citizenship in society more broadly. Discrimination is created and maintained by personal beliefs and behaviour, reinforced by ideologies that develop from the power exerted by groups in order to sustain and strengthen their dominant position within social structures. This is an increasingly important concept in critical theory, as we saw in Fook’s account of critical practice in Chapter 15. Wilson and

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Beresford (2000) go further, arguing that the way in which social work has given importance to anti-oppressive practice allows social workers to appropriate the ideas of oppressed service users while retaining the power to define what is oppressive. Service users still lose control of how their lives are defined, and this in itself is oppressive. One of the ways in which discrimination is maintained through cultural means is using language and social assumptions to support conventions that are discriminatory. This makes important connections with social construction theory. Denney (1992) argues that poststructuralist theory provides a method for exploring, through an analysis of court or agency reports, how people have moved from assumptions to making discriminatory decisions. Another example is using the words ‘spastic’ and ‘idiot’ as terms of abuse, when they were originally technical terms referring to a form or severity (respectively) of physical and intellectual (respectively) disabilities.

PAUSE AND REFLECT  Your life experience Think about the categories of race and ethnicity, gender, disability, sexuality and ageism, and, if possible, compare your thinking with that of others. At what age and in what circumstances did you become aware that you were different from others in each of these categories? What were social assumptions about such differences in your family or among your peers? How would you describe your present attitudes?

Some suggestions We tend to take for granted such assumptions about ourselves. For example, I am white and grew up without meeting any black people until my late teens, so I find it hard not to think of being white as normal and being black as out of the ordinary. Another example is Owusu-­ Bempah’s (1994) research showing that social workers assume that self-identity in black children will be problematic, but they do not make the same assumptions about white children. This suggests that we need to be open and flexible in our views about all ethnic groups and listen carefully to their own perspective, rather than taking any issue for granted in relation to ethnic identity.

Connections Concerns about social conflict led to attempts to frame an approach to combating racism within social work and to a lesser extent other related occupational groups. Impetus was given to many of these developments by the curriculum development activities of the UK and US education authorities for social work (for example, Norton, 1978; CCETSW, 1991; CD Project Steering Group, 1991; Patel, 1994, all on race). Some reviews of theory do not refer to anti-­ discrimination (for example, Teater, 2014; Lishman, 2015; Lishman et  al., 2018). This may reflect the debate about whether anti-discrimination is a separable theory of practice, since it does not refer to many social problems faced by social workers and might be better regarded

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as a value principle that should permeate all approaches to social work. Clifford and Burke (2009) take this permeation approach in a text framing anti-oppressive practice as ethics and values applicable to all social work theory, rather than as a separate practice model.

Analyses of anti-discrimination A creation of the 1990s is an approach that includes all forms of discrimination in a generic anti-discriminatory (Thompson, 2016) or anti-oppressive (Dalrymple & Burke, 2006; Cocker & Hafford-Letchfield, 2014; Morgaine & Capous-Desyllas, 2015) approach. Both make an analysis of discrimination that takes a concentric view of the relevant social forces. Figure 18.3 compares the terminology and approach of each. Norton’s position sees the individual and their family and immediate community as being ‘embedded’ (1978: 4) in a wider social system. The individual’s primary identification is to the nurturing or immediate system. The wider or sustaining system is seen as ‘taking on the attitude of the wider society in regard to oneself ’ (1978: 4). Thompson’s (2016) anti-discriminatory theory links the personal/psychological, cultural and structural levels of analysis of social issues. Here, the personal (P) level is about interpersonal relationships and the personal or psychological feelings, attitudes and actions between people. This includes social work practice, which is mainly carried out at this level. It takes

Dalrymple and Burke (2006: 119) Level of activity/ political action Level of ideas/ changed consciousness

ivid

rtu

Ind

Nu

l/ na cal i rso Pe holog yc ps

ral ltu Cu al

tur uc

Str

Thompson (2012)

ua l rin gs ge ne ystem ral ize /im Su d o me ma sta the dia jor inin te r ge ne g sys ral t e ize m/ do the r

Level of feelings/ biography

Figure 18.3  Three concentric formulations of anti-oppressive practice Sources: Norton (1978), Dalrymple and Burke (2006: 11), and Thompson (2017).

Norton (1978: 5)

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place within a cultural context (C), which influences and forms individual thought and action; that is, the C level refers to shared ways of thinking, feeling and acting. It is thus about commonalities between people within different groups, an assumed consensus about normality and the assumption that people conform to social norms created within particular cultures, cultural norms that we internalize. These levels are in turn embedded in a structural level (S), which is an established social order and a set of accepted social divisions. This established social order and its structures, as well as the cultural norms and assumptions and personal behaviour that result, come from an acceptance of the social order and its divisions. Social workers have a good deal of influence over the personal level but decreasing influence over matters at cultural and then structural levels. Dalrymple and Burke’s (2006) analysis develops a practice model involving the practitioner and client in a partnership committed to change in order to achieve greater equality in society. This operates at three levels: at the level of feelings, reflecting the client’s and social worker’s biographies; at the level of ideas, working to achieve a changed consciousness of both feelings and society; and at the level of political action in wider society. There are, however, problems with a concentric view, because it may assume that wider social ideas and structures are always mediated in their effect on individuals’ ideas and feelings by a more immediate culture. Against this, the immediate culture may be in conflict with the wider society, and may support individuals against wider ideas and structures. Alternatively, individuals may conflict with their culture and be more in touch with wider ideas.

The politics of anti-oppression and sensitivity We have seen that anti-oppressive practice is an alternative perspective to ideas of multicultural sensitivity that contribute to cultural competence or awareness practice. Competition between them derives from different emphases: ●● ●●

an emphasis on structural explanation in anti-oppression theory; an emphasis on cultural and social inclusion in sensitivity theory.

While both perspectives include both elements, structural explanations would logically obstruct the inclusion and empowerment strategies that sensitivity theory focuses on. Sensitivity perspectives see themselves as a legitimate alternative, encouraging an awareness and acceptance of structural explanations but leading to an empowerment objective, which does not prioritize them to focus on social change. Sensitivity perspectives may also be taken up as an aspect of relational social work in complex therapeutic work, since cultural and ethnic issues are often important aspects of the issues faced by such clients (Ganzer & Ornstein, 2002). American accounts of anti-racism (for example, Pinderhughes, 1988, 1989) attached great significance to power, but see this in relation to its interpersonal effects and its consequences for behaviour and experience. Similarly, Dietz (2000) argues for a clinical practice that assesses the impact of oppression but works on strengths and personal social and political contexts. The increasing emphasis on different cultural expressions of spirituality is another aspect of this approach (see Chapter 13). Gould (1995) argues that we should develop multiculturalism to offer a framework for all groups to integrate thinking across cultures.

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Black perspectives propose a more experiential and political understanding of the black experience. We should focus on understanding and working with power differentials and value opportunities to achieve power for black perspectives, black participation and black influence, and control in services and attitudes. Black perspectives connect with the approach of the disabled living perspective and some aspects of normalization and ordinary life perspectives. This leads us to the possibility of an oppressed groups’ perspective, with a detailed analysis and understanding of the views and experience of oppressed groups. This is the basis for social work action and for promoting the involvement of members of those groups in managing and developing services. O’Hagan (2001) presents a multicultural critique of anti-discrimination as follows: ●●

●●

●●

In analysing racism, it ignores important cultural aspects of discrimination, such as religion. It focuses on ‘black/white’ distinctions, referring to such ideas as ‘black tradition’, ‘black experience’ and ‘black perspectives’. This is contrary to the wishes of many people within the groups so labelled, who prefer to distinguish different histories, cultures and religions as aspects of their personal and social identity. Anti-discrimination uses terms such as ‘ethnicity’, with a meaning in historical derivation implying ‘not us’, that are associated with pejorative terms such as ‘ethnic cleansing’ and have come to be used offensively, as in referring to people from minority groups as ‘ethnics’. Since O’Hagan was writing, the abbreviation BME (black and minority ethnic group) and reference to BMEs in daily practice has sometimes been seen as similarly offensive, but the abbreviation BAME is now in widespread use.

In addition, Clarke (2003) proposes that the structural origins of racism interact with emotional responses to it to create a complex mixture of factors; neither the internal and emotional nor the external can be ignored. Robinson (1999) argues that the stage a person has reached in the development of their racial identity is more important than the mere fact of their race. Thus, in general, the picture is of a more complex set of social interactions than simple discrimination would suggest. Even so, Robinson (2001) suggests that there is a shared experience of discrimination and racism. Attempts to create an overall theoretical model of anti-discriminatory and anti-oppressive practice seek to subsume anti-racist concerns and concerns about other groups with feminism’s focus on gender discrimination. The strong ideological and theoretical roots of feminism in wider political, social and cultural ideology, and its many distinctive features, however, make it a separate force. Anti-discriminatory and anti-oppressive practice theory sees the interaction between various oppressions as complex and requiring analysis, for example through intersectionality. This, however, presents practical and ideological problems. Macey and Moxon (1996) criticized anti-racism because it emphasizes racism as an explanation of discrimination in the context of high levels of poverty and poor environments. Poor education, crime and disorder, unemployment and inequality are due to many other factors, and anti-discrimination exaggerates the importance of racism in its interaction with other sources of inequality. An agency or social workers may specialize in ways that make it impossible for them to accord equal

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weight to all the oppressions. The needs of clients may present in one area, and social workers may resist dealing with other areas. Both practitioners and clients may, at the level of ideas, have difficulty in accepting the equivalence of oppression of, say, older people or lesbians and gays with that of, say, people from other cultures. This may be owing to their own prejudice or their reasonable assessment that ageism, for example, has far less serious consequences than racism for particular clients or in general.

Values issues Both anti-oppressive and multicultural sensitivity theory implement the shared principles of critical practice and a concern for rights (see Figure 1.7). Recent accounts of anti-­oppressive practice (Clifford & Burke, 2009; Gray & Webb, 2010) make a strong connection with social justice and human rights. Gray & Webb’s (2010) analysis connects anti-racism, anti-oppression and participatory actions with human rights and social justice objectives. Ife’s (2012) important analysis of human rights practice sees it as a moral action, invoking a passion for justice. Both are part of social rather than moral values. Clifford & Burke (2009) see such social objectives alongside the interpersonal values, such as feminist relationship ethics; that caring derives from interpersonal connectedness rather than justice perspectives.

Applications Anti-oppressive, sensitivity and other social work practices We have seen that anti-oppressive perspectives are critical of all social work practice and organizations in their failure to incorporate major social change to achieve equality and social justice for oppressed groups. Multicultural sensitivity approaches question this structuralist focus on inequalities and social change, suggesting that other issues are just as important in practice. The choice presented for practitioners is to embrace the structural critique completely (a social change theoretical strategy) or focus on the perspectives of cultural and black or oppressed groups as a way of being committed to meeting oppressed minorities’ needs within interpersonal and therapeutic practice (a theoretical strategy of empowerment). Anti-discriminatory practice theory seeks to incorporate into social work practice a concern for combating discrimination against all groups. Thompson’s (2016) analysis of anti-­ discriminatory practice is important as being the first account to attempt to provide a theoretical rationale for practice across a range of discriminatory behaviour. Some writers (for example, Sisneros et al. 2008; Marsiglia & Kulis, 2015) emphasize diversity and ideas of cultural pluralism and multiculturalism. This approach stems from literature accentuating the cultural element of ethnic difference, including different dress, social customs, artistic and musical contributions, and diet and cuisine. The education of children in religious and social customs is an important strategy, and in the 1980s multiculturalism played a part in influencing education. Forte (1999) proposes that social workers develop ‘toolkits’ of information about the values associated with different cultures. A characteristic of 1990s American literature (for instance, Jacobs and Bowles, 1988; Ryan, 1992; Dhooper & Moore, 2001) is the exploration of

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detailed information about different minority groups. There are also examples covering other nations, such as Laird’s (2008) account of anti-oppressive work, most of which provides cultural information about different UK minority ethnic groups. Using this approach appears to be at least partly because of the presence in the USA of large groups of Indigenous Native American ethnic groups and recent migrants, raising specific language, cultural and practical issues. Dungee-­Anderson & Beckett (1995) argue that we need to understand other cultures with which we work to avoid mistakes in intervention caused by a misunderstanding of our own or our clients’ reactions. Developing from this is the idea of workers having ‘cultural competence’ (O’Hagan, 2001; Lum, 2011; Laird & Tedam, 2019) or being ‘culturally grounded’ (Marsiglia & Kulis, 2015), practising with respect for maintaining diversity and understanding the main cultures they have contact with. Emphasizing culture presents difficulties. Culture may imply a relatively unchanging, dominating collection of social values, and assumes that members of an identified group will always accept all of these. Laird and Tedam (2019: 11) make the point that culture is often an ideal set of values rather than expressing the reality of people’s lives. In this way, culture is a political position within a social group, expressing some aspect of its ideals, often to be contrasted in a discourse with another cultural group’s values. Sources of influences on an individual or a social or ethnic group may vary. We have seen that multiculturalism in education is criticized for encouraging people to gain a smattering of other cultures without an in-depth appreciation of the origins and reasons for the differences. Applied to social work, anti-­ oppression theorists argue that multiculturalism may encourage a surface appreciation of visible diversities without dealing with substantial social inequalities and discrimination. It risks ignoring diversity within categories, subordinating alternative cultures to Western interpretations of them, or simplifying them and denying real philosophical and practical differences in cultural views (Gross, 1995). In this way, multiculturalism does not address inequality, discrimination and the depth of cultural diversity. Fellin (2000) argues that multiculturalism also fails to address diversity within white communities, focusing instead on the differences within minority ethnic groups and between minority ethnic and white groups. Taking a rather different approach to diversity, Cox and Ephross (1998), like Lee (2001; see also Chapter 14), highlight the lens through which practitioners see clients and their social situations, arguing that we must identify aspects of homogeneity and heterogeneity in the ethnic groups we deal with. So, faced with a situation in which ethnicity is an issue, practitioners should assess where there are connections with wider issues of inequality and structural racism; they should also identify issues that particularly affect the group, including diversities such as those of gender and sexuality. We would identify that an African Caribbean man suffers structural inequality in Western societies, for example, but also work on the specific issues raised by his oppressive gender relations with his wife and the personal and social issues raised by his increasing awareness that he is gay. Seeley (2004) suggests that, in short-term work with people from cultural minorities, it is important to focus on their own interpretations of their cultural experience so that we can grasp issues that are important to the client. The practice benefits for workers in diverse societies have ensured the continued use and development of approaches involving ethnic and cultural sensitivity and competence. Their pragmatism and their emphasis on the contested concept of culture means, however, that the ideological and theoretical elements of anti-discrimination theory have in many respects become a theoretical position that competes with ethnic sensitivity.

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Because the range of opinion and terminology is considerable, I have selected two example texts that take different viewpoints in illustrating how writers from different theoretical traditions have applied anti-oppressive and cultural sensitivity approaches in inclusive accounts of practice.

 xample text: Morgaine and Capous-Desyllas (2015) E on anti-oppressive practice The starting point of Morgaine and Capous-Desyllas’s (2015) approach is to arrive at a personal understanding of the paths by which we have reached our present position. This leads to thinking through why anti-oppressive practice is important to us, so that it may offer hope and possibility for effectively working with clients. Anti-oppressive practice develops from an understanding of how social justice intersects with social work, and this picks up some of the arguments we examined in Chapter 14. Distributive justice, or equalizing resources between social groups, is not sufficient for anti-­ oppressive practice. Fraser’s (2008) recognition perspective on social justice proposes that we need to accord respect, privilege, esteem and social status to minority groups, celebrating cultural and social patterns associated with them. In this way, we avoid status subordination. Sen’s ‘capabilities’ approach to justice (see Chapter 14) is also relevant: by looking at what people (individually and their social group) are actually able to achieve, we can gain a sense of the justice with which they are treated in the social relations of their present position. Indigenous and postcolonial justice requires a process by which we hear the voices of peoples who are dispossessed or unrecognized. Postmodern justice similarly requires us to prioritize local knowledge and understanding, the detail of people’s lives. We also need an awareness of the requirements for justice in the religious and spiritual elements of minority groups’ beliefs. For example, Christianity believes in the common good and the restoration of harmonious relationships. Traditional Islamic beliefs base social justice on freedom of conscience, human equality and mutual responsibility. Buddhist ideas, while focused on self-awareness, require selflessness and active engagement with others as factors in social justice. Figure 18.4 sets out these elements of social justice, thereby leading to a foundation for social justice practice. This requires exploring and defining both your own and also clients’ individual social identities, social identity groups, oppression and privilege. Developing your own self-awareness of these, you engage in the processes for achieving social change. This involves a cycle of dialogue with clients and their social locations to understand the structures and systems where injustice takes place, and to form an understanding of how liberation may be developed. This will again influence your social awareness. Liberation involves thinking through how to achieve intrapersonal, interpersonal and systemic change. The engagement of your aware self with clients and social groups in social change then leads you to use the key concepts of anti-oppressive practice. Following from their analysis of the social justice basis for anti-oppressive practice, Morgaine and Capous-Desyllas (2015), like Clifford and Burke (2009), propose that practitioners need to consider the values and ethics that are required to underpin anti-oppressive practice and draw on the full range of practice theories. Anti-oppressive practice may be, and

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Participants’ experience of oppression

Work in partnership

Empower participants

Maintain minimal intervention

Anti-oppressive practice

Self awareness

Processes of social change Liberation

Social identity groups

Redistribution

Recognition

Individual social identities

Capabilities

Dialogue

Oppression

Indigenous, postcolonial

Figure 18.4  The social justice foundations of anti-oppressive practice Source: Morgaine and Capous-Desyllas (2015: 4–27).

