Clinical Social Work

Definition, Practice And Vision

Rachelle A. Dorfman

• Publisher: Routledge
• Year: 2013
• Topic: Psychology
• eBook ISBN:
  9781135063047
• Subtopic: Mental Health in Psychology
• Index: Psychology

Published in 1996, Clinical Social Work is a valuable contribution to the field of Psychiatry/Clinical Psychology.

1

SOCIAL WORK: A NOBLE TRADITION

CLINICAL SOCIAL WORK

I am a clinical social worker. I have worked in a day-care center, a community mental health center, a private psychotherapy office, and an institution of higher learning. I have counseled emotionally disturbed children, adult individuals, couples, families, and groups. Among my clients are the poor, the sick, the abused or neglected, the elderly, the disabled, and the disenfranchised. Some of my clients have had more advantages than most, but nevertheless have suffered emotional pain. Although my work is often fraught with frustration and despair, it is deeply satisfying because—I believe—it contributes toward making the world a better place.

These words describe my understanding of clinical social work and its personal significance to me. They speak to the heart. Another definition (which speaks to the head) is more comprehensive. It is the definition approved in June 1984 by the Board of Directors of the National Association of Social Workers (NASW). The NASW is the largest organization of professional social workers in the world. As of January 1994, it had over 146,00 members in 55 local chapters throughout the United States, Puerto Rico, the Virgin Islands, and the international community.

Clinical social work shares with all social work practice the goal of enhancement and maintenance of psychosocial functioning of individuals, families, and small groups. Clinical social work practice is the professional application of social work theory and methods to the treatment and prevention of psychosocial dysfunction, disability, or impairment including emotional and mental disorders. It is based on knowledge of one or more theories of human development within a psychosocial context.

The perspective of person-in-situation is central to clinical social work practice. Clinical social work includes interventions directed to interpersonal interactions, intrapsychic dynamics, and life-support and management issues. Clinical social work services consist of assessment; diagnosis; treatment, including psychotherapy and counseling; client-centered advocacy; consultation; and evaluation. The process of clinical social work is undertaken within the objectives of social work and the principles and values contained in the NASW Code of Ethics (NASW, 1989).

This book is about clinical social work, a field of specialization in social work practice not formally recognized by NASW until 1987. Although most clinical social workers are employed by formal organizations, the proportion of clinicians in independent private practice has increased over the last decade (NASW, 1989). To practice clinical social work independently, one must have an MSW (Master of Social Work) degree from a social work program accredited by the Council on Social Work Education (CSWE), have completed two years of full-time experience (or the part-time equivalent) supervised by a clinical social worker, and hold membership in the Academy of Certified Social Workers (ACSW) or a state license or certification that verifies and regulates the advanced level of the clinician (NASW, 1989).

What is clinical social work? Where is clinical social work practiced? How do you do it? These are a few of the questions that will be answered in this text. But first we should acquaint ourselves with the work of the early social workers.

THE FIRST SOCIAL WORKERS: SOCIAL REFORMERS AND SETTLEMENT WORKERS

Because there have always been individuals committed to helping others, it is impossible to name the first person to do “social work.” Social work was going on long before the term was coined by educator Simon Patten in 1900. Patten applied the term “social workers” to the friendly visitors and settlement house residents. He is reputed to have argued with Mary Richmond about whether the major role of social workers should be advocacy or the delivery of individualized social services (Barker, 1991). This brief history will begin, not at the beginning, but farther down the line with the social reformers of the Progressive Era, from 1900 to 1917 (Noble, 1984). These social workers were mainly college-educated men and women who were frustrated with the lack of career opportunities in a newly industrialized society. They were not attracted to big business or organized labor. The broad array of professional opportunities we are familiar with did not open up until after World War I. What many of these idealistic men and women shared was a gnawing dissatisfaction with the social conditions of the late 19th century and early 20th century and a drive toward reform.

