Every career path has a face, a legacy, and a story to tell. Each has the potential to reshape a piece of the human experience. Clinical social work is unique because the ability to change individuals' lives is not ancillary to its professional purpose but rather its very core. In the therapy room perspectives of patient and clinician collide, creating a sense of relationship and situation that shifts and transforms over time. While the therapist's perspective includes needed expertise that can, when communicated well, be effective in changing a person's long-standing habits, the philosophical predecessors to modern social work that subtly inform his practice can at times also threaten to undermine his patients' wellbeing. No human-conceived methodology or way of thinking is perfect, and failing to acknowledge that fact can be detrimental to the progress and general good of individuals and society.
Much of what a therapist does is
often very effective. The reason that a person goes to a therapist is to get a
new perspective on their problems so that they can fix them. By fostering
the understanding of their own inner workings, the social worker shows them
where their levers and pulleys are so they can take control of their own
lives. A mind is like a hill made
out of dirt. As time goes on, a person has many thoughts and experiences,
raindrops trickling down the hill that turn tiny ruts into large
trenches that are difficult to change. However, clinical social workers
have the training to walk people through the process of consciously changing their
thought patterns in order to re-carve the grooves of their minds and improve their
functionality. The more clearly a
therapist communicates this process to a patient in terms of their particular
circumstance and understanding, the better chance there is for recovery.
As significant as patient successes
are, they can also blind therapists to problems and damage that current
practice causes and impede forward progress.
In saying this, I don't mean to imply that social work practitioners are
not as focused as they should be on their patients' wellbeing. In fact, compared to marriage and family therapy and psychology,
social work focuses far more heavily on actually helping people rather than merely understanding them. It is
the only discipline that I know of that actively encourages its practitioners
to sacrifice their own interests for those of their clients on a regular basis (National
Association of Social Workers, 2008). What
I am saying is that very attitude makes it difficult to acknowledge that
deficits still exist, just as the advocate for women's rights is often the last
to see sexism in himself.
The problem itself is a historical
one. Both psychology and social work
trace their ideological lineage through Greek philosophy. One
of the prevailing Greek epistemologies, or methods of accepting validating
ideas, was empiricism, which involved acquiring knowledge by using sensory
observations and is the basis of modern scientific thought. The problem is that reducing humans to collections
of atoms that only act as they are acted upon leaves no philosophical room for
free will or moral absolutes, as Dr. Edwin Gantt of the psychology department of
Brigham Young University has argued (Gantt & Williams, 2014).
While humans are perfectly capable
of embracing ideas that are inherently contradictory, the natural implications
of ideas often have a way of squeezing their way into practice. For example, although as a whole the
discipline is a proponent of self-determination, in my experience it is common
for social workers to place responsibility for a patient's problems on their
environment rather than their own actions (National Association of Social
Workers, 2008).
Such an approach is useful in encouraging people to feel compassion for those who are disadvantaged, but it also undercuts a patient's self-efficacy because it leads them to believe that they are not in control of their circumstances. Granted, social workers also value empowerment, which ideally means that a patient is in charge of his or her own development, but without a sense of self-accountability such a standard is of limited usefulness (National Association of Social Workers, 2008). If a person merely sees themselves as a victim of circumstance it is difficult to help them believe that they can also be its champion. A personal friend who has been a part of the mental health system for many years said that clinicians' attempts to convince him to "just be content" with his circumstances as a person with a disability damaged his belief in his own capacity to construct a better life for himself. Human beings can do amazing things when they feel trusted and empowered, even under thorny circumstances. In therapy situations the difficulty of the patients position should be acknowledged, but social workers should be cautious in implicating that there are goals beyond their patient's reach. It isn't just the communication itself that is important, but also the underlying messages that accompany it.
Such an approach is useful in encouraging people to feel compassion for those who are disadvantaged, but it also undercuts a patient's self-efficacy because it leads them to believe that they are not in control of their circumstances. Granted, social workers also value empowerment, which ideally means that a patient is in charge of his or her own development, but without a sense of self-accountability such a standard is of limited usefulness (National Association of Social Workers, 2008). If a person merely sees themselves as a victim of circumstance it is difficult to help them believe that they can also be its champion. A personal friend who has been a part of the mental health system for many years said that clinicians' attempts to convince him to "just be content" with his circumstances as a person with a disability damaged his belief in his own capacity to construct a better life for himself. Human beings can do amazing things when they feel trusted and empowered, even under thorny circumstances. In therapy situations the difficulty of the patients position should be acknowledged, but social workers should be cautious in implicating that there are goals beyond their patient's reach. It isn't just the communication itself that is important, but also the underlying messages that accompany it.