Social justice practice

Privilege

Postmodern

Religion, spirituality

Elements of social justice

Reviewing social change and development theories

Critical selfreflection

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perhaps should be, used at every level of social work, working with individuals, families, groups, organizations, communities, policy change, social movements and globally. I set out the analysis of anti-oppressive practice with individuals in Figure 18.5. In each phase, we can identify elements of practice that focus on anti-oppressive practice and which also make connections with many of the theories discussed in previous chapters. For

Phase

Elements

Self-awareness

Feelings and emotions Social location Acknowledging our power

Relationship-based practice

Equality and sharing Warmth, interest in the other Unconditional positive regard Genuineness, authenticity Mutuality Humour, playfulness Caring, connectedness

Engagement

Mutual empathy, tuning-in Observation, noticing Body consciousness Listening, silence Dialogue Reframing resistance Cultural humility Commitment to uncertainty

Teaching and learning (assessment)

Collaboration Structural inequality Reframing, re-visioning, re-storying Individual strengths

Action and accompaniment (intervention)

Plan collaboratively Participatory decision-making Support and create alliances Cultivate resources

Evaluation

Participants’

- Formative, as you go along

- ability to make choices

- Summative, outcomes Critical reflection Celebration

- involvement in wider influence

- ability to influence others

Figure 18.5  Anti-oppressive practice with individuals Source: Morgaine and Capous-Desyllas (2015: 136–65).

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example, awareness of our social location, and acknowledging power, mutuality in relations, cultural humility, assessment of structural inequality, supporting and creating alliances and involvement in wider influence are particularly anti-oppressive in approach. We can also see unconditional positive regard, genuineness and authenticity deriving from humanistic practice, caring and connectedness from feminist ideas, reframing resistance from motivational interviewing, reframing, re-visioning and re-storying from narrative approaches. Distinctive anti-oppressive features of other types of practice may also be identified in the analyses of practice. In working with families, for instance, practitioners should address issues of power, acknowledge and work with structural barriers to helping the family make the changes that it wants to achieve, and focus on strengths and empowerment of the family. Among the challenges of this work are de-pathologizing mental health assessments. Anti-­ oppressive groupwork can emphasize mutual aid and empowerment. With organizations and communities, you seek participation, flattened hierarchies, popular education and sustainable development, and focus on coalition-building. Working on policy, social movements and global issues again identifies participation, coalitions and environment and sustainability.

 xample text: Sisneros et al. (2008) on critical E multicultural social work Sisneros et  al. (2008) provide an example of an interpretation of sensitivity practice that reflects some incorporation of wider cultural issues than ethnicity and race, as well as ideas such as intersectionality and (racial) identity development. It covers ethnicity and race, gender and disabilities. I have not summarized their account of problems in each of these areas, but have instead focused on their analysis of practice. Sisneros et al.’s account concentrates solely on the USA, and I have generalized this material to refer more broadly to a wider range of societies. This text sees societies as patchworks ‘of overlapping stories, perspectives and worldviews’ (Sisneros et al., 2008: 1), and practitioners need to engage with this variety and complexity. Critical multiculturalism implies a move beyond simply acknowledging diversity to engaging with the variety of differences between people and social groups and accepting that power, dominance and socioeconomic class shape social structures and interactions. Practitioners need to analyse these systems and understand how they maintain and perpetuate inequality, with the value objective of taking action for greater equality (see Figure 1.7). Oppression is pervasive and universal, and operates simultaneously at individual, institutional and societal levels. This tells us that change must also operate at each of these levels. Oppression is maintained by five processes: ●● ●●

exploitation, one group appropriating the benefits gained by others; marginalization, in which individuals and groups are denied participation in social life and relations;

Anti-oppressive, Indigenist and multicultural sensitivity practice 503 ●● ●● ●●

powerlessness, where social groups lack power, status and a sense of self; cultural imperialism, in which the culture and experience of one group is the norm; violence, where some groups are subjected to physical and emotional violence, ridicule, harassment and stigma.

Diversity is presented in some social perspectives as frightening and threatening, causing alarm and hostility. Multiple threads in people’s stories are ignored in favour of one account of a society’s history and culture. Political and economic systems are then organized to follow that dominating story. To respond to this, critical multicultural practice seeks to develop self-­ awareness in people’s understanding of their life and social relations. Critical reflection is required so that they can analyse their present position and become aware of potentialities and opportunities. It is important not to be ‘empty of assumptions’ (Sisneros et al., 2008: 26). That is, we must be aware of the social assumptions that we take for granted, learning and accepting misinformation and myths. It is important for people to develop a clear personal and social identity on which we can build the acceptance of multiple world views. Ideas about the development of racial identity (Helms, 1993, 1995) suggest that people move through a series of stages in encountering and internalizing an identity that is focused on their race and ethnicity. Similarly, white people develop an identity of difference from black people and need to develop a non-racist identity, immersing themselves in alternative cultures and developing a commitment to opposing racism. However, alternative conceptions of identity development propose that people have a variety of simultaneous experiences of differences that intersect and influence each other, rather than going through a developmental sequence. People’s experience includes differences in and group history, language, culture, traditions and spirituality. Other factors may include the experience of hostility, stigma and social injustice and inequality, and their impact on our lives and relationships. Gender identity and sexual orientation may include biological factors and alternative views of well-being; that gay or lesbian life preferences might legitimately be different from heterosexual life aims, for example. Our understanding of identity development needs therefore to be multidimensional, including the results of experiencing privilege and disadvantage. Each individual’s self-­ identity and how it interacts with others around them needs to be explored. It is also necessary to understand how relationships and patterns of behaviour generate the capacity to understand and respond to multidimensional world views for both practitioners and clients. Understanding how multiple identifies intersect in individuals, families and communities is an important aspect of this. Sisneros et al. (2008: 82–94) express understanding and practice in this model as ‘creating a web’ of the various dimensions of someone’s identity, understanding their position and then shifting it through providing additional or alternative experiences. This involves interweaving various aspects of privilege and marginalization.

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Case example: Selma’s life develops from profound Deafness Selma was born Deaf to two Deaf parents. As described earlier in the chapter, the capitalization of ‘D’ in ‘Deaf’ denotes her position as part of a community of Deaf people, who see themselves as having a shared culture informed by the shared use of sign language. Until her teenage years, most of Selma’s social life took place in organizations of Deaf people. Although she went to a mainstream school, alongside other children who were not deaf or Deaf, and learned some lip-reading skills, most of her friends were Deaf young people. During her teens,

she became interested in gymnastics and took part in competitions and teams. This gave her the motivation to improve her lip reading, and she gained a number of friends who were not deaf or Deaf, who became increasingly important to her. However, her parents were concerned that she was cutting herself off from the supports available in the Deaf community. She herself regretted some of the losses in convenient social relationships, and she spent some time discussing these issues with the social worker for the Institute for Deaf People.

In this case example, we can see strengths that may be derived from the support of the Deaf community, and from social engagement in it, but also marginalization from other communities. An alternative experience stimulated reflection on Selma’s position in this ‘web’, and her work with the social worker was concerned with shifting her position so that she was able to draw strength from both social situations with which she was engaged. The practitioner could see that this repositioning might also strengthen her capacity to make better use of her school experiences and help with the development of her education. Sisneros et al. (2008: 87) developed a diagram of the web of intersecting identities that may be relevant, and I present a simplified and generalized form of this in Figure 18.6. This diagram defines a variety of factors that contribute towards a personal identity. It is this identity that defines access to privilege, power, access and resources or limitations on them. We

Reframe practice around…

Explanation

Prevention

Look for ways of preventing difficulties arising and avoid making things worse

Assessment

Use assessment to involve people in identifying their needs and to enhance their rights and service provision

Planning

Forward-looking practice obtains better outcomes, and shared planning generates agreed aims

Involvement

Seek ways of involving people in the decisions that affect them, offering a range of opportunities that respond to their needs and the situation

Evaluation

Engage peopleand colleagues in reflection and more formal evaluations of the practice and services provided

Figure 18.6  Web of intersecting identities Source: Sisneros et al. (2008: 87). Reprinted with permission from Lyceum Books.

Anti-oppressive, Indigenist and multicultural sensitivity practice 505

can look at this web in individual cases historically, as the situation is now or in order to provide aims for the future. Exploring this shifting web in our lives can be transformative, allowing us to see strengths that we have not previously identified. Cultural competence allows us to understand our own world view, based on this shifting web, and to help others identify and value their own world view.

PAUSE AND REFLECT  Using the web of intersecting identities Review Selma’s situation from the previous case example and identify where identity strengths were in her childhood and her teenage years. In addition, think through how to work on positive identity shifts for the future.

Some suggestions Selma’s early identity strengths were with her family and the Deaf community, while her ‘ability’ at school and in non-Deaf language was not strong. However, her growing ability in gymnastics enabled her to shift those identities. Further shifts might include shifts in possible employment and socioeconomic status coming from improvements in her education and language. Since the development of gender and sexual orientation identities are often important in the teenage years, it would be useful to explore how these changes in identity affected Thelma’s development in these areas.

 onclusion: using anti-oppressive and multicultural C sensitivity approaches Anti-oppressive and multicultural sensitivity are useful because many societies and agencies face pressures from the consequences of population migration through an increasingly global economy and refugee population movements. In addition, attitudes among groups such as women, disabled people and people with diverse sexualities have become less deferential, less accepting of present patterns of power. These theoretical perspectives help to analyse and respond to these social issues. Perspectives from black and other oppressed groups and multicultural understanding have also helped practitioners to use knowledge about various minority ethnic groups and women, disabled individuals and older people in social relations. Anti-oppressive theories also make an important theoretical contribution to other social work approaches, and they draw on other theoretical approaches. They contribute to critical theory an analysis of the different bases for the oppression of groups and the production of inequalities and divisions in society, and thus provide a more effective account of issues that critical practice must face. The focus on oppression raised important social issues that make important use of critical theory. Anti-oppressive theories draw attention to the weaknesses of

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many psychological and individualistic theories of social work in dealing with discrimination and the issues facing minority groups and women in present-day society, and offer a way of understanding these issues. They thus strengthen the sociological basis of social work. The perspectives of oppressed groups and those of black people do not permit a wholly structural response. They require careful attention to be paid to the wishes and needs of the groups affected, in all their variety and in their local environments. Anti-oppressive practice cannot accept just one structural explanation of oppression or one conceptualization of social justice. Nonetheless, the shared experience of oppression requires a response from services and workers because it directly engages with social justice. Multicultural sensitivity approaches and those of black and oppressed people reject the alignment of all members of a group together as victims of oppression, and seek a more diversified, complex analysis of their needs. Sensitive plural responses will be required, while acknowledging the importance of structural analyses of power as partly conditioning the appropriate response. As a result, a variety of services involving and fitting the needs of particular minorities and oppressed groups would grow up. Sensitivity approaches focus on building up a range of social workers with detailed and specialized understanding. All social workers would take responsibility for a sensitive response to the expressed needs and wishes of the people they worked with. If these required specialized understanding, there would be referral to someone with the appropriate knowledge and experience. While these two approaches represent values and demand understanding that should permeate social work, it is not clear that either can form the only basis of practice: other services and therapeutic objectives will usually also be required. Both approaches seek to influence all forms of social work, rather than create specific models of practice. They therefore often call for an empowerment approach, although this may not be consonant with the structural focus of anti-oppression theory. Structural explanations of oppression are central to anti-oppression and offer a clear view of the social objectives of such a theory. Multicultural sensitivity approaches mainly help by providing an understanding of the diversities that practitioners will have to deal with in practice.

Additional resources Further reading

Baines, D. (Ed.) (2017). Doing anti-oppressive practice: Social justice social work (3rd Ed.). Halifax: Fernwood. Clifford, D. & Burke, B. (2009). Anti-oppressive ethics and values in social work. London: Red Globe Press. Dalrymple, J. & Burke, B. (2006). Anti-oppressive practice: Social care and the law (2nd Ed.). Maidenhead: Open University Press. Esquao, S.  A. & Strega, S. (Eds.) (2015). Walking this path together: Anti-racist and anti-­ oppressive child welfare practice (2nd Ed.). Halifax: Fernwood. Morgaine, K. & Capous-Desyllas, M. (2015). Anti-oppressive social work practice: Putting theory into action. Thousand Oaks, CA: Sage.

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Mullaly, R. P. B. & West, J. (2018). Challenging oppression and confronting privilege: A critical approach to anti-oppressive and anti-privilege theory and practice. Don Mills: Oxford University Press. Useful recent presentations of values and practice views of anti-oppressive practice. Devore, W. & Schlesinger, E. G. (1999). Ethnic-sensitive social work practice (5th Ed.). Boston, MA: Allyn & Bacon. A significant text presenting a sensitivity approach, although it is now somewhat elderly. Sisneros, J., Stakeman, C., Joyner, M. C. & Schmitz, C. L. (2008). Critical multicultural social work. Chicago: Lyceum. A more recent account of cultural sensitivity approaches incorporating some critical elements. Dominelli, L. (2002). Anti-oppressive social work theory and practice. London: Red Globe Press. Dominelli, L. (2018). Anti-racist social work (4th Ed.). London: Red Globe Press. Two examples of Dominelli’s many ideologically informed books in this area. O’Hagan, K. (2001). Cultural competence in the caring professions. London: Jessica Kingsley. A good account of the cultural competence approach to responding to diverse ethnicities. Thompson, N. (2021). Anti-discriminatory practice: Equality, diversity and social justice (5th Ed.). London: Red Globe Press. The latest edition of Thompson’s important introductory text.

Journal Journal of Ethnic and Cultural Diversity in Social Work – Taylor & Francis.

Websites https://www.un.org/en/letsfightracism/ The United Nations website on anti-racism has worldwide links. https://www.enar-eu.org, https://www.ilga-europe.org The websites of the European Network Against Racism and ILGA-Europe (campaigning on equality on issues of sexuality) have links to organizations across Europe and internationally and useful information resources.

