Structural Social Work and Clinical Practice

Over the past few weeks I have been absent from blogging because I am in the last month of my masters program, meaning that rightfully I am (trying to) spend more time doing school work than other things like checking e-mail and blogging.

However, I have not ceased entertaining new ideas for posts. 

As those of you who are in the field of social work may know our educational institutions have largely shifted the philosophy of education to that of a philosophy of structural social work.  This means that our level of analysis is to always include the impacts of unjust societal arrangements on people’s problems.  In The Structural Approach to Direct Practice in Social Work (Goldberg Wood and Tully, 2006)  it emphasizes the importance of trying to change an oppressive situation before engaging in clinical work with an individual.   For example, a depressed elderly person fearful to leave the home may need increased protection from police to decrease gang violence or a change of home to a safer neighborhood, not simply therapy to deal with fear.  In this type of example the author explains that it would likely be futile to engage in therapy without first addressing her environment or larger systemic problems contributing to her individual problem.

This seems logical for this particular situation, but for social workers the tools and ability to change a situation of a barrier for a client are out of reach or take too much time to truly benefit an individual.  In seeing the picture we have the burden (my our profession and our education) to change the bigger picture to benefit our clients; few other professions have this within their aims or purposes.

The reality is that many social workers (myself included) choose to practice on and individual level using clinical skills borrowed and developed from the field of psychology.  However, in being a social worker we have the added layer of assessing for the role of social and environment and then working for change within that realm as well as on the individual level.  This is helpful, but also challenging and can go outside of the framework of evidence based practice models that we may be using to mix it with an advocate role.  One complication of using a structural model is that in theory it is quite black and white (fight injustice!), but in practice people and situations are far more complicated; the oppressed are oppressors, we are both holding power and without power, resisting and engaging. 

In some cases in my work I have found it is not very applicable.  For example in counselling a middle-aged women with depression reporting a satisfactory marriage and middle-income status I am building a relationship and targeting symptoms of depression with various counselling techniques; I’m not working on an issues of injustice as she did not bring that forward after careful assessment.

However, at other times the knowledge of the effect of injustice, the barriers faced by those who are discriminated against can be used in therapy to help people normalize their experience and understand that our system is not just a meritocracy and that their not “making it” in life is not just an effect of a character flaw. Looking first to understand who is disadvantaged and discriminated against is also a good guide to research.  For example if I am doing research and find out that those with lower-income consistently die more after having cardiac surgery I would not just accept this fact but want to examine the structures that contribute to this injustice and lobby to change this.

So there are advantages to having a grounding in structural theory, but also limitations in practice.

As a social worker do you use structural theory as a basis for your work?  How well does it go work within the context of your agency/practice?  What alternative models do you find useful?

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6 thoughts on “Structural Social Work and Clinical Practice

  1. I think that many universities have started to look past structural social work as being a bit dated. It’s not that larger social structures have no effect on individuals. I think that perhaps it has become obvious over the past two decades that it is really difficult to effect “macro” level change.

    The fact is that groups can only be interacted with on an abstract level; they are really only constructs. Human beings only actually interact with other individual human beings in life, and within a helping profession context, that is hard enough!

    My question is this: what has “structural” social work actually done for anybody? I would love to hear a concrete example of a social worker who did something on a structural level that changed the lives of a whole class of people.

    This isn’t to say that the effects of oppression and structural barriers are not real. It is that maybe our notion of how much we can really achieve as social workers is what is really illusory. Perhaps I am just cynical, but I think that it is actually arrogant for social work theorists, professors, etc., so suppose that they can A) Know exactly (or even roughly) what macro changes need to occur to help the downtrodden, and, B) Act in such a way, and with such fortitude that those changes will actually occur. The nature of the universe and human nature would (and has) nullified those paltry efforts.

    Anyway, that’s my $0.02.

    • Thanks Sean for you two cents worth. I believe structural social work is still alive and well in schools, albeit in the form of Anti-Oppressive social work which is the party line officially adoped by all the universities. It is quite simplistic (and like you said arrogant and presumptious). I found it ideological and not very nuanced. Yeah, not all professors are on board- however I ended up research the use of structural social work in individual practice as suggested by professor as a theoretical model for a paper.

