( Clinical Social Work's ContributiorT)
          to a Social Justice Perspective ^
                                      ...
leadership in assessing theories, practices, and           can be directed, a goal both broader and more
service delivery ...
contract theorist quot;in the tradition of Locke,                      be clear that Rawls's language, and mine follow-
Ro...
practice. Without a strengths perspective, social
perspective. But first, is it legitimate to evaluate
                   ...
the realities of being quot;locked inquot; and                         issues. Walz and Groze (1991) wanted to
 marginaliz...
Narrative Approaches
requires that practitioners pay careful attention
to their own experiences of oppression and of      ...
the idea of quot;inviting responsibilityquot; as a general              Mutual Aid Groups
stance that the therapist can ta...
of exploring our own experiences ot oppres-
social and political change through developing
                               ...
References
 to people with the greatest needs. Unjust social
 conditions, such as poverty and violence, which            A...
Moore, L., & Wallace, G. (1993). Emancipatory social
   162). Amherst: University of Massachusetts
                       ...
about a taped conversation. Paper presented at              White, M. (1995). Re-authoring lives: Interviews and
    Templ...
Clinical Social Works Contribution To A Social Justice Perspective
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Clinical Social Works Contribution To A Social Justice Perspective

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Clinical Social Works Contribution To A Social Justice Perspective

  1. 1. ( Clinical Social Work's ContributiorT) to a Social Justice Perspective ^ Carol R. Swenson Social justice is increasingly described as the organizing value of social work. But does that apply to clinical social work? Following Wakefield, this article argues that it does and offers a variety of theories and practices to elaborate this claim, including ways to understand clients in the contexts of their strengths, social positions, and power relationships. In addition, clinicians can develop techniques to enable clients to understand themselves in these relationships and to be liberated when these relationships are oppressive. The clinician engages in self-reflection about personal experiences, not only of oppression but also of privilege and domination. Clinicians may work with people who are privileged and powerful to help them assess their motivation to change behavior associated with such roles. And finally, clinicians can develop new structures in agencies to counter oppressive beliefs and practices and work to develop programs that will offer social, economic, spiritual, political, and psychological resources. Social workers can offer a social Justice perspective to members of other therapeutic professions who are interested in clinical social Justice practice. Key words: clients; clinicians; social Justice S ocial justice is increasingly being seen as the programs, and community education. They also organizing value of social work. For clinical join with other social workers and their clients social workers, this conceptualization clari- in social action (Swenson, 1995). Clinical social fies and focuses a unique contribution that work should not be equated with practice based clinical social work can make to the mental on a medical model, a focus on pathology, quot;blam- health professions. In this article quot;clinical social ing the victim,quot; or social conservatism. Clinical workquot; is used in this sense to include case man- social workers can consider what a social justice agement, advocacy, teamwork, mediation, and perspective means and how it can be enacted in prevention roles, as well as therapeutic and clinical contexts. They can think about work counseling roles. Clinical social workers engage with individuals, families, and groups from a in supervision, organizational change, directing social justice perspective. They can provide National Assodjiion of Social Wiirkers. 527
  2. 2. leadership in assessing theories, practices, and can be directed, a goal both broader and more service delivery arrangements from the point of specific than quot;producing growth-inducing and environment-meliorating transactionsquot; (Gor- view of increasing social justice. don, 1969, p. 10). Defining Social Justice Dorothy van Soest (1995), in the Encyclope- First, the profession must consider what quot;.social dia of Social Work, said that there are three justicequot; is and why it is being considered the components of social justice: legal justice, organizing value for social work. Furthermore, which is concerned with what a person owes to what is an organizing vaiue? The term comes society; commutative justice, which is con- from Wakefield (1988a, 1988b), who has writ- cerned with what people owe each other; and ten one of the most definitive statements about distributive justice, which is quot;what society owes social justice in social work, particularly in re- a personquot; (p. 1811). She said that distributive gard to clinical social work. He described the justice involves decisions about allocating re- quot;defining functionquot; or primary purpose of a sources and that it is the most important, in the profession as its quot;organizing value,quot; in the sense sense that it underlies the other two. Others di- in which the organizing value of medicine is vide social justice into different components, curing disease; of education, learning; and of but distributive justice—social workers' con- law, legal justice. cern—is always one component. (See, for ex- ample, Tyler, Boeckmann, Smith, & Huo, 1997.) Traditionally, when social work has tried to define its function, it has emphasized the quot;per- Social justice figures prominently in the re- son-in-situationquot; construct. That construct be- vised NASW Code of Ethics (NASW, 1996) and