Social Group Work Today and Tomorrow

Moving From Theory to Advanced Training and Practice

Benjamin L Stempler, Marilyn Glass

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781135431419
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

A comprehensive introduction to policy and planning approaches, methods, models, ways of thinking, and techniques, Social Group Work Today and Tomorrow is presented in a reader-friendly fashion for persons with no prior formal training in this area. The book teaches social workers, group counselors, educators and students, and practitioners how to apply group work theory to practice in an increasingly time-limited and managed-care-oriented society. Social Group Work Today and Tomorrow converts sophisticated policy and planning concepts and techniques into a form which even non-experts can understand, relate to, and apply in their own practice.Chapters reflect the work of the "giants" of social group work and also recognize contributions being made by the current generation of educators and practitioners. The contributors'chapters span many topical areas, among them:

• an interactionist theoretical perspective on creative uses of groups
• a moving look at the second decade of the AIDS epidemic
• creative use of dance with group work
• creative group work with ill elderly
• practice groups for students to prepare them for professional work with groups
• women's issues and empowerment
• creative ways to use groups to educate among homosexual men on safe sexual practices
• the use of one-session groups to respond to job-related traumaChapters strike a strong note for social group work's base in an interactionist perspective and for the overall efficacy and uniqueness of the method. Throughout the text, readers learn and explore group types and formats ranging from verbal to activity; from one session to beyond a year; from education to support; and from developmental to rehabilitation. Ethics, self-esteem, identity, and empowerment themes are prominent throughout this work's pages.Social Group Work Today and Tomorrow is an accurate reflection of the quality, creativity, and energy that made up the Fourteenth Annual Symposium on Social Work With Groups. The creativity and innovativeness reflected in these pages offers new ideas and direction to all of social workers, counselors, and educators who choose the experience of working with groups.

Chapter 1

Social Work with Groups: Paradigm Shifts for the 1990s

Lawrence Shulman

INTRODUCTION

As the social work profession enters the last decade of the century it is undergoing fundamental changes. The paradigms that guide professional practice are shifting. Social work with groups, one of the three foundation methods that make up the trinity of practice (casework, group work, and community organization), has played an important role in transforming the way we think about clients and about the helping process. This chapter discusses these paradigm shifts and some of the resultant changes. In addition, the discussion suggests some unique elements associated with social work practice with groups, which may explain why it has played a unique role in this rethinking of the way we work. First, the term paradigm and the concept of a paradigm shift is explained and illustrated.

PARADIGMS AND PARADIGM SHIFTS

The term paradigm is used in this discussion as it was described by Kuhn (1962) in his book on the process of change in scientific theory development. He described a paradigm as including the models, theories, and research approaches that guide a discipline in its pursuit of knowledge. Within a single paradigm there could be many different theories; however, all would be guided by the basic framework to which most, if not all, scientists in the discipline subscribe. In one illustration, he described the paradigm that dominated astronomy in its early stages. This paradigm, developed by Ptolemy, suggested that the earth was the center of the universe. Kuhn described how Galileo and Copernicus shifted the guiding paradigm by advocating a new model that placed our sun at the center of the universe. In turn, the Copernican paradigm was replaced by later shifts that enhanced the ability of astronomers to explain the universe (e.g., Newton, Einstein, and the more recent models). Social work, as well as other helping professions, is experiencing its own fundamental paradigm shifts.

THE MEDICAL PARADIGM

Social work adopted a paradigm early in its development. This model was borrowed from the medical profession, considered to be a high-status, successful profession (Shulman, 1991, 1992). The medical paradigm described practice as a three-stage, linear process. First, the professional would conduct a study designed to obtain information about the client’s current life, and often about the client’s family history as well. In the second stage, the professional, often with the help of a supervisor or team, would use the information to develop a diagnosis or assessment. The client might be involved in this stage, contributing to the identification of the problem. In the third stage, the diagnosis would form the basis of an initial treatment plan to be implemented with the cooperation of the client. Evaluation of treatment outcomes was added as a fourth stage designed to feed information back into the study process, which might lead to a revision in the diagnosis and alternative treatment strategies. This medical paradigm helped social work to move from the “friendly visitor” (Richmond, 1918) phase of its development to a more professional model. Each of the elements of the paradigm—study, diagnosis, treatment, and evaluation-will always be central to our work.

