Reshaping Theory in Contemporary Social Work

Toward a Critical Pluralism in Clinical Practice

William Borden

• Publisher: Columbia University Press
• Year: 2009
• ISBN:
  9780231519335
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

William Borden's persuasive collection of original essays reaffirms the place of theory in social work practice, showing how different theoretical models, therapeutic languages, and modes of intervention strengthen eclectic and integrative approaches to psychosocial intervention. A distinguished group of scholars and practitioners examine emerging developments in cognitive theory, psychodynamic thought, resilience research and family therapy, psychobiography and narrative perspectives, and conceptions of place and environment in psychosocial intervention. They introduce integrative frameworks for intervention and examine a series of crucial issues in the field, including the role of theory in evidence-based practice, the development of practice wisdom, and the ways in which conceptions of love, acceptance, and social justice influence theorizing and practice.

The contributors to this volume, each one carefully selected, reaffirm the framing perspectives and core values of the social work profession and identify fundamental challenges and tasks in developing theory and practice. Exploring contemporary yet no less essential concerns, they reflect the richness and creativity of theorizing in our time.

PART ONE

THEORY AND PRACTICE

Orienting Perspectives

1 TAKING MULTIPLICITY SERIOUSLY

Pluralism, Pragmatism, and Integrative Perspectives in Clinical Social Work

WILLIAM BORDEN

YOU MUST BRING OUT OF EACH WORD ITS PRACTICAL CASH-VALUE, SET IT AT WORK WITHIN THE STREAM OF YOUR EXPERIENCE…. THEORIES THUS BECOME INSTRUMENTS…. PRAGMATISM UNSTIFFENS OUR THEORIES, LIMBERS THEM UP.

–WILLIAM JAMES, PRAGMATISM

A RANGE OF intellectual traditions have shaped the collective wisdom of social work practice over the decades, and clinicians continue to make pragmatic and creative use of ideas and methods from a variety of theoretical perspectives. Although most clinicians endorse eclecticism as their fundamental orientation to practice, there is surprisingly little discussion of the ways in which workers integrate differing concepts, empirical data, and technical procedures over the course of intervention. In this chapter I introduce critical pluralism and pragmatism as orienting perspectives in comparative approaches to clinical theory and show how mastery of the foundational schools of thought strengthens eclectic, integrative approaches to psychosocial intervention.

In the first section I review the growing emphasis on integrative perspectives in contemporary practice and examine the role of theory in eclectic, individualized approaches to treatment. In the second part I introduce conceptions of pluralism and pragmatism, drawing on the work of William James, and show how they provide critical perspectives in comparative approaches to clinical theory. I examine a case from four theoretical perspectives and illustrate the ways in which a pluralist orientation strengthens formulations of psychosocial intervention. In the third section I review lines of inquiry that have shaped integrative models of intervention, broadly characterized as technical eclecticism, common factors approaches, and theoretical integration, and identify exemplars of each perspective. Further discussion of the case report presented in the preceding section illustrates core elements of the differing approaches to integration. Finally, I consider the relative merits of pluralist points of view and integrative models of psychosocial intervention and emphasize the importance of ongoing dialogue across divergent schools of thought in continued development of critical perspectives and theoretically informed practice.

INTEGRATIVE PERSPECTIVES IN CONTEMPORARY PRACTICE

Representatives of the foundational schools of thought in contemporary psychotherapy have increasingly come to appreciate the strengths and limits of differing perspectives, over the last decade, and there is growing dialogue across the therapeutic traditions in efforts to identify common elements and clarify differences. Practitioners have integrated core concepts and methods of intervention from divergent points of view in their attempts to engage a wider range of clients, broaden the scope of intervention, strengthen the empirical base of treatment, and improve therapeutic outcomes.

Thinkers have drawn on psychodynamic, cognitive, behavioral, humanistic, family, and ecological perspectives in building integrative models of practice. For example, Paul Wachtel has developed a psychodynamic approach that links core concepts in relational psychoanalysis with cognitive, behavioral, experiential, and systemic perspectives, extending earlier integrations of psychoanalytic constructs and behavioral theory (1977, 1997, 2008). Marsha Linehan has integrated behavioral and cognitive approaches with relational concepts and Eastern mindfulness practices in developing her model of dialectical behavior therapy (1993). Sharon Berlin has introduced an integrative cognitive perspective that encompasses core concepts in neuroscience, the foundational schools of thought in contemporary psychotherapy, ecological points of view, and framing perspectives in the social work tradition (2002). James Prochaska and Carlo DiClemente conceptualize differing stages and levels of change in their transtheoretical framework, integrating psychodynamic, behavioral, cognitive, humanistic, and family systems perspectives (2002).

