Define structural social work practice (1-page) a. Identify 3 underlying assumptions about this practice framework regarding: i. The role of social worker experiences, biases, values, b

10.1177/0886109903254586ArticleAffilia Fall 2003Parker

A Social Justice Model for Clinical Social Work Practice

Lynn Parker

Feminists have long challenged social workers to address issues of equity and justice in clinical practice. This article presents a case study of a family services program, the Institute for Family Services (IFS), whose intention is to do just that. At IFS, power issues are central to all therapeutic conversations and to the structure of the program. Findings from interviews with staff members and clients and observation of the program illustrate how the program sets out to reveal and influence issues of power, privilege, and oppression. Fundamental and unique to this model are the use of same-gender therapy groups, social education, and community sponsors.

Keywords: feminist therapy; social justice

Feminists have long challenged social workers and family therapists to address issues of equity and justice in clinical practice (e.g., Almeida, 1993; Bricker-Jenkins, Hooyman, & Gottlieb, 1991; Carter & McGoldrick, 1999). So have others—notably the “Just Therapy Team” from Australia (Tamasese & Waldegrave, 1994), social constructionists (e.g., Baber, & Allen, 1992; Laird, 1993; White, 1997), and critical psychologists (e.g., Fox & Prilleltensky, 1997). They and others have argued that therapy is political whether the therapist knows it or not. Accordingly, at the minimum, practitioners need to be aware of their own political stances (overt and covert) and to be proactive to identify and eliminate oppressive practices.

Early feminist writings focused primarily on gender inequality, claiming that gender is the primary organizer of social life (e.g., Chodorow, 1978; Gilligan, 1982; Miller, 1976). Although these early writings did put women’s experiences into the picture, they often did so by substituting one essentializing subject position for another. These writers challenged the notion that there is a universal reality—that of Western, bourgeois, hetero- sexual, White men. However, they offered as a replacement another

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universal, that of Western, bourgeois, heterosexual, White women. Conse- quently, the meeting of feminist theory with postmodern theory provided a needed critique of feminist theories that generalized or reduced the variety and complexity of women’s experiences (Hare-Mustin & Marecek, 1990). Missing from early feminist work were the realities of women and men who not only experience gender inequality but live within historical networks of class, race, culture, and sexual orientation.

Feminist postmodernists challenged social workers and family therapists to address the multiple interacting issues of oppression and power. This lit- erature (Almeida, 1993, 1998; Comas Diaz & Green, 1994; hooks, 1990; Laird & Green, 1996; McGoldrick, 1998; Minh-Ha, 1991) went beyond the question, Should we be political? to the question, How inclusively are we being politi- cal? Do we view the world from our own limited perspective, perpetually gazing upward and never downward within the hierarchy of social location (i.e., “Who has more power and privilege than I do?” rather than “What are my privileges?”)? Or is our lens sufficiently broad to view the multiple reali- ties of diverse peoples in various social locations?

In this article, I present a case study of an innovative family services pro- gram that attempts to meet this challenge. This case study expands on my previous study, in which I delineated attributes of feminist couples’ therapy (Parker, 1997). In that study, I interviewed prominent feminist social work- ers and family therapists throughout the country regarding how they address power issues in sessions with couples. One of the feminist social workers I interviewed was Rhea Almeida, director of the Institute for Fam- ily Services (IFS) in Somerset, New Jersey. The study presented here concen- trated on Almeida’s program. I selected IFS for study because it appeared to be clearly political in approach, with issues of social justice central to its ther- apeutic program structure. Just how a family services program goes about addressing issues of power and privilege practically was the focus of my inquiry.

METHOD

Because I wanted to present an in-depth description of the program, not conduct an evaluation of the program, I chose the single case study method of qualitative research. Case studies require access to a “bounded system” (Stake, 1995, p. 2) for study and the availability of multiple sources of infor- mation, so that a portrait and understanding of the case is garnered. Both these requirements were met in this study. I carefully followed the guide- lines for case study research set forth by Stake (1995) and Creswell (1998). In the next section, I describe the sample and procedures used for gathering and analyzing the data.