came more conceptually rigorous as systems in the current quot;Curriculum Policy Statementquot; and ecological theories and theories of attach- of the Council on Social Work Education ment, coping, adaptation, and resilience, as well (1992). In the curriculum policy statement, as quot;two-person psychologiesquot; in psychody- promotion of economic and social justice are namic thinking developed. So, for instance, we mandated content areas, as are diversity, popu- had Gordon's (1969) definition of social work lations at risk, and ethics and values. All of purpose as matching people's coping capacities these can be seen as different perspectives on and the qualities of impinging environments. the concept ot social justice. Populations at risk are people from whom social resources have The person-in-situation conceptualization been unjustly withheld; diversity entails respect- has always had some difficulties. Social work is ing the cultures of everyone, not just the privi- not tbe only profession adopting systems think- leged few; and social work ethics and values em- ing or any of the other theories mentioned, and phasize the dignity and worth of each person, many professions could be said to improve the respect for difference, promoting social change, goodness of fit between people and environ- and multicultural competence. All these are ele- ments. In fact, in one way or another, all profes- ments of a just society. The newly revised Code sions do. Education gives people skills and of Ethics includes substantially more attention knowledge to navigate their world more com- than the previous one to social justice as a re- petently and effectively, and law helps people sponsibility of all social workers, including at- make claims against some unjust environments. tention to diversity, oppression, and popula- Medicine cures people of diseases they have tions at risk. All social workers are expected to caught from noxious environments, makes en- influence social policy, engage in social action, vironments more healthy, and helps people and advocate for disadvantaged groups. overcome health challenges that compromise their functioning in various environments. So- The philosopher John Rawls (1971) made a cial justice would seem to be a more convincing major contribution to theories of social justice organizing value for social work than the per- when he rebutted libertarian and utilitarian son-in-situation construct. But then what does views on the grounds of equality. He said that quot;social justicequot; mean? Social justice defines a hardships of some people cannot be justified goal to which the person-in-situation construct by a greater common good. Rawls is a social Social Work / Volume 43, Number 6 / November 1998 528
  3. 3. contract theorist quot;in the tradition of Locke, be clear that Rawls's language, and mine follow- Rousseau, and Hobbes,quot; which Rawls integrates ing Rawls, does not imply any shortcoming with quot;the Kantian moral tradition, where . . . whatsoever on the parts of the people or groups every person is taken to be morally equal and who are quot;deprived.quot; (1 want to thank Claudia deserving of respectquot; (Wakefield, 1988a, pp. Cassel, MSW, whose careful attention to lan- 196-197). Rawls's views provide a rigorous guage identified this and other instances when philosophical argument for long-standing social words quot;make a difference.quot;) These deprivations work values. can be of many different kinds but may be clus- tered in the broad categories of political, social, Rawls (1971) developed two principles: (1) psychological, physical, and spiritual. Then the Basic liberties must be equal, because citizens in question becomes, What types of clinical theo- ajust society must have equal rights; (2) there ries, interventions, and service-delivery ar- should be equality of opportunity and of social rangements are most congruent with the value resources for each person. Inequalities in re- of social justice? And how do we allocate scarce sources should not be allowed, unless they ben- resources? Would all people with all kinds of efit those who are worst off (Dworkin, cited in deprivations be equally deserving of interven- vanSoest, 1995, p. 1811). tion? I address the second issue first. Social resources are most often thought to be economic in nature, but Rawls's analysis can be Who Deserves Intervention for Social Justice? applied to noneconomic goods as well. Wakefield (1988a) said. Rawls (1971) offered a direction for thinking in his concepts of quot;relative deprivationquot; and In particular, Rawls's analysis implies that quot;minimally acceptable levelquot; of resources. Thus, some psychological traits, such as self-respect, the more deprived a person is in the various that are closely linked to the structure of social dimensions of economic, political, social, spiri- institutions and to how people react to each tual, and psychological resources, the more other are a kind of social benefit for which compelling is his or her claim. A person who is justice requires an attempt at fair distribution. poor and a victim of childhood sexual abuse has If this is so, then psychotherapy-style inter- a greater claim than a sexual abuse survivor ventions aimed at imparting such psychologi- who is not poor; a depressed, divorced woman cal goods would play an integral role in a jus- caring for children and elderly parents has a tice-oriented profession. greater claim than a depressed male president of I believe that a Rawlsian approach to dis- a major company. More subtly, if relieving tributive justice has the power to make sense someone's deprivation, even if it is relatively of the social work profession and its disparate less compelling, might enable her or him to re- activities in ways not yet generally appreciated. duce the deprivation of others, a justice-based Social work can be conceived as a profession argument could be made for providing clinical engaged in alleviating