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?