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Data Sources

Consistent with the guidelines for designing a case study (Stake, 1995), I gathered information from multiple sources: interviews with clients, staff members, and sponsors; observation of all aspects of the program; and a review of the program’s documents (Stake, 1995). Clients were initially invited to participate in the study by the clinical staff. These clients then told others, which created a snowball sample, as described by Patton (1990). The resulting sample of clients included 35 women, men, and children who were of diverse ethnic groups (Asian Indian, Jewish, African American, Mexican American, European, Pakistani, Puerto Rican, Uruguayan, and Cuban), sex- ual orientations (heterosexuals, gays, and lesbians), and partner statuses (married, partnered, divorced, and single). The youngest person inter- viewed was 6 years old, and the oldest was 63. I interviewed 22 females and 13 males with a broad range of social class representations: a migrant dish- washer, students, professionals, business owners, and clerical and service workers. The clients were also diverse in the problems that brought them to therapy—from domestic violence to problems with relationships or their families to depression, anxiety, or stress.

Additionally, I interviewed all IFS clinical staff members—all of whom were social workers and had completed postgraduate family therapy train- ing. They, too, were of diverse ethnic groups (Latino/Latina, Cuban Ameri- can, African American, Irish American, and Asian Indian), sexual orienta- tions (gay, lesbian, and heterosexual), and various social class backgrounds. Notably, laypersons were also woven into the therapeutic program, which afforded an even broader base of diversity through the sponsorship pro- gram. These “sponsors” act as mentors and cultural consultants to clients. Initially, sponsors were recruited from the community and trained by team members. Now, they are often “graduates” of IFS.

Procedure

I entered the program as an independent researcher who was interested in learning more about the program. Fortunately, the program participants and staff were generous in their willingness to share their thoughts with me. I traveled from Denver to New Jersey to observe the program and to conduct interviews with clients and staff members in July 1997 and October 1998. Interviews followed a “general interview guide approach” (Patton, 1990, p. 280), using a set of open-ended, general questions whose goal was to obtain both the clinicians’ and clients’ candid perceptions. The clinicians spent many hours meticulously describing the philosophy and process of the program. The questions asked of the clients included “What has been your experience in the program here? What has been helpful or not helpful? For whom does (does not) this program work?”

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During the four week-long periods of data collection, I observed 38 group sessions, three intake interviews, and four team meetings. I participated in numerous informal team discussions about clients and the program, and I reviewed the program’s documents and videotapes. I took field notes to record these general observations.

Interviews with the clinical staff and clients were tape-recorded, tran- scribed, and entered into NUD.IST, along with the field notes. NUD.IST is a qualitative data analysis computer software program that aids researchers in organizing and storing nonnumerical and unstructured data. I conducted the data analysis according to the following steps set forth by Stake (1995): (a) engaging in “categorical aggregation” and “direct interpretation” (p. 74) to create categories and themes, (b) searching for patterns and correspon- dence among categories, (c) developing naturalistic generalizations, and (d) describing the case. I used an inductive, cross-case strategy to analyze the data. Transcripts of interviews were scrutinized line by line for themes, pat- terns, and discrete ideas until no more new categories were perceived. Themes were then labeled—a process called open coding (Strauss & Corbin, 1990)—and entered into NUD.IST.

To satisfy the challenges of validity, or as Wolcott (1994, p. 347) put it, “not get it all wrong,” I used the following steps: “talk a little, listen a lot” (p. 348); record accurately (recording field notes immediately after interviews and using a tape recorder and transcriptions); and include as much primary data as possible to “let readers ‘see’ for themselves” (p. 350). Afinal step to bolster credibility was to seek feedback from the participants. The assembled case analysis was sent to individual client and staff participants to verify the descriptions, interpretations, and themes that were generated. This feed- back was then incorporated into the final case study I present next. Readers are reminded that my intent was to provide a portrait of a therapeutic pro- gram whose mission is to promote social justice.

FINDINGS

First, I briefly provide background information about IFS (how it was con- ceived and its central mission) and describe the model that underlies the program’s philosophy, the cultural context model. Fundamental to the model are empowerment and accountability in a public (versus private) context. This information was derived from observations of the program, interviews with the clinical staff members about their experiences with the program, and documents from the program. Second, I present the themes I uncovered in my interviews with the clients. These themes illustrate how empowerment and accountability are integrated into therapeutic work.

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The Cultural Context Model

Rhea Almeida, founder and director of the IFS, developed the cultural con- text model. As the name suggests, people and problems are considered in relevant cultural contexts—thus diverging from Western patriarchal views of the solitary (rugged) individual or even families as isolated self-sustain- ing systems.