deprivation in all its intervention. For example, if relieving the pre- varieties, from economic to psychological; viously mentioned company president's depres- social workers identify people who fall below sion enabled him to develop a more compas- the social minimum in any justice-related sionate stance toward his employees, perhaps good and intervene in order to help them rise reducing their relative deprivation in important above that minimally acceptable level, (p. 194) ways, clinical intervention would be consistent with a social justice perspective. Social Justice Criteria What Theories, Interventions, and So, if we are persuaded by Rawls (1971) and Arrangements are Congruent with Wakefield (1988a) that alleviating various quot;dep- Social Justice? rivations,quot; not just economic deprivations, can be a form of social justice work, social workers The other issue is the adequacy of various theo- need to identify other types. Rawls's terms are ries, interventions, and service delivery arrange- somewhat unfortunate. It is very important to ments when considered from a social justice Swenson / Clirtical Social Work's Corttributm to a Social Justice Perspective 529
  4. 4. practice. Without a strengths perspective, social perspective. But first, is it legitimate to evaluate workers are left with theories that pathologize, theory and practice from the point of view of a emphasize deficits, and quot;blame the victim.quot; value, which social justice clearly is? The mod- These theories suggest a relative deprivation of ern scientific tradition has held that theories respect and often are internalized as not being and practices should be evaluated on the basis worthy of respect. They also cut people off from of empirically measured outcomes. The view is potential internal and external resources, thus widespread that theories are quot;value freequot; and increasing their relative deprivation. that choosing among them is not a question of match with values but of tbeir quot;explanatory Weick and Saleebey (1995) used the follow- powerquot; or quot;rigorquot; (Prilleltensky & Gonick, ing language (a strength and resource in itself): 1994). One unfortunate result has been that so- quot;the imagery, power, and richness of human cial workers, perhaps especially clinical social experiencequot; (p. 3), quot;array of capacities, ingenu- workers, have been burdened with theories that ities, and resources,quot; quot;mobilization and articu- are not particularly congruent with social work lation of inherent talents, abilities, aspirations, values. resources, wiles & grit,quot; quot;capacities, competen- cies, possibilities, visions, values, hopes,quot; quot;what Fortunately, some important contemporary people know and can doquot; (p. 4). Contrast this views recognize that all theories embody values. with the language of the DSM-IV (American These include postmodernism, critical theory, Psychiatric Association, 1994), for example. social constructionism, and hermeneutics, or Weick and Saleebey also found possibilities in interpretive social science (Berger & Luckman, people's life-worlds: quot;stories and narratives; val- 1967; Derrida, 1974; Foucault, 1980, 1981a, ues and beliefs; informal, natural resources; vi- 1981b; Gergen, 1985; Habermas, 1971, 1983/ sions and hopes; abilities and gifts; cultural lore 1990; Lyotard, 1984). Social constructionism and lessonsquot; (p. 5). They identified ways com- has alerted the profession to the ways that munities can amplify resilience: Acknowledge knowledge is socially created, as people filter and use assets of members, have an ethos of in- quot;dataquot; through the lenses of their experiences, volvement and participation, and offer indi- values, and prior knowledge. Hermeneutics di- viduals many ways to contribute to the moral rects attention to the complexity of meanings and civic life of the community. Weick and inherent in supposed quot;facts.quot; And postmod- Saleebey also offered this poetic but straightfor- ernism and critical theory have emphasized that ward and intensely practical description of a ideas that become privileged as quot;knowledgequot; are helping role: quot;uncovering, naming, embellish- those that support powerful interests (and ing, and celebrating abilities, talents, and aspi- which powerful interests support). All of these rations in the service of desired changequot; (p. 8). perspectives challenge the belief in tbe objectiv- And fmally, they emphasized the quot;transforming ity and neutrality of data. They offer support interaction between community development, for using values as a standard for evaluating the group empowerment, and individual resiliencequot; adequacy of theories and practices. (p. 6). If we use advancing social justice as a core value for clinical practice, we can determine Ethnic-Sensitive Practice which clinical theories and practices are most Ethnic-sensitive practice (Devore & Schlesinger, congruent with that value. There are many 1996; McGoldrick, Giordano, & Pearce, 1996) clinical theories and practices that we can claim emphasized the significance of race and or reclaim. ethnicity as a mediator of people's day-to-day objective experience and of their subjective Relevant Theory and Practices sense of self Such practice restores to people an Strengths Perspective appreciation for their particular cultural experi- ence and identity. Lee (1994) added class as an The strengths perspective (Saleebey, 1992,1994; equally significant mediator. Lee said that class- Weick, Rapp, Sullivan, & Kisthardt, 1989) is a sensitive practice must understand and address key element of social justice-oriented clinical Social Work / Volume 43, Number 6 / November 1998 S30