Another Greek idea is that labels
define identity. Being a brother, employee,
or a smart person is thought of as relatively permanent. This contrasts sharply with Hebrew thought,
in which labels are tied more specifically to actions. For example, a Hebrew might describe a pencil
as "something I use to write with," while a Greek would describe it
as " a yellow wooden stick" (Ancient Hebrew Research Center, n.d.). Under a Hebrew perspective, to change what a
person does is to change the very nature of that person. In contrast, our ideological history leads us
to give labels to people via the diagnosis of mental illnesses, thereby subtly imposing
a new identity on them that is far more permanent, one that they often choose
to live up to. Patients tend to see
diagnoses, especially for chronic illness, as descriptive of who they are rather
than a simple outline of symptoms and behaviors that are distinct from the
person himself and are potentially temporary. We then attempt to elicit attitudes and
behaviors from the person that contradict the identity we just imposed on
them. Granted, sometimes this actually
works. One has to wonder, though, what
recovery rates would be like without the placebo effect working against us.
Social work is an agent of great
good in society. However, sharper knives
get the job done more effectively than dull ones and make it less likely that
someone will get hurt along the way. Presupposing
that the way things always have been is as good as they can ever get is faulty
logic with human capital wagered in the balance. I am not suggesting that decades of thought
on ideal clinical social work practice should be completely abandoned, but
rather that we should understand more deeply our own assumptions and the effect
of those assumptions on other people as they inevitably commandeer and
manipulate the messages clients receive.
My prescription is intense intellectual humility, not
recalcitrance. Metacognition, not
mutiny.
Being content with current progress
is understandable, but it also leads to stagnation. To me, being satisfied with doing less than
our best to help those within our reach to attain their potential is not
acceptable. Every person within our
sphere of influence can be, and already is, a creature beyond
comprehension. The opportunity to change
the life of such a person in any capacity is a sacred honor. Having the power to do so in a more powerful
way than at any time in the past is possible.
That should be our goal. The
social work field cannot let clients suffer because we were unwilling to
require them to be accountable for their actions or let human-manufactured
labels dictate the limitations of their future.
We must constantly evaluate the underpinnings of our beliefs and actions
and be willing to question and change fundamental parts of them if doing so
will help those around us to reach their potential.
While Greek philosophy has been the
mechanism of great societal growth over the last two millennia, we should not
let it limit us from further progress.
Rather, we should gather the initiative to stand on the shoulders of the
great thinkers of antiquity, thereby appreciating the goodness of the past
while not allowing it to restrain us from striding boldly and innovatively into
the future, changing the way that therapists think and communicate so that
clients receive the messages of progress and hope that they need to heal. Such a thought process will naturally lead us
to correct problems no one realized needed correcting. It will lead us to rethink and creatively
implement new approaches to finding new approaches. Ultimately, it will extend the reach of
therapists the world over to better combat the overwhelming ills of society and
to change the lives of those in their sphere of influence forever.
Works Cited
Ancient Hebrew Research Center.
(n.d.). Hebrew Thought. Shamar.org, http://www.shamar.org/articles/hebrew-thought.php#.VmMUMzZdFOw
Gantt, E. E. & Williams, R.
N. (2014). Psychology and the legacy of newtonianism: Motivation, intentionality,
and the ontological gap. Journal of
Theoretical and Philosophical Psychology, 43(2), 83-100.
National Association of Social Workers. (2008). Code of Ethics of the National Association
of Social Workers.
Image Credits
Cheung, Roy. Lonely. Digital Image. No changes made. February 9, 2008. https://creativecommons.org/licenses/by-nc/2.0/legalcode
Image Credits
Cheung, Roy. Lonely. Digital Image. No changes made. February 9, 2008. https://creativecommons.org/licenses/by-nc/2.0/legalcode
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