Relational Theory for Clinical Practice

Sharon Freedberg

• Publisher: Routledge
• Year: 2015
• ISBN:
  9781135077921
• Edition: 2
• Topic: Medicina
• Subtopic: Atención sanitaria

Relational Theory for Clinical Practice offers students and practitioners a conceptual framework for thinking relationally about social work with clients within a biological, psychological, and socio-cultural framework.

Integrating relational theory with the principles of clinical practice, and demonstrating how this can be applied to social work practice, this book has been revised and updated to be suitable for students. Using plenty of case material to demonstrate the theory in action, the new edition incorporates teaching points to aid readers in drawing out the practice principles developed in each chapter.

Keeping relationships at the center of the text, this edition includes substantially expanded chapters on assessment and intervention, and takes into account recent research on issues such as the impact of trauma and stress; neuroscience and brain research; and the necessity of practicing in a culturally sensitive way with diverse populations. It broadens the feminist focus of relational-cultural theory by extending and applying it to men also.

Designed for use on master's level courses in practice, as well as courses on human behavior and the social environment, this concise and practical book is a valuable text for social work and counseling students.

1 The history of social work through a relational lens

10.4324/9780203067123-1

Social work has always been concerned with people and their relationships. In fact, one of the distinguishing characteristics of the social work profession is its focus on the whole person interacting with social systems in the environment—this includes relationships with family, significant others, friends, neighbors, community, work place, culture. Beginning in the last half of the nineteenth century in the pre-professional days of the Charity Organization Society (COS) movement, and continuing to the present, attention has alternated between the individual and the individual's relationships in his or her environment.

Social work has historically paid attention to relationships in its approach to helping individuals solve personal and social problems. However, the conceptualization of relational issues and their place in practice has shifted and evolved over time depending on economic, social, and political trends, and prevailing theoretical and practice approaches: such as the influences of Social Darwinism, Freud's psychoanalytic theory, advances in psychiatry and psychology, and wars and their aftermaths.

Farley et al.'s definition of social work as “an art, a science, a profession that helps people solve personal, group (especially family), and community problems and attain satisfying personal, group, and community relationships through social work practice” (2008, p. 7) is consistent with the basic assumption underlying the material presented in this chapter. Further, this chapter will take a longitudinal view of the client–worker relationship and its application to practice.

Casework before the 1920s: the attempt to “uplift”

Between the late 1800s and the early 1900s the COS movement was established as a way of helping the poor by providing an alternative to public relief. The COSs were philanthropic organizations functioning under private auspices and endowed with a moral mission of moving the poor, intemperate, and indolent toward self-sufficiency and financial independence—a goal consistent with the spirit of individualism in a capitalist society. Partly a product of the era of Social Darwinism, which fostered a belief that those who could not manage in society without help were unlikely to survive, this ideal of helping people to become self-sufficient was carried out by the societies’ “friendly visitors” (Freedberg, 1984).

In accordance with the Judeo-Christian ideals of good citizenship, upper- and middle-class female volunteers acted as “friendly visitors” who, through face-to-face contact, attempted to uplift the mental and moral nature of the less fortunate and to motivate people applying for aid to find decent work and become good citizens. It was the visitor's role to determine the worthiness of the dependent's character and needs through the relationship. Boston COS leader Octavia Hill's (1875) motto “not alms but a friend” was reflected in the charity worker's new attitude of sympathy, rather than fear and pity, toward the poor and the adverse circumstances they had to overcome.

While visitors were instructed to form friendly relations with the applicants, the disparity in social and economic power perpetuated a system of inherent paternalism that rendered the notion of “honest and simple” friendship somewhat paradoxical. The realization that the relations between visitor and client might not actually be “friendly,” in the sense that they did not produce a basis for a satisfactory relationship, contributed to the decline of friendly visiting in the twentieth century and the move toward a more systematic method of helping the poor (Lubove, 1969). By the end of the 1800s, paid agents (usually men) had joined the ranks of the friendly visitors (usually women), and their strategies could be grouped into five areas representing the principles of what they called “scientific philanthropy”: (1) investigation, (2) registration, (3) friendly visiting, (4) cooperation, and (5) constructive work. The major method of the Societies became systematic investigation into the causes of dependence and pauperism in order to provide an individualized solution to the problems of the poor.

As the nineteenth century drew to a close, charity giving was becoming more systematic and rational, heralding a new era of professionalism. With the rise of capitalism, guided by the American belief in “pulling yourself up by your own bootstraps,” the notion of “rugged individualism” reflected the mood and culture of the country in this historical period. At this point in the profession's history, the caseworker's array of interventive tools was aimed at the individual, and the method of helping the poor based on one-to-one work with individuals served as the underpinning for the casework method.

The principle of individualizing poor and dependent clients was seen as progressive for the times, because it personalized the relationship and required that the worker accept and respect each individual client (Germain & Gitterman, 1996). This concern with individualization undercut the tendency toward moral judgment and the categorization of clients.

