Paradigms of Clinical Social Work

Rachelle A. Dorfman

• Publisher: Routledge
• Year: 2015
• Print ISBN: 9781138009516
• eBook ISBN: 9781317713654
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

This fully-integrated volume written by the leading experts in the field of social work presents a wide rage of therapeutic paradigms. Especially noteworthy is the common framework provided for all paradigms discusse, thus facilitating comparison and contrast between each approach. These paradigms include cognitive, brief-oriented, and psychosocial therapies, as well as Adlerian theory and radical behavorism.

PART I

History and Case

1

Clinical Social Work: The Development of a Discipline

Rachelle A. Dorfman, Ph.D.

Although the profession of social work is young—less than 100 years old—the practice of helping others is ancient. There have always been people willing to devote large portions of their lives to alleviating human suffering. This chapter will focus on some of the people who were instrumental in the development of the profession, as well as on some early efforts to help the poor, which eventually expanded to include help for all socioeconomic classes and for emotional as well as social problems. In addition, the chapter will trace the development of social consciousness and social welfare that laid the foundation for the contemporary practice of clinical social work, a field that has been called an entirely separate discipline (Alexander, 1977), a specialization of social work (Strean, 1978), and a movement (Briar, 1983).

We know from the anthropological record that prehistoric peoples engaged in cooperative and helping behaviors that contributed to their survival in a harsh environment. Nevertheless, this account begins arbitrarily at a more recent point, 4,000 years ago, with Hammurabi, the king of Babylon, who declared—in a sweeping gesture of social consciousness—that he would protect every widow and orphan in Babylon. Two thousand years after Hammurabi’s reign, the Greeks were supporting their dependent citizens in the same manner and teaching their children that it was better to give than to receive.

Similar teachings can be found in ancient religious writings. For example, the Old Testament says, “Thou shalt not harden thine heart nor shut thine hand from thy poor brother” (Deuteronomy, 15:7). Farmers are told that after they harvest their fields, they should not return to fetch a forgotten sheaf, but should leave it in the field “for the stranger, for the fatherless, and for the widow” (Deuteronomy, 24:19). The Talmud, a collection of Jewish law and tradition, excuses no one from giving: “Even a poor person who is kept alive by tzedakah funds [charity] must give tzedakah from what he receives” (Shulchan Aruch, Yoreh De’ah, 248:1). Other examples can be found in the Koran, the Islamic holy book, which exhorts Muslims to donate a portion of their assets to the poor. The Christian world regards charity as the supreme virtue, demonstrated in the passage: “And now abideth faith, hope, charity, these three; but the greatest of these is charity” (I Corinthians, 13).

ENGLISH AND AMERICAN ANTECEDENTS

When the Christian church was small, most of the help for the needy came from relatives and friends. By the sixth century, however, Christianity dominated Europe and the monasteries became centers for relief of the poor. Not only was relief given at the monastery door, but, in the prototype of modern outreach services, monks went into the community to perform charitable acts.

The plague, the famines of the 15th century, and the dismantling of the feudal system (which meant the loss of the master’s caretaking) contributed to a tremendous rise in unemployment, homelessness, and crime. By 1536, England turned Protestant and relief of the poor was secularized. Monasteries were dissolved and the monks, whose work was to aid the poor, instead joined the ranks of the poor.

In the following decades, suffering and social disorder became widespread. Probably moved more by fear of insurrection than benevolence, English lawmakers wrote The Poor Law of 1601. This landmark in public welfare legislation stood nearly unchanged in England for the next 250 years and was a major influence on American social welfare policy:

In short, people were expected to look out for themselves and their families. If they got into trouble, they would first turn to their relatives and neighbors, just as we do today. If these resources were inadequate, the community was morally obliged to share with them through the poor law, but on the other hand, officials were justified in seeing that individuals or members of the family did not evade their responsibilities. (Leiby, 1978, p. 40)

In colonial America, poor children were apprenticed to tradesmen and many people who were unable to care for themselves were literally “farmed out” to the lowest bidders at town meetings. The able-bodied were put to work; the old and incapacitated were granted small amounts of money (outdoor relief) or were placed in institutions (indoor relief). For a time, indoor relief was the favored method of dealing with the poor, and hundreds of almshouses were built.

At first, indoor relief seemed more humane than farming-out or meager outdoor relief. Although the intent may have been humane, conditions inside these institutions deteriorated rapidly. Children, criminals, the mentally ill, and epileptics were housed amid filth, disease, hunger, and violence. Spurred by reports of these conditions, reformers demanded that children be removed from the poorhouses and that state and federal governments provide aid to improve the quality of care for those who remained.