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547

Author index A Abrams, L. J., 491 Adam, B., 410 Adame, A. L., 436 Adams, M., 394 Adams, R., 88, 375, 378, 394 Adler, R. B., 292 Ahmad, B., 159 Ainsworth, M. D., 137, 145 Albuquerque, C. P., 377 Aldgate, J., 139 Alinsky, S. D., 277 Allan, J., 406, 410 Allen, D., 406 Allen, T., 267 Alston, M., 436, 438, 440, 442 Alter, S. K., 262 American Psychiatric Association, 116 Angell, G. B., 293 Anthony, W. A., 347 Applegate, J. S., 192, 193 Archer, M. S., 21, 60, 62 Argyris, C., 80, 82, 83, 89 Artiga, S., 364 Ashencaen Crabtree, S., 489 Ashton, R., 261 Askeland, G. A., 258, 268, 273–4, 435 Atherton, C. R., 57 Atherton, J. S., 235 Ayalon, L., 492 Aymer, C., 485 B Bailey, R., 412 Baines, D., 375, 401, 486, 506 Baldwin, C., 316, 323, 326–8, 335 Baldwin, M., 90–1 Bandura, A., 181, 263 Banerjee, S., 260 Banks, S., 269–70 Banton, M., 488 Barker, M., 11 Barnes, C., 379 Baron, S., 292 Barry, M., 491

548

Bassot, B., 80, 84 Bateman, N., 366, 376, 394 Bayisenge, J., 462 Bayley, M., 377 BBC, 287 Beck, A. T., 181, 189 Beck, J. S., 181 Beckett, C., 69, 80, 140, 364, 365 Beckett, J. O., 498 Bell, J., 371 Bell, L., 296 Bellamy, J. L., 55 Bellinger, A., 49 Belsky, J., 43 Bennett, S., 139, 149 Bennett, S., 141 Berenson, B. C., 344 Béres, L., 315, 318, 324–7, 330–1, 335 Beresford, P., 59, 378, 493–4 Berg, I. K., 60 Berger, P. L., 19–20, 63 Bergman, A., 109, 139 Berne, E., 343, 345 Bernstein, A., 390 Bertens, H., 299 Berzoff, J., 109 Besthorn, F. H., 227, 272, 431, 438 Bettelheim, B., 112 Bettmann, J. E., 139, 142, 149 Bhadha, B., 324 Bhaskar, R., 60 Bilge, S., 480 Bilson, A., 58 Bion, W. R., 112 Black, B. L., 388–9 Blewitt, J., 374 Blom, B., 60–1, 341, 349 Blom. I., 109, 132, 139, 142, 149 Bloom, D., 374 Blundo, R., 289 Boeck, T., 436 Boehm, A., 365 Boetto, H., 439–1 Bonner, C. E., 102 Boone, M. S., 177, 179, 209

Borden, B., 70, 103, 105, 298 Borton, T., 80 Bos, E., 48 Bottomore, T. B., 373 Bourdieu, P., 301 Bourn, D., 183, 209 Bowell, T., 88 Bowes, A., 377 Bowlby, J., 45, 109, 112, 133–4, 137–9, 144 Bowles, D. D., 497 Bowser, B. P., 488 Boylan, J., 366, 376, 380, 383–5, 387, 394 Bradley, A., 45, 373 Brake, M., 412 Brandell, J. R., 103, 105, 108, 116–20, 126, 129 Brandon, D., 344, 347–8, 366, 377 Braye, S., 364 Brearley, J., 129 Brechin, A., 47, 51–2, 299 Bremble, A., 47 Bricker-Jenkins, M., 453 Brigham, T. M., 268, 413 Briskman, L., 406 Bronfenbrenner, U., 234 Brookfield, S., 83 Brough, F., 260 Brown, E., 265 Brown, H., 381 Brown, K. M., 143 Brown, L. B., 41, 49, 156, 157 Brown, S., 183 Bruce, L., 84 Brueckner, M., 433, 439 Bruner, J., 319–20 Buchanan, F., 462 Burack-Weiss, A., 318, 322, 330, 332, 333, 335 Burden, D. S., 453, 475 Burghardt, S., 270 Burke, B., 372, 485, 494, 497, 499, 506 Burr, V., 30 Butler, G., 80

Author index 549 Butler-Mokoro, S., 453, 463 Bywaters, P., 364 C Callahan, M., 463 Cameron, C., 256, 263–5, 269 Canda, E. R., 339, 348, 359 Cannan, C., 412 Caplan, G., 156, 161, 162, 241 Caplan, G., 241 Capous-Desyllas, M., 485, 494, 499–502 Carey, M., 316 Carkhuff, R. R., 344 Carlton-LaNey, I., 490 Carney, M. M., 143 Carniol, B., 407 Carr, A., 203–4 Carr, W., 70 Cassady, C. M., 179–80 Cassidy, J., 138, 149 Castells, M., 277 Cavanagh, K., 461 CCETSW, 493 CD Project Steering Group, 493 Chambon, A. S., 297 Charfe, L., 256, 262 Chatterjee, P., 183 Cheers, B., 255 Chilwalo, M., 462 Chonody, J., 462 Christie, A., 460 Cigno, K., 183, 209 Clark, J. J., 298 Clark, M., 261–2 Clarke, I., 180 Clarke, J., 472 Clarke, S., 102, 496 Clasen, J., 272 Clegg, D., 272 Clifford, D., 372, 494, 497, 499, 506 Clough, R., 49–50 Cnaan, R. A., 339, 348, 359, 365 Coady, N., 37, 41, 54 Coates, J., 430–2, 436–8, 448 Cocker, C., 485, 494 Cohen, S., 241 Cole, M., 491 Collins, B. G., 455, 461 Collins, S., 154 Colomina, C., 292 Commission on the Social Determinants of Health, 364

Compton, B. R., 236–7 Conley, A., 25, 254, 275, 280 Connolly, M., 39, 291, 317, 326, 333 Cooke, B., 263 Cooper, A., 58 Corcoran, J., 213, 223, 289 Corden, J., 154 Corrigan, P., 409 Cort, E., 177 Coulshed, V., 460 Cox, C. B., 498 Craig, G., 374 Crane, R., 177, 179, 209 Crawford, F., 89 Crawford, K., 48 Cree, V. E., 74, 461 Crisp, B. R., 339, 348, 349, 358, 359 Croft, S., 59, 378 Crow, G., 341

Dobson, K. S., 176, 179, 209 Doel, M., 155–7, 167–73 Dominelli, L., 23, 24, 60, 88, 236, 274–5, 432, 435, 436, 438, 443–7, 453, 455, 475, 485–7, 490, 507 Donnison, D., 366 Donzelot, J., 298 Doran, G. T., 171 Dore, M. M., 111 Douglas, H., 45 Drisko, J., 316 Dumbrill, G., 467 Dumpson, J. R., 53 Dungee-Anderson, D., 498 Dunham, A., 339, 348, 359 Dunlap, K. M., 111 Dupré, M., 407, 413, 415–21, 426 Duschinsky, R., 135 Dutton, J., 122 Dziengel, L., 467–8

D Dalrymple, J., 366, 376, 380, 383–5, 387, 394, 485, 494, 495, 506 Daly, C., 456 Danikou, A., 462 Dannefer, D., 492 Danto, E. A., 112 Dattilio, F. M., 154 Davis, L. V., 464 Davis, P., 179, 181, 186 D’Cruz, H., 12 Deacon, L. J., 37, 50 Deegan, P. E., 346–7 Delgado, M., 261 Delgado, R., 491 de Maria, W., 408, 414 Denney, D., 487, 493 Dent, H. R., 46, 482 Department of Economic and Social Affairs, 258 Derrida, J., 319 Desai, M., 255, 258, 273–5, 280 de Shazer, S., 60, 290 Devore, W., 485–7, 507 Dewey, J., 81 Dhooper, S. S., 497 Dickinson, D., 47 diClemente, C. C., 210, 213–14, 224 Dietz, C. A., 495 Dobson, D., 176, 179, 209

E Eamon, M. K., 364–5 Earnshaw Smith, E., 89 Edwards, S., 309 Egizio, L. L., 212, 213 Eichsteller, G., 263–4 Elliott, D., 268 Ellis, A., 181 el Nasr, M. M. A., 268 Ely, P., 487 England, H., 348, 351 Ephross, P. H., 498 Epstein, L., 41, 49, 156–8 Erikson, E., 109, 159, 161 Espinoza, S.Y., 462, 467 Esquao, S. A., 485, 506 Essed, P., 487 Esteves, A. M., 368 Estey-Burtt, B., 324 European Union, 323 Evans, D., 238 Evans, E. N., 258 Everly, G. S., 160 Ewles, C. D., 190 Eynaud, P., 261 Eyrich, K. M., 241 Ezell, M., 379 F Fabiano, E. A., 190 Fairclough, N., 300, 481–2 Farmer, R., 192–4

550

Author index

Fawcett, B., 303, 456, 460, 462 Featherstone, B., 456, 461 Fejo-King, C., 462 Fellin, P., 498 Fenton, J., 401, 426 Ferguson, I., 402, 407, 412–13, 426 Fewell, C. H., 142 Field, T., 133 Finlay, L., 85, 86 Finley, R., 46 Fischer, J., 53, 180 Fisher, M., 451 Fisher, R., 258 Flannery, R. B., 160 Fleet, F., 49 Fonagy, P., 132 Fook, J., 5, 8, 24, 67, 85, 89, 91, 92, 406, 408, 422–6, 457 Forcey, L. R., 456 Ford, D., 37 Ford, P., 155 Forte, J. A., 497 Fortune, A. E., 49, 157 Foster, J., 454, 455, 461 Foucault, M., 277 Foulkes, S. H., 112 Frankl, V. E., 343–4 Franklin, M. E., 111 Fraser, N., 366 Fraser, S., 11 Freddolino, P. O., 366, 375 Freeman, A., 154, 180, 209 Freire, P., 83, 389, 460 Friedman, D. D., 139, 149 Froggett, L., 98, 112 Frost, B. G., 347 Furman, L., 348, 359 Furman, R., 58 G Gaard, G., 436 Gamble, D. N., 439, 440 Gambrill, E., 33, 53, 57, 155, 158, 180, 182, 406 Ganzer, C., 495 Garber, B., 109 Gardee, M. R., 491 Gardner, A., 256, 262, 263, 267, 270 Gardner, F., 67, 81, 89, 91, 92 Garfinkel, H., 5 Garrett, P. M., 12, 33, 82, 140, 141, 298, 402, 410 Garvin, C. D., 388

George, E., 47 George, V., 341–2 Gergen, K. J., 21 Gergen, M., 21 Germain, C. B., 230–1, 234, 236, 242–9 Gerth, H. H., 373 Gibbons, J., 155 Gibbs, G., 80 Gibbs, L., 57 Gibson, A., 109, 325 Gibson, F., 298, 317 Gibson, M., 133, 135 Gibson, N., 139 Gilgun, J. F., 8 Gilliand, B. E., 155–6, 160–2, 173 Gilligan, C., 464 Gitterman, A., 230–1, 234, 236, 242–9, 378 Glaister, A., 88 Glasby, J., 59 Glasser, W., 181 Glassman, U., 48, 340, 354–6, 359 Gochros, H. L., 180 Goffman, E., 184, 253 Golan, N., 158 Goldberg, E. M., 53 Golding, K. S., 44–7 Goldstein, E. G., 99, 103, 123–30 Goldstein, H., 183, 234, 344 Goleman, D., 79 Gollins, T., 290 Gonzales-Prendes, A. A., 179–80 Goodman, J., 84 Gorey, K. M., 53, 452–3 Goscha, R. J., 289, 290, 305, 312 Gottlieb, N., 453, 475 Gough, B., 85 Gould, K. H., 495 Gould, N., 90, 487 Graham, M., 341, 343, 485, 490 Grant, L., 453, 462, 463 Graversen, B. K., 272 Gray, M., 11, 12, 33, 39–40, 54, 57, 64, 67, 289, 374, 390, 430–2, 436, 438, 448, 497 Green, L., 461 Greene, G. J., 228, 290, 306, 307, 310, 312, 318 Greene, R. R., 11, 290, 317 Griffiths, M., 340, 343, 359 Gross, E. R., 490, 498 Guidry, J. D., 258 Guthrie, L., 132, 142, 149

Gutiérrez, G., 258 Gutiérrez, L. M., 380 H Habermas, J., 82, 402 Hafford-Letchfield, T., 485, 494 Haigh, R., 112 Hall, C., 59 Hall, N., 93, 236 Hallett, C., 491 Hämäläinen, J., 262 Hamilton-Perry, M., 143 Hanmer, J., 453 Hanrahan, P., 53 Hanson, B. G., 235 Hardiker, P., 11 Hardiman, M., 259, 268 Harms, L., 39, 291, 317, 326, 330, 333 Harrington, R., 44 Harris, J. R., 74, 135 Harris, T. A., 345–6 Harrison, P., 485 Harrison, W. D., 74 Hart, M. A., 268, 349, 480 Hartley, N., 48 Hatton, K., 256 Hawkins, C. A., 227 Healy, K., 11, 457–9, 463, 466–7 Heap, K., 49 Hearn, G., 234 Hearn, J., 74 Helms, J. E., 503 Herbert, M., 45 Heslop, P., 50 Hesse, E., 138 Heyman, I., 325 Hick, S. F., 191, 209 Hill Collins, P., 455, 480 Hill, J., 47 Hill, R., 162 Hindmarsh, J. H., 69 Hinton, E., 364 Hirschman, O., 385 Hodge, D. R., 350, 357 Hodgson, D., 12, 33, 366, 372–4, 395 Hoefer, R., 395, 401 Hohman, M., 211, 213, 215, 219–23 Holak, M. A. (2018), 453, 462 Holland, S., 316 Hollis, F., 111, 121, 235 Holloway, M., 340, 353, 357–8, 359

Author index 551 Holmes, J., 50, 132, 136 Holthoff, S., 263–4 Hood, R., 227, 231, 232, 240–1, 249 hooks, b., 277 Horner, N., 69, 80, 140, 364, 365 House, R., 56–7 Houston, S., 60–1, 373, 402, 410 Howard, J., 344 Howe, D., 5–6, 73, 77, 79, 90, 132, 133, 137, 138, 143, 146–7, 149, 318 Hudson, B., 188–9 Hudson, C. G., 58, 227, 241, 249 Hughes, D. A., 43, 45, 46 Hui, A., 6 Hujo, K., 290 Hulme, D., 258 Humphries, B., 58, 365 Hunter, M., 44, 45 Hunter, S., 379 Huss, E., 48 I Ife, J., 350, 422 Illich, I., 412 Ingram, R., 50 International Federation of Social Workers, xxi, 22–4, 28, 40, 95, 111, 236, 283, 363, 371, 397, 435 Ioakimidis, V., 151, 275, 412–13, 442 Irvine, E. E., 110 Isajiw, W. W., 489, 490 J Jacobs, C., 497 Jacobs, S., 4–5 James, R. K., 155–6, 160–2, 173 Jamieson, L., 462 Jansson, B. S., 375, 395 Jasper, M., 80–1, 84 Jasperson, R. A., 142 Jehu, D., 180 Jenkins, R., 458 Jenkins, S., 487 Jensen, N. R., 256 Jenson, J. M., 54, 57 John, M., 98 Johns, C., 84 Johnson, L., 462, 467 Johnson, Y. M., 238 Jojo, B., 440 Jokinen, A., 30, 59, 297

Jones-Devitt, S., 406 Jones, D. N., 435 Jones, J. F., 259 Jones, K., 54 Jordan, B., 372 Joseph, T., 488 Juhila, K., 59, 297 K Kadushin, G., 153 Kahan, B., 185 Kanel, K., 156, 160, 162, 166, 172, 173 Kao, H. S. R., 257, 259 Karls, J. M., 111 Karvinen, S., 59, 297 Kasca, M., 256, 263 Kattilakosli, M., 432–3, 439 Kazi, M. A. F., 53, 60, 179, 182, 184 Kearney, J., 238 Keating, E. F., 412 Keefe, T., 344 Keller, H., 134 Kelly, G., 294 Kemp, G., 88 Kemp, S. P., 298 Kennedy-Kish, B., 407 Kermode, F., 319 Keval, N., 121 Khandwalla, P. N., 259 Killilea, M., 241 King, A., 492 Kirke, D. M., 242 Kisthardt, W. E., 291 Kleibl, T., 255, 268 Klein, M., 109 Kling, J., 258 Koggel, C., 464 Kohli, R. K. S., 122 Kondrat, D., 289 Kornbeck, J., 256 Kortetmäki, T., 439 Kothari, U., 263 Kreitzer, L., 268 Krill, D. F., 340, 344 Kübler-Ross, E., 9–10 Kulis, S., 485, 497, 498 Kumar, H., 343–5 Kummitha, R. K. R., 261, 280 L Laing, R. D., 343 Laird, S. E., 498 Landau, R., 350

Langer, C. L., 37, 111 Laszlo, J., 320 Launer, J., 318, 327–9, 335 Lavalette, M., 151, 275, 402, 408, 412–13, 426, 442, 485 Laville, J. L., 261 Lawler, J., 58 Leamy, M., 347 Ledwith, M., 277, 373, 401, 410 Lee, J. A. B., 366, 390–3, 395, 498 Lee, M. Y., 228, 290, 306, 307, 310, 312, 318, 340, 344, 348, 352–3 Lehmann, P., 37, 41, 54 Leitner, L. M., 436 Leonard, P., 277, 404–5, 409, 412 Leonardsen, M., 364 Leskošek, V., 439 Levy, A., 185 Liddle, R., 287–8 Lietz, C. A., 37, 111 Limb, G., 350 Lindemann, E., 156 Lindsay, C., 272 Lindsay, T., 48 Lishman, J., 38, 50, 493 Livingstone, A., 467–8 Li, W., 305 Loewenthal, D., 56–7 Lohmann, N., 255 Lohmann, R. A., 255 Loney, M., 270 Longres, J. F., 460 Lorenz, W., 262, 266, 369 Loughran, H., 151, 156, 160, 165, 173 Lucas dos Santos, L., 260 Luckmann, T., 19–20, 63 Luhmann, N., 231 Lukes, S., 277, 373 Lum, D., 498 Lusk, M. W., 413 Luwangula, R., 442 Lyon, K., 293 M Macaulay, C., 74 Macdonald, D., 262 Macdonald, G., 5, 33, 41, 53, 180, 186, 188–9 Macdonald, S. J., 37, 50 Mace, C., 191 Macey, M., 496 MacGregor, S., 436 MacGuiness, N., 12, 140