The cultural context model is multifaceted and community based, situat- ing “issues of race, gender, class, and sexual orientation in culturally diverse groups at the core of therapeutic intervention” (Almeida, Woods, Messineo, & Font, 1998, p. 414). The structure of the program runs counter to most ther- apeutic programs that limit the experience of change to the interior bound- ary of individual and family life. In contrast, the cultural context model breaks through perceived barriers around the nuclear family by creating a community that directly links families to one another. Within this multifam- ily, or community milieu, clients are helped to examine gender, class, and other systemic patterns that contribute to their dilemmas. The walls of the therapy room are further extended by inviting other significant persons into the therapeutic process, including community and religious leaders. The model focuses on dismantling traditional rules of privacy and access to power and social opportunity via open dialogues that focus on the princi- ples of empowerment and maintaining accountability over time.

Dismantling rules of privacy and privilege. The program is structured to dis- rupt power hierarchies between therapists and clients, among therapists, among clients, among family members, and in the society.

With regard to therapists and clients, a team, rather than a single thera- pist, conducts most of the therapy. Clients are also assigned volunteer spon- sors (often graduates of IFS), who serve adjunctively to ensure that clients are integrated into and supported by the larger IFS community. Sponsors are often present as resources even in initial intake sessions. Both structural components aim to level power and therefore reduce the dependence of cli- ents on therapists. Therapeutic influence is expanded, as is accountability (i.e., responsibility and answerability) for maintaining change. Therapists are also monitored for sexism, racism, and homophobia by other team mem- bers, who observe sessions from behind a one-way mirror (or via a televi- sion monitor). These observations provide accountability for therapists in sessions and raise their consciousness.

In relation to power hierarchies among clients, therapy is conducted pri- marily within same-gender groups, or what IFS calls “culture circles,” rather than as individual, couples, or family counseling. The culture circles expand traditional therapeutic paradigms to include other nonrelated per- sons in the change process. The process is built on Freire’s (1978) model for building critical consciousness. There are women’s, men’s, children’s,

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adolescents’, and couples’ culture circles, all containing persons of mixed ages, social classes, races, and sexual orientations. The groups are also var- ied in the problems that bring clients to therapy. This structure takes apart notions of what is “private” in personal and family life from what could ben- efit from being more public. It also levels power hierarchies among diverse client populations, thus liberating (i.e., providing a legitimate forum for) the perspectives of traditionally subjugated groups (Figueira-McDonough, Netting, & Nichols-Casebolt, 2001).

IFS uses many tools to help clients identify power issues in their families (as well as in work arenas and the society at large). For example, clients are given power and control wheels (see Font, Dolan-DelVecchio, & Almeida, 1998), by which they can readily identify power abuses that have occurred. These tools also serve to educate clients about what constitutes power and control issues. After the initial intake session, all clients join a same-gender, 6- to 8-week, socioeducational orientation group, in which they examine the many factors that contribute to the problems for which they came to therapy, including broader social issues. Video clips of movies and documentaries provide vivid material and examples of how issues of power, privilege, and oppression play out in families and society.

The aims of the sponsorship program and IFS’s active advocacy projects are to dismantle power, privilege, and oppression at the broader societal level. Clients speak about their wish to “give back” what they learned at IFS. In this regard, several male clients established the first National Organiza- tion of Men Against Sexism group in New Jersey, and other clients have spo- ken at schools and churches on the prevention of violence, sexism, and domestic violence. Many former clients serve as sponsors of new IFS clients. The sponsors are not therapists but support persons who serve in a variety of roles. They serve as mentors to those who are struggling with issues of equity and nonviolence in relationships. They offer expanded notions of masculinity (e.g., nurturing, gentleness, and empathy) and femininity (e.g., financial viability and empowerment), including respect for women, chil- dren, people of color, sexual minorities, and others who are different from them. Moreover, they may serve as resources to clients of the same cultural or religious background or may provide needed and missing information on a topic for a particular culture circle.

The structure of therapy at IFS (i.e., culture circles, sponsors, and socioeducation)—its organization and feminist framework—suggests to clients that issues related to power, privilege, and oppression are central to all relationships; problems have social roots; and problems are better solved in a community, particularly one that shares a critical consciousness. Like- wise, broader social values that isolate family life from community life are problematic. The program’s philosophy conveys that elevating privacy and autonomy perpetuate male rites of passage that are often organized around themes of violence and the devaluation of women.