SCIENTIFIC CHARITY

The Civil War brought with it a temporary reversal in charitable practices: Outdoor relief replaced indoor relief as the favored method of dealing with the poor. Large amounts of public and private funds were appropriated to help sick and destitute soldiers and military families. After the war, private agencies multiplied, particularly in the larger cities. In 1878, in Philadelphia alone, there were 800 such groups (Trattner, 1979). Despite the great number of agencies, relief was chaotic and ineffective.

In that era, it was assumed that people are by nature lazy and self-indulgent and that if they are given relief, they will become demoralized parasites, unwilling to work. (That assumption persists in some circles even today.) Herbert Spencer, the English philosopher, applied Darwin’s theory of evolution to social conditions. He believed that there was a natural evolutionary process toward higher forms of social life and that, if left alone, the lower forms (i.e., the needy) would die out. He and other “Social Darwinists” felt that it would be unnatural (or worse, would lead to a disastrous weakening of the species) if the poor were given relief, because then they would become irreversibly dependent (which translated to “unworthy”). Spencer and his followers believed that minimal volunteer charity was justified only because it encouraged the development of Christian virtue in the givers. They believed that moral failure was the cause of poverty and distress and that for everyone—except the “unworthy” (irreversibly dependent)—moral uplift was the remedy.

Charity workers had to first distinguish the worthy from the unworthy (an impossible task) and then employ “benevolent stinginess” (Lubove, 1965), which meant that, for their own good, the needy were given little financial assistance. Next, the charity workers had to devise and implement a method for moral correction to elevate those who were deemed morally deficient but “worthy” nevertheless.

By the last part of the 19th century, there had been an unprecedented rise in the number of charities, but there was no corresponding increase in their effectiveness. At the same time, however, the intellectual community was developing a new respect for science and the doctrine of single causation—the idea that every effect could be traced to a cause. If the cause could be uncovered, the cure could be revealed. This philosophy suggested that science might lead to a cure-all for all kinds of human problems. Charity workers began to think that this linear scientific model might also provide them with solutions to social ills (Germain, 1970).

With missionary zeal and high expectations, scientific charity was born in the United States with the emergence of the Charity Organization Societies (COS). The first COS was established by an Episcopalian minister, Stephen Humphreys Gurteen, and his businessman parishioner, T. Guilford Smith, as a response to the destitution and ineffective relief in Buffalo, New York, in 1876.^* Gurteen spent the summer of 1877 in London, studying the Society for Organizing Relief and Repressing Mendacity. He returned to model the first American COS after the London society.

The stated objective of the COS was to eliminate sentimental almsgiving and replace it with scientific investigation and businesslike organization and efficiency. District agents in each COS registered each case (to eliminate duplication of services) and then determined the worthiness of the applicants. Thorough investigation and the assessment of individual needs were primary functions. Money was rarely given. Instead, referrals were made to agencies with specialized services. Leiby (1978) has pointed out that the best part of the work—probably because it was the most intellectually stimulating—was the case conferences held by volunteer district committees. Professionals, society women, and knowledgeable community members were invited to discuss cases and formulate recommendations. In keeping with the COS motto, “Not alms, but a friend,” the committee frequently assigned a “friendly visitor” to the family.

Friendly visitors were respectable, successful, and “moral” volunteers who would befriend needy families and, by their example, attempt to guide the families out of poverty and suffering. The relationship between friendly visitor and needy person was by no means equal, but it was supposed to be reciprocal: “The poor were to learn diligence, abstinence, and thrift, as basic to self-support” (Lewis, 1977, p. 97) “and the rich might benefit from examples of courage and good cheer displayed by the poor” (Lubove, 1965, p. 114). Mutual understanding between the classes was supposed to reduce friction and foster social harmony.

Robert Treat Paine, a COS spokesman from Boston, said that friendly visiting was “the only hope of civilization against the gathering curse of pauperism in the great cities” (Lubove, 1965, p. 5). Although it did not turn out to be the salvation of civilization, friendly visiting was an appealing, if idealistic, concept. It is at this point that one can begin to recognize systematic investigation, attention to individual needs, case conferences, and the therapeutic relationship as the embryonic form of casework as we think of it today.