I strongly support efforts to deepen our understanding of common elements that operate across the major schools of thought and to integrate core concepts and technical procedures in pragmatic approaches to psychosocial intervention. In doing so, however, I believe it is crucial to preserve the distinct identities of the foundational therapeutic traditions for two reasons.

First, if clinicians fail to develop an understanding of the major theories of the field, they do not have conceptual frames of reference to understand the constructs, empirical findings, and methods they are trying to integrate in practice. Technical procedures are deprived of context, in the absence of theoretical understanding, and clinicians run the risk of carrying out reductive, mechanized approaches to treatment by protocol (see Borden, 2008b). Second, as clinical scholars have emphasized, integrative approaches themselves cannot evolve unless thinkers preserve the integrity of the core theoretical systems in their own right (see Gurman & Messer, 2003; Liddle, 1982). There is a generative tension between the purity of approach that defines the foundational schools of thought and the pragmatism of integrative perspectives that sponsors dialogue and development in both domains of activity.

In light of these concerns, I believe it is critical to introduce the major theoretical perspectives as distinct systems of thought in social work education and clinical training. The foundational theories of contemporary psychotherapy set forth compelling accounts of the human situation, offering divergent conceptions of self, relational life, the social surround, and therapeutic action. As such, they provide orienting perspectives for differing renderings of persons and lives. Although each line of understanding inevitably fails to capture the variety and complexity of human experience, they are crucial because they set forth distinct visions of reality and world views (Messer & Winokur, 1984) and help practitioners appreciate the implications of certain ideas by pressing them to their limits (Strenger, 1997).

In introducing the theoretical systems, it is important to consider the historical circumstances and intellectual traditions that have shaped the development of understanding and practice. In exploring the history of ideas within the differing traditions, students and clinicians develop an appreciation of the social, cultural, political, and economic conditions that have influenced conceptions of personality, relationship, and social life; renderings of health, well-being, and the common good; and recognitions of vulnerability, need, and problems in living.

Practitioners come to realize the ways in which persons and lives, problems in living, practice settings, and the social surround have influenced particular ways of working—how, for example, the contributions of Jane Addams and the culture of the settlement house influenced the development of group methods and ecological approaches, or the ways in which the values of the social democratic movement of central Europe and the free psychoanalytic clinics of Vienna, Berlin, and Budapest enlarged conceptions of vulnerability and social justice in the broader psychodynamic tradition. Without an appreciation of the intellectual traditions, world views, and essential concerns that have shaped understanding and practice in the therapeutic traditions, as Alan Gurman and Stanley Messer (2003) remind us, clinicians are likely to find theories “rather disembodied abstractions that seem to evolve from nowhere, and for no known reason” (p. 5).

In the domain of psychosocial intervention, comparative analysis of the theoretical systems clarifies differing conceptions of the helping process; the structure of intervention; the range of application; the functions of the therapeutic relationship and the role of interactive experience; strategies and technical procedures; curative factors, facilitating conditions, and change processes; and methods of monitoring progress and evaluating outcomes.

A growing number of graduate social work programs have established generalist, atheoretical, skills-based courses of study. Such approaches are problematic in that they fail to introduce the foundational theories of the field and fail to provide opportunities to develop the critical analytic capacities needed to negotiate the concrete particularities, complexities, and ambiguities of clinical practice. As Jeffrey Applegate (2003) observes in his critique of social work education, the knowledge base of direct practice has increasingly neglected the dynamics of inner life, personal meaning, and facilitating processes believed to sponsor change and growth.

The orienting perspectives and ethos of the social work tradition urge practitioners to approach the person as an individual—not as an object but as a subject—“as a human being first and last,” in the phrase of Oliver Sacks, engaging “the experiencing, acting, living ‘I’” (1984, p. 164). While students learn how to implement technical procedures in skills-based courses of study, they do not develop knowledge of the conceptual foundations needed to carry out what Donald Winnicott would call “experiments in adapting to need” that serve as the basis for individual approaches to intervention (Borden, 2009).

In the domain of social work practice, the psychodynamic, behavioral, cognitive, humanistic, and ecological perspectives focus our attention on overlapping realms of experience from differing points of view and enlarge ways of seeing, understanding, and acting in the clinical situation. What counts as theory, as Carlo Strenger reminds us, is always “an attempt of other therapists to make sense of their attempts to do the best they could” (1997, p. 144), and the cumulative experience that they have tried to represent and characterize in their formulations enlarges our understandings of what carries the potential to help in the clinical situation. Practitioners realize, however, that theory itself cannot replace the power of critical thinking and judgment.