552

Author index

MacLaren, C., 181 Macy, R. J., 179, 181, 186 Maguire, D. C., 368 Maguire, L., 241 Mailand, M., 272 Mansell, W., 181 Manthorpe, J., 58 Marmot Review, 364 Maroda, K. J., 114–15 Marsh, J. C., 55 Marsh, P., 156, 157, 167–73, 341 Marshall, M., 492 Marsiglia, F. F., 485, 497, 498 Martin, E. P., 341, 490 Martin, G., 258 Martin, J. M., 341, 490 Martin, R. R., 490 Mary, N. L., 430–1, 436 Marynowicz-Hetka, E., 263–4 Maslow, A., 344 Matarese, M., 59 Mathiesen. R., 262 Matthews, S., 11 Matthies, A.-L., 430–2, 436, 440, 448, 492 Mawson, A., 261 Maxwell, N., 217 Mayo, M., 374 McClanahan, S., 290 McCleod, E., 453, 460 McColgan, M., 103, 121, 130 McCracken, S. G., 55 McCranie, A., 346 McDonald, C., 90 McGlynn, P., 160, 173 McIntyre, D., 411 McKinnon, J., 436, 438 McLaughlin, H., 58, 64 McLaughlin, J., 454 McLaughlin, N., 103 McLeod, J., 318 McMahon, L., 122 McMillen, D. P., 227 McMullin, C., 103, 121, 122, 130 McTighe, J. P., 318, 321, 326, 335 Mead, G. H., 266, 292 Mehta, V., 258 Meichenbaum, D., 189 Menzies-Lyth, I., 122 Mercer, G., 379 Meredith, C., 50 Meyer, W. S., 112 Mezirow, J., 82–3 Michailakis, D., 231–2

Midgley, J., 25, 254, 255, 259, 260, 267, 268, 273, 275, 280 Miehls, D., 193 Mikulincer, M., 138, 149 Milkman, H., 190 Millar, J., 139 Miller, D. J., 305 Miller, W., 212, 213, 217–19, 223 Milliken, E., 454 Mills, C. W., 373 Milner, J., 302, 322, 460 Minahan, A., 234, 236–7 Mirick, R., 462 Mitchell, J., 102 Moio, J. A., 491 Mokate, K. M., 258 Mondros, J. B., 378 Moore, S. E., 497 Moorey, S., 177 Moreau, M. J., 389, 407 Morén, S., 60–1 Morgaine, K., 485, 494, 499–502 Morgan, R. T. T., 187 Morris, J., 492 Morrison, T., 79 Moss, B., 340, 353, 357–9 Moss, P., 263 Moulding, N., 453, 462, 475 Moxon, E., 496 Muldoon, A., 236 Mullaly, B., 407, 413, 415–21, 426, 485, 489, 507 Mullaly, R. P., 412 Mullen, E. J., 53 Mullender, A., 395 Mullin, A., 465–6 Munford, R., 12 Murdach, A. D., 58 Murphy, M., 83 Murphy, Y., 480 Musson, P., 34, 39, 40 Muzumdar, A. M., 344 Mwale, L., 462 Myers, L. L., 183 Myers, S., 290, 302–3 N Naess, A., 438–9 Närhi, K., 430–2, 436, 440, 448 Nash, M., 456 van Nijnatten, N., 59 Nuccio, K., 455, 456, 458, 459 National Institute for Health and Care Excellence, 139

Neary, M., 191 Nee, R. H., 33 Nelson, J. K., 139, 149 Nevo, I., 58 Newbigging, K., 366, 395 Newman, J., 472 Ney, T., 484 NHS Health Advisory Service Report, 42 Nicholls, A., 261–2 Nicolini, D., 6 Nkunika, A. I. Z., 267 Noonan, M., 99, 103 Norton, D. G., 493–4 Nurius, P. S., 179, 181, 186 Nursing and Midwifery Council, 373 Nzira, V., 485 O O’Brien, D., 268 O’Byrne, P., 59, 85, 290, 312, 318 O’Donoghue, K., 12 O’Hagan, K., 159, 485, 488, 496, 498, 507 Oham, C., 262 Okech, D., 462 Okitikpi, T., 485 Oldfield, M., 191 Oliver, M., 492 Omona, J., 462 Orme, J., xxii, 58, 452, 456, 458, 461–4, 467 Ornstein, E. D., 495 Orton, S., 48 Osei-Hwedie, K., 268 Osmo, R., 350 Otto, H.-U., 33 Owusu-Bempah, J., 493 P Pace, J., 268 Page, T., 139 Paiva, J. F. X., 259 Palakkappillil, J. P., 368 Pandey, R. S., 259–60 Pankow, L. J., 194 Papell, C. P., 48 Parad, H. J., 155, 159 Parad, L. G., 155, 159 Parker, G., 451 Parker, I., 21 Parkes, C. M., 109, 136 Parkinson, C., 122

Author index 553 Parrott, L., 12, 140 Parton, N., 59, 85, 290, 312, 318, 460 Patel, L., 280 Patel, N., 493 Pawson, R., 60, 62 Payne, C., 235 Payne, M., xxiv, 8, 15, 21–3, 28, 30–1, 33–4, 37–9, 46, 48, 67–9, 76, 82, 88, 112, 173, 242, 249, 258, 268, 273–4, 287, 295, 298, 300, 303, 340, 342–3, 350, 359, 429, 435, 458, 492 Pearce, S., 112 Pearson, G., 403 Pease, B., 24, 365, 406, 412, 451 Peeters, J., 439 Penketh, L., 463, 485 Pereira, T., 292 Perlman, F. T., 105, 108 Perlman, H. H., 111, 112 Peterson, N. A., 381 Petrie, P., 256 Phillips, D., 148 Phillipson, C., 492 Philp, M., 376 Philpot, T., 481 Phung, T.-C., 121 Pickett, K., 259 Pilkington, A., 488 Pillai, V., 289 Pincus, A., 234, 236–7 Pinderhughes, E. B., 495 Pitman, E., 345 Pitts, J., 191 Plath, D., 33, 54, 57, 64 Polsky, H., 112 Popple, K., 275–80 Pösö, T., 59 Postle, K., 155 Potter, C., 260 Powell, J. L., 297 Preston-Shoot, M., 154 Prigerson, H. G., 109, 136 Prior, V., 146–8 Prochaska, J. O., 210, 213–14, 224 Pružinská, J., 76 Pugh, R., 255 Pulla, V., 305 R Race, D. G., 381, 492 Rambaree, K., 440 Ramon, S., 151, 381, 442 Rantamäki, N., 432–3, 439

Ranta-Tyrkkö, S., 440 Rapoport, L., 162 Rapp, C. A., 289, 290, 305, 312 Rawlinson, D., 112 Rawls, J., 366, 369–70 Raynor, P., 190–1 Redmond, B., 81, 86–7 Rees, S., 380 Reid, W. J., 53, 54, 56, 156–8, 171 Reisch, M., 395 Reith, M., 15, 48, 300 Reith-Hall, E., 38, 43–7, 68, 201–8 Rex, J., 489 Rhodes, M. L., 464 Richardson, K., 48 Richardson, V., 160 Ricoeur, P., 319 Righton, P., 111–12 Ritchie, P., 379 Robb, M., 426 Roberts, A. R., 151, 154, 161, 166–7 Roberts, B., 5 Roberts, R. W., 33, 235 Robinson, L., 490, 491, 496 Rogers, C. R., 217, 338, 343, 344, 351 Rogers, M., 406 Rogowski, S., 426 Rojek, C., 154, 365, 405, 409 Rollnick, S., 212, 213, 217–19, 223 Ronen, T., 180, 189, 209 Ronnby, A., 414 Rooney, R., 212 Roscoe, K., 330 Rose, S. M., 388–9 Rosengren, D. B., 213, 219, 224 Ross, D., 433, 439 Ross, R. R., 190 Rothman, B., 48 Rovine, M. J., 43 Rowntree, M., 461 Rubin, A., 53 Ruch, G., 103, 121, 129 Rutter, M., 110, 134 Ryan, A. S., 76–7, 497 Rzepnicki, T. L., 158 S Sage, N., 180 Saleebey, D., 312, 321 Salzberger-Wittenberg, I., 109 Sanders, D. S., 483 Sands, R. G., 455, 456, 458, 459 Sansfaçon, A. P., 464

Sartre, J.-P., 344 Savage, M., 319 Schafer, R., 319 Schirmer, W., 231–2 Schlesinger, E. G., 485–7, 507 Schön, D. A., 67, 80, 82, 83, 89, 92 Schore, A. N., 139, 140 Schore, J. R., 139, 140 Schut, H., 75 Scourfield, J., 404, 462, 463 Scragg, T., 84 Secker, J., 69, 89 Seed, P., 241 Seeley, K. M., 498 Seligman, M., 290–1 Sellick, M. M., 60 Sen, A., 34, 366–7 Shapiro, F., 143 Shapiro, J. R., 192, 193 Sharry, J., 48 Shaver, P. R., 138, 149 Shaw, M., 316 Sheedy, M., 50, 317, 372, 374 Sheldon, B., 5, 33, 41, 179, 180, 185–6, 189 Shemmings, D., xxii, 58, 132, 135, 138, 140, 142–9 Shemmings, Y., 132, 135, 138, 140, 142–9 Shennan, G., 290, 305–11, 312 Shepard, B., 439–40 Shepard, M., 76–7, 467–8 Sherman, J. W., 75 Shier, M. L., 111 Shirran, A., 215 Shulman, L., 378 Shyne, A. W., 157 Sibeon, R., 8 Sidell, M., 51–2, 299 Silvasti, T., 439 Sim, D., 377 Simon, B. L., 379 Simpson. L., 271 Sinclair, E., 381 Singh, G., 490 Sinha, D., 257, 259 Siporin, M., 234 Sisneros, J., 485, 487, 497, 502–5 Skeith, P., 258 Slayter, E., 462 Slonim-Nevo, V., 58 Smalley, R. E., 111 Small, J., 490 Smid, G., 67 Smith, D., 190, 339

554

Author index

Smith, H., 381 Smith, L., 406 Smith, M., 122 Smith, P., 301 Smith, S. R., 67 Soares, H. H., 388 Solomon, B. B., 390 Solomon, R., 121 Solomos, J., 487 Sorter, D., 143 Speer, P. W., 381 Spitzer, H., 255, 434 Spong, S., 68 Stallard, P., 203 Stanley, T., 292 Staples, L. H., 365 Stark, C., 408 Statham, D., 453 Staub-Bernasconi, S. M., 263 Stefancic, J., 491 Stehlik, D., 440 Stephens, P., 256, 263 Stepney, P., 37, 58, 179, 181, 186, 277, 278 Stevenson, O., 121 Stirrat, R., 267 Strean, H. S., 99–101 Strega, S., 485, 506 Stroebe, M., 75 T Tattersall, R., 379 Taylor, C., 86, 92 Taylor, P., 456 Taylor, S. I., 439 Teater, B., 34, 37, 58, 64, 111, 208, 212, 235, 374, 462, 493 Tedam, P., 498 Tedmanson, D., 462 Tesch-Römer, C., 492 Tester, F., 440 Tew, J., 347 Thomas, A., 267 Thomas, E. J., 180 Thomlison, B., 179, 183, 186 Thomlison, R., 179, 183, 186 Thomlison, R. J., 53 Thompson, E. F., 368 Thompson, N., 5, 38, 58, 80, 84–5, 153–4, 156, 160–7, 173, 258, 292–3, 322, 340, 344, 359, 368, 494, 507 Thompson, S., 80, 84–5

Thyer, B. A., 37, 40, 48, 51, 57, 179, 183, 184, 186, 187 Tibbs, M.-A., 492 Tilley, N., 60, 62 Tolson, E. R., 49, 156, 157, 173 Torres, S., 492 Towell, D., 492 Trevillion, S., 242 Trevithick, P., 37, 48, 98, 213 Truax, C. B., 344 Truell, R., 435 Turnell, A., 309 Turner, F. J., 38–9 Turner, M., 258 Turney, D., 103, 122, 129 Tusasiirwe, S., 462 Twikirize, J. M., 255, 262, 268, 349, 434 U United Nations, 323 US Department of Health and Human Services, 364 Uwihangana, C., 275 V van de Luitgaarden, G. M. J., 58 van den Bergh, N., 453, 467 van Elst, T., 461 van Ewijk, H., 227, 231, 232, 240, 249 van Krieken, R., 67 van Ours, J. C., 272 Vanstone, M., 190–1 van Wormer, K., 272, 431, 438 Videka-Sherman, L., 53 W Wakefield, J. C., 250 Walker, B. G., 460 Walker, S., 240 Wallen, J., 112 Walsh, F., 290 Walsh, J., 11, 99, 106 Walsh, P., 133, 135 Walter, U. M., 348 Walton, R. G., 268 Wanberg, K., 190 Wandrei, K. E., 111 Ward, A., 122 Wastell, D., 133, 135 Watson, D., 185 Watts, L., 12, 33, 366, 372–4, 395

Watts, M., 346 Webb, S. A., 11, 12, 33, 39–40, 51, 54, 57, 64, 67, 374, 426, 497 Weber, M., 257, 373 Weick, A., 113 Wendt, S., 453, 454, 462, 475 West, J., 415, 485, 489, 507 Whitaker, D., 265 White, M., 318, 321, 327, 330, 335 White, S., 59, 86, 89, 91, 92, 133, 135 White, V., 425, 453, 469–74, 476 Whyte, W. F., 60 Wilding, P., 341–2 Wilkinson, R., 259 Wilks, T., 159, 366, 380, 381, 383–6, 388, 394 Williams, C., 485 Williams, P., 485 Williams, T. R., 350 Wills, D., 111 Wilson, A., 493–4 Wilson, H., 180 Wilson, S. M., 378 Winkels, D., 466 Winnicott, D. W., 109 Witkin, S. L., 57, 294, 321 Wolfensberger, W., 381, 492 Wong, S. E., 186 Wong, Y.-L. R., 191 Wood, K. M., 107 Woods, M. E., 111, 121, 235 Woodward, R., 407 World Bank, 258 Y Yasas, F. M., 258 Yeager, K. R., 151, 154, 160, 166–7, 173 Yelloly, M. A., 104, 105, 109, 112 Young, G. C., 187 Young, P. M., 143 Young, K. P. H., 156 Z Zapf, M. K., 227 Zimmerman, S., 54 Zannattino, L., 462 Zidar, R., 439 Zulu, J. M., 462

Subject index In the subject index, major discussions of a listed topic are shown in bold. A absent/hidden but implicit conversation, 326–7, 334 acceptance (MI), 217 acceptance and commitment therapy (act), 192 acceptance in social work relationships, 45–6, 110, 184, 344, 350, 488 accurate empathy, 217, 351 see also empathy; structural empathy action, landscape of (narrative practice), 327 activation, 252, 272, 279 active crisis, 152, 162–5 activism, 28, 37, 254, 258, 346, 369, 372, 375, 401, 412, 429, 432–5, 439, 448, 454, 469, 484, 488 see also critical action adaptation (ecological systems), 226–7, 236, 242–5, 391–2, 411, 428–9 adapting theory, 70, 73–5, 76–9 adult attachment, 137–9, 140, 149 Adult Attachment Interview, 137–8 adult education, 83 adventure pedagogy, 440 advocacy, 26, 34, 36–9, 59, 159, 165, 254, 256, 261, 275, 323, 361–6, 368–9, 371–90, 393–5, 401, 408, 410, 412, 421, 423–5, 435, 440, 484 see also case/ cause/instructed/noninstructed/peer/policy/self-/ systemic advocacy; welfare rights affiliation, 330, 446 affirmation, 210–11, 216, 217, 221, 222, 305, 358 see also self-affirming; validation