It is not the separate elements themselves but rather the linear nature of the three-stage model that requires reconsideration. When the social work profession adopted this paradigm, it also accepted a number of associated assumptions that have increasingly come into question as our practice and research have altered our understanding of the nature of helping. For example, a social worker engaged in the study phase during a first group session is already well into the treatment process. The group leader’s questions, empathy, display of interest, and concern in the members, and the group members’ recognition that they are “all in the same boat” have started the healing process. A linear, three-stage paradigm that describes treatment as following study and diagnosis does not adequately describe this more dynamic process. The use of this paradigm as a model can easily lead a novice group worker to focus on “information gathering” in first sessions while ignoring the important, therapeutic processes initiated in the engagement phase.

Another potential problem associated with the medical paradigm is the suggestion that the group leader is the “expert” who can provide a “solution” once the problem is properly diagnosed. This model may minimize the importance of mutual aid and the recognition that the most important help comes not from the leader, but from the members themselves. An alternative paradigm would suggest that the group leader is not an expert in life but rather an expert in helping group members to create, develop, and maintain mutual aid systems. This idea is often commonly described as an “empowerment” model that had its roots in group work practice.

The medical paradigm may also lead the professional to take responsibility for determining what problem or issue should be dealt with in each session. Thus, the group leader feels that he or she “owns” the group and it should be used for the professional’s therapeutic purposes. One consequence of this approach is that the group leader takes over the work of the group by developing “goals” for each session, sometimes in consultation with a supervisor or team. In reality, the group members’ sense of urgency should determine the focus of the session, and a group leader intent on achieving his or her own goals may completely miss the indirect cues at the start of a session signalling the clients’ agenda.

In one classic videotape, which was part of my early research (Shulman, 1981), a young woman was talking with a social worker in a room with only a video camera present. The client had given permission for the videotaping as part of the research project, but did not know the researcher (this author) who would view the tape. The young woman made repeated attempts to raise through indirect means a problem related to sex. Each effort was missed by the worker, who though attentive, was busy pursuing her own written agenda for the session. The hints became stronger. Fifteen minutes into the session, the client turned to the camera, and in an exasperated tone, asked: “Do you understand?” In this research, when 120 hours of individual and group sessions were videotaped and analyzed using a category observation system developed by this author, this lack of “sessional contracting” was observed as group leaders appeared to be working on one agenda while the clients were sending signals of another—each missing each other.

Finally, another potential problem associated with the use of the medical paradigm is the tendency to rely on a pathology or illness orientation for making assessments. In this diagnostic framework, an emphasis is placed on what is wrong with the client and what needs to be changed. For example, teenage mothers might be judged as inadequate and referred to a parenting group in order to “teach them effective parenting skills.” The focus of the group discussion might be on helping the parents better understand their children’s needs for “quality time” and parental support. An agenda for discussion and presentations might be designed to teach a curriculum for effective parenting. Many of the group members may be attending because their child-welfare-protection social worker suggested it could be helpful for them if they wished to keep or regain custody of their child. Group sessions of this type often create an illusion of work with clients learning to say what they think their group leader wants to hear as opposed to what they really think and feel.

The medical model as a diagnostic approach has been challenged by many new and emerging frameworks (e.g., strength model, ecological framework, feminist psychology). More recently, a unifying theme focusing on oppression and vulnerability has been articulated. One version of the oppression model will be illustrated in the next part of this chapter.