  5. 5. the realities of being quot;locked inquot; and issues. Walz and Groze (1991) wanted to marginalized by oppression. counter a quot;conservative retreatquot; in social work. More universalistic approaches deprive They noted that professional social workers people of the meaning of these social dimen- have left or been forced out of public welfare sions of their existence by acknowledging nei- positions, that social work services are increas- ther their negative effects (racism, classism, and ingly directed to middle-class clients, and that so forth) nor their strengths as a positive re- social work students are less altruistic and less source. Universalistic approaches also unwit- activist than in the past. They said, quot;Social work tingly impose cultural norms and values of the belongs . . . serving the needs of the most op- dominant culture while claiming to be culture- pressed and needy [sic] people in society. . .. free. A non-English-speaking recent immigrant The clinician is data gatherer and analyst, in from a culture where time is measured by the addition to therapist. The client becomes the rising and setting of the sun, a single parent centerpiece of change, revealing to the therapist with three children under school age, who must the types of system-wide changes or reforms take two buses to go to the clinic is held to the that are necessaryquot; (p. 501). Walz and Groze same expectations of timeliness as a college stu- concluded, quot;The current clinical social worker dent unencumbered with job or caretaking re- must be convinced that 'client interest' advo- sponsibilities and able to afford a car. cacy research is a legitimate clinical activity, (as is] institution building, broad public education, Feminist Practice and political actionquot; (pp. 501-502). Feminist practice attends to difference, as eth- Justice-Oriented Practice nic- and ethnic/class-sensitive practices do. However, it also includes an analysis of power Justice-oriented practice can be seen as one and offers a critique of power relations charac- implementation of the clinician-activist model. terized by domination and subordination. Hopps, Pinderhughes, and Shankar (1995) of- Feminist practice suggests an alternative way of fered data on effective interventions with over- understanding and using power based on col- whelmed clients, who are offen poor women of laboration and cooperation rather than on color with muhiple problems. These are the competition (Bricker-Ienkins, Hooeyman, & people who suffer the most deprivation, receiv- Gottlieb, 1991; Van Den Bergh & Cooper, ing less than Rawls's (1971) quot;minimally accept- 1986). Feminist thought has been particularly able levelquot; of many resources. Hopps et al. helpful in its insistence that quot;the personal is po- (1995) called for comprehensive services incor- liticalquot;—that is, the linking of personal rela- porating clinical work with health, employ- tionships with social structures. ment, anticrime, and housing initiatives; pro- viding group and community change activities, Although feminist practice particularly em- as well as individual and family work; and offer- phasizes gendered patterns of power, most ing extensive availability, affirmation, and high feminists are committed to identifying and ad- expectations to clients. dressing practices that disempower or oppress anyone, whether on the basis of race, religion, Although both approaches move beyond di- sexual orientation, or any other category. Femi- rect work to consider whole programs, they also nist practice is also effective as a tool for con- share a continued emphasis on the professional sciousness raising about other oppressions. as an expert. The next several approaches at- Feminist ideas are particularly important be- tempt to alter the power arrangements between cause so many clinicians resonate to them, and client and clinician, between client and others, this awareness can be used to raise conscious- or between client and society. ness about other oppressions. Self-Awareness Until now, we have particularly focused on ideas that can inform direct work with clients. Self-awareness, or reflexivity, is one of the most The clinician-activist model seeks to move be- central concerns in clinical social work, as it is yond direct work and to address larger societal in critical theory. A social justice perspective Swenson / Clinical Social Work's Contribution to a Social justice Perspective 531
  6. 6. Narrative Approaches requires that practitioners pay careful attention to their own experiences of oppression and of Interventions from the quot;narrativequot; approach privilege or domination. Most clinicians have (Freedman & Combs, 1996; White, 1995; White learned to engage in scrutiny about interper- & Epston, 1990) are particularly effective in em- sonal patterns and internal processes. Many bodying ideas of social justice. Michael White, have considered the implications of experiences who practices social work in Australia, draws of being oppressed. Less common is the expec- his theoretical analysis from Foucault, especially tation that clinicians will learn about their own Foucault's ideas about the inextricability of privilege and the power inherent in the clinician power and knowledge. White (1995) described role. several ways to make power and knowledge more available to clients, ways that will move in Millstein (1994, 1997) developed methods the direction of a more just society. One of that clinicians can use for systematic reflection these ideas is quot;externalization,quot; or separating on their practice—in particular their experi- problems from the person so that the person ences of racism and oppression. These are can exercise increasing influence over the prob- structured processes, which, if repeated at regu- lem. As the person becomes more influential, lar intervals, can serve as a document of chang- she or he becomes liberated from the oppres- ing experiences and attitudes about racism over sion and power of the problem. The quot;problemquot; a professional life span. Garcia and Swenson may be the kinds of social processes we have (1992) offered another means, this time for been discussing, such as racism or sexism. They partners to create a dialogue in