Africa, 24, 184, 212, 255, 257, 281, 341, 343, 349, 390, 434, 442, 455, 469, 489, 491 alienation (critical practice), 421, 483, 491 alienation (humanistic practice), 337, 341–2 alliance, therapeutic alliance, 4, 27–8, 35, 54, 74, 110, 115, 117, 119, 124, 126, 157, 165, 191, 195, 210–12, 269, 274, 279, 286, 361, 405–6, 411–12, 426, 486, 501–2 ambiguity, 285, 293, 321 see also uncertainty ambivalence, 75, 98, 137–8, 144–5, 164, 210–11, 214, 219–21, 355, 368, 371, 374, 474, 483 ambivalence and empowerment, 36, 361–5, 368, 369, 371–2, 374–5, 379–80, 389, 393 ambivalence and representation, 371, 376, 384 animals, 349, 368, 432, 438, 441–2 anti-discrimination, 50, 278, 362, 374, 399, 407–8, 460, 479–82, 485, 489, 493–4, 496, 498 anti-discrimination and anti-oppressive practice, 477, 480, 482 anti-oppressive practice, 36–9, 225, 235, 254, 324, 348, 371–2, 406–8, 410, 425, 452–4, 460, 462, 469, 473, 477–502, 505–7 see also oppression anti-racism, 37, 276, 407, 416, 478, 485–7, 495–7 anxiety, 43, 45, 98, 108, 112, 116, 120, 121, 126, 136, 138, 144, 166, 175–6, 179, 181, 184, 187, 191, 192, 197, 200, 202–8, 223, 331 anxious-avoidant attachment, 44 arenas of debate, 67, 379, 454 arenas of social work construction, 28–30, 70, 72, 412, 430, 472

art/the arts, 48, 286, 299, 321, 332, 337–8, 343, 347, 349, 351 Asia, 24, 212, 255, 257, 259, 273–5, 281, 343, 408, 484, 489 assertive community treatment (ACT), 192 assertiveness training, 175–6, 189, 201 assessment, 7, 45, 50, 53, 58, 76–7, 79, 111, 116–17, 124–5, 129, 135, 138, 142, 146–7, 161, 165–7, 169, 175, 179, 182–3, 195–9, 202–3, 206–8, 221, 240–1, 245, 247, 252, 287, 289–90, 309, 320, 323, 350, 364, 386, 392, 418, 424, 425, 441, 463–4, 474, 490, 498, 501–2, 504 see also spiritual assessment assessment sandwich, 221 assimilation, 478, 485, 487, 490 Attachment and Behavioural Catch-up (ABC), 139 attachment behaviour, 131–2, 134, 138–42, 145–6, 148, 202 attachment figure, 131–2, 138, 141–2, 144 attachment practice, 35, 131–3, 141–50 see also adult attachment; attachment theory; disorganized/secure attachment Attachment story completion task (ASCT), 139 attachment style, 132–3, 137–8 attachment theory, 16, 37–40, 43–7, 50, 73, 75, 97, 99, 100, 102, 105–6, 109, 112–13, 118, 123–4, 131–42, 193–4, 202, 204, 219, 467–8 attachment theory and neuroscience, 140, 146, 194 attunement, 45–6, 125–6, 132–3, 135, 143, 219 authenticity, 86, 124, 501–2 see also genuineness authentization, 268

555

556 Subject index authority, 68, 86, 118, 123, 220, 235, 246, 253, 261, 265, 297, 345, 354, 460 see also influence; involuntary clients; power authorship, 328 automatic thoughts, 200, 206–7 autonomy, 109, 123, 138, 139, 216, 240, 261, 263, 297, 345, 367, 372, 385, 389, 411, 422, 454, 472 B balance, 27, 137, 156, 162, 165–6, 241, 257, 266, 349, 352–4, 432, 447 see also doctrine of the mean; middle path bare attention, 191 barriers, 25, 36, 69, 83, 85, 98, 113, 121, 123, 124, 128, 166, 169, 221, 262, 348, 354, 361–2, 365, 374, 477 bereavement, 14–16, 75, 109, 131, 136, 156, 160, 204, 331, 358 biography, autobiography, 319, 321, 380, 494–5 body consciousness, 501 body, human, 143, 191, 206, 233, 297, 353, 429, 501 body-mind-spirit practice, 193–4, 249, 337, 340, 348, 352–3 boundary, 11, 17, 46, 91, 122, 126, 239, 263, 269, 293, 302, 319, 376, 422, 461, 475 see also systems boundaries Bourdieu, 12, 50, 301 bridge/bridging in practice, 124, 195, 309–10, 326, 333 Buddhism, 191, 339, 341, 352, 357, 499 see also balance; bare attention; harmony; middle path bullying, 115, 202, 204, 351, 463 bureaucratic, 91, 274, 374, 472 bureau-professional regimes, 472–3 C CAIMeR, 60–1 capacity-building, 252, 260, 269 care and men, 240, 451, 456

care, caring, 35, 45, 83, 109, 115, 125, 133, 145, 146, 160, 173, 194, 212, 245, 264–5, 272, 286, 294, 329, 341, 351, 354, 357, 363, 379, 387, 390, 435, 447, 450, 458, 460, 462, 464–8, 474, 497, 501–2 see also cash for care; ethics of care; leaving care; long-term care; mental health care; packages of care; self-directed care; spiritual care care for environment, 433 caregivers/carers, 42–5, 84, 111, 131–7, 140–2, 146–7, 183, 248, 249, 298, 305, 351, 354, 375, 378, 383, 420, 447 see also expert carers; foster carers; women carers; young carers care homes, 4, 142, 333 care management, 26, 192, 286, 289–90, 311, 377, 424 carer-led services, 379 carer’s assessment, 470 caring community, 437 caring labour, 465 caring networks, 241–2 see also networks caring processes, 245 caring professions, 82, 362 caring triangle, 447 case advocacy, 256, 362, 366, 375–6 case management see care management cash for care, 101, 377, 379 catastrophizing, 200 cause advocacy see policy advocacy challenge, 44, 61, 80, 207, 246, 328, 354, 372, 378, 391, 416, 420, 424, 450, 455 change talk, 210–11, 215, 216, 222–3 chaos theory, 35, 37–9, 225, 231, 235, 242, 429–31 characterization, 328, 331 child and adolescent mental health service (CAHMS), 42–7, 148, 184, 202 childcare/child welfare, 109, 134, 136, 140, 144, 322, 409, 451, 455, 462, 467, 488, 490 children’s rights, 366

child safeguarding, 135, 137–8, 148, 153, 210–13, 257, 287, 309, 467, 472, 475 China, 156 Christianity, 258, 339, 348, 357, 360, 368, 413, 499 citizen advocacy, 377, 394 citizenship, 60, 232, 276, 305, 311, 362, 367, 369, 372, 415, 440, 477, 492 see also citizen advocacy clarification, 120 client-centred practice see person-centred practice clients as their own social workers, 198 clinical psychology, 41, 49, 51, 107, 114, 117, 136, 138, 157, 180, 183, 184, 223, 226, 238, 239, 302 clinical social work, 47–8 closed systems, 232–3 cognitive behavioural practice (CBT), 13, 28, 35–9, 40, 44, 48, 53, 75, 76, 99, 148, 154, 157–9, 165, 175–209, 216, 228, 322, 392, 414 cognitive behavioural practice and mindfulness, 191–2 cognitive behavioural practice and neuroscience, 192 cognitive restructuring, 189–90, 207–8 cognitive theory/therapy, 37–8, 39, 50, 73, 148, 154, 161, 162, 175–6, 178–184, 186, 189–90, 192, 199–201, 204, 206, 233, 294, 321–2, 344, 381, 391, 424–5 see also structural cognitive therapy collective aims/action, 251, 266, 269–71, 273, 274, 278, 298, 317, 349, 355, 363, 367, 384, 389, 391, 404, 409, 411, 421, 428–9, 432, 438–40, 446–8, 453, 474 colonialism, 255, 257, 258, 267–88, 273–4, 277, 339, 349, 483–4, 488 see also postcolonialism colour-blind policies, 491 commonalities, 349, 392, 450, 463, 467, 469, 495 communication, 58–9, 82, 201, 204–5, 213, 219, 223, 231, 263, 292–3, 299–300, 387

Subject index 557 communication skills, 15, 49, 76, 121, 125, 191, 201, 216, 267, 278, 323, 325 communication theory, 15, 292–3, 299, 373 see also Habermas community care, 277–8, 451 community/community action/community engagement, 25–6, 29, 64, 83, 117, 134, 154, 163, 165, 190, 213, 223, 226, 229–30, 234, 238, 241–3, 247–9, 252, 260–2, 268–71, 277–80, 291–2, 305, 311, 313, 322, 346–9, 365–6, 367, 374, 386–7, 390–3, 410, 423, 429, 432, 434, 436–7, 439–41, 445–7, 450, 451, 464, 479, 484, 486, 489–90 community development, 59, 83, 242, 251, 257–8, 260, 266, 268, 278, 280, 289, 378 community education, 278 Community Empowerment (Scotland) Act, 2015, 374 community groups, 236, 276, 374, 386 community mental health, 156, 289, 346–7 community needs, 279 community organization/s, 272, 277–8, 378, 411 community social work, 37, 251–2, 261, 277, 313 community work, 26, 37, 47–9, 81, 83, 213, 242, 251–4, 255–7, 258, 266, 270–2, 275–81, 375, 391, 406, 408 commutative justice, 368 complexity (justice), 368–71 complexity (social), 11, 14, 43, 47, 52–3, 56–9, 66–8, 102, 121–2, 135, 153, 155, 169, 182, 187, 189, 194, 214, 216, 225, 230, 240–1, 263, 275, 297, 301, 304, 316, 319–22, 327–8, 351, 353, 365, 391, 409, 411, 422–3, 454–8, 472, 495–6, 502, 506 complexity (social work), 11, 26, 57, 60, 67, 70, 74, 91–2, 98, 181, 238, 297, 299, 327–30,

365, 385, 425, 432, 450, 460, 466, 468 complex (adaptive) systems, 35, 37–9, 225–8, 231–6, 240, 242, 429–31 conflicts, interests/model/theory, 67, 69–70, 76, 382–3, 405 conflicts, political/social, 36, 90, 151, 275, 315, 380, 415, 447, 477, 479–80, 483, 486, 489, 492 conflicts, psychology/ relationships, 35, 97, 107–8, 109, 110, 119, 136, 159, 228, 263, 293, 355, 402, 404, 466, 486, 491 congruence, 337, 344 connectedness, 267, 337, 347, 428, 437–8, 442, 450, 467–8, 497, 501–2 consciousness-raising/ conscientization, 36, 83, 342, 380–1, 391, 394, 400, 404, 405, 408, 413, 450, 454, 460, 475 see also critical consciousness consent, 27, 68, 167, 170, 185, 225, 236, 287, 322, 350, 461 see also self-determination consultation, 44, 46–7 consumerism/consumers, 59, 348, 367, 374, 378, 389 contextual-ecological model, 161 contextualization/contextual practice, 88, 203–4, 350, 389, 423–5, 467 control (behaviour), 11, 44, 46, 105, 108, 111, 113, 115–16, 124, 143, 145, 156, 165, 185, 188, 192, 204–5, 222–3, 246, 291, 298, 302, 311, 321–4, 334, 341–2, 347, 350, 352, 365, 373–5, 378, 380, 388–90, 393, 403, 421, 443, 447, 451, 455, 461, 493, 496 see also self-control control (economic/managerial/ political), 57, 67, 69, 90, 185, 261, 269, 297–8, 380, 401–2, 409, 412, 420, 471–3 control (social work role), 400, 402–3, 409, 411–12, 420 conversational maps, 318, 327, 331–2

coping, 79, 98, 111, 121, 127, 146, 152, 160, 162, 165–6, 189, 197, 204–5, 243–5, 305, 309–10, 351, 391–2 co-production, 316, 368, 379, 446–7 counselling, 37–8, 41, 48–9, 54, 99, 105, 107, 114, 117, 147, 180, 183, 194, 212, 217–18, 221, 223, 226, 238, 338, 343, 421, 461, 474 counterconditioning, 187 criminal justice, 184, 190–1, 208, 210–12, 418 crisis, 152, 153, 155, 159–62, 164, 247 crisis, developmental/ maturational/transition, 109, 159, 161 crisis intervention, 16, 35–6, 37–41, 86, 88, 101, 109, 151–6, 158–67, 172–4, 179, 213–15, 233, 241, 244, 247, 294, 393 critical action, 406, 414 critical consciousness, 377, 388, 391 see also consciousness-raising critical incident analysis, 89 critical multicultural practice, 502–5 critical practice (shared principle), 4, 27–8, 60, 383, 475, 497 critical practice, 24, 26, 36–40, 49, 84, 85, 230, 267, 278, 285, 303, 314, 325, 362, 364–5, 372, 374–5, 383, 391–2, 394, 399–427, 432, 436, 450, 453, 460, 462, 466, 467, 485–6, 497, 505 see also critical race theory; eco-critical practice; structural social work critical practice and child safeguarding, 467, 472, 475 critical practice and feminist practice, 457–8, 475 critical race theory, 479–80, 491 critical realism, 32, 60, 62, 182, 437 critical reflection, 66, 67, 70, 79, 81, 85, 90–3, 372, 422, 486, 500–1, 503 see also reflection; reflexivity

558 Subject index critical social justice theory, 372–3, 376 critical theory, 73, 103, 113, 159, 177–8, 227, 235–6, 242–3, 254–5, 260, 266, 269, 278, 294, 301–2, 304, 342, 348, 367, 370, 374–5 , 380, 389, 391, 399–413, 423, 438, 448, 450, 457, 460, 467–8, 485–7, 491, 505 see also Habermas; Frankfurt School critical thinking, 11, 66, 76–7, 79, 87–90, 99, 393 cross-cutting ideas see transversal theory cultural awareness/competence, 244, 468, 477–80, 485, 489, 491, 495, 498, 505 cultural capital, 301 cultural deficit, 490 cultural imperialism, 503 see also colonialism; postcolonialism cultural lag, 241 cultural pluralism, 478, 487, 497 see also pluralism culture, 8, 11, 27, 36–9, 56–7, 59, 61, 63, 74, 83–4, 92, 97, 98, 101, 104, 109, 125, 128, 135, 154, 171, 177, 213, 227, 243, 255, 258, 268, 272–4, 277, 294–5, 298, 300–1, 314–15, 317–19, 322, 325, 332, 339, 348–9, 358–9, 372–3, 392, 399–400, 402, 410, 413, 416–17, 424, 434, 436, 446–7, 454–5, 459, 464, 478–80, 482–5, 487–90, 492, 494–5, 498–9, 501–3 see also diversity; hegemony; multicultural sensitivity practice culture, family, 83, 203, 298, 300, 417, 455 culture, organizational/staff, 85, 265 curiosity, 45–6, 326, 327, 329, 331, 356 D Deaf culture, 133, 492, 504 decolonization, 257, 268, 281, 368 see also colonialism; postcolonialism

deconstruction, 86, 286, 299, 301, 314–15, 321–2, 325, 326–7, 416, 423–4, 425, 459 deduction/deductive theory development, 9–10, 66, 70–2, 74, 404 deep ecology (Naess), 431, 438–9 deficit, 28, 136, 186, 286, 291–2, 305, 311, 352, 490 degradation, environmental, 329, 436, 441–2, 447, 448 degradation of theoretical development, 72 de-growth, 429, 432 democracy (practice), 112, 263, 337, 340, 341, 354–5, 368, 378, 446 see also social democratic democratic (policies), 60, 260–1, 276–7, 363, 486 see also social democratic de-pathologizing, 502 dependence/dependency, 135, 143, 258, 389–90, 444, 465–6, 471 see also independence; interdependence dependency theory (social development), 258, 274 depression, 115, 122, 146, 166, 175–6, 179, 181, 184, 191–2, 193, 197, 200, 202, 204–5, 208, 258, 302 deprofessionalization, 412, 473 descriptive turn (sociology), 314 developmental-ecological model, 161 diachronic narratives, 320–1, 323–4 see also histories of people’s lives; stories diagnostic theory, 73, 111, 124 dialectical behaviour therapy (DBT), 50, 177, 192 dialectic, 322, 352, 421, 453 see also dialectical behaviour therapy dialogue, dialogic practice, 27, 36, 91, 128, 266, 291, 302, 305, 314, 389, 400, 405, 412, 413, 421, 449–50, 453, 457, 463–4, 466–7, 475, 477–8, 499–501 dialogue in research, 60 diamond model (social pedagogy), 263–4 dichotomous thinking/either-or, 200

difference, cultural/ethnic, 36, 128, 246, 294, 478–80, 497–8, 502–3 difference, gender, 456–7, 459 see also gender discrimination difference, 11–12, 22, 128, 240, 246, 274, 294, 295, 311, 351, 354–5, 369–70, 416, 422–4, 454–5, 457, 469, 480, 488 see also natural differences direct payments, 377, 379 direct use of knowledge/theory, 32–3, 50–1, 63, 75 disaggregation of theories, 39 discrepancy, 211, 212, 215, 219–20 discrimination, 136, 246, 357, 369, 371, 374, 388, 391, 477–9, 480, 482, 484, 486, 489–90, 491–4, 496, 497, 498 discrimination and diversity, 484 discrimination and oppression, 477, 480, 482 disrupting (shared principle), 27–28, 105, 128–9, 158, 161, 423, 461 dissonance theory, 215 distraction, 200 distributive justice, 361, 364, 370 diversity, cultural/ethnic, 28, 267, 392, 416, 436, 477, 479, 484–5, 487, 489–91, 497–8, 502–3 see also difference; superdiversity diversity, gender, 449, 451, 456, 458–9, 462, 468, 475 diversity, human/practice/social, 12, 56–7, 232, 244, 255, 274–5, 340, 351, 417, 423, 437–9, 458, 462, 463, 467, 468, 469 doctrine of the mean, 156 domestic violence, 41, 143–4, 160, 202, 205, 275, 278, 286, 302, 322, 403, 452, 456, 460, 472 dominating relationships/story, 416, 503 dreams, 291, 390 see also hope drives, 107–9, 113, 117, 345 dual process theory (bereavement), 75 dynamic-genetic formulation (psychodynamic), 116–17

