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Journal of Social Work Practice Psychotherapeutic Approaches in Health, Welfare and the Community
ISSN: 0265-0533 (Print) 1465-3885 (Online) Journal homepage: http://www.tandfonline.com/loi/cjsw20
Narrative social work: conversations between theory and practice
Karen Dawn Roscoe , Alexander M. Carson & Lolo Madoc-Jones
To cite this article: Karen Dawn Roscoe , Alexander M. Carson & Lolo Madoc-Jones (2011) Narrative social work: conversations between theory and practice, Journal of Social Work Practice, 25:1, 47-61, DOI: 10.1080/02650533.2010.530344
To link to this article: http://dx.doi.org/10.1080/02650533.2010.530344
Published online: 26 Nov 2010.
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Karen Dawn Roscoe, Alexander
M. Carson & Lolo Madoc-Jones
NARRATIVE SOCIAL WORK:
CONVERSATIONS BETWEEN THEORY
This paper begins by reviewing the current situation in social work practice. It is contended that much of the literature around social work consists of diverse models of practice that urge social workers to take up various theoretical positions. Equally, social workers are often encouraged to listen to the views of service users. In this complexity, it is often difficult for social workers to know which approach to take. This paper goes on to propose a narrative-based approach to social work practice. Narrative social work is defined as a conversation between theory and practice, which can lead to development in both social workers and service users. An example from the lead author’s practice is used to outline the model in action. The paper concludes with some comments about the values inherent in narrative based social work.
Keywords narratives; critical realism; conversations; engagement; reflection
A number of studies have identified how social workers draw selectively on models or methods during practice. Bull & Shaw (1992) for example, explored the deployment of professional knowledge in social work to support ‘diagnoses’ in casework. They found that social workers tended to draw on preferred theories to understand human circumstance. These, in turn, tended to reflect the most dominant approach/theore- tical perspective of the time. They noted how systems theory was favoured over more linear approaches to finding causes for people’s problems; whilst behaviours, on the other hand, were referred to in terms of psychodynamic theory. Scourfield and Pithouse’s (2006) later study highlighted how social work with children and families was dominated by psychodynamic ideas. Similar to Bull and Shaw’s (1992) study, in Scourfield and Pithouse’s (2006) research social workers privileged certain theoretical perspectives over others. These studies suggest how theories and methods in social work were selected strategically to maintain an emphasis on professional ‘expertise’. This served to support a particular narrative plot or diagnoses for the service user. In the endeavour to explain human behaviour and situations, social work practice is very often a mix of social workers’ overt ‘common sense’ alongside a more implicit application of models and theories (Pithouse & Atkinson, 1988; Hall et al., 1997, 1999; Riemann, 2005; Scourfield & Pithouse, 2006). Researchers have typically been critical
Journal of Social Work Practice Vol. 25, No. 1, March 2011, pp. 47–61
ISSN 0265-0533 print/ISSN 1465-3885 online q 2011 GAPS
http://www.tandf.co.uk/journals DOI: 10.1080/02650533.2010.530344
of those who adopt common sense claims to understanding human complexity in social work practice (Pithouse & Atkinson, 1988; Hall et al., 1997, 1999, 2006; Riemann, 2005; Scourfield & Pithouse, 2006).
‘Theory’, in Scourfield and Pithouse’s study (2006) for example, was argued to comprise the interaction of professional and lay knowledge, in as much as reference was made to ‘best practice’ literature. The choice of theory and of which practice issue to theorise was dictated in part by lay assumptions (Scourfield & Pithouse, 2006). In the context of practice with children and families, common sense approaches to practice are understood as ‘lay theorising’ (Pithouse & Atkinson, 1988; Scourfield & Pithouse, 2006). Whereas professional theorising reflects the formal theories and methods of social work which social workers draw on in their everyday work, lay theorising consists of common sense assumptions which reflect broader cultural and social ideas which contain discriminatory and oppressive assumptions. Broader cultural and societal ideas include a moral assessment of the service user, and this is argued to have a greater influence on practice than is recognised (Hughes, 1994). This has more to do with social workers’ evaluations of service users’ worthiness than a purely evidenced-based account to support practice assumptions (Clark & Mishler, 1992; Hughes, 1994; Johnson & Webb, 1995). Equally, the deployment of formal, professional knowledge in the way of theory has its difficulties in social work; for example, in Care Management frameworks.