      My question for you: if (perhaps the better question is when) you were to train the future BSW and MSW’s of the future what would you teach and how?

      • Surprisingly, I think you would find that UBC Okanagan does not consider anti-oppressive social work practice to be its party line. In fact, in the MSW program I found that most profs railed against it heavily. I remember a student who received her BSW from the University of Ottawa (a very “structural” school) in our program. She was very shocked by the lack of support for those views.

        I think of structural theory and practice as a piece of the puzzle, like feminism, or other theoretical positions. However, most like to make their own theoretical position the “default” standpoint. I think this is human nature.

        How would I train BSW/MSW students? That is a tough philosophical question. For example, the student destined to become a worker bee in an agency requires a much different skill set than a clinician. And the one going on to higher education requires yet another skill set. There is no one way.

        That said, in the BSW I would focus on three things: 1) Personal therapy, 2) Critical thinking skills, and 3) Basic down and dirty counselling/conflict management skills

        Mandatory personal therapy is number one (and would be a great opportunity for MSW students to cut their teeth!). More problems are caused by a lack of self-awareness, poor boundaries, unconscious motivations, “soft” personality disorders, and ineffective coping skills than anything else. Most just aren’t ready to be thrown in yet and will be traumatized when they are. Further, they will harm others as they attempt to psychologically protect themselves from abuse.

        Critical thinking skills are a must because we do need to learn to see clients from different perspectives and be able to truly enter those perspectives.

        Basic counselling tactics are foundational. If a worker cannot deal with conflict or do basic empathic responses then they will be in trouble when they get thrown in. This would be a great opportunity for BSW’s to help large numbers of people on a volunteer level.

        I would expand the MSW program and teach APA, research methods, etc. to that crew. I wouldn’t even bother with the BSWs. Maybe there could be an optional MSW stream that could be used for credit toward an enhanced MSW.

        For the MSW, I would have streams. I would have a mandatory clinical practicum with heavy supervision. We have a skill deficit! Theory is important, but it is also a distraction. We need to be able to identify social theory, but be more concerned with the direct service of people.

        Anyway, there’s another $0.02 (Okay, maybe $0.04 this time!)

  2. I think macro has happened when society is ready for it, and when your lobby has enough money and influence. But some mezzo changes can be one individual in a local community effecting change.

    I work in hospice on a micro level and mezzo, we have people all the time that we place in safe boarding and nursing so that they are taken care of with meals, personal needs etc.

    But the issue of choice comes up all the time. We are beholden to self-determination and cannot force someone who is in a dangerous situation to do what is good for them. If they want to lay at home on the floor in their own feces, then that is their right; and the police and fire cannot afford to be nannies to obstinate old folks.

    This is also a solution focused issue as families know how to cope with their own forms of crazy and we should explore their own coping structures and not assume that ours is better.

    In the context of “justice”, how often is this issue not informed by our own biases and also the political nature of what society considers “Just” at the time, which is currently enforced by the progressive left, which a lot of patients want no part of.

    • Thanks for you thoughtful comments from your practice. I too find that change happens slowly and that we basically work on a micro and mezzo level.

      For example, I have found working as a social worker, that unlike my nurse counterparts in mental health I tend to zero in and ask more poignant questions about a person’s social support, how they’ve been coping, rather than the medical issues. I take into account the effect of a socioeconomic class and history in their behavior rather than pathologizing their behavior right away. But I credit my nurse colleauges for their extensive medical knowledge; they know all the different conditions, side effects of medications, etc- a whole lot of knowledge that I may learn but was not trained to do. In conversations about Native Canadians by other colleagues I can bring some more info to the table about residential schools, etc. that help us understand their circumstances and how we can relate to them. I think this is structural although it is not changing the world, it can change understandings and diversify approaches.

      However, as you said, too often our ideology of “justice” taught by left-leaning social work schools is not relevant to patients or colleagues, and even to us as social workers in the real world. We have to be careful about that and willing to let go of some ideas that just don’t work.

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