Subject index 559 E EBP see evidence-based practice eclecticism in feminist practice, 469, 471 eclectic use of theory, 41–3, 63, 67, 76, 99, 158, 167, 406 ecocritical practice, 343, 430, 432, 436, 440 ecofeminism, 227, 436 ecological social work, 431 see also social ecological social work ecological (eco), systems theory, 37, 40, 161, 225–7, 234–5, 236, 245, 257, 343, 411, 425, 429–30, 432, 436, 437 see also life model economic rationalism, 408 eco practice, 36–9, 236, 349, 372, 408, 410, 428–48 eco practice and human rights, 428 eco practice and spirituality, 432, 433 ego, 98, 102, 103, 105–8, 117, 262, 345, 391–2 ego psychology/theory, 97, 99, 105, 106, 111, 139, 156 ego support, 111, 152 elderly, elders see older people eliciting, 170, 210–11, 221–2, 309 elites, 24–5, 261, 373, 402–3, 409, 411, 413, 418, 487 emancipatory approaches/ knowledge, 24, 82–3, 263, 371, 374–5, 399 emancipatory knowledge/ practice, 24, 82–3, 263, 371, 374–5, 399 emergence emergent properties becoming emotion, 35, 37, 45–6, 50, 78–9, 92, 102, 113–16, 118, 120–2, 125–6, 131–2, 140, 142–4, 148, 163–4, 167, 175, 192, 197, 199, 200, 201, 291, 302–3, 419, 501 emotional intelligence, 79, 92 empathy, 12, 45–7, 60, 115, 132, 147, 217, 219, 223, 247, 258, 305, 330, 337, 340, 344, 351, 392, 421, 467, 468, 470, 501 see also accurate empathy; structural empathy emplotment, 319, 328

empowerment and advocacy, 361–2, 376–9, 388–90 empowerment and critical practice, 362–3, 380, 399, 403, 406, 408, 410, 421, 425 empowerment and feminist practice, 467, 469, 471–2, 474 empowerment and justice, 367–9, 371–3 empowerment and liberation social work objectives, 4, 22–6, 34–36, 226, 283, 363 empowerment and multicultural sensitivity, 480, 495, 497, 502, 506 empowerment and social change, 373–5, 383 empowerment and strengths, 285 empowerment, client/personal, 338, 347, 357, 380–1, 414 empowerment in macro practice/ social development/, social pedagogy, 254–5, 263–5, 267, 269, 274, 278 empowerment in systems practice, 225–6, 235, 242–3 empowerment practice, 34–40, 48–9, 70, 124, 159, 361–6, 373–4, 390–4, 440 empowerment view of knowledge, 32, 58–60, 63 enactment, 293, 424 see also racial enactment end-of-life care, 18, 75, 300, 358 energy/fuel, 438, 441 entropy, 233–4 enuresis, 187 environmental hardship, 428–9 environmental justice, 428, 431, 433, 445, 447–8 environmental stressors, 243, 246 see also life stressors; stressors environmental sustainability, 236, 267, 273, 275, 336, 428, 431–2, 436, 438, 441–2, 447–8, 502 environmental transition, 429, 432–3 en-voicing, 321 epistemic privilege, 59 epistemology, 56–7 see also knowledge equality, 24–8, 59, 88, 126, 154, 244, 259, 261, 267, 269, 274,

278, 297, 302, 338, 349–51, 354, 361, 362, 363, 368–70, 372, 381, 385, 400, 410, 415–18, 421, 425, 432, 439, 449, 450–1, 453, 455, 469–71, 473–5, 477, 484, 486–7, 492, 495–7, 499 see also gender equality; women’s equality equal opportunities, 370, 455, 473, 487 equifinality, 234 equilibrium, 112, 161–2, 225, 233, 241 equipoise, 219 essentialism, 416 see also universal knowledge ethics of care, 265, 450, 460, 464–6, 468, 487, 501–2 ethnicity, 246, 267, 317, 332–3, 364, 387, 419, 455, 462, 467, 478, 480, 486, 492–3, 496, 498, 502–3 ethnocultural transference, 102 European Charter of Fundamental Rights, 323, 403 European Court of Human Rights, 316 evidence-based practice (EBP), 32, 51–9, 64, 67, 70, 82, 88, 91, 298, 337–9, 404, 412, 460, 468 evidence-based practice, alternatives/critique, 59–64 evidence-based practice and CBT, 175–7, 180, 208 evocation, 121, 211, 218, 219–20, 221 exchange (interaction), 242–3, 245, 248, 345, 386, 389 exchange (systems), 243 exchange, emotional, 115 exclusion, social, 252, 262, 305, 311, 357, 372, 392, 416, 446, 477, 480, 492 existential ideas/psychologies, 341–4 existentialism, 336–7, 339, 340–2 expert carers/clients/patients/ users, 59, 379 expert knowledge, 68 expert role, 46, 60, 68, 303 explanatory theory, 3, 13–14, 18, 51 exploration, 120, 124, 141, 356

560 Subject index externalization, 61, 314–15, 318, 325, 330–2, 424 extinction in CBT, 187–188 extinction, species, 431 F fabula (narrative practice), 320 fairness, 14, 361, 363, 367, 433 family group conferencing, 341 family support, 83, 135, 138, 140, 253 see also support; support systems family therapy, 8, 45, 47–8, 49, 53, 230, 234–6, 239–40, 242 feedback, 53, 80, 84, 189, 195, 199, 206, 221, 244–5, 318, 356, 385–6, 421 feedback loop (systems theory), 197, 232–3, 328 feminism, 8, 13, 36–40, 42, 60, 75, 78–9, 81, 83, 84, 102, 123, 124, 177–8, 230, 258, 266, 267, 274, 276–7, 294, 301–2, 304, 407–8, 412, 416, 419, 449–53, 454–6, 461–6 see also ecofeminism; ethics of care; dialogue feminism and management, 458, 460 feminism and men, 26, 101–2, 178, 275, 302, 322, 436, 449–52, 453–6, 460 see also pro-feminist practice feminism and postmodernism, 458–60 feminist and anti-­discrimination, 410, 412, 485–6, 492, 496 feminist and critical practice, 399, 405–8, 410, 412, 416, 457–8, 460 feminist and eco practice, 425, 438 feminist and humanistic practice, 342 feminist and narrative practice, 314, 325 feminist and solution practice, 302 feminist community work, 81, 278 feminist practice, 103, 175, 278, 391–2, 408, 449–53, 457–8, 462–6, 466–75, 480 feminist practice and consciousness-raising, 413

feminist practice, advocacy and empowerment, 362, 372, 373, 389 feminist research, 56, 85 financial assistance/support, 160, 304, 451 see also welfare rights fit (ecological systems theory), 226, 242–5, 411, 428–9 fixation, 108 food aid/security, 246, 273, 275–6, 278, 439, 441–2, 444, 460 formulation (CBT), 195–9, 203, 206, 208 Foucault, 12, 50, 276, 297, 373 see also governmentality frame, 315 see also reframing framework of theory, 3, 11, 13–14, 16–18, 30, 44, 45, 64 Frankfurt School, 373, 401–2, 407, 410 Freire, 83, 276, 277, 389, 391, 400, 412–13, 460 see also consciousness-raising Freud, 99, 103–4, 107, 108, 109 Freudian slip, 104 fulfilment, human, self-, 23, 25, 156, 292, 336, 359, 429 functional theory, 38, 73, 111, 116, 124, 158 G games, 337, 338, 345–6 Gandhi/Gandhian social work, 336, 343–5, 368 gender, 8, 101, 113, 125, 133, 230, 240, 246, 260, 267, 273, 275–7, 317, 333, 364, 369, 374, 392, 403, 416–17, 436, 450–1, 453, 455–7, 460, 461, 462, 464, 468, 469, 473, 475, 496 gender and anti-oppressive practice, 478, 486, 487, 490, 492, 493, 496, 498, 502–5 gender discrimination, 452, 460, 462, 496 gender equality, 273, 275, 417 see also women’s equality gender fluidity, 450, 461, 467–8 gender identity, 468, 475, 503 see also sexuality gender violence, 459 see also domestic violence general systems, 37–8, 234–5

genetics, 37, 116–17, 136, 146, 194, 203–4, 323–4, 369 genre (narrative practice), 318–20, 328 genuineness, 78, 123, 212, 337, 340, 344, 350, 382, 501–2 see also authenticity gerontology, 317, 492 see also narrative gerontology; gerontopedagogy gerontopedagogy, 257 global consciousness, 436 globalization, 12, 30, 50, 258, 277, 367, 407–8, 415–16, 422, 428, 440, 486, 488 goal/goal-setting theory, 215, 460 goals, 47, 48, 53, 115, 161, 165, 185, 202–4, 212, 215, 218, 243, 245, 248, 262, 265, 271, 305, 308, 320, 355–6, 378, 380, 387, 391, 453, 469 see also social goals goal-setting in practice, 165, 195, 215, 460 goals in task-centred practice, 167, 168–72 governmentality (Foucault), 297, 373 Gramsci, 12, 276, 298, 373, 401–2, 410 grand narrative, 402 green social work, 432, 435, 436, 438, 443–7 grief, 39, 109, 156, 160, 334, 437 Group Attachment-Based Intervention (GABI), 139 groupwork, 8, 36–8, 47–9, 53, 65, 98, 165, 175, 252–3, 268, 289, 388, 391, 395, 433, 440, 444, 449, 474, 502 groupwork and community work, 278, 391, 410 groupwork, humanistic, 340, 344, 354–6, 359 groupwork, psychodynamic, 111–12 H Habermas, 12, 50, 82–3, 373, 402, 410 habitat, 243, 443–4, 447 habitual representations (Bruner), 320 harmony, 156, 252, 263, 342, 349, 352

Subject index 561 hazardous event, 152, 162–3 healthcare, 48, 49, 83, 194, 226, 234, 248, 259, 261, 300, 451, 462 health inequalities, 259, 364 see also social determinants of health hegemony, 258, 276–7, 273, 400, 402, 404, 410, 412–13 Hinduism, 341, 344, 348, 357, 368, 483 see also Gandhi historical materialism, 401, 409, 416 see also Marxism histories, community/cultural, 294, 349, 392, 402, 484, 487, 496, 502–3 histories, of people’s lives, 81, 125, 140, 146, 153, 294, 317, 320–1, 324, 329, 350, 351, 389, 463 see also narrative; reminiscence; stories histories, social, 153, 304 history, oral, 490 holism and eco practice, 428–9, 432, 440–2, 446–7 holism and social pedagogy, 257, 263–5 holism/wholeness, 225–6, 235, 303, 337, 345, 358, 374, 392, 480, 486 homeostasis, 162, 233 see also equilibrium homework, 171, 195, 199, 206–8, 285, 310 see also ‘in vivo’ work hope, 123, 132, 195, 202, 221, 246, 291, 300, 303, 305, 307, 347, 358, 390, 499 hospice, 14–16, 26, 300–1, 323 see also end-of-life care house model of parenting, 45–6 human categories, 296–7 human rights, 12, 27–8, 254, 263, 274, 275, 294, 323, 336, 340, 350–2, 363, 368, 369, 372, 379, 403, 417, 422, 428, 447, 461–2, 497 humanistic psychology, 303, 336–7, 340, 344 humanistic social work, 13, 23, 35–9, 48, 76, 78, 147, 178, 183–4, 217, 257, 267, 292, 298, 302–3, 314, 321, 336–56, 358–60, 393, 404, 405, 502 humanism, 37, 273, 336–8, 340–1, 351, 359, 360, 415

I id, 98, 105, 107, 108, 345 identity and postmodernism, 402 identity, collective/group, 349, 355, 367, 418, 499–500 identity, cultural, 434, 436, 478, 483 identity, ethnic, 230, 267, 332, 478, 488, 489, 493, 496, 502, 503 identity, feminist/women’s, 449, 454, 456, 463, 467, 469, 472 identity, gender, 230, 267, 503 see also identity feminist/ women’s identity, landscape of (narrative practice), 327 identity, male, 465–6 identity, national, 230, 267, 488 identity, personal/social, 21, 62, 122, 124, 139, 179, 203, 233, 239, 244, 249, 257, 262, 267, 292, 294, 297, 298, 317, 326, 330, 332, 336, 347, 351–2, 358, 375, 402, 421, 423–4, 443, 450, 454, 458–9, 465–9, 478, 489, 496, 503–5 see also self-identity identity, sexual, 109, 333, 456 identity, social work, 69, 422, 469 ideology, 28–9, 56, 70, 73, 88, 273–4, 277, 292, 373, 380–1, 400–1, 403–4, 412, 416, 423, 430, 437, 439, 453, 496, 498 ideology in research, 60 independence, 139, 258, 261, 345, 365, 377, 380, 492 Indigenist practice, 36–9, 255, 349, 477–9, 480, 483–4, 490 indigenization, 268 Indigenous knowledge/peoples/ values, 180, 213, 219, 255, 268, 274, 275, 317, 339, 349, 367, 432, 433, 437, 438, 442, 468, 478–80, 483–4, 488, 498, 499–500 individualism, 97, 113, 121, 225, 227, 236, 238, 253–4, 257, 269, 273, 289, 315–16, 364, 369, 425, 471, 506 inductive theory development, 9–10, 66, 74 inequality, 155, 259, 317, 365, 369, 370, 372, 399–400, 402, 409–10, 451, 474, 491, 496,

498, 501–2, 503 see also health inequalities inequality, gender, 260, 455 see also gender equality; women’s equality influence by clients, 56, 333, 385, 388, 412, 471 influence in social work practice, 99–100, 115, 180–1, 228, 271, 273, 292, 344, 366, 376, 405, 410 influence, individual/ psychological, 97–8, 103, 123, 125, 135, 228, 337, 381, 471 influence, interpersonal, 90, 223, 239, 285, 292–3, 318, 319, 451, 471, 495, 501 influence, mutual, 115, 503 influence of/over theory, 4, 16, 19–20, 24, 27–30, 32, 49, 50, 51, 63–4, 70, 72, 74–5, 92, 102, 104–5, 109–13, 127, 155, 158, 176–7, 184, 234–5, 269, 279, 292, 297, 338, 339, 341, 343–4, 375, 405, 408, 438, 456–7, 460, 492, 506, 543 influence, political, 3, 4, 27, 496 influence, social, 51, 63, 68, 72, 90, 103, 228, 241, 271, 273–4, 277, 285, 301, 304, 339, 373, 380, 400, 402, 404, 424, 446, 452, 466, 473–4, 495, 499, 501–2 input (systems theory), 232–3 insight, 97, 98, 100, 110–11, 112–14, 117, 148, 153, 179, 183, 405, 411, 421 institutionalized discrimination/ racism, 378, 489 instructed advocacy, 376, 384 integrated/ive practice, 47, 158, 225, 242, 253, 340, 352, 391 intellectual/learning disabilities, 323, 362, 366, 377, 434, 452, 481, 493 interdependence, 257–8, 337, 344–5, 352, 354, 380, 389, 392 interdependence, ecological, 433, 439, 443–5 internationalism, 278, 407, 432 interpretivism, 32, 51–2, 56–7, 58–64, 81, 121, 177, 299, 343 intersectionality, 277, 454–5, 467–8, 479, 480, 496, 502