Research concerning the deployment of professional knowledge in adult services on the other hand, outlines how social workers view Care Management as ‘de-skilling’ (Jones, 2001; Postle, 2002; Carpenter et al., 2003; Carey, 2007; Stanley et al., 2007). These research studies have highlighted the uncertainty surrounding the deployment of models and methods. Social workers saw their practice as mostly related to ‘bureaucracy’, organisational change and feelings of not being acknowledged as having any ‘skills or abilities’ (Jones, 2001; Carey, 2007). The Care Management model was often understood in terms of the constraints of bureaucracy and administrative tasks, with the dominant ‘voice’ on Care Management as a model which restricts the freedom to deploy more creative methods or ‘face to face’ social work (Jones, 2001; Postle, 2002; Stanley et al., 2007; Carey, 2007). Despite moves to more of a case management model of social work, however, it is still the case that social workers retain some discretion to interpret and moderate policy in practice (Scourfield & Pithouse, 2006).
Dominelli & Hoogvelt (1996) argue that the fragmentation and routinisation of complex professional tasks in assessment and Care Management privilege managerial over professional values and objectives. Howe (1992, 1996) supports this, viewing social work as a proceduralised professionwith interventions that are functional almost to the exclusion of any creativity or skill. This is understood by many authors as a result of the more authoritarian elements of social work practice under CommunityCare policy because of its emphasis on managerial outcomes (Ife, 1997; Pease & Fook, 1999).
While some practitioners favour specific professional methods and theories, they also deploy a mixture of lay and professional theorising within the notion of ‘expertise’ (Pithouse & Atkinson, 1988; Hall et al., 1997, 1999; Riemann, 2005; Scourfield & Pithouse, 2006). Other practitioners may insist on engagement, creativity and interpretation as vital elements of social work and social workers here insist on the service user’s ‘expertise’ regarding a given situation. Researchers however caution us against any common sense view from the street, and in practice it seems that social
JOURNAL OF SOC IAL WORK PRACT ICE4 8
work might have elements of these often contradictory ‘models’ of practice. Social workers are expected to take the service user’s perspective into consideration as well as any particular model of practice that they adopt. The problem is that these views and practices become the unspoken, implicit assumptions behind social work practice. If a social worker simply adopts one of these theories or perspectives, there is no opportunity to test these assumptions. This has grave implications for social work if it is to develop itself as a reflective profession. Into this complex situation, narrative approaches have promised a way forward in the development of models for practice.
In social work, the narrative turn has been slow to arrive (Solas, 1995) and according to Margolin (1997) and Riessman (1993) this is understood, among other reasons, as some social workers’ reluctance to adopt methods or models for practice that defy notions of science and ‘professionalism’. We want to argue against this view of professionalism based on the current literature discussed, which indicates that there is currently a tension in social work practice. This tension is between a view of practice as the implicit adoption/interpretation of certain theories or conceptual models and the need for more models that adhere to anti-discriminatory and anti-oppressive practice. This includes service user participation and involvement in their support and care.
Social work practice has become increasingly more complex and some theories, in reality, may not be possible to apply in practice. For example, some may view that in working in state social work, this hinders any possibility of creativity. It is worth reminding ourselves, however, that Care Management links with Lipsky’s (1980) arguments, that is, whilst management and organisational ideology establish the rules and procedures for social workers, they will also find it difficult to control the work which is undertaken by the social worker. Lipsky’s (1980) theory of discretion argued that policy implementation required considerable discretion exercised by the social worker and it was their ability to make rules or interpret policy which influenced practice. Here, we argue it is how we engage with service users in our ‘face to face’ assessments and care planning procedures which constitutes professional discretion and creativity in social work practice.
Equally, while we think that service user involvement is essential to any professional relationship, we also think that service users can be wrong or mistaken. The question remains for practitioners to decide between these, at times, competing claims. The current answer is probably that social workers sometimes prefer service user views and interpretations and that sometimes they go with a more theoretical orientation. However, their reasons for doing so need to be more clearly articulated. In trying to provide a justification for their decisions in practice, we have developed a narrative-based approach to social work. It has no particular theoretical orientation and it begins from the ground up, with social workers and service users sharing their stories and experiences. We want to suggest a way forward for social work practice in helping to develop an authentic relationship with service users and an ethical model of practice.
Social work and narrative approaches
The term narrative is used in a variety of ways in history, anthropology, socio-linguistics, nursing, social work and education (Riessman, 1993). ‘Narrative’ has acquired an increasingly high profile in the last decade (Squire et al., 2008) and originates from the
NARRAT IVE SOC IAL WORK 49
‘linguistic turn’ towards language in the social sciences, primarily rooted in social constructionism and other relativist approaches (Gergen, in Kazdim, 2000). From this perspective, a narrative is a story-based account of happenings/events, but contained within it are other forms of communication which convey the social and cultural location of the teller (McLeod, 1997). The narrative, then, is seen as more than just a simple story but also points to a particular situation or context. Narratives are both reflexive and indexical accounts of what happened, to whom it happened and where it happened (Garfinkel, 1967). Reflexivity here means that the narrative constructs a particular reality while indexicality refers to the context that the narrative articulates and situates itself in. Narratives then make a claim about context and reality. While some have seen them as rather individualistic accounts, reflexivity and indexicality show us that all narratives situate themselves in social and political contexts.