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How does this program operate practically? IFS is a nonprofit agency that serves about 200 diverse clients per year. The center is located in a lower middle-class community, on a bus line. The diversity of the clientele is due not so much to the location of IFS as to the program’s philosophy, which does not separate people by race, sexual orientation, class (via fee structure), or presenting problem. Additionally, the program’s reputation for success- ful work with clients who are involved in domestic violence has garnered clients from a wide socioeconomic base, who have been referred by other therapists, organizations, and the court system across the state and beyond. Fees are determined on a sliding scale according to the clients’ ability to pay and are adjusted to allow multiple members of a family to participate in the therapeutic program. Approximately 30% of the clients pay fees that are near the lower end of the fee scale, and 10% pay fees that are at the high end; 60% use some form of insurance, with sessions billed according to the ser- vice received (usually group sessions but occasionally a family or individual session). IFS does not participate in managed care, which it considers to be “a subversive system of care . . . oppressive to providers and consequently to clients” (R. Almeida, personal communication, February 20, 2003).

Most therapy is conducted in the culture circles, which vary in size up to about 20 people per group. The groups often meet simultaneously and are therefore convenient for family members. This group treatment structure also allows the therapeutic staff members (full- and part-time) to work as teams with students in training and sponsors. As was mentioned earlier, the sponsors are IFS volunteers who have graduated from the program or are asked to participate in a session because of their unique perspectives or skills (e.g., a policeman; a clergy member; or a person of a particular race, ethnicity, or religion). The team format seems to energize the staff and to maximize the time they spend with clients.

Liberation of self and accountability. The program is guided by two over- arching principles. First, all therapeutic interventions are intended to liber- ate, or empower, clients by developing their critical consciousness. IFS maintains that personal and social liberation occurs when collectives begin to decipher mechanisms of power, privilege, oppression, and dehumaniza- tion (Freire, 1978; Martin-Baro, 1994); understand how power relationships shape people’s perceptions and experiences; and identify how they can assume a role in social change (Gutierrez & Lewis, 1999). Accordingly, the process of building critical consciousness is central to all aspects of thera- peutic work at IFS—particularly the socioeducational component.

The second principle involves the assumption that the liberation of women depends on the accountability of men (Almeida, in press). That is, women and subjugated others are not empowered—their voices are not heard (Dinerman, 2002; Weick, 2000)—unless those who dominate and/or wield power begin to take responsibility for change. Disparities in power

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and equity (between men and women, among various races, and among persons of different sexual orientations) need to be redressed for people (especially women) to achieve liberation. The program is atypical in this fea- ture. Most therapies (including most clinical social work) involve a single therapist working with an individual, couple, or family. Feminist therapies typically focus only on women. There is generally no built-in source for holding clients (particularly the ones with more power and privilege—e.g., men) accountable for maintaining attitudinal and behavioral changes over time. At IFS, the group structure, sponsors, and team approach serve to initi- ate this accountability. The goal of this therapeutic emphasis on male accountability is to take pressure off those with less social power (e.g., women) to do all the changing and accommodating. Instead, the responsi- bility for change is placed on those with more power to change the oppres- sive social structure.

The following is an example of how these two principles operate in the program. I witnessed a 52-year-old African American man read to his wife and four children a letter detailing his abusive behavior toward family members. The reading occurred within the public forum of the men’s cul- ture circle. Reading the letter demonstrated the man’s willingness to take responsibility for his actions toward his family and to begin the process of reparation (making amends to family members and beginning to repair or atone for his offenses). The circle of men provided support to both the father and his family members in this difficult truth telling. Accountability was addressed by way of the other men’s commitment to hold the father respon- sible for not harming his family. This latter point (safety for family mem- bers) is integrally tied to the two principles. The mother and children who were involved in the session claimed to feel physically and psychologically safe, confident that the other men would support the father in keeping his promises and maintaining nonviolent behavior with his family. Accord- ingly, the father was held responsible for his misdeeds, was answerable sub- sequently to his family members and his men’s culture circle for maintain- ing more responsible and less controlling behaviors and began the process of reparation in this public truth telling.

Others have written about the value of witnesses in the therapeutic con- text. Reflecting teams (e.g., Hoffman, 1992) and “definitional ceremonies” using outsider witnesses (White, 1999) are examples. What seems different at IFS is that the witnesses come back the next week and the next. The group work structure affords an ongoing community that can challenge misuses of power and privilege directly and thus empower those with less power and privilege. Even more critical for women, it can hold the participants (both clients and staff) accountable over time to the new critical consciousness. This program is attempting to change the balance of power and privilege between women and men and among persons of various classes, racial groups, and sexual orientations.

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Clients’ Impressions

What do clients say about their experience with the IFS program? In this sec- tion, I present four themes that are characteristic of those that emerged in the interviews with IFS clients, who responded to the question “What has been your experience here at IFS?”