By 1900, the role of the paid agent was upgraded and the role of the volunteer visitor was diminished, probably because it was difficult to recruit enough volunteers to fill the need and because COS leaders were interested in promoting the professionalization of the discipline of “Applied Philanthropy” (the infant social work). However, the main reason for the decline of the importance of the volunteers was that after extensive contact with the needy, people in the COS movement realized that poverty had more to do with social, economic, and psychological factors than with personal moral shortcomings. They began to have serious doubts about the effectiveness of friendly visiting. It was difficult to maintain the belief that poverty was unrelated to the massive cyclic economic depressions in the latter part of the 19th century: “If moral failure was not the cause of poverty, then friendly visiting was not the solution” (Popple, 1983, p. 75).

THE SETTLEMENT MOVEMENT

Many people thought that the “solution” to poverty could be found in a new ideology, the short-lived settlement movement, which arose at the same time as the COS. From the outset, settlement workers concentrated on environmental determinants. Although they did not deny that personal shortcomings contributed to poverty, they relegated them to a minor role.

In the late 19th and early 20th century, the larger American cities were overcrowded and filthy. Immigrants in pursuit of a better life flooded the urban areas: 14 million came between 1860 and 1900, another 9 million between 1900 and 1910. Most immigrants worked as unskilled laborers in factories, subject to the brutal working conditions and periodic layoffs that kept them locked into poverty.

During this period, the nation’s universities were also expanding, and a large group of young men and women began to graduate and seek roles in the new industrialized society. There was no clear place for them—big business was at the top and organized labor was at the bottom. Many of these idealistic men and women became alienated from society as it then existed, and sought to change it by becoming social reformers. The settlement movement provided them with a meaningful niche (Hofstadter, 1956).

The charity workers had taken a friendly but unquestionably superior position in their efforts to change the individual, whereas these young men and women claimed equality with the poor and chose to live in neighborhood settlement houses in the heart of the poor communities. Their client was the community, not the individual. As the movement progressed, involvement extended from the neighborhood to the city, the state, the nation, even the world. Instead of moral exhortation, the “treatment” was activism: creating day-care centers, libraries, dispensaries, employment bureaus, literacy classes, art classes, and social and recreational activities and clubs. The settlement workers obtained playgrounds, gymnasiums, garbage collection, and public bathhouses for their communities. They became “spearheads for reform” (Davis, 1967), becoming involved in the labor movement and in activism for civil rights.

The first American settlement, the Neighborhood Guild, was founded in New York City in 1886 by Stanton Coit, a young American who had spent three months in England living at Toynbee, the first English settlement house. (Again, this is evidence of the English influence on American social welfare policies and programs.) Coit was impressed by the university students he saw who were living and working among the poor, attempting to create small-town neighborliness in the midst of the London slums. The idea spread rapidly in America. By 1897 there were 74 settlements, in 1900 over 100, and by 1910 over 400.

One of the most well-known of the settlement houses was Hull House in Chicago, which was founded in 1889 by another Toynbee visitor, Jane Addams. Many Hull House programs became models for other settlements. Addams’ work ranged from the mundane (she was the trash inspector in her Hull House neighborhood) to the lofty (she was president of the Women’s International Peace Conference at The Hague).

Although much has been written about Jane Addams, she still remains an enigma (Davis, 1973). She has been depicted as suprahuman, saintlike, and as a symbol for the Progressive Era. Historians have speculated on what motivated her to devote her entire life to political action. Among the speculations are rebellion against family pressure to be the “maiden aunt” (Lasch, 1965), guilt because of her material comfort in the face of the social ills of the period, her early feelings of uselessness and depression, or (as she wrote in her autobiography) “a conversion experience” that occurred shortly after she witnessed the slaughter of animals at a bullfight in Madrid (Addams, 1910).

Perhaps all of the explanations are valid. At any rate, Addams was a college-educated woman who was uninterested in marriage and family in an era that offered her few other opportunities or occupations. Like many other Victorian women of her upper-middle-class background and privilege, for a while (eight years of her early adulthood) she languished with illnesses, neurotic breakdowns, and invalidism, mixed alternately with abortive attempts to further her education.

Addams’ “creative solution” (Davis, 1973) to her long search for something to do that had value and meaning, her growing awareness of the gap between the classes, and perhaps some righteous indignation about what she observed in the industrialized cities contributed to her founding of Hull House. Jane Addams was a tireless activist for peace as well as social reform, and in 1931 she received the Nobel Peace Prize for her work.

The settlement movement declined after World War I. The poor were still present, but they were less visible in the postwar prosperity, and fewer university students...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Foreword
• Acknowledgments
• About the Editor
• About the Contributors
• Introduction
• Part I History and Case
• Part II Paradigms
• Part III Metaparadigms
• Epilogue
• Author Index
• Subject Index