writing. The may also be more idiosyncratic problems such writing gives both a record of the dialogue and as encopresis in children or the experience of a special quot;spacequot; that verbal dialogue does not infertility for adults. White and others have de- afford—the opportunity to reflect in private veloped a process of questioning that enables and for a period of time before responding or the client to gain more power over the problem. initiating ideas. This makes it particularly suit- The questions try to fmd in the client's lan- able for conversations on difficult and sensitive guage, or to create, an emotionally resonant topics. Although both techniques address rac- name for the problem (like quot;Sneaky Poo,quot; for ism, they could easily be adapted to other expe- encopresis). riences of privilege or oppression. Other means of deepening self-awareness include peer The narrative therapists have also devised therapy, or cotherapy, as it is sometimes particularly creative ways to reduce the clini- known, and, of course, personal therapy. It is cians' power in relation to clients. Their stance particularly helpful if that therapy is undertaken is one of respectful curiosity. They convey a be- with therapists who are able to do the social jus- lief that the client wants to change, can change, tice work of identifying social experiences of and has valuable hut subjugated knowledge and oppression and privilege. skills to draw on. They have developed methods It is often diftlcult for clinicians to see them- of recordkeeping that record the session and selves as powerful, privileged, or oppressive. serve as letters to the clients. With practice, And yet clinicians do their clients and the goal these take no longer than ordinary recordkeep- of social justice a disservice when they cannot ing, but they do away with the pathologizing bear to see this. Clients are more burdened than language and implicit expert power of most clinicians are, and they see our privilege and records. Thus, they serve as excellent tools to power. It is a sad commentary that the very ser- enact a strengths perspective. vices that may enhance social justice may in- Oppressors as Clients stead serve to increase the psychological experi- ence of injustice. It is particularly important to Work with quot;oppressorsquot; as clients is particu- have done this personal and professional work larly challenging work for the social justice- about one's own privilege and power when un- oriented clinician. Again the narrative thera- dertaking work with oppressors as a form of pists have come up with helpful perspectives. clinical social justice work. White (1995) and Jenkins (1990/1993) offered Social Wor/t / Volume 43. Number 6 / November 1998 532
  7. 7. the idea of quot;inviting responsibilityquot; as a general Mutual Aid Groups stance that the therapist can take toward people Mutual aid groups build and build on the whose behavior is oppressing others. After care- strengths of individuals to give help to each ful questioning designed to elicit the client's other {Gitterman & Shulman, 1994; Schwartz, wish to be responsible, the therapist works to 1971, 1985/1986; Shulman, 1992). They offer identify quot;restraintsquot; to acting on that wish (a instrumental, informational, and expressive parallel to externalizing the problem). It is espe- support. Mutual aid groups are particularly use- cially important that the clinician has done her ful for naming the problem, or consciousness or his own work on ways she or he is privileged raising, and collective problem solving. Almost and even an oppressor, so as to be able to work any shared situation can be a focu.s of mutual with these clients. aid groups: AIDS education for teenagers, par- ents of chronically ill children, severely mentally quot;Justquot; Therapy ill adults, people in recovery from substance quot;Justquot; therapy has been developing in New abuse, men who abuse their wives, partners of Zealand and has been introduced to American people with Alzheimer's disease. On occasion, audiences by narrative and collaborative thera- groups may be helped to organize themselves to pists {Tamasese & Waldegrave, 1994; Walde- take collective action. When they do so, they are grave & Tapping, 1990). Tamasese and on their way to being empowerment groups. Waldegrave (1994) .said, quot;Therapy can be a ve- hicle for addressing some of the injustices that Empowerment Practice occur in a society. It could be argued that in Empowerment practice (Gutierrez, 1990; Lee, choosing not to address these issues in therapy, 1994; Simon, 1994; Solomon, 1976) emphasized therapists may be inadvertently replicating, reducing direct and indirect power blocks, or maintaining, and even furthering, existing in- those caused by external and internalized op- justicesquot; (p. 5). pression. In the tradition of the critical theo- The quot;just therapistsquot; have identified three rists, reflecting on and understanding one's underlying assumptions: spirituality, justice, own situation in relation to sociai processes is and simplicity. Waldegrave and Tapping ex- considered essential for effective change at ei- plained, quot;Since spirituality informs every aspect ther the personal or the collective level. of life in Maori and Pacific Island cultures, we There is some controversy over the use of the have learned to respect the sacredness of all life. term quot;empowerment.quot; Some authors include . . . We view the process of therapy as sacred. personal empowerment, that is, an enhanced People come, often in a very vulnerable state, self-respect and increased efticacy in negotiat- and share some of their deepest and most pain- ing one's immediate environments, .social and ful experiences. For us, these stories are gifts physical. Others wish the term to be limited to that are worthy of honour. The therapists practice that enables people to take collective honour them by listening respectfully for their action on behalf of others, a.s