The recognition of the client–worker relationship as a key dynamic in social work practice was beginning to emerge through the work and writings of Mary Richmond. However, no scientific basis existed for understanding the effects of family relationships and complex interactions between and among individuals.

The professionalization of social work

Mary Richmond (1861–1928), a pioneer in the development of this new profession, helped shape American social work philosophy and practice during this period. By the turn of the twentieth century Richmond was established as a leader in the field, having been at the helm of two of the larger COSs in the country: the Baltimore Charity Organization Society (1891–1907) and the Philadelphia Charity Organization Society (1900–1905).

From the beginning of her career with the COS movement, Richmond recognized that the client–worker relationship itself was a fundamental factor in the helping process. According to Richmond (1899, p. 180), “Friendly visiting means intimate and continuous knowledge of and sympathy with a poor family's joys, sorrows, opinions, feelings, and entire outlook upon life.” Clearly, Richmond was aware that the intention of the friendly visitor to “do good work” would have a relational impact on the client–worker relationship. However, she did not have a psychological framework to guide her practice; nor was there theory to help the worker understand the psychosocial dynamics intrinsic to relational processes. But this notion of the client–worker relationship was soon to transform itself into a more “professional” one, in which the worker used him or herself as an instrument for change.

By 1908, Richmond had moved away from her COS colleagues, whose focus had been on the moral roots of dependency, to a new concept of social work based on what she thought was a “scientific” approach to casework. In 1909 she became the director of the Russell Sage Foundation's Charity Organization Department in New York, where she was able to devote herself to writing, research, and the pedagogy of social casework (Pumphrey & Pumphrey, 1961).

Convinced that social work needed specific skills, knowledge, and a systematic method of practice that could be transmitted through formal training, Richmond called for the establishment of a school of “applied philanthropy.” This was revolutionary because at this time women were not encouraged to undertake higher education in preparation for a paid career (Lubove, 1969). A one-year course was established at the New York School of Philanthropy in 1904 (later the New York School of Social Work, and since 1962, the Columbia University School of Social Work). Coinciding with the proliferation of schools of social work in pre-World War I America, the term “social worker” came into general usage (Ehrenreich, 1985).

Mary Richmond, like her contemporaries Mary Jarrett, a pioneering psychiatric social worker, and Ida Canon, an early medical social worker, recognized the importance of introducing a care-centered female relational field within a scientific framework of professional practice, both to legitimize themselves with respect to their client population, and to gain support from the male-dominated professions of medicine, psychology, and the natural sciences (Hiersteiner & Peterson, 1999). However, resistance to becoming involved in university education emanated, in part, from the Charity Movement's fear that greater emphasis on theory and method might dilute the visitor's charitable concern and helpfulness (Hiersteiner & Peterson, 1999).

Nevertheless, Richmond forged ahead in her efforts to professionalize social casework. Closely allied with the medical establishment in the Baltimore hospitals, she applied the linear model of the medical sciences to social casework, the dominant method of social work in her time. In her groundbreaking book Social Diagnosis (1917), she introduced her method of casework practice, arguing that good social work was based on disciplined study and observation, a thorough gathering of social evidence, an interpretation of the data, an accurate diagnosis of the problem, and an appropriate treatment plan. By demanding a thorough and systematic gathering of facts, she believed, the social worker could uncover the cause of the problem and develop an eventual “cure” for the person in trouble (Germain, 1970).

Implicit in this innovative approach to casework practice was her appreciation of relational ties in diagnosing personal difficulties. Richmond described “social diagnosis” as:

the attempt to make as exact a definition as possible of the situation and personality of a human being in some social need—of his situation and personality, that is, in relation to the other human beings upon whom he in any way depends or who depended upon him, and in relation to the social institutions of his community.

(Richmond, 1917, p. 357)

By the time she had written Social Diagnosis, Richmond (1917) had moved toward replacing the “friendly” relationship with the more formal expertise of a professional social worker trained in a systematic method of uncovering causes and treating the individual and family (Lubove, 1969). Her interpretation of social evidence gave her a better understanding of the social environment and her stress on “the action of mind upon mind” directed her attention toward the individual and his or her unique personal characteristics (Germain, 1970, p. 101).

What appeared to be missing from Richmond's social casework method was an analysis of complex interactions and relational dynamics and theories from which interventive methods could be derived. However, it must be kept in mind that at this point in time general acceptance of psychodynamic theories and relational concepts had not yet occurred.

By the 1920s the “friendly” relationship of the volunteer charity workers had been, by and large, replaced by the more formal expertise of the professional social worker trained in the systematic and thorough method of gathering extensive evidence, uncovering causes, and treating the individual and family based upon the social diagnosis.

