Politically progressive casework

WHEN PRACTICED social work at a large psychiatric hospital in Adelaide, South Australia, a standing joke about the hospital went something like this: Question: Do you know how to find the social work department? Answer: lust follow the derelicts. This joke was told and retold by various professionals, both social workers and others. Even today, find the joke funny, offensive, and true. Social work has always been associated with the dregs of society: the poor, the disabled, and the oppressed. No other helping professionals can claim such a close association with marginalized populations in society, certainly not our higher-status colleagues in psychiatry or psychology or the other low-ranking helping professions such as nursing, teaching, and occupational therapy. Indeed, the psychiatrists and psychologists at the hospital where worked generally fell over themselves trying to get away from "derelicts" who came in droves to the social work department with referral forms in hand.

As a social work practitioner, have enjoyed working with "derelicts" in all kinds of settings: in the Australian desert, on the streets of inner-city slums, in psychiatric hospitals, halfway houses, a hospice, and most recently, prisons. Through my work with these populations am well aware that am a "derelict" by association. My professional colleagues are aware of this, too, which is a main reason psychiatrists refer their hard-to-reach clients to social workers and why so many of our colleagues have abandoned the title social worker for sexier epithets such as community worker, family therapist, counselor, consultant, or (most gruesome of all) manager. Not so long ago many social workers merely wanted to be therapists like our colleagues in the "grown-up" professions. Today, however, the new spirit of corporate managerialism is luring a whole generation of social workers into the seductive arms of managers.

Social work practice is an ambiguous and conflict-ridden activity that is difficult to define or describe in a way that outsiders can readily understand or appreciate. Our work output is hard to quantify, and we are seldom able to control the factors that determine successes and failures. If we are agents of the state, we must regulate the behavior of others and administer the niggardly benefits that prop them up. We are criticized by liberals for acting on behalf of the state against the poor and we are criticized by conservatives for interfering with market forces. As a result, much of our work is conducted in a hothouse of guilt, blame, and recrimination. Take child protection workers, for example. When they remove a child from his or her parents because they believe the child is at risk, they are accused of interfering with the rights of parents. But when they leave a child at home because they wish to give parents the benefit of the doubt, they are attacked for putting the child at risk. Dilemmas such as this typify the ambiguous nature of social work, making it difficult to prove that our work is valuable and successful.

As a result, social workers are not a powerful lobbying group. We lack the influence and public acceptability that cowers politicians and shapes public opinion. Despite these drawbacks, however, social work practice can make a difference by assisting powerless individuals to speak up for themselves. Empowering others is the challenge and the reward of social work practice. But before we can help clients find their voice, we must understand how powerless people are silenced in the first place.

The Psychology of Powerlessness

In the mid-1960s, a group of American psychologists (Overmeier 6 Seligman, 1967; Seligman, Maier, & Geer, 1968) used classical conditioning procedures to train dogs in avoidance behavior in response to a neutral tone. They trained dogs to fear the tone by administering a painful electric shock whenever the tone was sounded. The dogs were restrained in a hammock and presented with numerous pairings of the stimuli. The researchers hypothesized that fear conditioning could be used to develop escape-avoidance behaviors in later learning trials. In other words, because the dogs had learned to fear the tone, they would quickly learn an escape-avoidance response when the tone was sounded. Most of the dogs, however, were incapable of learning the response and after a few trials ceased responding altogether. Although the researchers were surprised by this finding, they eventually realized that the dogs had been desperately trying to escape the shock from the outset, but, because the animals were restrained in a hammock, escape quit trying to escape. When the escape option was offered during the learning trials it was too late--the dogs had learned that they were helpless, that shock would occur whether they tried to escape or not. The researchers later showed that the only way to teach the dogs that escape was possible was by literally dragging them repeatedly across the barrier. This phenomenon of learned helplessness provides a useful analogy for describing what happens to all organisms, including humans, when they are denied control over their life.