well as themselves. meaning, and offering new meanings which en- Still others maintain that these distinctions are able resolution, hope, and self-determination.quot; arbitrary and open to question. Lee (1994) de- Justice involves quot;naming the structures and ac- scribed a continuum of empowerment from the tions that oppress and destroy equality,quot; personal to the interpersonal to the social and a whether it be at the micro level of the family or continuum of actors from the single person to the macro level of the society. And therapy re- the group to broad coalitions. flects simplicity, because people and societies Empowering practices, which also may be have been resolving their difficulties without the called liberatory or emancipatory practices, are necessity for therapists from time immemorial. emerging in many different fields. A common quot;The therapy we offer finds its expression in the link is critical theory. Critical theory, which can movement in meaning from problem-centered be related to postmodernism (Doherty, Gra- patterns, to new possibilities of resolution and ham, & Malek. 1992; Rosenau, 1992), tries to hopequot; (Waldegrave & Tapping, 1990, p. 7). connect the emancipation of individuals with Swenson / Clinical Social Work's Contribution to a Social justice Perspective 533
  8. 8. of exploring our own experiences ot oppres- social and political change through developing sion, and of privilege and power as well. We as- critical consciousness. Critical theorists empha- sess clients' quot;relative deprivationquot; and quot;mini- size reflexivity, the human capacity to reflect on mally acceptable levels of resourcesquot; in the our own history, as essential for truly liberating economic, political, physical, social, spiritual, social change (Dean & Fenby, 1989). and psychological domains. We acknowledge These ideas have led to interest in emanci- political, moral, and ethical issues as political, patory or liberatory practices in areas as diverse moral, and ethical and let clients know where as religion (liberation theology [Boff, 1996]), we stand, when appropriate (Dougherty, 1995). rhetoric (emancipatory dialogic rhetoric it means we encourage clients to experience the [Simons, 1991]), psychology (liberation psy- reciprocal help of mutual aid groups and to or- chology [Martin-Baro, 1994]), literature (narra- ganize for collective social action. tives of liberation [Taylor, 1989]), education (conscientization, pedagogy of the oppressed, Clinical social justice work also includes transformative education [Freire, 1970/1973; planning services and advocating for services Hooks, 1994]), and psychiatry (revolutionary that decrease clients' relative deprivation in po- psychiatry [Fanon, 1968]). In social work there litical, economic, social, spiritual, and psycho- are such contemporary and historical writers as logical spheres. It means examining all the ways Breton (1989), Moore and Wallace (1993), and that professionals interact with clients from a Reynolds (1934/1982, 1951/1973). There is a position of expert power and attempting to do social justice-oriented journal, the Journal of things differently. It means examining agency Progressive Human Services, which publishes structures and attempting to create structures some clinically relevant material. that are socially just. Following the lead of the just therapists (Tamasese & Waldegrave, 1994), This account of theories and practices is nec- we seek to raise issues of socioeconomic status, essarily incomplete. The work that lies ahead race, and gender in the agency and devise strat- includes continuing to explicate the values un- egies of accountability from the more to the less derlying theories and practices. Then the pro- powerful groups. Social action for social justice fession must evaluate them for their contribu- is a central component. tion to quot;the affirmation of self-determination for diverse and oppressed groups, to the just Sadly, in the contemporary world, social jus- allocation of resources, and to the expression of tice-oriented clinical practice is under assault. marginalized voicesquot; (Prilleltensky & Gonick, Managed care and other cost-cutting measures 1994, p. 168). Social workers also must ensure appear to be increasing social injustice, rather that their methods of developing knowledge are than increasing social justice. It is important to compatible with their value and theoretical preserve, articulate, and attempt to implement a commitments (Witkin, 1993). vision of clinical social justice-oriented prac- tice. I suggest some ways to do so. Synthesis and Conclusion: Clinical Social We can capitalize on the ways that social jus- Justice Practice tice-oriented practice is congruent with the ide- ology of managed care. Some elements are an What does social justice mean when we sit with emphasis on strengths; planning comprehen- a client? It means profound appreciation for a sive, continuous, and integrated community client's strengths, contexts, and resources. Ex- services; and supporting people to remain in periences of race, ethnicity, gender, class, reli- the community. At present, the implementa- gion, sexual orientation, and ability, because tion of managed care often seems to run these shape clients' worlds and meaning-mak- counter to its own ideology. Services are brief, ing, are seen as central. It means we engage in quot;remedicalized,quot; and focused on reducing pa- thorough analyses of professional and organiza- thology and achieving concretely measurable tional power and actively work to increase cli- outcomes. The best services are going to people ent power relative to professionals and agencies. who can afford to buy them privately or can be It means we acknowledge and articulate the persuasive advocates for themselves, rather than client's social realities. We engage in the work Social Work / Volume 43, Number 6 / November 1998 534