In her book What is Social Casework (1922), Richmond continued to highlight the individualized approach to social work, focusing on the client's ability to adjust to the objective realities of life. She defined the casework method as consisting of “those processes which develop personality through adjustments consciously effected, individual by individual, between men and their social environments” (pp. 98–99). Social evidence provided a good deal of insight into the person and the problem; and although she considered the impact of the social context on the individual—family, friends, neighbors, and social institutions—her actual practice side-stepped social reform and was aimed squarely at individual change to increase the person's ability to adjust and function in the social environment.

This idea of the caseworker as a sympathetic “friend” and listener was developing into one in which the worker used him/herself as a disciplined instrument of change in Richmond's casework method. Professional spontaneity and warmth were compromised as the relationship resembled one in which clinical distance and logical thought dominated. Presumably, this more objective stance would allow the worker to maintain enough objectivity to gather evidence, categorize questions, and organize information elicited in order to make the best social diagnosis possible.

Interestingly, case material cited in What is Social Casework reflected the way in which the worker used him/herself was similar to contemporary practice skills and techniques, such as active listening, reflection, exploration. Richmond cites an example in which a client was talking about problems she was having with her mother. In order for the worker to be fair and objective, she/he needed to help the client see both sides of the situation. The worker said: “From what I have heard, I do not think you have told me everything. This led to a quite different account which was possible to substantiate later.” The worker's attention to the client's relationship with her mother presages the profession's future concern with relational issues.

Like the friendly visitor of the COS, the social worker remained in control of the relationship. The difference was that in Richmond's configuration, the client was viewed as a diagnostic entity dependent on the social worker who, armed with expert knowledge, used him or herself as a professional tool to effect change within the individual (Ehrenreich, 1985).

However, it is important to note that, compared to the preconceived moral judgments about the character of the poor held by early COS workers, Richmond's objective approach to problem solving, which individualized each client's particular situation, was progressive for her time. The establishment of a professional client– caseworker relationship required objectivity; there was no room for moral judgment (Lubove, 1969).

The Settlement House era: late nineteenth to early twentieth centuries

Simultaneously with the COS movement, the Settlement House movement began in large cities at the turn of the twentieth century when social work was in transition from an avocation to a paid profession; it was a time when thousands of immigrants were arriving in America daily, looking for opportunities and freedom in a newly prospering society. However, for the newcomers, housing, working conditions, and sanitary conditions were poor, and immigrants making substandard wages were forced to crowd into steamy tenements and city streets.

The settlement workers were mostly middle-class, educated young men and women, who sought to carry out their mission in close relation to the people they served. Unlike Richmond's early caseworkers, these dedicated settlers established relationships that involved doing with, rather than doing for, with the intention of promoting equality between themselves and community residents.

Concerned about the inequities they witnessed, they believed that living among the community residents in poor and working-class neighborhoods would bring about a level of relational intimacy that would be beneficial in raising their neighbors’ sense of cultural, political, social, and intellectual awareness. The personal relationships that the settlers attempted to develop with neighborhood residents was an attempt to reduce social distance in the interest of working together toward common goals of economic and social justice (Specht, 1994).

The settlers believed in what Jane Addams, prominent reformer and Settlement House pioneer, called the “reciprocal relationship of classes” (Addams, 1960). Concerned that these newcomers, who had virtually little or no political power, could be manipulated for the good of local politicians, they engaged in progressive political activities and were in the vanguard of many reform efforts, such as public health, education, and vocational training (Beck, 1977).

Addams and the other settlers saw the newcomers as alienated and disconnected from their new society. They perceived their work as a way to help the immigrants feel less anonymous and more connected to the other people and institutions in their neighborhood. By working side by side with community residents, and through close participation in the neighborhood life and community relations, settlement workers believed they could advance the best interests of the local residents. In their helping relationships, they modeled appropriate social roles, helped immigrants adapt to American ways, and worked to develop interpersonal relationships into a mutual aid system (Wenocur & Reisch, 1989).

Furthermore, Addams, who believed that women should be active in community and political affairs, also saw settlement work as an outlet for women to extend their natural sense of maternal responsibility—the skills and values of motherhood—to disenfranchised and economically disadvantaged communities. Ironically, gender roles traditionally associated with the domestic sphere replicated themselves in relationships outside the home, perpetuating gender-linked stereotypes associated with the social work profession (Ehrenreich, 1985).

The Settlement House commitment to instructional and practical services, group activities, and social reform was the forerunner of the group work met...

Table of contents

• Cover
• Halftitle Page
• Title Page
• Copyright Page
• Contents
• Preface
• Acknowledgements
• 1 The history of social work through a relational lens
• 2 Relational theory in a nutshell
• 3 The client–worker relationship
• 4 Relational theory and empathy: a relational–cultural perspective
• 5 Assessment: a relational–cultural point of view
• 6 Intervention: a relational–cultural point of view
• 7 Ethics and values: a feminist perspective
• Appendix A
• Appendix B
• References
• Index