According to learned-helplessness theory (Seligman, 1975), helpless behavior entails three deficits. The first deficit is in the organism's lack of motivation to act. The incentive to act requires the expectation that one's actions will work. The second deficit is cognitive in nature and concerns the difficulty organisms have learning to reassociate responses and outcomes in the future. For example, some of the dogs responded correctly by jumping over the barrier in the shuttle box but they did not benefit from their actions and consequently did not repeat the behavior. The third deficit is affective in nature and occurs when the uncontrollable outcome is also aversive. Learned-helplessness theory claims that the organism's first reaction to an uncontrollable event is fear, a motivator that energizes the organism to overcome the trauma. However, if the organism perceives that its actions cannot bring desirable consequences, fear gives way to resignation and despair. Thus, learned helplessness occurs as follows: First, the organism is exposed to an uncontrollable event. Second, the noncontingency between outcome and response is learned. Finally, the organism exhibits helpless behavior.

Learned-helplessness theory provides ins sight into the world of the poor, the oppressed, and the handicapped, indeed, all who are regularly confronted by events beyond their control. For the powerless, choices are few and control over valued outcomes resides with the actions of others. Helpless behavior occurs when two conditions are satisfied: (1) the person is exposed to uncontrollable circumstances and (2) the person expects that his or her responses are useless. To reverse the first condition, the helpless client must be exposed to as many controllable events as is possible, thus helping the client to understand that some valued outcomes can be attained and some negative ones avoided. Reversing the second condition involves working with clients' expectations that their actions cannot produce desirable outcomes. Clients must be encouraged to act in order to defeat the assumption that events are beyond their control. It must be demonstrated repeatedly that particular responses can have desirable effects; that is, clients may need to be "dragged" repeatedly over their cognitive barriers before they learn that they are able to control outcomes. Thus, powerless clients will become politically active when (1) they are coaxed into action and (2) some of their efforts are rewarded with immediate success. The social worker must approach these goals incrementally and proactively.

A Process Model of Practice

A process model of practice moves from casework to community organization as the intervention gathers momentum and clients begin to explore increasingly complex responses. Figure illustrates this process. Social assessment is the point of entry into the model and the most important component of the case plan. Whether casework promotes or impedes social change will be determined at this stage of the model. Traditionally, social work has dedicated itself to resolving the social, as opposed to the narrowly psychological, problems of clients (Bartlett, 1970; Boehm, 1958; Gordon, 1969). Social work is a nonreductionist helping profession, perhaps our most important contribution to human service work People are not perceived as isolated individuals, but as units in a social system that includes as well as transcends them.

Many social work authors have embraced general systems theory as a way to express this idea (Compton & Galaway, 1984; Goldstein, 1973; Hartman, 1970; Janchill, 1969; Pincus & Minahan, 1973; Stein, 1974; Strean, 1971; Vichery, 1974), because the systems approach focuses on the interdependence or interaction of various psychological, social, and environmental factors. According to systems theory, a client's ecological environment can be conceived of as a set of nested structures that extend beyond the client's immediate problem or situation (Bronfenbrenner, 1979).

Clearly, all casework must begin by exploring the client's perceptions of his or her situation. Beyond these perceptions lies the microsystem, or the pattern of activities, roles, and interpersonal relations of the client in a given setting. The microsystem forms the client's immediate phenomenological environment and contains all individuals and settings with whom and with which the client has a direct relationship, such as family members, the workplace, friendship networks, and so forth. Beyond the microsystem lies the mesosystem, or the interrelations of the various settings in which the client participates. At this level of analysis, the social worker assesses relationships among the various microsystems, such as the relationship between the home and the workplace or between the home and friendship networks. The next level of analysis deals with the exosystem, which refers to settings in which the client does not actively participate but that affect settings in which the client is a participant. Exosystem analysis typically involves assessing social policy issues that directly or indirectly affect the client. The macrosystem, which consists of lower-order systems existing at the subcultural or cultural levels, is the final level of analysis.

The person-in-situation tradition of social work allows for significant differences in interpretation, and the worker's conception of what constitutes a client's social context is a profoundly political decision. Whether for reasons of expediency or in imitation of psychotherapists, social workers are often guilty of psychological reductionism, despite the holistic viewpoint from which they claim to operate. This phenomenon is probably most striking in the case of family-oriented social workers who retain the language of systems theory while limiting their analysis to the family unit. Less direct, but potentially more significant, systemic influences are ignored. Although such practice may be valuable to some clients, it is not social work.