This same group of teen mothers when viewed from a “strength” perspective might be seen as showing incredible determination and backbone for wanting to keep their children. A support group with this orientation would start with the assumption that these mothers need help from the workers and each other in reinforcing their determination and developing strategies for coping. The same mothers viewed from an ecological model (Germain and Gitterman, 1980) would be best understood as experiencing a conflict between the normative developmental needs of their children and their own needs as teenagers. Discussion might focus on what formal and informal support systems can help them to deal with the absence of a “goodness of fit” between their needs and those of their children.

At this point, it is important to note the difference between the terms medical model and medical paradigm. The term medical model, as just described, refers to an assessment framework that may make up one element of the medical paradigm. The term medical paradigm, as used here, refers to the overarching, three-step model of the helping process (study, diagnosis, and treatment). It is entirely possible for a group leader to abandon the medical model as a diagnostic orientation and yet still practice within the medical paradigm. For example, a social worker may use a strength orientation for understanding the group members while still conceiving of the helping process as one in which diagnosis follows assessment and is then followed by treatment.

In the next section, an oppression model for assessment is presented as an alternative to the medical model. This model provides a framework that fits more comfortably into the interactional paradigm-described in more detail in a later section.

AN OPPRESSION MODEL AND SOCIAL WORK PRACTICE

Frantz Fanon, an early exponent of the psychology of oppression, was a black, West Indian revolutionary psychiatrist (Buhlan, 1985). Whereas Fanon’s work emerged from his observations of white-black oppression associated with the efforts of European colonial powers to economically exploit third-world countries, many of his insights and constructs can be generalized to other forms of oppression. While the complete exposition of his views is more complex than presented here, the central idea of gaining one’s sense of self through the exploitation of others can be seen in different oppressive relationships and takes many forms: (1) the abusing parent and the abused child; (2) the battering spouse and his partner; (3) male-female sexism; (4) the scapegoating of religious, ethnic, and racial groups; (5) the “abled” population and the “differently abled”; (6) the “normal” population and the “mentally ill”; and (7) and the straight society’s oppression of gay men and lesbian women. In all of these examples, one group (usually the majority) uses another group for enhancing a sense of self.

Repeated exposure to oppression, subtle or direct, may lead vulnerable members of the oppressed group to internalize the negative self—images projected by the external oppressor—the “oppressor without.” The external oppressor may be an individual (e.g., the sexual abuser of a child) or our society (e.g., the racial stereotypes perpetuated about people of color). Internalization of this image and repression of the rage associated with oppression may lead to destructive behaviors toward self and others as oppressed people become “autopressors,” participating in their own oppression. Thus, the oppressor from without becomes the oppressor within. Evidence of this process can be found in the maladaptive use of addictive substances and the growing internal violence within communities of oppressed people, such as we are witnessing in our inner cities.

If we consider the group of teenage mothers described in the previous section, then an oppression framework might focus on the various forms of oppression that these young women have experienced. All of them have experienced some form of gender or racial oppression. As children, some may have experienced physical, emotional or sexual abuse. The internalized negative self-image (the “oppressor within”) is fostered as these same women experience the economic oppression associated with poverty. With this perspective in place, one quickly can identify the strengths that have been required to help these young women simply survive. A parents group may help them develop the skills associated with effective parenting, but the orientation of the oppression model would be toward helping them identify and freeing themselves from the internalizations that have blocked their ability to be supportive of their children. The focus of the work is not on the pathology of the women, but rather on helping them develop more adaptive ways of coping with the psychological and emotional impact of long-term and persistent oppression. The group would attempt to deal with the needs of the parents, which, in turn, will provide help for the children.

Buhlan (1985), who chronicled Fanon’s life and focused on his psychology, identified several key indicators for objectively assessing the degree of oppression. Whereas Fanon’s work explored these indicators in the context of slavery, Buhlan suggests that “All situations of oppression violate one’s space, time, energy, mobility, bonding, and identity” (p. 124). Consider these six indicators (Buhan credits the first four items of this list to Chester M. Pierce) as you read the process recording excerpts in the next section taken from a discussion by mentally ill patients on a psychiatric ward.