“Therapy was such a different thing than I had thought.” This first theme rep- resents clients’ reactions to the therapeutic format. Several clients said that the therapy they received was different from what they expected. Some talked about their initial resistance to the same-gender culture circle format. The following quote is from Stan, a 34-year-old German American construc- tion worker. Stan and his wife came to the program because their arguments were becoming more intense and frequent. He was also unhappy with their sex life. He stated,

Therapy was such a different thing than I had thought. I thought we would be in couple sessions. . . . So, when you’re put in with a bunch of men and you only have a short period of time to talk, I always wondered what was happen- ing with her. We weren’t having couples sessions. It was hard at first because things people said in the group were going against all the roles I grew up with in my household—the role of the male, the husband, the son—it challenged all those fundamental ideas. But I look back, and I think it was for the best. I con- centrate on what’s going on with me first and not as a couple. I tell this to the men that come here not to get all excited and angry about things because you’re uncomfortable with confiding in men.

Stan described his reaction to and initial discomfort with the structure of the program. That is, he found himself in a men’s group and his wife in a women’s group, instead of couples therapy, which he expected. He said that he was uncomfortable not knowing and unable to control what his wife was saying in the women’s group. At the same time, he was put in a situation that required intimate sharing with other men. Both are structurally imposed changes in partners’ ordinary way of relating to each other. The structure is designed to encourage people (particularly men) to take respon- sibility for their own emotional lives by requiring them to deconstruct their interpersonal issues first in the context of the culture circles. Rather than couples’ insulating themselves in perhaps more comfortable couples coun- seling, partners go to same-gender culture circles first to expand their views of themselves and the situation. When couples counseling is held, it is done within the context of the men’s, women’s, or couple’s circles. Paradoxically, many men I interviewed stressed how intimacy with other men taught them skills for being more intimate with their partners. One man said that learn- ing to “carry my own emotional burden, instead of putting it on my part- ner—to feel my own feelings and to share significant events with other men—frees me up to be more intimate with my wife and family.” Women

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learn “I’m not crazy; my situation is.” This connection seemed more avail- able to female clients because “crazy-making” issues of power and privilege are directly and specifically tackled in all the culture circles, although sepa- rately, by both genders. Although most clients, especially the men, expressed initial reservations about being in gender-specific culture circles, all the clients I interviewed proclaimed the value of these circles.

“Breaking down barriers.” Many clients said that the diverse (i.e., inter- generational, interracial, mixed-problem, sexual-orientation, and social class) culture circles help to break down barriers between people who are different and would otherwise have little or no contact with each other. They were surprised by the commonalities they found. The following comment is by William, a 31-year-old African American male psychology student. Wil- liam stated that he initially wanted to be in a “Black men’s group” but later came to appreciate the value of the diverse men’s culture circle. He noted the following:

The program helps us to draw connections between men of color, men of dif- ferent classes, and men at different places on the power and control wheel. It helps to bring us together and to see the ways we use power and control in our own lives. The society through the media tells us that we’re all separate and [that] there really aren’t many similarities between us. The program here breaks down a lot of the differences that we otherwise might put up as walls between us to keep us from communicating with each other and coming to terms with the way we use power and control in our lives.

I was one who bought into that separation. Then, sitting right next to me in the group was a White male cop who physically abused his wife! And then, on the other side sits a White man who is three times my age who sexually abused his daughter! I would say to myself, “What am I doing here because that’s not my background. I haven’t used my power in those ways.” So, early on, I was putting up walls and saying, “Well, I’m not really sure this is for me because of the obvious differences.”

Over time, I’ve realized it is all connected. The ways in which we men use power in our workplace and family life crosses culture and profession and race and age, which I otherwise probably wouldn’t have seen. . . . If I say, “Well I’m not a child molester, I’m not a rapist, I’m not a woman abuser,” then the things I’m doing are kind of small, as opposed to, “Wow, I’m doing almost exactly what he’s doing, just to a lesser degree. Or maybe I ostracize my girl- friend just as much although I don’t play around or drink. But, she still feels just as isolated.” Now that goes hand in hand with breaking down those barri- ers. I’m able to see myself in them and say, “Maybe I do need to be here. Maybe there is some work that I need to do.”

When university police used racial profiling to stop and harass William, the larger IFS community of clients and staff members supported him finan- cially and emotionally to take legal action, which he did and won. In his men’s circle, William also had many opportunities to give older White men advice, breaking down traditional racial and social mores—experiences that

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would not be afforded him in a more traditional therapeutic setting or in a Black men’s group.

In the foregoing quotation, William said what many did—that hearing other men share the diverse problems for which they come to therapy helps them to see their own mis

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