The Casework Phase

The casework phase, the first phase of the practice model depicted in Figure 1, focuses on the immediate and more obvious factors influencing the individual, the microsystem, and the mesosystem. (Figure 1 omitted) Indeed, because it takes considerable practice experience to become fully aware of the broader or more complex systemic issues affecting a client's situation, less experienced caseworkers may remain focused on the less complex levels. For example, although pathological relationships within a client's family may be quite obvious from the outset, the worker may need years of accumulated experience to appreciate the influence of insufficient community resources on the client's problem.

Recognizing the complexity of social assessment, the model assumes that workers will tend to remain involved in phase-1 assessment for some time before shifting their analysis to higher system levels. However, even though phase-l analysis does not deal with the whole problem, intervention can still be effective. The insights gained in phase lay the foundation for community organization in phase .

The Transition Phase

The transition phase, phase 2, is perhaps the most important phase of the model. At this point, the worker begins to see patterns or regularities in the problems confronted by his or her clients and recognizes the need for change at broader system levels. During the transition phase, the worker shifts focus from individual problems to social and political issues, for example, when a worker realizes that the problems of several deinstitutionalized clients cannot be resolved until support services in the community are improved. Of course, an individual social worker calling for some new service or alteration to existing social policy is unlikely to evoke much response from policymakers. However, when that voice is joined by those of a well-organized client group, policymakers may begin to take notice. Accordingly, phase 2 involves two kinds of activity: (1) collecting evidence to support the need for change or reform and (2) making contact with individuals who can form the core of what Alinsky (1969) termed a "people's organization." It is beyond the scope of this article to outline the methods for gathering evidence, but it is worth emphasizing that the task is a political one, rather than a scientific one, designed to attract public sympathy and attention to the need for reform.

In gathering evidence during the transition phase, the worker brings clients together for mutual support and to share their perceptions of the problem. If clients are dealt with individually and on a case-by-case basis, they are unable to perceive themselves as members of a marginalized class of people. For clients, making the transition from individual client to group member is a critical point in the model. The parents of psychiatric patients struggling to maintain their children at home or single mothers dealing with poverty and the demands of 24-hour child care can derive great support from others who are in similar predicaments. Group membership breaks down the isolation that keeps clients powerless. Eventually, client groups will begin to reflect on their common problems and consider ways to improve their lot through small-scale communal actions. In phase 2, then, the worker promotes group solidarity and reflection and shares the evidence he or she has gathered in support of the need for change.

The Community-Organization Phase

In the community-organization phase of the model (phase 3), the worker seeks to (1) build a client organization around issues of importance to clients and (2) engage clients in the snuggle for change. The transition from client to activist is not easy to make because it normally involves a shift in the client's view of the world. Moreover, the study of individuals who have emerged from oppressed communities to become politically active demonstrates that such transitions can be made only when certain preconditions are met (Kieffer, 1984). First, the emergent activist must be confronted by a direct, tangible threat to his or her individual self-interest. Long-term oppression is easier to tolerate than is a sudden setback, even if the setback is trivial compared with more fundamental and long-term privations. The transition to political activism also requires "integrity," that is, feelings of pride, determination, and belonging within a supportive and caring community (Kieffer, 1984). Integrity and the community that spawns it provide a secure base from which the political process can be explored. The worker helps create such integrity by bringing clients together in a mutually supportive forum.

The worker should also look for opportunities to present policy issues that threaten the interests of the group, for example, the closing of a child-care center, the tightening of admission criteria at a psychiatric hospital, or the failure of a local council to provide a needed service in the community. Such issues provide springboards to political action.

In the early stages of the group's life, the problems identified should be relatively minor and capable of being influenced by the group. The problem should be partialized in ways that allow clients to achieve an early measure of success. At this level, the issue itself is not nearly as important as is the experience of working together in a group. The group's early activities may be politically naive, for example, taking up a petition or writing to a government minister. Nevertheless, such activities and suggestions represent a crucial turning point in the life of the group and can eventually turn into an escalating campaign for political action.

