Work Vrodit*-(?rrowcd from che medicai ;-jrotcis:cii. considered to be a iuecessioJ example for building■srienrifu-knowledge. The medical paradigm considered intervention ;is a three-stage process; study, followed by diagnosis, and then ireacment. Evalua-;ion of Treatment outcomes was added «s a fotirth feiagr designed to feed Formation back into ihe study process. Mary Richmond (191R), an carl v advocate of die importance of moving »cinl worker* from 11«; sunns of ■*i entUj veiion" to scientifically inlormcd proFcssionals,encouraged tin* adoption: of the model. This paradigm helped social work develop zs a profession, and element of die paradigm will probably always I» central to our work, The itgument advanced here is :h.»i there have been sign i f tem i changes iii .•■;r Lmdcrstandirvj o: the helping pJUtCÍS_Jiid the dynamic way in whii ' ivotVc:> .!• dejienu teract These ne* insights suggest thai .1 paradigm «hift may he usel::;. Thi*. new parjdi;»m would incorporate the besi > \ whai we have developed under :lie inedita I paradigm while providing: á ffercnt model For viewing practice. Such a paradigm sluli may .1 :<:».< 'x- uitdét wav It's important t<: poím nut that I inn nor using thewniiJswtóaŕííufl.Ví. ■^ u a so sometimes used, w deserib-j .m iHncwamd patholoßv m co tattoo :v'w.ttd assessment of clients- Pro f©«*) na Is. w\U uftun tt.II mc (Mat :hc\ hav« abandoned the medical model, meaning (hat ;bcv locus-, on .t :c-i < urengths raibei than limitations, and that ihcy sceclieiiis m their -ix ;:i- liuuext. I hii is j cijiiiniuii bul narrow use of the term. I run rclef-nriK i" the medical paradigm that maj stil! be employed l>y those who usea health ratherthan illness orientation for diagnojhig clients l helíevť ~lt.ii interest in j health and systems ffaminvoŕlc tni understanding clienL-i i .. signal <">! the paradigm shite taking plate. Even mki.i! workers who develop a loctal and community action approach [otlieirpractitc, helping :lit ;:is iu organize (eg . tenant rfssoaations in housing prujecta) may still :r; using the thfee-Ka^emedicaipa/adigiiialthough they mayeinphj.si-fte diagnosing and dunging the íysiem and may stdistiuite .1 diRt-rem :i uology Issues Associated with the Current Social Work Paradigm Wim anajiome of the issues associated wich the med&aj paKiíligiii thai mighi lead as 10 want to consider a paradigm sluli? First, the paradigm ?u^'jľs;š that the helping professional lysomehow-tMu-Hdefof the process r : she y/ishes to influence. 'rhejrtjrkcrsjMt^i^erjupnsave vigwed as :hc result c^u sound .sludi..and .didgnosj-i. When Oik- examines actual examples of pranice, as for example in an analysis cond-acicd in one of :u\ eari) s;udies nf practice ;Saultnan. IU78;, wc see chat, in reality, dur worker's movement» arc as much influenced hy the moment-by-moment n—íJdfi'iiiT n Tfc..(.-_ .,/• n_„,( ;„„ . /] inieracú«n_wjih iheciienr. as., by the ircatnicr.í pton. In one p?.ri of :h:s study, when we examined 120 videotaped hours of social work practice wiih individuals and groups, using s computerized interaction analysis system that I developed lor che study, it was clear rhat ihe interaction between worker and client was reciprocal m nature. The movements of •he worker influenced die responses of the client and the client responses influenced the worker, and so on throughout ihe session. Does a three-step paradigm adequately describe diis interactional process? I dyn't believe it does, and ;n fact.! think jt shifts onr_thepry-building efforts and research away from a locus on the process tovard a focus on tlie client apart from the process. Evidence for this a raiment can he found m a review of our practice research that i* influenced liy our professional paradigm. Very few orour praaicejstudics actually focus on what the worker say«, and does with the client. Although the current influences of behavioral and psychotherapy models have led us to examine method more closely, by and large, social work studies have ignored ihe interaction between work«." and client. In Fischer'* controversial review of the social work practice literature (I9?:l>. he asked, "Is Casework Effective?" Fischer decided that die research had not supported the efficacy of our practice. What was overlooked in hss analysis is thai none of ihe studies reviewed examined whal ihe workers were actually doing with their clients. The independent variables ir. die studies included how often they did '"it* (e.;tí . frequency of contacts perwcaltj. Ute social worker's level of ipuning when they dKl "it [e.g., M.S.W. versus H..S.VV. or inn rained), or ihe modality of service used when they did 'it" (<"■«.. individual, family, or group work). Wh;ii was noi studied ill any of dir projeti!» was toltiti the ~iť* was riot ial workers Wrie dome. The opo:aii>;iia.'i.::iii; of Ihe indrpendcni var-lahlc (SOCial work practice) "<■* »ever lakcn to the level thai would have allowed us to disdnguish between die effective workers and those who we're nut effective; We have all seen workers with similar professional decrees who were snore or le.ss effective. We were asking. "Is casework effective:*" The question we should have been exploring was. "Wh..t is casework!1" k\ my argument ihat the question was not even nosed treatise our paradigm did noi lead u.