CLINICAL SOCIAL WORK PHILOSOPHY
By Mickey Skidmore, AMHSW, ACSW, MACSW
A few weeks ago World Social Work Day was observed (17 March 2020). In recognition of this, I am sharing some highlights of my own personal Social Work philosophy. I do this in response to my own critical observations that the Social Work profession often struggles to articulate its role and what it does, and that Social Work leadership around this is lacking. Thus, I offer a few thoughts about what has shaped and guided my practice for the past 35 years.
In the years that I have practiced Clinical Social Work, I have come to believe that we “co-create” the meaning of each other’s experience and the world by our participation with it and with one another. It follows then in my view, that we are in a cooperative relationship with it. My approach to therapy is choosing to notice certain patterns — rather than labelling pathology, but purposefully punctuating ongoing experience. Moreover, my philosophy is one of goal-direction, health discovery, and concentrates on factors of the entire eco-system. Additionally, my philosophy tends to emphasise an approach that is generally future-oriented, dealing with current, situational, and developmental problems. My philosophy does however, recognise that it is sometimes useful to be knowledgeable and/or versed in and sometimes to temporarily hold other frames of reference — including more traditional philosophies in order to benefit our clients. I believe this overview can be better conveyed by emphasising of the following elements of my personal Social Work philosophy:
Positive & Individualistic
I place great emphasis and importance on carefully treating each person as an individual, and not according to any preconceived notions based on personality theories or rigid approaches to therapy. I stress flexibility towards clients who are appreciated for their uniqueness. I have come to expect that people will make the best choice they have learned how to make, and that people are constantly learning and storing these learning’s, even though they are usually unaware of the process. Therapeutic change results from helping clients reorganise and re-associate their natural abilities and experiences so that these resources become available in new ways.
By strategic, I am referring to a broad definition involving the devising and employing of plans or strategies towards the goal(s) of the client. In my view, a careful assessment of the individual or system to be treated is to emphasise the establishment of treatment goals rather diagnostic labels. It is necessary to understand what a person needs so that “symptoms” are no longer needed. While the therapist and client develop the strategies, the client is fully credited and responsible for accomplishing the therapeutic goals, as they will change only in ways that are meaningful and relevant for them anyway. The therapist simply facilitates the opportunity to “co-create” therapeutic outcomes that are consistent with their values.
Consistent with Social Work training, my philosophy includes a systems-oriented value. I frequently attempt to incorporate the larger social network to help clients generate resource experiences. Moreover, I work to help clients find and fit comfortably into their place within that network in an ongoing and unfolding way. In short, my philosophy emphasises generative change, or change geared to the whole person in their larger social context. Thus, my approach is often both strategic and systemic regardless of the particular technique being used or the number of clients actually seen in the therapy session.
Action Rather Than Insight
In my personal Social Work philosophy, I place only partial or limited emphasis on helping clients achieve insight for their problems. Rather, I rely on strategic approaches, hypnotic approaches, indirection, and various task assignments in an effort to get them to do something. Many of my clients understand the “why’s and how’s” of their afflictions, but this insight has not helped them to change their circumstances. Consequently, efforts are instead focused on creating a set of circumstances under which the individuals can respond spontaneously and change themselves.
Throughout my practice, I can say that I have had several experiences of joining people in dramatic ways that resulted in immediate rapport and credibility. Many of my clients have been willing to do seemingly bizarre or strange things at my request/suggestion. I like to believe this occurred, in part, because I had communicated a genuine acceptance of the persons and even of their symptoms as having a reasonable and positive purpose. In my work, I am willing to appreciate and strategically incorporate whatever behaviour the client brings to therapy. Even the most “resistive” behaviours from clients I consider to be their best effort at cooperating and getting their personal and interpersonal needs met. With this belief as a foundation, I can begin to assess what the client needs in order to learn or obtain gratification without continuing the symptom.
Indirection & Hypnosis
I believe that people have the capacity to do their own thinking and solve their own problems despite limiting conscious beliefs. While I find direct communication to be highly effective, I have also come to realise that direct suggestions are useful only to the extent that clients know what they want, are congruent about wanting to accomplish it, and have the resources necessary to make these changes. In my experience, clients seeking therapy rarely meet these criteria. Therefore, my philosophy includes the use of hypnotic approaches including indirect communications to facilitate an unconscious search and retrieval of personal learning’s and abilities that in turn stimulate clients to solve their problems in uniquely effective ways.