562 Subject index intersubjectivity, 102, 123–6 see also reflection; intersubjective intimate partner violence see domestic violence in vivo work, 195, 198–9 see also homework involuntary clients/participation, 153, 210, 212, 298, 322, 345 Islam, 339, 341, 348, 357, 368, 483, 489, 490, 491, 499 Islamophobia, 485, 488 J justice, 277, 361, 362, 364, 367–71, 451, 499 see also commutative justice; distributive justice; environmental justice; fairness; social justice justice and fairness, 361, 367, 404 K knowledge, 3–6, 11, 20, 32, 50–1, 54, 56, 57–60, 62–4, 67, 70, 75, 80–3, 89, 92, 177–8, 193–4, 268, 297–9, 338, 343, 392, 409, 422–3, 447, 460, 464, 490, 499, 505 see also epistemology; process knowledge; tacit knowledge; travelling knowledge; universal knowledge knowledge, theory and practice, 5–10, 12–18 L language/linguistic issues, 59, 62, 82, 88, 91, 104, 266, 274, 285–6, 288, 292–3, 295, 299, 300, 315–16, 318, 319–22, 325, 327, 339, 380, 392, 402, 418, 423–4, 456, 459, 460, 478–9, 481–2, 484, 492–3, 498, 503, 505 learning disabilities see intellectual disabilities learning theory, 148, 175, 180, 182–3, 186 learning transfer, 66, 217 lethality, 166–7 liberal feminism, 455, 461 liberalism, economic liberalism, 154, 273–4, 367–9, 380, 399,

408, 416, 436, 438 see also economic rationalism; neoliberalism liberal, pluralist/social, 8, 22–3, 25, 26, 154, 461, 478, 487, 491 life course, 226, 243–4, 247 life model, 231, 242–8 life stories, 298, 317–18, 320–1, 324, 424, 463, 503 see also reminiscence life stressors, 226, 243–4, 246, 247 see also stressors life transitions, 246 linear explanation/process, 66, 177, 182–3, 228, 347, 351–2, 458 linguistic turn, 322 links between practice and theory, 66–75, 92 links between theories, 12, 26, 140, 157, 158, 236, 242, 267, 302, 340, 349, 391, 411, 414 links in networking, 241–2 links in practice, 7, 132, 202, 276–278, 304, 354, 387, 454, 480, 484 long-term care/conditions, 153, 158, 289, 394 loss, 14–16, 39, 109, 132, 137, 141, 146, 172, 204, 244, 317, 334, 350, 388, 437 love ethic, 439 M maat, 225, 349 macro practice, 12, 34, 35–38, 47, 49, 124, 241–2, 251–4, 254, 256–7, 262, 267, 269, 271–2, 275, 279–80, 298, 366, 375, 425, 430, 432, 438, 440 macrosystems, 225, 229–30, 232 managerialism, 50, 57, 82, 90–1, 412, 422, 437, 472–3, 486 marginalization, 447, 462, 491, 502–4 Marxism, 8, 39, 73, 258, 275, 369, 373, 374, 399, 401–2, 403–4, 406–7, 409–10, 415–16, 423, 455, 457, 467, 491 materialism, 348, 409, 416 meaning of social work, 8, 21–30, 47–8 meaning, behavioural/personal, 11, 46, 161, 189, 300, 337, 339,

341, 344, 347, 351–2, 356–8, 364, 373, 414 meaning-making, 82, 112, 189, 300, 321, 326, 333, 337, 341, 344, 347–8, 352, 357–8 meaning, social, 20, 82, 112, 300, 467 medical practice/science, 184, 192, 217, 346, 456 see also model; medical medication, 82, 194, 197, 346, 388, 424 mental health/illness, 35, 40–1, 42–3, 49, 100, 102, 103, 112, 113, 118, 129, 134, 135, 136, 145, 148, 151, 155–6, 160, 166, 180, 183, 184, 193–4, 205, 208, 212, 241, 259, 269, 275, 289, 290, 302, 305, 316, 324, 336, 343, 346–7, 354, 358, 362, 364, 366, 374, 377–8, 379, 392, 432, 440, 446–7, 452, 462, 467, 492, 502 mentalization, 125, 132, 140, 142–4, 146, 147–9 meso/mezzosystems, 229–30, 232 microaggressions, 333 microsystems, 225, 229, 232 middle path, 352 milieu therapy, 112 mindfulness-based cognitive therapy (MBCT), 192, 209 mindfulness-based stress reduction (MBSR), 191–2 minorities, 219, 348, 359, 388, 390, 460, 480, 483–4, 487–8, 489, 490, 497, 498, 506 miracle question, 308 MI spirit, 210, 217–18, 219, 220 modality, 47–8, 49, 245, 248, 252–3 model, 13, 18, 24, 48, 73–4, 87, 91, 99, 143–4, 161, 166–7, 182–3, 185, 202, 212–13, 226, 231, 277–8 see also diamond model; life model; social model of disability; transtheoretical model model, explanatory, 182–3 model, medical, 44, 100, 153, 211, 217, 346, 492 model, psychological, 100, 208–9, 211, 225, 311, 405 model, Western, 184, 268–9

Subject index 563 modelling, 91, 98, 128, 172, 176, 181, 183, 186, 188–9, 205, 256, 265, 372, 419, 451 modernism, 298–9, 416 modernization theories (social development), 241, 257, 273–4, 280 moral adequacy, 86 moral relativity, 456 mother-blaming, 132–4, 140 see also victim-blaming motivational interviewing, 35–9, 50, 210–24, 298, 306, 309, 319, 327, 350, 502 multiculturalism, 274, 392, 468, 477, 479, 489–91, 497–8 see also cultural pluralism multicultural sensitivity and anti-oppressive practices, 479–81, 483, 484–5, 486–7, 495–8, 502–6 multicultural sensitivity practice, 39, 267, 366, 436, 477–78, 479 multifactorial explanations, 225, 226, 228 see also linear explanation multifinality, 234 Munchausen’s syndrome by proxy, 316 mutual aid, 49, 260, 354–5, 378, 502 N narrative, 31–5, 126, 318–23, 402, 423–5, 481 see also grand narrative narrative and language, 320, 321–2, 423–4, 481 narrative as human right, 323–4 narrative competence, 330 narrative gerontology, 317 narrative practice, 35, 37–9, 51, 59, 86, 119, 240, 256, 288, 292, 298, 304, 312, 314–18, 322–35, 391–2, 502 narrative turn, 314, 318, 322 see also descriptive turn; linguistic turn natural differences, 170 needs, individual, 12, 24, 42, 44, 45, 58, 63, 107–9, 116, 123–4, 133, 135, 139, 143, 191, 217, 245, 247, 290, 316, 336, 338,

345, 348, 354–5, 364, 376–8, 384, 386–7, 389, 401, 404, 411, 468, 497, 504 needs, local, 433, 439, 473 needs, nature, 433, 440 needs, social, 66, 176, 177, 179, 240–1, 243, 249, 251–2, 255, 258–9, 268, 273–5, 278, 279, 280, 336, 364, 369, 376–8, 384, 401, 404, 408, 415, 422, 440, 451, 497, 506 needs to change (MI), 222 neoliberalism, 22–3, 25, 26, 39, 50, 121, 152, 154–5, 159, 179, 232, 260, 286, 289–90, 374, 399, 408–9, 428, 438, 467, 471, 472–3, 486, 491 see also liberalism networks and social capital, 305 networks, social networks, 121, 135, 166, 202, 223, 225–6, 232, 238–9, 241–2, 245–6, 254, 259, 278–80, 285, 290, 305, 366, 379, 388–9, 401, 425, 440–2, 447 see also caring networks new public management see managerialism niche, 243, 311 non-directiveness, 74, 76, 100, 110, 153, 351 non-instructed advocacy, 375–6, 384 non-judgemental, 286, 290, 351, 358 normalization, 362, 381, 390, 421, 492, 496 normative professionalism, 232 nursing, 40, 51, 81, 82, 184, 346, 373, 383 O OARS (MI mnemonic), 219, 221–2 object (things), 343, 349, 459 object, objective (target), 83, 210, 214, 221, 226, 242, 254, 297, 307, 470, 471, 502 object, person as, 51, 125, 341, 389, 412 object relations, 97, 103, 105–6, 108, 117, 123, 127, 139 objective of social work, 24, 34–6, 40, 97, 283, 352, 355,

362–4, 371–3, 393, 397, 439, 495 see also shared objective objectivity (approach/ knowledge/ research), 20, 32, 51–2, 58, 124, 162, 182, 373, 389, 422 offenders, 133, 144, 153, 190–1, 214, 243, 268, 272, 322, 340, 363, 365, 403, 413, 418, 455 older people, 20, 41, 58, 141, 149, 183, 218, 238, 240, 255, 257, 278, 298, 317–18, 331, 354, 363, 375, 376, 381, 388, 393, 409, 440, 444, 447, 451, 455, 462–3, 472, 492, 505 open systems, 61, 232–3 operant conditioning/learning, 37–9, 175, 181, 186, 187–8, 195 oppression and gender/women, 267, 277, 302, 449, 451, 452, 454, 455–6, 457, 460, 462–3, 468, 474, 490, 492 oppression and identity, 468, 491–2, 499 oppression and privilege, 415–17, 418–19, 467, 480, 482, 485, 499 oppression, behaviour/ experience, 60, 151, 185–6, 225, 351, 358, 378, 381, 388, 391–2, 393, 399–402, 413, 418–19, 421, 457, 463, 467, 475, 477–8, 480–1, 486–7, 489, 495, 497, 502–3, 505–6 oppression, religious, 403 oppression, social/structural, 24, 36, 151, 155, 159, 177–8, 258, 277, 358, 365, 369, 371–2, 391–3, 399–402, 405, 407, 409–10, 413, 415, 417–19, 420, 422, 426, 450, 454, 456, 457, 460, 464, 467, 474, 477, 485, 486–7, 490–1, 500, 502–3, 505–6 otherness, 270, 333, 357 output (systems), 232–3 P packages of care/services, 288, 377 palliative care see end-of-life care parapraxis, 104

564 Subject index participation, 20, 91, 124, 245, 252, 254, 261, 263, 268, 270, 272, 274, 276–7, 289, 298, 302, 316, 337, 352, 354–5, 362, 365, 367, 368, 369, 371, 374–5, 379–81, 384–5, 392, 413, 415, 420, 428, 433, 444, 446–7, 474, 477, 484, 486, 489, 492, 496, 502 see also citizenship; commonalities; exclusion; partnership participation, critique, 267, 270 partnership, 155, 159, 217, 242, 291, 305, 354, 379, 428, 433, 437, 439, 467, 474, 495, 500 pathway through life course, 146, 244 pathway to service, 18, 20, 29, 327 patriarchy, 60, 102, 416, 451–2, 455, 456, 460, 462, 463, 480 peace, 254, 274, 456 peer advocacy, 377, 435 peer relationships, 135, 245 peer support, 42, 383, 385–6 personal construct theory, 294–5, 358 ‘personal is political’ 277, 419–20 personalization, 338, 377, 379 person-centred practice, 215, 336, 338, 343–4 person-in-environment/ situation, 98, 107, 111, 124, 226, 248, 429 perspective (approach to practice), 12–13, 16, 18 phobia, 175, 179, 184, 186, 187, 202 place, 206, 243, 270, 333, 430, 439, 447 planned environment therapy, 111 plot (narrative theory), 315, 316, 318, 319, 325, 328 pluralism, 478, 479, 487, 489, 497 point of view (narrative theory), 320, 328 policy/political advocacy, 256, 265, 266, 275, 440 politics of theory, 21–7, 57–8, 64, 84, 112–15, 159, 184, 216–17, 235, 268–9, 302–3, 322–3, 325, 347–9, 379–81, 412–13, 438, 461–3, 495–7

positivism, 51–2, 53, 56–7, 60, 62–4, 81, 99, 113, 121, 176–77, 182, 208, 298, 404, 460, 464 postcolonialism, 255, 260, 268, 274, 277, 339, 455, 499–500 postmodernism, 58, 285, 292, 294, 298–9, 301, 303–4, 365, 399, 402, 403, 407–8, 416–17, 456 postmodernism and feminism, 460 poverty, 12, 50, 83, 100, 121, 134, 140–1, 149, 155, 193, 211, 246, 252, 261, 267, 268, 269, 273, 274, 277, 317, 364, 368, 369, 376, 389, 390, 392, 401, 402, 412, 434, 435, 442, 443, 446–7, 451, 460, 462–3, 467, 469, 496 poverty eradication/reduction (social development), 273, 275 power, abuse, 242–3 power, agency/professional, 154, 185, 235, 238, 246, 271, 292, 297, 364, 389–90, 474, 501 power and social control, 403 power, economic/market, 277, 339, 368, 372, 373, 409, 415, 450, 456 power, gender/patriarchal, 178, 392, 454–60, 467–8, 472 power hidden, 154, 373 power, imbalance/inequality, 154, 297, 300, 333–4, 373, 443, 445 power, interpersonal, 6, 86, 112, 123–4, 178, 238, 254, 271, 277, 285–6, 292, 297, 300, 301, 317, 322, 324, 334, 346, 361–2, 364, 380, 495–6, 502 power, juridical, 373 power, mental, 114 power, personal, 23–4, 36, 85–6, 123–4, 254, 322, 325, 341, 347, 362, 365, 378, 380, 391, 400, 471, 502 power-sensitive practice, 365 power, shared, 369, 502 power, social, 8, 12, 24, 50, 59, 85, 90, 235, 242–4, 256, 271, 274, 276, 277, 285–6, 298, 301, 304, 317, 322, 339, 345, 354, 361–2, 365–6, 368, 369, 372–4, 376–7, 380, 390, 392–3, 400, 403, 403, 410, 414, 415, 421–3,

424, 446–7, 450, 452–3, 463, 469, 472, 477, 482, 487, 488, 490, 492–3, 496, 502, 504–6 powers, social workers’ legal, 126, 238, 469 power, state, 235, 272, 409, 471, 473 powerful analysis/ideas, 136, 153, 287, 339 powerful emotions, 78, 98, 126, 163, 201 powerlessness, 56, 243, 245, 324, 334, 373, 390, 412, 413, 442, 503 powerlessness, social workers’ 124, 185, 458 practice theory, 3, 5–7, 10, 12–18, 27–8, 32–3, 50, 63–4, 70–5, 79, 86 see also shared principles practice theory, groups, 33–40 praxis, 389, 392, 400, 405, 412–14 precipitating event/factor, 152, 162–7, 196–7, 203–4, 247, 294 prevention, 83, 156, 504 privatization, 411 privilege, 415–17, 418–19, 455, 480, 485, 489, 499–500, 503–4 privilege, male, 419, 467, 472 privilege, white, 333, 419 problem-based/focused practice, 102, 253, 292, 385 problem-solving, 22, 28, 37–39, 45, 81, 111, 124, 153–4, 157, 190, 245, 262, 285, 311, 338, 351–2, 401, 403, 413, 421, 489 process knowledge, 66, 76–7, 79 pro-feminist practice, 449, 451, 461 professionalization, 363, 411–12 see also deprofessionalization; normative professionalism projection, 89, 108, 110, 114 proximity, 131–2, 138, 141–2, 144–5 psychiatry, 40, 49, 104, 113, 117, 155, 156, 239, 346 see also mental health psychiatry, 49, 113, 117, 136, 155, 239, 346 psychoanalysis, 38, 39, 50, 75, 89, 102, 104–11, 112, 114, 118, 123, 129, 136, 139, 319, 345