Case Example

S was 18 years old and on the verge of qualifying to study economics at a university

when he suffered his first psychotic breakdown. The details of the episode remained vague and mysterious in S's mind, but he readily accepted that he had become progressively more withdrawn and suspicious in the weeks leading up to his final examinations. He remembered a voice, "Kill or be killed," that would not leave him alone, despite the blaring rock music he used to drown it Out. Sometimes the voice would add the word "fag" in an accusatory tone. The voice terrified him. The hospital psychiatrists eventually agreed on a diagnosis of schizophrenia, a label that virtually assured him of a long association with the mental health system.

In addition to the stultifying drugs he was forced to take, yawned his way through hours of psychotherapy administered by clinicians positing erudite theories about latent homophobia, developmental aberrations, family pathology, and so forth. The returns, however, did not justify the investment. S merely quipped that he has launched more careers than the Graduate Record Exam.

From a social work perspective, one would not expect that these reductionist interpretations would resolve S's problems. Although psychotherapy may be necessary for , it is unlikely to be sufficient. Social work assessment revealed that S's parents were one of the thousands of European refugees who sought peace and prosperity in Austria following World War II. S's father was retired after working 30 years as a laborer for the council maintenance authority. S's mother never mastered English and consequently was socially isolated. S experienced his family environment as inward, intense, and suffocatingly ambitious.

Today, S is 23 years old. He needs to put some distance between himself and his doting, interfering parents, but he has nowhere to go. He is unemployed and poor, his only income a subsistence-level unemployment benefit insufficient to meet the cost of even the most primitive boarding house. In desperation, sometimes seeks respite in night shelters and hostels filled with transients, drunks, and people he regards as losers. S is largely unoccupied and isolated. He sleeps during the day and stays up late listening to music, talking to himself, and reading magazines. At one time, looked for work and retained the hope of living an independent life. But even on a good day, his behavior is eccentric, and he is not qualified for any particular occupation.

To make matters worse, neither the local Community Youth Support Scheme nor Adelaide's sheltered workshops will accept him into their programs because of his schizophrenia. Both organizations state that psychiatric patients have proved too disruptive in the past. In addition, the hospital's simplistic deinstitutionalization policy has exacerbated S's problems. In practice, the policy has meant no follow-up, limited access to professional help, and no community services for people like . This view is shared by community-based agencies, which resent: the psychiatric patients queuing on their doorstep. In short, S's problem is a social problem as well as a psychopathological one.

Social Work Intervention

Lately, however, S is beginning to see some change for the better. A social worker initiated the process by assessing S's perspective on his life without dwelling on the vagaries of S's psyche. In her analysis of S's microsystem, the worker sought answers to three interrelated questions: (1) Are S's interpersonal relationships somehow affecting his inability to survive in the community? (2) Can these relationships be made more supportive? (3) How can supportive relationships outside the hospital be promoted? and his social worker looked at ways of structuring activities outside the house, enlisting the help of S's only real friend (a school buddy) to take out and monitor his symptoms. In an effort to reduce S's parents' overinvolvement with him, the social worker helped the couple make contact with the Polish club, where difficulty with English would present no obstacle. At the mesosystem level, the social worker endeavored to build better relationships between S's immediate social network and the hospital where she worked. and his parents contracted to maintain regular contact with the social worker in an effort to head off potential crises. With S's agreement, his social worker contacted others in his tenuous friendship network and encouraged them to contact her when showed signs of breaking down.

Initially, every intervention seemed to be compromised by problems in S's exosystem. Almost all of the recreational and vocational options and his worker pursued were closed to because of his psychiatric diagnosis, and they could find no affordable living accommodations outside the home. These problems were symptomatic of deficiencies in social policy that neither S nor his social worker fully understood.

S's social worker encouraged other psychiatric patients and their families to discuss these problems and to support one another in coping with them. In the early stages, group members were startled by how much they had in common: overreliance on parents, idleness and isolation, lack of vocational and recreational outlets, a shortage of alternative living accommodations, an unresponsive mental health system. Eventually, the participants formed an association dedicated to promoting the interests of psychiatric patients and their families. A public meeting was planned and the media were contacted. The group had no particular campaign in mind, but approximately 500 participants turned out for the meeting. A newly elected organizing committee put its efforts into lobbying for a halfway house for persons with schizophrenia. Conscious of an upcoming election and the potential photo opportunity, the minister of health provided monies allowing the halfway house to open several months later. Excited with this early success, the association soon became the lobbying group for schizophrenic patients and their families in South Australia. The association has established links with the Unemployed Workers Union as its agenda expands and becomes more sophisticated.

