BOOK REVIEW

Critical Clinical Social Work

BY JIM MORTON, MSW, RSW

In Critical Clinical Social Work: Counterstorying for Social Justice, the book’s editors, Catrina Brown and Judy E. MacDonald, offer what they describe as “an original critical clinical approach to social work practice” (p. 2). The book includes both their own perspectives and those of 29 other contributors, most of whom are affiliated with the School of Social Work at Dalhousie University. The editors rightly point out that this focus on clinical practice is significantly overdue because radical social work, for the last fifty years, has viewed “clinical practice as focusing on the individual and not contributing to social change” (p. 2). Their timeline is unerringly correct. In March 1969 the Committee on Psychiatry and Social Work published a monograph expressing alarm that “during the past decade...especially in the schools of social work…adequate training in the methods of casework is being or soon will be dangerously curtailed by the increasing focus on social theory and techniques at the expense of attention to the problems of the individual client” (Group for the Advancement of Psychiatry, p. 36). Books like Critical Clinical Social Work are indeed overdue and urgently needed.

Critical clinical practice is an “approach to social work practice that intentionally ensures that critical theory and understandings of problems or struggles people experience are reflected in the approach to therapeutic conversations” (p. 16).

Feminist and narrative methods of therapy are emphasized, and problems are understood to emerge in a social context.

This context is influenced by neoliberalism, which tends to medicalize human problems, placing responsibility for difficulties on individuals, while ignoring larger structures that generate troubles. In addition to the editors’ introductory and concluding commentary, the book’s 17 chapters cover content that ranges from critical clinical theory to mental health issues, violence against women, substance abuse, child welfare, immigration services, spirituality and African Canadians, chronic pain and an interesting overview of the functioning of the Dalhousie School of Social Work Community Clinic.

Critical Clinical Social Work has many strengths. The content choices speak to matters that regularly confront social workers and these issues are, for the most part, deftly handled. Clinical problems are ‘unpacked’ with a clarity that demonstrates the authors’ familiarity with the research and their commitment to scholarship. Each of the chapters explores its theme with reference to professional social work roles and principles and links individual experience to community and the larger socio-economic and political environments. The critical clinical approach to practice describes a refreshing commitment to listening deeply and to collaborating with clients who are understood to bring essential expertise to the clinical encounter. In this valuing of clients who find themselves struggling in the neoliberal vortex, Critical Clinical Social Work offers an important alternative to the prescriptive and dominant biomedical model and calls on our profession to double down on its commitment to social justice.

The book also left me wishing for more in three key areas.

I was surprised that so little is said about the connections between biology, epigenetics, social relationships and individual functioning in the discussion of human challenges. Critical clinical practice links problems, and the solutions it offers, to language, philosophy and the creation of new, more hopeful narratives. In this sense the approach is largely cognitive, ignoring advances in neurobiology and its implications for individuals and the family systems and communities they inhabit (Noone and Papero). This area of science is clearly relevant to clinical practice, as well as to social work’s core concern with the person in society.

Secondly, I was struck by the extent to which the authors ignored families. “There were 14.1 million private households in Canada in 2016, 9.5 million (67.7%) of which were composed of at least one census family” (Statistics Canada) yet it is not until page 201 in this 409 page book that the reader is encouraged to recognize, not humans, but companion animals as family members. Oblique references to families occur in discussions of child welfare, immigration, indigenous culture, and work with older people, but nowhere within this collection of articles is the family itself recognized as a structure worthy of focused attention.

This is no small point. As a species we evolved within family groups. Millions of years of evolution and millennia of lived social experience mean that individuals are closely attuned to each other and that families can be understood as ‘emotional units’ (Kerr, 2019). The immediate social - and genetic - contexts of social workers and their clients are those we identify as mothers, fathers, siblings, cousins, grandparents and aunts. (If there is doubt about this, check out postings on social media.) It seems odd to recognize community and social culture while ignoring the immediate social systems that influence everyday lives from conception to death.

Family theory, like clinical work, tends to get little attention in Canadian schools of social work (Pirie & Morton, 2019). This may mean that families are not so much misunderstood as ‘invisiblilized,’ to use the language of critical clinical theory.

Finally, as someone who has spent many years in the consulting room and decades as a supervisor of social workers and students, I would like to see more exploration of the actual clinical encounter. Critical Clinical Social Work touches on the clinical relationship, but emphasizes theory. It’s one thing to intellectually appreciate the connections between symptoms and family and larger social systems. It’s an entirely more daunting matter to be a social worker, sitting alone with a troubled client or a client-family, in the consulting room. Clinical work means experiencing the anxiety of a recent assault. It involves exposure to a parent’s panic following a teenager’s suicide attempt. It demands being present with clients whose anger and despair are frequently directed at the social worker.

How does a clinician find ways to remain calm and thoughtful in such moments? How does one find a way to work with the anxiety in the room while moving toward a richer understanding of the client’s experience? What do effective clinical encounters look like? When is it productive to explore family and other relationships and how can this best be managed? How is an interview ended when the issues remain muddled and the next client is in the waiting room? We need conversations about being in the clinical room and more literature that validates the legitimacy of such dialogue.

Critical Clinical Social Work: Counterstorying for Social Justice makes a valuable contribution to the social work literature. My hope is that it will be widely read and studied and that it sparks a lively discussion about the place of clinical activity within social work and its many specialties. I also hope it stimulates research, writing and conversation related to neurobiology and epigenetics, the nature of family systems, and about the clinical encounter itself. We’ve been worried about this gap for more than 50 years. It’s time to focus on clinical work. Critical Clinical Social Work is a good start.

REFERENCES:

Brown, Catrina and MacDonald, Judy (Editors). (2020) Critical Clinical Social Work: Counterstorying for Social Justice. Toronto: Canadian Scholars.

Group for the Advancement of Psychiatry. (1969). On Psychiatry and Casework: A position statement formulated by the Committee on Psychiatry and Social Work. New York.

Kerr, Michael E. (2019) Bowen Theory’s Secrets: Revealing the Hidden Life of Families. New York: Norton.

Noone, Robert J. & Papero, Daniel V. (2015). The Emotional Family System: An Integrative Concept for Theory, Science and Practice. New York: Lexington Books.

Pirie, Anne and Morton, Jim. (2019) Reclaiming Our Place: Successful Social Work Practice in Medical Model Settings. Connections Volume 2 Issue 3. Halifax: Nova Scotia College of Social Workers.

Statistics Canada (2017): Retrieved from: https://www150. statcan.gc.ca/n1/daily-quotidien/170802/dq170802a-eng.htm

JIM MORTON, MSW, RSW is a social worker with interests in mental health, family systems theory, politics, and social change. He lives in Kentville, Nova Scotia.

Book cover of Critical Clinical Social Work: Counterstorying for Social Justice

https://www.canadianscholars.ca/books/critical-clinical-social-work