  9. 9. References to people with the greatest needs. Unjust social conditions, such as poverty and violence, which Albee, G. (1986). Toward a just society: Lessons are known to increase mental distress and from observations on the primary prevention of physical illness (Albee, 1986), are not only not psychopathology. American Psychologist, 41, 891- being addressed, but are being permitted to 898. intensify. American Psychiatric Association. (1994). Diagnostic However, the creative and committed social and statistical manual of mental disorders (4th justice-oriented clinician can fmd ways to ed.). Washington, DC: Author. maintain her or his vision and practices. One Berger, P., & Luckman, T. (1967). The social con- approach is to become quot;bilingualquot;: to be able to struction of reality. Garden City, NY: Doubleday. think and speak the managed care language as Boff, L. (1996). The future of liberation theology. Un- well as social justice language. One can then use published lecture. Harvard Divinity School, Cam- the languages selectively: the social justice lan- bridge, MA. guage with chents and quot;kindred spiritsquot; and the Breton, M. (1989). Liberation theology, group work, managed care language with administrators. and the right of the poor and oppressed to par- Another strategy is to argue for social justice ticipate in the life of the community. Social Work thinking or interventions using the managed with Groups, /2(3),5-18. care ideology, when these are congruent. For Bricker-Ienkins, M., Hooeyman, N., & Gottlieb, N. example, the quot;medica! offset effectquot; research is (1991). Feminist social work practice in clinical encouraging some HMOs to offer more psycho- settings. Newbury Park, CA: Sage Publications. educational, prevention, and mental health ser- Council on Social Work Education. (1992). Curricu- vices to reduce medical costs (personal commu- lum policy statement for master's degree programs nication with Rita van Tassel, then chair, in social work education. Alexandria, VA: Author. Massachusetts NASW Managed Care Commit- Dean, R., & Fenby, B. (1989). Exploring epistemolo- tee, October 21, 1997). Social justice-oriented gies: Social work action as a reflection of philo- chnicians can support enhanced services as in- sophical assumptions. Journal of Social Work trinsically worthwhile and cost-effective as Education, 25, 46-54. well. Derrida,}. (1974). White mythology: Metaphor in We can also educate other professionals the text of philosophy. New Literary History, 6 about a social justice perspective. They may (l),5-74. have entered their work out of a wish to quot;make Devore, W., & Schlesinger, E. (1996). Ethnic sensitive the world a better placequot; but found litUe sup- social work practice (4th ed.). Boston: Allyn & Ba- port from their profession for understanding con. their work in this way. And we must continue Doherty,}., Graham, E., & Malek, M. (Eds.). (1992). social action focused on changing social values Post-modernism and the social sciences. New York: and institutions so that social justice—in the St. Martin's Press. economic, political, social, physical, psychologi- Dougherty, W. (1995). Soul searching. New York: cal, and spiritual domains^—^becomes available Basic Books. to all. Fanon, F. (1968). The wretched of the earth. New I share with Wakefield the hope that social York: Grove Press. justice—that is, alleviating deprivation in its Foucault, M. (1980). Power/knowledge: Selected inter- many forms—will gain credence as the organiz- views and other writings. New York: Pantheon ing value of social work. I believe it offers a Books. means for clinical and nonclinical social work- Foucault, M. (1981a). Technologies of the self. In L. ers to understand themselves more fully as part- Martin, H. Gutman, & P. Hutton (Eds.), Tech- ners in the same profession. And as clinical so- nologies of the self {pp. 16--19). Amherst: Univer- cial workers clarify the meaning of clinical sity of Massachusetts Press. social justice work, they have a contribution for Foucault, M. (1981b). The political technology of non-social work clinicians who seek to under- individuals. In L. Martin, H. Gutman, & P. stand their practice as social justice work. • Hutton (Eds.), Technologies of the self (pp. 145- Swenson / Clinical Social Work's Contribution to a Social Justice Perspective 535
  10. 10. Moore, L., & Wallace, G. (1993). Emancipatory social 162). Amherst: University of Massachusetts work: The application of post-modern theory to Press. social work education and practice. Paper pre- Freedman, J., & Combs, G. (1996). Narrative sented at Council on Social Work Education An- therapy: The social construction of preferred reali- nual Program Meeting, New York. ties. New York: W. W. Norton. Millstein, K. (1994). Building knowledge from tbe Freire, P. (1970/1973). Pedagogy of the oppressed. study of cases: A reflective model for practitioner New York: Seabury Selections. self-evaluation. Journal of Teaching in Social Garcia, B., 8i Swenson, C. (1992). Writing the stories WorJt,S( 1/2), 255-280. of white racism. Journal of Teaching in Social Millstein, K. (1997). The taping project: A method Work, 6(2), 3-17. for self-evaluation and quot;informed consciousnessquot; Gergen, K. (1985). The social constructionist move- in racism courses. Journal of Social Work Educa- ment in modern psychology. American Psycholo- tion, 33, A9-506. gist, 40, 266-275. National Association of Social Workers. (1996). Gitterman, A., & Shulman, L. (Eds.). (1994). Mutual Code of Ethics, Washington, DC: Author. aid groups, vulnerable populations, and the life Prilleltensky, I., & Gonick, L. (1994). The discourse cycle (2nd ed.). Itasca, IL: F. E. Peacock. of oppression in the social sciences: Past, present, Gordon, W. (1969). Basic constructs for an integra- and future. In E. Trickett, R. Watts, & D. Birman tive and generative conception of social work. In (Eds.). Human diversity: Perspectives on people in G.Hearn (Ed.), The general systems approach: context {pp, 145-177). San Francisco: Jossey-Bass. Contributions toward a holistic conception of social work (pp. 5-11). New York: Council on Social Rawls, I. (1971). v4 theory of justice. Czmhtid^e, MA: Work Education. Harvard University Press. Reynolds, B. C. (1934/1982). Between client and com- Gutierrez, L. M. (1990). Working vnh women of munity: A study in responsibility in social casework. color: An empowerment perspective. Social Work, Silver Spring, MD: National Association of Social 35, 149-153. Workers. Habermas, J. (1971). Knowledge and human interests Reynolds, B. C. (1951/1973). Social work and social (J. Shapiro, Trans.). Boston: Beacon Press. living. Silver Spring, MD: National Association of Habermas, J. (1990). Moral consciousness and com- Social Workers. municative action (C. Lenhardt & S. Nicholson, Rosenau, P. M. (1992). Post-modernism and the social Trans.). Cambridge, MA: MIT Press. (Original sciences. Princeton, NI: Princeton University Press. work published 1983) Saleebey, D. (1992). The strengths perspective. New Hooks, B. (1994). Teaching to transgress: Education York: Longman. as the practice offreedom. New York: Routledge. Saleebey, D. (1994). Culture, theory, and narrative: Hopps, J., Pinderhughes, E., & Sbankar, R. (1995). The intersection of meanings in practice. Social The power to care: Clinical practice effectiveness Work. 39, 351-359. with overwhelmed clients. New York: Free Press. Schwartz, W. (1971). On the use of groups in social lenkins, A. (1990/1993). Invitations to responsibility. work. In W. Schwartz & S. Zalba, (Eds.), The Adelaide, Australia: Dulwich Centre Publications. practice of group work (pp. 3-24). New York: Co- Lee, J. (1994). The empowerment approach to social lumbia University Press. work practice. New York: Columbia University Schwartz, W. (1985/1986). Tbe group work tradition Press. and social work practice. Social Work with Lyotard, J. (1984). The post-modem condition: A re- Groups, 8(4), 7-27. port on knowledge. Minneapolis: University of Shulman, L. (1992). Skills of helping individuab and Minnesota. groups (3rd ed.). Itasca, IL: F. E. Peacock. Martin-Baro, I. (1994). Writings for a liberation psy- Simon, B. (1994). The empowerment tradition in chology. Cambridge, MA: Harvard University American social work. New York: Columbia Uni- Press. versity Press. McGoldrick, M., Giordano, ]., 8c Pearce, J. (Eds.). Simons, H. (1991, March). Arguing about the ethics (1996). Ethnicity and family therapy (2nd ed.). of past actions: An analysis of a taped conversation New York: Guilford Press. Social Work / Volume 43. Number 6 / November 1998 S36
  11. 11. about a taped conversation. Paper presented at White, M. (1995). Re-authoring lives: Interviews and Temple University Conference on Dialogic essays. Adelaide, Australia: Duiwich Centre Publi- Rhetoric, Philadelphia. cations. Solomon, B. (1976). Black empowerment: Social work White, M., & Epston, D. (1990). Story, knowledge in oppressed communities. New York: Columbia and power. In Narrative means to therapeutic ends University Press. (pp. 1-37). New York: W. W. Norton. Swenson, C. (1995). Clinical social work. In R. L. Witkin, S. (1993). A human rights approach to social Edwards (Ed.-in-ChieO. Encyclopedia of social work research and evaluation. Journal of Teaching work (19th ed.. Vol. 1, pp. 502-513). Washing- in Social Work, 8, 239-253. I ton, DC: NASW Press. Tamasese, K., & Waldegrave, C. (1994). Cultural and Carol R. Swenson, DSW, is professor and chair, gender accountability in the quot;just therapyquot; ap- Clinical Practice Sequence, School of Social Work, proach. Dulwich Centre Newsletter, 2 & 3, 55-67. Simmons College, 51 Commonwealth Avenue, (Adelaide, South Australia) Boston, MA 02116; e-mail: cswen$on@simmons. Taylor, P. (1989). The narrative of liberation: Perspec- edu. tives on Afro-Caribbean literature, popular cul- ture, and politics. Ithaca, NY: Cornell University Original manuscript received June 16, 1998 Press. Accepted August 24,1998 • Tyler, T., Boeckmann, R., Smith, H., & Huo, Y. / (1997). Social justice in a diverse society. Boulder, CO: Westview Press. Van Den Bergh, N., 8J Cooper, L. B. (Eds.). (1986). Feminist visions for social work. Silver Spring, MD: National Association of Social Workers, Tlie Sckool of Social van Soest, D. (1995). Peace and social justice. In R. L. Edwards (Ed.-in-Chief), Encyclopedia of social At The University of Georgfia worfc(19thed.,Vol. 3, pp. 1810-1817). Washing- Invites Applications to ton, DC: NASW Press. Wakefield, J. C. (1988a). Psychotherapy, distributive justice, and social work: Part 1. Distributive jus- Tke Doctoral Program tice as a conceptual framework for social work. Social Service Review, 62, 187-210. Building Knowledge & Skills Wakefield, J. C. (1988b). Psychotherapy, distributive justice, and social work: Part 2. Psychotherapy For Social Work Fy-actice and the pursuit of justice. Social Service Review, 62, 353-382. An advanced program of study leading to the Ph.D. Waldegrave, C , & Tapping, C. (1990). Social jus- degree for the experienced social work professional, tice and family therapy. Dulwich Centre News- offering training in research, theory and practice. letter (Special issue), 1. (Adelaide, South Austra- Graduate assistantships availaUe. lia) For further information, contact: Walz, T., & Groze, V. (1991). The mission of social Dr. David Kurtz TTie School of Social Work work revisited: An agenda for the 1990s. Social TudterHall Work, 36, 500-504. The University of Georgia Weick, A., Rapp, C , Sullivan, W. P., & Kisthardt, W. Alhais, GA 30602 (1989). A strengths perspective for social work (706)542-5461 email: miund@ardies.uga.edu ^785 practice. Social Work, 34, 350-354. Weick, A., & Saleebey, D. (1995, October). A post- modern approach to social work practice. Paper presented at Adelphi University, School of Social Work, Garden City, NY. Swenson / Clinical Social Work's Contribution to a Social Justice Perspective 537

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