THE INTERACTIONAL PARADIGM

The argument advanced in this chapter is that the helping professions are experiencing a fundamental shift in the paradigms that guide our practice. The shift to an oppression perspective for assessing clients is just one element of this broader change. This change illustrates Kuhn’s (1962) suggestion that an alternative paradigm must be available before a discipline will give up the old one. The interactional paradigm offers one alternative method for organizing our thinking about the helping process. It incorporates the elements that have always been important to our practice, but organizes them in a manner that departs from the linear, three-stage model. In addition, it fits well with the oppression model described in the previous section.

A number of core elements from the interactional paradigm are described and illustrated in this section: (1) understanding the dynamic interaction between the group and the environment; (2) responding to the productions of the group members; (3) integrating one’s personal and professional selves; (4) understanding the group as a dynamic system; and (5) the social worker’s responsibility for the two clients.

The process recording excerpts used as illustrations are drawn from the work of a social work student with a group of 40- to 65-year-old, white, male veterans, primarily working class from various ethnic groups. All of the men have a diagnosis of chronic schizophrenia and are institutionalized on a psychiatric ward. Many of the concepts of the oppression model, introduced earlier, can readily be applied to the institutionalized mentally ill population. In the excerpts that follow, it is not difficult to perceive violations of institutionalized patients’ space, time, energy, mobility, bonding, and identity.

The student noted the heavy load of mandated “therapy” and “living” groups on the ward and decided to offer a voluntary, task-focused group with the purpose of developing and publishing a patient newsletter. These mandated groups could be viewed as two indicators of oppression-violations of time and energy. The student’s assessment of the problem demonstrated her understanding of the interactional paradigm principle of the dynamic interaction between the group and the environment--in this case, the hospital system. She also communicated her clear sense of her social work role.

The task this group faces is one of negotiating the larger system in which it is situated in order to produce a patient newsletter. Some of the challenges faced by the group are the resistance from the larger system (the hospital), resistance within the group (fear of making waves), members’ fear of retribution from staff, feelings of disempowerment, and suspicion from inside and outside of the group. The major problem then, as I see it, is the feeling of disempowerment embodied by the group members. This is illustrated by the reluctance to express themselves honestly in the newsletter. A second, related problem is the hospital’s low expectations of the patients and the ambivalence of the hospital toward change. The problem I face is to find a way of mediating between these two systems.

Several incidents occurred which led to this assessment. When I began the newsletter, I observed a great deal of enthusiasm initially, both from group members and staff, but this enthusiasm began to falter after the first few meetings. Many of the members failed to complete the assignments they had volunteered for, and the p...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Foreword
• Preface
• Acknowledgments
• Chapter 1. Social Work with Groups: Paradigm Shifts for the 1990s
• Chapter 2. Making Joyful Noise: Presenting, Promoting, and Portraying Group Work to and for the Profession
• Chapter 3. AIDS and Group Work: Looking into the Second Decade of the Pandemic
• Chapter 4. Positive Group Work Experiences with African-American Adolescents 1935-1945: An Afrocentric Retrospective Analysis
• Chapter 5. The New Patient Mix: Group Work and Chronic Disorders in an Acute Care Hospital
• Chapter 6. Bringing the Mountain to Mohammed: An Experiential Approach to Teaching Group Dynamics in the Classroom
• Chapter 7. Social Group Work with Recovering Women: An Empowerment Model
• Chapter 8. Redefining Adult Identity: A Coming Out Group for Lesbians
• Chapter 9. Being Non-Deliberative on “A Hot Winter’s Night”: Confessions of a Creative Practitioner
• Chapter 10. Trauma Debriefings: A One-Session Group Model
• Index