Large American cities were overcrowded and filthy. Urban areas teemed with unskilled laborers, many of them immigrants, who suffered under brutal working conditions and the consequent poverty brought about by frequent layoffs. The social reformers attempted to improve society by advocating for prohibition, better working conditions, women's suffrage, laws to limit immigration and child labor, and the promotion of health and welfare programs.

Many reformers found their niche in the settlement movement, which consisted of individuals living together in innercity areas festering with social ills. Initially, the settlement workers focused on the narrow confines of their neighborhoods. For example, small children who fended for themselves while their mothers labored in sweatshops were taken in, fed, and protected in settlement day-care programs. The settlements buzzed with recreational and social clubs, educational classes, employment bureaus, literacy classes, and dispensaries.

Soon, settlement workers expanded their activities to wider circles of reform. They obtained playgrounds, gymnasiums, garbage collection, and public bathhouses. Then they became even greater “spearheads for reform” (Davis, 1967), becoming involved in the labor movement and in civil rights.

Jane Addams (1860–1935)

The most well-known of the settlement workers was Jane Addams. Addams was born to an upper-middle-class family in Cedars, Illinois. She was very much influenced by the political views of her father, John Addams, a state senator, Quaker, and abolitionist. From childhood, Addams was never interested in the traditional female roles of the Victorian Era. Instead, she had an absorbing interest in the plight of the poor. In the 1880s, Addams went on several trips to Europe, a common occurrence for young women of her background, but instead of soaking up the Old World charm and culture prescribed by such “grand tours,” she spent a great deal of time visiting the factories and slums of London's East End. It was during one of these trips that she visited Toyneebee Hall, the first English settlement house. Addams had long felt adrift, finding her studies of literature meaningless in the face of the pain and suffering she witnessed in the overcrowded slums.

Finally she returned to Chicago, and on September 18, 1889, with the help of her lifelong companion, Ellen Gates Starr, she opened Hull House. Hull House became a model for settlement houses at home and abroad. By 1920, there were over four hundred settlements in the United States. Jane Addams went on to champion many social welfare causes and organizations. She worked tirelessly for women's suffrage and world peace. In 1931, she received the Nobel Peace Prize for her work.

The settlement movement declined after World War I. However, it played an important role in the development of what was later to become clinical social work. Its most important contribution was that it helped to alter the belief that human distress and poverty originated from an individual's moral weakness. Eventually, the profession adopted the position that human problems are caused by individual factors (such as personality traits) as well as environmental determinants (such as inadequate housing, limited employment opportunities, lack of education, poor health care, and institutional racism). This realization evolved into the person-in-environment approach (which will be discussed in detail in Chapter 2).

THE CASEWORKERS

The settlement movement was a precursor to contemporary clinical social work, but that is only part of the story. At about the same time the settlements were flourishing, a second movement, with a different perspective on the causes and alleviation of poverty, was developing by leaps and bounds—the Charity Organization Societies (COS).

After the Civil War, private charity agencies proliferated throughout the United States. For example, Trattner (1979) reported that in 1878 there were eight hundred such groups in Philadelphia alone. These agencies had little connection to one another. A shrewd individual could easily solicit and receive duplicate services from a number of different charitable organizations. Not only were the agencies unaffiliated, their individual efforts were often chaotic and ineffective. The independent charitable agencies eventually united, first in Buffalo, New York, and later throughout the country. By 1882, there were 22 COS in the United States. The stated objective of the COS was to eliminate sentimental almsgiving (the charitable gifts of money and goods) and replace it with scientific case investigation and organized and efficient delivery of services.

Service delivery, in the COS, typically meant the assignment of a “friendly visitor”—that is, a respectful, successful, “moral” volunteer from the community. Because poverty was considered to be the consequence of moral failure, friendly visitors were, by their good example and leadership, supposed to lift poor people from their destitution. District agents in the COS registered cases to eliminate duplication of services. They also determined the “worthiness” of each case, making judgments regarding individuals' capacity to reverse their “dependency”. In those days, such work was called applied philanthropy. By 1900, when the participants in the COS movement began to realize that poverty had more to do with social, economic, and psychological factors than personal moral shortcomings, the era of friendly visiting drew to a close.

