Max Siporin

Clinical Social Work as an Art form

Many social work practitioners consider social work an art form. The author considers the nature of this art form and describes how practitioners use style, relationship, and metaphor to create an aesthetic experience for both clients and practitioners in the therapeutic process.

Situational Assessment and Intervention

There is evident now a rich renewal of development in situation theory and of the situational approach within a comprehensive, eclectic framework for practice

The social worker's style

The style of the social work practitioner is a very influential factor for therapeutic effectiveness and is a way of expressing the practitioners creative artistry. The meanings and functions of style are clarified. The practitioners general style is analyzed as a combination of personal and professional style elements, responsive to artistic role-task performances in helping clients. A case presentation illustrates a social workers particular style. Wider cultural influences of a practitioners style also merit recognition.

Practice theory for clinical social work

It is suggested that practice theory for clinical social work practice is in a state of disarray. Six new books on clinical social work practice are reviewed, with an identification of their contributions to the development of clinical practice theory. The expanded societal functions of clinical social work have resulted in major changes in method and in practice activities, without commensurate development of appropriate theory, as about environmental-situational interventions. Good theoretical advances have been made, as about a basic ecological systems model, though with need for a greater openness to new theories and to an eclectic approach. Advances have also been made in clinical research and knowledge building, handicapped though this may be by current critical inadequacies in the professional schools, particularly in the continued resistance to the development of clinical doctorate programs.

Treatment of Schizophrenia: Another View

Simon, McNeil, Franklin, and Cooperman’s article, titled “The Family and Schizophrenia: Toward a Psychoeducational Approach” (Families in Society, June 1991), presents helpful information about the psychoeducational approaches and models in the family treatment of schizophrenia. However, the article is flawed by distortions regarding the history of the family therapy movement and inadequate discussion of current family therapy approaches. Regrettably, the authors tout the superiority of a set of currently fashionable therapy “models” by depreciating and inaccurately or narrowly defining earlier family therapy approaches as “interactional” in nature. The marriage and family therapy movement in social work (and in the allied helping professions) flowered in the 1950s. The movement developed out of a traditional social work problem-person-situation (or systems) approach (Siporin, 1952, 1956, 1980). Applied to the treatment of schizophrenia and depressive disorders, it represented the application of psychodynamic approaches in reaction to the prevailing reliance on lobotomies and shock and insulin therapies of earlier periods. Although aberrations may have existed in fashionable theoretical themes (e.g., the “schizophrenogenic mother”), the family therapy movement with its psychodynamic orientation contributed a set of realistic and practical approaches to working with the family unit in the treatment of severe mental disorders. These helping procedures took a systemic view, emphasizing education, resocialization, crisis intervention, and community linking. Approaches included teaching family members the skills and attitudes of constructive communication, relationship, and problem solving in an effort to alter family structures and hnctioning patterns. In depreciating the psychodynamic “interaction” approaches, Simon et al. neglect to discuss the family therapy literature that presents the valuable and positive contributions of this orientation (see, for example, Ferber, Mendelsohn, & Napier, 1972). Satir (1963, 1964), the founding mother of the family therapy movement and pioneer in the social work treatment of families with schizophrenic members, is particularly neglected. The value of these contributions is not negated by their lack of research support based on quantitative, control-goup, and statistical research designs. The “psychoeducational approach” needs to be understood as the expression, in large part, of a behavioral orientation, with emphasis on research procedures, limited goals, and behavior change. As the authors admit, the psychoeducational approach refers to an admittedly narrow focus on information giving, stress reduction, and skill development; there are significant limitations in the use of this approach. Certainly, focusing on specific behavior and attitude changes is important. However, it should be recognized that when “covert” cognitive behaviors such as beliefs, perceptions, and attitudes are of concern, treatment will include intrapsychic, psychodynamic approaches. Thus, we can assume that the five models of treatment presented by Simon et al. do include some psychodynamic procedures in motivating cognitive, perceptual, and attitude change. I also take issue with the authors’ statement that there is a “growing consensus that schizophrenia is an organic brain pathology that may be structural or functional in nature” (p. 326). In line with their belief that schizophrenia is a brain disease and with their dismissal of the psychodynamics of schizophrenic symptoms as being expressive of family dysfunctioning, the authors accept the need for maintenance medication as part of a psychoeducational approach. However, the question of whether schizophrenia is structural (genetic, constitutional brain disease) or functional (psychosocial reactive) is still controversial (Haley, 1988). Moreover, the acceptance of the “functional” nature of organic hrain pathology is consonant with recognizing that hrain pathology may be reactive to a combination of constitutional vulnerabilities and to situational stresses. Also, although narcoleptic drugs may enable psychotherapeutic approaches to take effect in the short term, serious negative consequences exist. The use of drugs, in itself, is not an effective response to schizophrenic disorder (Cohen, 1988;