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. 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. 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. 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. 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. 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. 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. 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. References
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