The COS movement shaped what we now know as clinical social work. Among the contributions are systematic investigation and assessment of cases; case conferences (case presentations before a group to acquire the fullest understanding of the problems and to determine the best course for problem resolution); recognition of the significance of the relationship between the social worker and client; outreach services (extending service beyond the walls of the agency); and the eventual professionalization of social work.

Mary Richmond (1861–1928)

Mary Richmond had been a sickly child, and as a grown woman she spent much of her life overcoming chronic invalidism (Trattner, 1979). In spite of her frailness, she accomplished a great deal, including transforming “charity work” into a profession. Richmond started her career as an assistant treasurer and friendly visitor in the Baltimore COS, but she soon rose to leadership. At that time, social work's professional status was in question because it had no well-defined technique or method.¹ Richmond went on to formulate the first “social casework method,” which emphasized the sociological influence of the environment on individual personality development and adjustment. Her book, Social Diagnosis (1917), which presented techniques for investigation, diagnosis, and treatment, was met with tremendous acclaim inside and outside the social work ranks. She is regarded as the founder of professional social work.

Richmond inaugurated the first training program for social workers in the New York School of Applied Philanthropy (the forerunner of schools of social work). She spent the last years of her career at the Russell Sage Foundation in New York City, dedicating herself to raising social work standards.

Social casework was the first unifying theoretical base to clinical social work practice, but it quickly became outdated. In the 1920s, caseworkers became enamored with the psychoanalytic approach, which emphasized diagnosis based on an investigation of the history of the client and treatment based on uncovering and understanding early childhood trauma. It relied on Freudian concepts, including the unconscious (see Chapter 6), resistance, and psychic determinism. These ideas eventually came to be called the “diagnostic school” or the Freudian approach.

In the 1930s, a small group of social workers at the University of Pennsylvania School of Social Work, who called themselves functional caseworkers, began to express their discontent with the Freudian/diagnostic approach, which viewed human beings as prey to the dark forces of the unconscious and the harsh restrictive influences of early internalized parental injunctions (Smalley, 1970).

The functional school, also called the Rankian approach, (after Otto Rank, a psychoanalyst and former disciple of Freud, who later came to disagree with him) adopted an optimistic view of human beings. People, functional workers purported, were not the end products of their pasts but were capable of continually creating and recreating themselves through the exercise of their will (an organizing force within the personality). Functional caseworkers saw people as fashioners of their own fates. They attributed pathological phenomena, such as psychosis, to the effort of the individual's will to effect a solution of a psychic problem. The diagnostic workers, on the other hand, believed that people were fashioned by the interrelationship between their basic needs and their physical and social environments. Members of the diagnostic school did not entirely discount the individuals' capacity to alter their environment, but they viewed psychopathology as a result of the inability of the individual to cope with inner and outer pressures (Kasius, 1950). Functional theory posited that the social work relationship provided the context in which the client's growth would be fostered and released. Therefore, the responsibility for treatment resided wholly with the client, not the social worker. The term “treatment” was avoided because it implied a clinician doing something to a client. Instead, the term “helping process” was used to illustrate that change was a consequence of participation in the therapeutic relationship. Exploration of the past, interpretation, and the setting of treatment goals were not a part of the functional school. The proponents of the ...

Table of contents

• Cover
• Half Title
• Full Title
• Copyright
• CONTENTS
• Dedication
• Acknowledgments
• Preface
• 1. Social Work: A Noble Tradition
• 2. THE PHILOSOPHY BEHIND THE PRACTICE
• 3. ROLES AND PRACTICE SETTINGS
• 4. THE CLIENT
• 5. THE INITIAL INTERVIEW: ASSESSMENT
• 6. INTERVENTION
• 7. TERMINATING THE THERAPEUTIC RELATIONSHIP
• 8. CLINICAL PRACTICE EVALUATION
• 9. THINGS THEY DON'T TEACH YOU IN PROFESSIONAL SCHOOL
• Appendix A Recommended Readings
• Appendix B The NASW Code of Ethics
• References
• Name Index
• Subject Index