CRITICAL PLURALISM AND PRAGMATISM

In this section I show how conceptions of pluralism and pragmatism provide orienting perspectives in efforts to engage differing theoretical perspectives and integrate core concepts with empirical findings and technical procedures over the course of intervention. In doing so, I draw on the work of William James, who increasingly elaborated notions of pluralism and pragmatism in his later writings on psychology, religion, and morality (James, 1907/1946; 1909/1977; 1911). I examine a case from four theoretical perspectives in order to illustrate the ways in which pluralist points of view enlarge concepts of change and therapeutic action in the clinical situation. Finally, I review exemplars of pluralist points of view in contemporary clinical practice.

James argues that human understanding is inherently limited, and he urges thinkers and practitioners to approach concerns from multiple, independent perspectives. He assumes that no single theory can in itself fully grasp the variety and complexity of human experience. There are equally valid points of view that inevitably challenge or contradict one another, he argues, and divergent perspectives potentially lead to insight, understanding, and action. For James, theories are tools for thinking. He writes: “Theories … become instruments, not answers to enigmas, in which we can rest. We don’t lie back on them, we move forward…. Pragmatism unstiffens all our theories, limbers them up and sets each one at work” (1907/1946, p. 53). Each theoretical system has its own history, root metaphors, domains of concern, purposes, rules, methods, strengths, and limits.

Pluralist thinkers thereby challenge notions of grand theory, which presume to set forth universal truths, and assume that theoretical formulations provide only fragmentary renderings of experience. Practitioners do not try to find a synthesis between differing theories or fashions encompassing systems of understanding. To the grand theorist, James would say: “Ever not quite,” reasoning that the concrete particulars of ordinary everyday experience, of life as we live it, are messy.

James met Sigmund Freud in September 1909 at a special convocation to celebrate the twentieth anniversary of Clark University. By his accounts he was uncomfortable with Freud, uneasy with his efforts to develop a grand theory of personality, psychopathology, and therapeutic treatment, calling him “a man obsessed by fixed ideas” (see Simon, 1998, p. 363).

The world we live in, James reminds us, is unfenced and untidy, presenting us with multiplicities and complexities, confusions and contradictions, ironies and ambiguities. Accordingly, the pluralist does not base decisions on abstractions, preferring to engage the concrete particularity of the individual case, seeking to understand the complexities, ambiguities, and uncertainties that grand theoretical schemes inevitably fail to represent (see Viney, King & King, 1992, p. 94). The pluralist turns away from “abstraction,” “absolutes,” “fixed principles,” and “closed systems,” searching for fact, concreteness, action, and adequacy (James, 1907/1946, pp. 43–81).

From a Jamesian perspective, then, pluralism encourages free exploration of alternative ways of seeing and understanding without the constraints of pure theoretical systems. Areas of agreement may emerge from independent lines of inquiry, which provide a basis for belief, for our best guess as to the truth of the matter, but the pluralist is willing to let many things stand alone, ever attuned to the dangers of presuming to know too much. There is an appreciation of gaps in understanding.

As biographers have emphasized, James’s approach to knowledge and understanding was fundamentally developmental, emphasizing process, growth, ever shifting frames of reference. He saw the world itself much as he thought of the field of vision: “There is always a fringe, there is an ever shifting horizon, and no static vantage point from which we can make the big claim” (Viney, King & King, 1992, p. 94). In working from comparative perspectives, scholars, researchers, teachers, and practitioners can better realize the possibilities and limits of varying points of view and enlarge notions of truth.

For James, what matters is what works, and his conceptions of pluralism are closely linked to notions of pragmatism set forth by C. S. Pierce and John Dewey. Briefly, pragmatism emphasizes the practical implications of our beliefs and the ways in which they contribute to effectiveness in the conduct of life. Louis Menand captures the essence of the pragmatic outlook in his seminal study of James, Oliver Wendell Holmes, and Charles Pierce, The Metaphysical Club: “An idea has no greater metaphysical stature than, say, a fork. When your fork proves inadequate to the task of eating soup, it makes little sense to argue about whether there is something inherent in the nature of forks or something inherent in the nature of soup that accounts for the failure. You just reach for a spoon” (2001, p. 361).

In his pragmatic conception of truth, James proposes: “The true is the name of whatever proves itself to be good in the way of belief and good, too, for definite, assignable reasons” (James, 1907/1946, p. 76). If we take an idea to be true, he wants to know, “what concrete difference will its being true make in any one’s actual life?… What, in short, is the truth’s cash value in experiential terms?” (James, 1907/1946, p. 200). The crucial question is not “Is it true?” but rather “How...

Table of contents

• Cover 
• Half title
• Title
• Copyright
• Dedication
• Contents 
• Acknowledgments
• Introduction
• Part One: Theory and Practice: Orienting Perspectives
• Part Two: Inner Experience and Outer Realities
• Part Three: Theory, Practice, and the Social Work Tradition: Critical Questions, Issues, and Prospects
• List of Contributors
• Index