The narrative turn towards social work saw a number of books being developed, such as Milner (2001) and Parton & O’Byrne (2000), both of which contained ideas drawn from narrative therapy. Although these authors explore how narratives can be a foundation for practice intervention, the application of narrative approaches from a variety of different theoretical perspectives is limited. Fraser (2004), for example, notes that social workers who wish to adopt narrative approaches will need to consider how they can avoid being seen as lacking political and social awareness if:
they ignore the politics of narratives and the extent to which they support or contest social structures and practices.
(Cited in Jackson, 1998, p. 62)
This again is an example that accuses narratives of being potentially blind to such obvious ‘things’ as social structure. This setting of one narrative, perhaps a service user’s or social worker’s, against another narrative, that of supporting or contesting social structures, is to have already insisted on a particular narrative that can judge social workers and their clients’ narratives in terms of their social and political awareness. This is an example where even professional knowledge could be questioned. Narrative approaches in social work should not only reflect aspects of ‘reality’ but should also challenge taken-for-granted assumptions in practice, including ways of interpreting policy initiatives and practice models such as Care Management.
Narratives now extend to a number of different disciplines and the definition of ‘narrative’ is a term that is in much dispute (Squire et al., 2008).
Narrative enquiry in the human sciences is a 20th-century development; the field has ‘realist’, ‘postmodern’ and constructionist and scholars disagree on its origins and precise definitions.
(Riessman & Quinney, 2005, p. 393)
Narrative social work, as we are defining it here, does not begin with a ready-made meta-narrative such as psycho-dynamic theories or critical ‘realist’, ‘postmodern’ and constructionist strands which can then be used to measure other narratives. We are sufficiently postmodern to agree that all narratives have immediately equal status but we do not believe that social work can leave things there. Postmodernism, as a social work
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practice, advocates what has been called the ‘campfire model of practice’ (Carson & Fairbairn, 2002). Here, all voices are equal and everyone is heard. So far, our narrative approach would support this but we want to go further and suggest a way that social workers could engage more authoritatively with their service users.We think that social workers have more to offer than this but we want to resist the idea that they should automatically assume that because of their more ‘theoretical and professional’ knowledge they are in a better position to make professional judgements. We have developed a conversational model of practice that does show how social workers can ethically engage with their service users. It questions the initial assumptions of all voices at the campfire.
Narrative social work as conversation and practice
We have developed a democratic model of practice based on professionals and service users sharing their stories. This model is based upon three stages of practice: engaging with the service user; exploring and deconstructing stories which may be theoretically and conceptually ‘saturated’; and working with service users to re-author stories (see Figure 1).
Engagement with service users is the key to successful practice and engagement skills remain a vital component of social work (Egan, 1990; Burnard, 1992). Lambert’s research (1992) outlines how successful relationships with service users are not solely related to theoretical orientation and the method employed. In fact, only 15% of any change as a result of intervention can be attributed to the model itself; 40% is attributed to service users themselves (things that happen in-between sessions), and a further 15% is attributed to placebo, hope and/or expectancy. The remaining 30% suggests that it is the relationship developed which is the most important component to successful practice. Whilst Lambert’s work is from psychotherapy, it is important to note that this reminds social workers of the value of developing meaningful relationships with service users when applying any model for practice. In conversations between social workers and service users, both can engage in sharing of stories with the
• Social worker • Service user • Share stories • Listening
• Background assumptions • Power relations • Culture history
• A new understanding • Self development
FIGURE 1 Narrative social work as conversation. Adapted from Roscoe and Madoc-Jones
(2009, p. 12).
NARRAT IVE SOC IAL WORK 51
initial assumption that both are of equal value. Mutual respect is a constitutive part of this type of engagement. This allows each to see where the other is coming from.
According to Winslade & Monk (2000), exploring stories involves the process of questioning or deconstructing taken for granted assumptions. Viewing things from a different perspective enables gaps or inconsistencies (unique outcomes) to be surfaced in the narrative. The particular theoretical/professional knowledge that social workers bring to their encounters with service users, as well as common sense assumptions of both are de-constructed. Some participants in these encounters may have a particular view of reality that they now need to question. Reality for a service user may be rather different from a social worker’s. In this sense, we attempt to make the familiar or taken for granted story strange rather than obvious. It can reveal methodological, cultural and historical assumptions that constitute each narrative.