Subject index 565 psychodynamic practice, 35, 36, 37–40, 54, 95, 97–150 psychodynamic theory, 33, 34, 48, 73, 74, 153–4, 156, 177, 179, 180–1, 226, 228, 235, 241, 287, 294, 298, 302–3, 314, 343, 391, 402, 404, 405, 411, 476 psychosocial intervention/ theory37–8, 40, 73, 103, 111–12, 117, 121, 124, 152, 159, 161, 235–6, 347 psychotherapy, 48–9, 54, 72, 97, 99, 105, 138, 191, 194, 218, 288, 290, 311, 338 Q questioning, 15–16, 47, 189, 198–9, 202, 207, 305–6, 306, 309, 323, 327, 329, 421, 475 see also Socratic questions questions, circular, 329–30 questions, coping, 309 questions, experience-near, 331 questions, externalizing, 330 questions, open-ended, 15, 210, 219, 221, 356 questions, scaling, 47, 309 R racial enactment, 102 rational emotive behaviour therapy (REBT), 180–1, 189, 200 rationalization, 108 readership (narrative practice), 328 reality therapy, 181 re-authoring, 315, 326–7, 331, 332 see also re-storying reciprocity (systems), 233–4 reciprocity, 45, 124, 242–3, 490 recovery, 35, 75, 290, 346–7, 377, 442 re-enchantment, 321 reflecting back (MI), 219–20 reflection, 66–7, 79–85, 86–8, 89, 91 see also intersubjective reflection reflection, amplified, 222 reflection and praxis, 414 reflection, double-sided (MI), 222 reflection in practice, 121–2, 169, 191, 198, 222, 245, 265, 329, 344, 356, 406, 412, 422, 504

reflection, intersubjective, 86 reflective journal, 84, 89 reflexivity, 4, 12, 52, 66, 79, 85–7, 88, 91–2, 302, 406, 410–12, 414, 446, 450 reframing, 211, 223, 314–15, 501–2 regulation (behaviour), 20, 123, 140–2, 146, 258 regulation (social work), 57, 473 relapse prevention therapy, 190 relational-cultural theory, 467 relational social work practice, 35–40, 73, 97–100, 103, 105–6, 110, 121–9, 139, 495 religion, 332, 339, 340, 341, 348, 357–8, 403, 456, 483, 496, 500 see also secularity; spirituality re-membering, 315, 326–7, 331–3 reminiscence, 298, 317, 325 see also histories of people’s lives; life stories representation of events/reality, 24, 27, 30, 59, 68, 315, 326, 330, 376, 404, 408, 490 representation of groups/ interests, 36, 260, 267, 277, 361, 371, 376, 381, 384–5, 454, 460 repression, 102, 104, 108 residential care, 47–50, 54, 111–12, 183, 185, 235, 246, 248, 251, 253, 256, 264–9, 316, 362 resilience, 35, 69, 79, 122, 226, 233, 241, 243, 245, 256, 285, 291, 305, 352, 358, 428, 437, 441–2, 446–7 resistance (psychodynamic), 98, 102, 104, 117, 119, 122, 128 resistance, rolling with (MI), 211, 216, 219–20, 222 resistance to feminism, 452 resistance to oppression, 185, 253, 258, 298, 302, 354, 424, 464, 486, 501–2 resonance, 219–20, 337, 374 respondent conditioning, 181, 188 re-storying, 315, 326, 330, 333, 334, 501–2 see also re-authoring rhetoric, 328

rights (shared principle), 4, 27–8, 286, 290, 381 rights, civil/political/social, 124, 143, 160, 185, 261, 269, 270, 300, 349–50, 361, 367–70, 372, 374, 376, 383, 385, 387–8, 420–2, 454–5, 474, 488–9, 491–3, 504 rights, women’s, 296, 375 risk, 12, 50, 61, 88, 131, 153, 162, 166, 167, 202, 241, 288, 294, 309, 352, 388, 439, 447 risks, little, 419 risk-taking, 61 rules of action, 77 rural social work, 255 S SAD reflection (MI mnemomic), 222 safe haven, 35, 131–2, 135, 141–2, 143, 144 safe place, 118, 200 see also safe haven scaling, 47, 176, 196, 199, 206, 218, 286, 309–10, 381 SCARED (MI mnemonic), 222–3 schemas, 175, 179, 201, 321 scripts, 337, 338 secular humanism, 273 see also humanism secularity, 336–7, 339, 340, 352, 357, 359 secure attachment, 45–6, 143, 205 secure base, 35, 45–6, 112, 118, 131–2, 136–7, 141, 144 secure base priming, 132 selective attention, 200 selective use of theory, 40–3 self, the, 99, 108, 122, 123–5, 192, 266, 292, 302, 324–5, 332, 334, 347, 351, 352, 391, 423, 459, 503 self-actualization, 260, 266, 336, 344 see also fulfilment self-advocacy, 376–7, 390, 394 self-affirming, 216, 358 self-agency, 347 self-awareness, 69, 79, 90, 377, 405, 499–503 self-blame, 302, 391 self-care, 46, 442 self-centred, 345

566 Subject index self-cohesiveness, 116 self-confidence, 89, 117, 120, 122, 165, 270, 361, 388, 390 self-consciousness, 428, 440 self-control, 98, 189, 258, 343, 345, 365 self-determination, 111, 113, 160, 185, 191, 260, 263, 350, 365, 368, 377 see also consent self-determination theory, 215 self-development, 115, 251, 341, 342, 348, 410 self-directed care, 377 self-direction, 158, 217, 404 self-discipline, professional, 3, 11 self-disclosure, 114–15, 126, 356, 421 self-efficacy, 211, 216, 219, 263, 350 self-empowerment, 421, 423 see also empowerment; client/ personal self-esteem, 120, 123, 125, 165, 204, 205, 358, 378 self-expression, 344, 354, 389 self-fulfilment see fulfilment self-growth/improvement, 190, 260, 269, 347, 351 self-harm, 192, 202, 204 self-help, 26, 48–9, 180, 185, 258, 267, 278, 289, 362, 375, 378–9, 425 self-identity/self-image, 61, 123–4, 202, 292, 478, 480, 493, 503 see also identity self-in-relation theory, 123 self-management, 79, 270, 379 self-monitoring, 191 self-objects, 117, 127–9 self-organizing systems, 231, 240 self-perception theory, 215 self psychology, 37, 97, 103, 105–6, 108, 123, 139 self-reflection, 82, 410 self-reflexivity, 299 self-regulation, 46, 144, 243 self-reliance, 136, 344–5 self-theory, 105–6 self-understanding, 347, 440 self, use of, 66, 77–80, 122, 267, 270, 278, 351 self-verbalization, 189 self-worth, 216, 341, 389 separation, 117, 137, 142, 145, 204, 248

separation-individuation, 109, 139 separation protest, 132, 142, 144, 416 seven-stage intervention model (crisis intervention)166–7 sexuality, 128, 246, 317, 364, 374, 450, 455, 461, 478, 486, 487, 490, 492–3, 498 see also gender fluidity sexual orientation see sexuality shared principles xxii, 4, 27–8, 54, 68, 74, 78, 110, 126, 151, 153, 154, 157, 158, 160, 165, 167, 212, 236, 256, 287, 301, 321, 350, 351, 405, 423, 475 sharing, 20, 26, 121, 126, 129, 325, 330, 348, 353, 358, 378, 410, 415, 462, 469, 501 signs of safety, 309 SMART, 171 social and economic development, 257–8, 439 social capital, 252, 254, 259, 280, 301, 305, 437, 447 social care services, 25, 100, 252, 290, 401 social change and development social work theory objectives, 4, 22, 24–6, 34, 36, 40, 49, 58, 225, 252, 254, 291, 361–6, 368, 397, 399, 430 social change practice, 20–1, 22, 24–5, 26, 40, 49, 51, 58, 63, 69, 76, 113, 161–2, 213, 225–7, 241, 251, 254–5, 257–8, 260–1, 269, 273, 280, 291, 303, 322, 325, 338, 361–7, 369, 371–2, 374–5, 379, 383, 392–3, 400–1, 405, 408, 410, 413, 416, 418, 420, 422, 425–6, 429, 432–3, 437, 442, 456–7, 467, 480, 482, 488, 495, 497, 499–500 social cohesion social work theory objectives, 4, 22, 24–7, 28, 34, 35, 40, 47, 49, 95, 97, 153, 154, 225, 251, 252–5, 279, 283, 285, 303, 311, 363–6, 368, 369, 397, 399, 411, 425, 430 social construction of social work, 3–4, 8, 18–31 social construction practice, 119, 284–9, 290–2, 302, 306, 311, 314, 317, 318, 319, 322, 327, 374, 405, 408, 425–6, 481, 493

social construction theory xxi, 3, 17–22, 28–30, 32, 35–9, 58–9, 63, 68, 99, 140, 182, 184, 216, 267, 290, 294, 298, 342–3, 380, 399, 438, 460 social control, 297, 400, 402–3, 411–12 social democratic (political philosophy), 23, 362, 399, 416 social democratic (position on justice), 23, 24, 25 social democratic (views of social work), 22, 408 social development of children, 48, 135 social development practice, 23, 24, 34, 35–38, 48, 49, 184, 251–5, 255–7, 259–60, 267–71, 273–5, 277, 278, 279–80, 244–5, 366, 375, 393, 406, 429, 435, 438, 440, 447, 462 social division, 154, 166, 368, 372, 473, 479, 484–6, 495 social ecological social work, 432 see also eco practice; ecological social work social entrepreneurship, 260–2 social goals (groupwork model), 48 socialism, 273, 416–17 social justice, 12, 23–4, 28, 36, 51, 58, 59, 69, 227, 236, 251, 254, 270, 273, 278, 303, 304, 322, 325, 336, 345, 361–2, 363–4, 366–72, 393–4, 455–6, 458, 477, 484, 485, 486, 497, 499–500, 506, 567 see also human rights; justice social justice, advocacy and empowerment, 374–7, 380–1, 385, 390 social justice and critical practice, 399–401, 404, 406, 408, 416–17, 425 social justice and eco practice, 428, 430, 432–3, 436–7, 439, 445 social justice and equality, 24, 267, 274, 338, 385, 417, 439, 486, 497 social justice and humanistic practice, 336, 338, 345 social justice and narrative practice, 322, 325

Subject index 567 social justice practice and advocacy/ empowerment, 361, 374–5, 380, 385, 393–4 social justice practice xxi, 12, 14, 361–5, 370–2, 458, 499–500 social learning theory, 175, 181, 182–3, 186, 189 social movements, 258 social networks see networks social pedagogy, 34–37, 48, 50, 251–2, 253–4, 256–7, 262–7, 269, 279–80, 393, 412, 430, 440 see also gerontopedagogy social psychology, 21, 285, 291, 292–4 social reproduction, 467, 473 social role valorization see normalization social skills training, 180–1, 189, 190, 193, 201 social, the, 99–100 Social Work Action Network (SWAN), 407, 427 social work education, 194, 268, 473 social work practice theory groups, 33–40 Socratic questions, 195–6, 198 solution practice, 28, 36–9, 47, 48, 51, 54, 59, 60, 111, 157, 165, 178–9, 206, 240, 256, 285–90, 292, 301–3, 305–12, 318, 322, 338, 393, 423 specialist theory transfers, 75, 79 spiritual assessment, 358 spiritual care, 337, 353, 358–9 spirituality, 7, 12, 35, 50, 175, 179, 249, 334, 336–7, 338, 339–40, 341, 343–4, 347, 348, 350, 351–2, 357–8, 341–2, 436–7, 447, 484, 486, 495, 500, 503 spiritual needs, 357 splitting, 108 SSRIs (selective serotonin reuptake inhibitors), 193 standpoint theory, 418, 454, 460, 464, 469 steady state, 152, 161–3, 165, 223, 413 stigma, 12, 50, 252, 292, 305, 324–5, 481, 484, 503 stories, in practice, 44, 86, 125–6, 148, 169, 289, 315, 317, 320–3, 324–30, 333, 355, 418, 421–2, 424, 463, 503 see also

diachronic narrative; narrative; re-storying stories, rights to tell, 323–4 stories, theory as, 68 storyline, 326–7, 333 storyline (narrative practice), 326, 333 story stem techniques, 138, 139, 148 storytelling and listening workshops, 324, 325 strange situation procedure, 133, 137–8, 143, 144–5, 150 strategic family therapy, 239 strengths practice, 35–39, 41, 55, 59, 78, 86, 116–17, 121–3, 125, 139, 152, 166, 179, 217–18, 221, 236, 245, 256, 262, 285–7, 289–2, 302–4, 305, 311–12, 318, 347, 353, 356, 367, 386–7, 392–3, 421, 437, 446, 453, 484, 495, 501–2, 504–5 stress, stressors, 141, 192, 202–4, 226, 243–5, 249 see also environmental stressors; life stressors structural change/reform, 259–60, 372, 374, 375 structural cognitive therapy, 190 see also cognitive theory structural empathy, 421 structural family therapy, 239 structural-functional sociological theory, 293–4 structural issues/oppression, 129, 153, 159, 258, 319, 365, 391, 399, 403, 407–8, 409, 410, 413, 420–2, 436, 453, 478–80, 481, 484, 485, 487, 489–91, 492, 494–5, 496, 497, 498, 501–2, 506 structural social work, 39, 81, 389, 407, 415–22 see also critical practice structural theory (psychodynamic), 105–6 structural theory (transactional analysis), 345 structural violence, 418 subject, person as, 51, 125, 341, 389, 412 see also object; person as subjectivity (approach/ knowledge/ perspective), 51, 81, 125, 162, 182, 389, 423

subjugation of narrative/truth, 317, 326, 361, 464 superdiversity, 240 superego, 98, 105–8, 117, 345 support, controlling, 115–16 support in practice, 26, 44–6, 48, 61, 70–1, 83, 115–16, 123–4, 136, 138, 140–1, 146, 148, 158, 165, 169, 171, 173, 187, 192, 211, 217, 219, 236, 243, 245–7, 249, 262, 271–2, 275–6, 279, 290, 302, 318, 354, 356, 375, 377–8, 383, 386–7, 389, 390, 406, 409, 438, 446–7, 450, 460, 463, 467, 483, 491, 492, 501 see also ego support support, mutual, 24, 49, 226, 252, 261, 265, 289, 324, 354, 402, 420–1, 460 see also mutual aid support networks, 290, 301, 388, 393, 441–2, 447 support of ideas/policies, 25, 151, 155, 259–60, 272, 275, 290, 336, 337, 367, 368, 369–70, 408, 409, 414, 419, 423, 451, 458, 466, 493, 495 support of practice(s) by evidence/knowledge, 5, 10, 11, 18, 22, 41–2, 46, 54–5, 57, 58, 59, 98–100, 151, 155, 179, 210, 286, 340, 381, 400, 403–4, 454 see also evidencebased practice; support of ideas support of social workers, 85, 122, 165, 184, 208, 288, 383, 385–6, 401, 464 support systems, 152, 154, 156, 165, 226, 241–2, 279, 388–9, 440–1, 447 see also networks sustainability, 27, 249, 336–7, 428, 430 see also environmental sustainability sustainment, 120 see also support sustain talk, 211, 216, 222–3 synergy, 234 systemic advocacy, 375–6 systemic family therapy, 240 systems boundaries, 225, 232–3 systems practice/theory, 13, 35–40, 49, 50, 67, 121, 124, 154, 225–50, 267, 280, 327, 351, 411, 429–30, 463 see also support systems

568 Subject index T taken for granted ideas, 26, 60, 86, 158, 299, 320, 416, 456–7 task-centred practice, 13, 25–6, 28, 36–9, 48, 53, 75, 81, 111, 151–6, 157–60, 165, 167–73, 179, 198, 214–15, 218, 291, 301, 306, 322, 337, 393, 394, 460, 471 task development (task-centred practice), 169, 171 task, in practice, 15–16, 49, 69, 88, 112, 148, 198, 200, 201, 214, 215, 218, 228, 243, 265, 306, 310, 312, 388, 392–3, 455, 460, 470–1 task planning and implementation sequence, 171–2 teaching profession, 9, 47, 81, 82, 220, 257, 417, 483 teaching, in practice, 144, 189, 191, 216, 501 technical rational, 82, 175, 412 theory development, 67, 70–3, 111, 191, 268, 380, 452 theory, what is it? 3–12 third wave therapies (CBT), 175, 177, 179, 180–1 throughput (systems theory), 232–3 time constraints/limits, 48, 85, 154, 157, 158, 165–6, 168–70, 195, 288, 371, 445

time in practice, 111, 232, 243–4, 262, 311, 314–15, 319, 321, 324–5, 353, 381 see also SMART; time constraints time machine question, 308 tokenism, 374 transactional analysis (TA), 336, 345–6 transfer of learning, 66, 74, 79, 217 transformational theory, 24, 83, 232, 253–4, 333, 349, 377, 389, 391, 400, 413, 415, 471–2, 486 transformation, family, 246 transformation personal, 349, 358, 446, 505 transformation, perspective, 83 transitional object, 132 transtheoretical model of change, 37, 210, 213–14 transversal theory, 263 trauma, 35, 38, 139, 146, 151, 154, 160, 193–4, 333 trauma, 35, 38–9, 146, 151, 154, 160, 193–4, 333 travelling knowledge, 66, 74 twinlineal identity, 349 U uncertainty, 35, 68, 88, 90, 133, 221, 225, 227, 232, 240–1, 300, 321, 501 see also ambiguity; ambivalence unconditional positive regard, 217, 263, 337, 344, 501–2

unconscious, 104, 106–8, 110, 112, 154, 404 Universal Declaration of Human Rights, 323, 403 universal knowledge/meaning, 177, 213, 253–4, 263, 298, 467 urban areas, urbanization, 257, 267–8, 436, 439, 445, 447 user-led services, 379 V ventilation, 120 Video-feedback Intervention to promote Positive Parenting (VIPP), 140 victim-blaming, 56, 99, 113, 141, 216, 406, 411 ‘victor not victim’, person as, 392 W women carers, 178–9, 294, 409, 450–1, 455–6, 461–3, 467, 470–1, 497 women’s equality, 453, 455, 471, 747 see also gender equality women’s needs, 462 wu wei, 156 Y young carers, 48 young people/youth, 160, 430, 491 youth service/work, 48, 141, 251, 257, 278–9