Social Work and Reform

The approach to social work practice presented above concentrates on relatively minor social reform. Truly radical change, some would claim, involves dramatic and far-reaching changes, not the kind of minor concessions and policy changes discussed here. But such a view ignores history: with very few exceptions, all social change, including revolutionary change, has begun as a series of small departures. Revolution requires more than the overthrow of those in power or the replacement of a particular system; it demands changes in culture and psychology as much as it does changes in economics and politics. For this reason, revolutionary change necessarily has incremental aspects.

A more sophisticated critique of social work practice evaluates the nature of change, not just the size of change. The most trenchant critics of reformism accuse it of failing to challenge the superstructure of society. Reformism, they say, is closely linked with liberal pluralism, which views public policy as emerging from the interplay of sectional interests and the agreements worked out among subgroups of the population. The role of government is to act as a kind of referee between competing and antagonistic groups. Faith in the beneficial effects of competition and the negotiated settlements of interest groups is a fundamental part of the ideology of reformism.

A more serious criticism of reformism is that it tends to isolate change efforts from one another by failing to recognize the linkages between specific change efforts and changes in the whole. If reformers focus their efforts on gaining resources for a particular group or area of need, the gains they make may result in a loss of resources for other equally exploited groups and in failure to consider dilemmas common to all marginalized groups. This can promote conflict among various disadvantaged groups. Reformers sometimes fail to see that social problems are rooted in social structures and that by focusing on the needs of a particular client group they may see only the symptoms of problems, not the problems themselves.

Clearly, it is pointless to work for the interests of one's clients if the concessions gained work against, rather than for, social justice. However, social workers can become disheartened by the radical critique and daunted by the magnitude of the "real" problem confronting them. Radical reformers frequently fail to realize that the involvement of marginalized groups pressing for their own interests is a vital, even essential, stage in freeing clients from what Freire (1972) referred to as "the culture of silence." The age-old casework injunction of "starting where the client is" is as true of social action as it is of psychotherapy. Immersed in their daily struggles for survival, most clients can see no further than their own immediate needs. It is pointless, if not insulting, to exhort such people to struggle for long-term structural change. The political conservatism of the poor is well known, and at least some of their reluctance to engage in radical social action can be attributed to their inability to see how the struggle helps them. Caseworkers understand that complex psychological change is best achieved through a series of successful actions that move toward the desired end; viewed in this light, engaging clients in minor reform activity is a logical starting point for client and societal change.

Conclusion

Involving clients in small-scale political campaigns advances the political education of clients in four fundamental ways. First, clients gain experience wresting tangible concessions from policymakers through persistence and assertiveness. Second, through communal action, clients are encouraged to develop a sense of class consciousness. Third, activity helps clients see that many of their victories are merely perfunctory and tokenistic, a realization that keeps at least some clients politically active, expanding the range and assertiveness of their demands. Finally, reform activities help clients learn firsthand about the political process.

In The Politics of Social Service, Galper (1975) claims that the best hope for social change in the West rests with "the bottom up approach." Social workers are found at the "bottom" with their "derelict" clients. We have firsthand experience of the "culture of silence." We see it every day in the passivity of clients with chronic and debilitating conditions. Passivity is the legacy of powerlessness. It is what happens to people who lack control over basic human needs such as food, shelter, and interpersonal relationships. The question is not why so many clients allow others to provide for them, but rather why we should expect them to do anything else. However, by proceeding cautiously and incrementally, social workers can help clients find their voice as well as influence, sometimes even control, the policy decisions that shape their lives.

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James G. Barber is Professor and Head, School of Social Administration and Social Work, Flinders University, Adelaide, South Australia, Australia. This article was based on work funded by Grants for Research into Drug Abuse, Commonwealth Department of Human Services and Health.

Copyright Family Service America Jan 1995
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