Re-authoring conversations is an invitation to reconstruct a new narrative that includes both social worker and service user in the development of a new understanding. This new understanding is a shared and inclusive practice. The model is not a theoretical construction but a structure and process that is open ended and inclusive. We can think of a conversation as something that ‘we’ share: it is not mine and it is not yours. It’s a very hot day and I am thirsty; I go into a café to order a cold drink. While waiting to be served, someone at the next table turns to me and says ‘it’s hot’. I know it’s hot and my new interlocutor knows that I know that it’s hot. Here conversation is defined as not so much a communication method but as a way of creating a social space that we share. Charles Taylor puts it very well when he states that:
. . . the image of the conversation conveys how the goal is to reach a common language, common human understanding, which would allow both us and them undistortively to be . . . The aim is fusion of horizons, not escaping horizons. The ultimate result is always tied to someone’s point of view.
(Taylor, 1995, p. 151)
The conversation is inclusive as it tries to collect all points of view to try and reach a new understanding that all share. All parties to this conversation can learn from each other. An assumption of anyone who engages in conversation is that their view is one view among a number of possible views. In encounters between social workers and service users this conversation can begin with each sharing their narratives of how they see the situation. This provides an inclusive model of practice that helps each to reflect on their own stories; both professional and lay narratives. In the next section, we will explore the model in action as a practical example of how this model might play out in practice.
Mrs Roberts was referred to an adult social services team. A carer’s assessment had been requested as her husband, who was 78 years of age, had been diagnosed with the ‘middle stages’ of dementia. Mr Robert’s had been getting progressively worse, there had been significant caring responsibilities and Mrs Roberts used terms like ‘stressed’ to explain how she felt.
JOURNAL OF SOC IAL WORK PRACT ICE5 2
In the interview, Mrs Roberts’ disclosed feelings of caring that included guilt, fear and worry but clearly stated that she would not accept any support or services for the family because she saw it as her responsibility to manage and would feel guilty if she was to accept help. The social worker accepted Mrs Roberts’ decision but gained an agreement from her to visit on a regular basis to talk with her some more, explaining the purpose and role of a narrative inquiry/conversation. Mrs Roberts met the eligibility criteria of ‘substantial risk’ under Unified Assessment Wales (Welsh Assembly Government, 2002). Substantial risk is understood within unified assessment as ‘there is, or could be, an inability (physical or mental) to carry out vital personal care, domestic or other routines’. Within a Care Management approach, the social worker documents this on a care plan as ‘social work support’ in the manner of an ‘ongoing assessment’ and ‘monitoring’ process in relation to any associated risks. As Lipsky (1980) reminds us, we have the professional discretion to interpret policy frameworks. Here the social worker draws on the ‘use of self’ (Harrison & Ruch, 2007; Reupert, 2007) in their practice. This is understood as the combining of knowledge, values, and skills gained in social work education with aspects of one’s personal self, including belief systems, life experiences, and cultural heritage (Dewane, 2006). The ‘use of self’ enables social workers to strive for genuineness with service users whilst honouring the values and ethics of anti-oppressive and anti- discriminatory practice.
The worker in this case used externalising conversations (deconstruct) with the primary objective to situate the problem (caring) away from the person, asking Mrs Roberts questions such as:
. What has the guilt tried to talk you into about your role as a carer?
. How has the fear tried to convince you that it is unsafe to leave your husband?
. How does the guilt link to your ideas about being a woman?
. How has the worry been influencing your ideas about caring?
(Adapted from Morgan, 2000; Pease & Fook, 1999)
It is important to note that terms such as ‘worry’ or ‘guilt’ could be associated with normalising psychiatric discourses such as ‘stress’ and ‘anxiety’. The practitioner in this context views etiology of mental ‘illness’ as classification systems which remain social constructs, but have consequences personally, culturally and structurally for that individual. The shift in language to ‘the’ worry is a way in which to see the problem outside of the individual. As the facets of the problem gradually develop it gains its own persona and the problem becomes ‘separate’ as a ‘thing’ or ‘being’ (Morgan, 2000).
Mrs Roberts was also invited to recall a time where she considered that the caring responsibilities were particularly difficult or easier. In one instance Mrs Roberts recounted a memory that gave insight into some of the assumptions underpinning caring that enabled her story to make sense.
I remember the time when my husband had been awake for three nights. I also had flu during this time, and so I was worried about catching up on sleep during the day in case he needed me at night. I was so tired, I remembered sitting downstairs in the kitchen and thinking that I needed some kind of help. I remembered bursting
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into tears and feeling a ‘tidal wave of despair’. The help I wanted was not help for caring, I mean help for cleaning because I knew this needed doing. I remember deciding against this and I said to myself ‘this is what you have to do as a wife’.