% in that direction Kuhn points out that among other things, a discipline's paradigm defines 'he important research question* < 1 QC»"i> The three-step diagnostic paradigm places greater «rmphasi» on understanding the client than it place» on understanding the proce.« of :nicratiinn between worker and client. Ic is n«ii accidental that the early leadership of ihe psychotherapy research, which focused on (he communication and relationship skills of the therapist, was provided by the group building upon the paradigm shift in psychotherapy advocated by Kogers (e.g. Trjax. i!)r}o). It was the new in:eraction-orientcd and clicnt-csneered paradigm 'hat sent (hese researchers in ihis direction. It is also interesting :o consider :he mode: building whi«:li sprang from our interest in general systems theory, sparked by the pioneering work of Cordon Hearn (1553. 19oiJJ. This view stressed the :mponance of un- 14 ' InltrraCtional'Racial Wnrk Prfcttr* licrs^ar.difig cJenci :ri dynamic interaction with the Systems around ihcn [family, gnwp, agency, etc.;. Htjwiever. most eiirlv mooch die. not include viswincthe worker-client irrtcractior, :n the sane wjv. u was as if the worker were outside of a dynamic system., looking in, A second issue related to the use of the niedxal paradigm is :i:e dctr-inar.ee in our theory-building efforts of a suggested dichotomy between a worker's professional and personal self. Professional objectivey was valued as the quality ;frat allowed the helper to divorce him or herself from subjective feelings, attitudes, ano lieUcís thai might negatively influence practice- A premium was placed upon presenting a prafesstona, seif upon which the dient might project, such as ,n tbe process of transference. The notion of maintenance of a professional stance was an important or.e in that i: protected aeains; a worker "acting out" his or her own problems with the client, ailowme personal prejudices to influence ihe process, or responding negatively, which might occur in association wiih countertransferer.ce. Unfortunately« this view created a dualism in the minds:.Ol many profesaonab between their personal ;civef and :heir professional selves. Rather than attempting in develop a synthesis of 'he two. in which each professional makes use of h:s or her personal self in implementing ihe professional function, many minefield believed professionalism repaired ihe suppression of ones feelings. One result of this offshoot ol the paradigm has been the dev-loptncn: »fa itcreotypcofa profissioniil without genuine feeling for his or her client. If one arflued lliat spontanea'.' u sharing or »orket affect in the disciplined pursuit >i one's professional function was at the core of the helping process, then a paradigm thai incorporated thu concept won.d more jo: u rate!* describe die helping process In ir.v earl» studies (Shulman, 1079k sharing of personal thoughts i:.ii feelings by ihe workei «us a -.kill ilu« correlated highly with developing j good ■-orking reLt.unship and effective lielpinjj,iw perceivOil 'i* clients.1 As one c:ien: put it m :;ct i cMnrncms on a (|ueUK>«nHÍrc; "I like mv worker. She isn't like a protessional. s:nr's bk«t_a real person-" In my training .*urk w:lIi thousands ofhefping prufcssiona:s.ov« ihr vears die\ consistertlv reported tha: their practica] experiences htitl tainjht them the impArtaikce of integrating ihcir human i|ualities into iheit inicracrlons with iheiiti. However, many felt (hey hjd in hide their wflrfc from their colleagues, who w>-niid nave considered them ' iiiiprotessioiial" these protes-uniuis would \>r aided '>> a paradigm in »huh the liitinan inter-action be:ween worker and i li«u was central '•: '.*>c rn«»del. In Hry own siudy oi the pracúce ol family pliysictitib wah iheii pnlieiits. I fount! :.^at ihe phvsnian"smtnude toward the palic^l {posíliv*, neutra;, or negative) wus an iniponaut predictor of the outcomes of patient comprehension, satis faction, arid compliance i.Shuluiao ä Buchán, IDŕíJ;. In -p.te of ihe fact ;hat the physicians were sure that their professional stance insulated them from the effects nľ their "personal" frrl'.n^s. their paiier.ts dearly perceived ir.ese attitudes and were effected by them. Dďie.'cemg a Thtttry of Pradie? • I? 238 This variable was added to the study design when a phyMcisn serving as a key informant during the instrument develcpmcn: s;a^s said. "Haw will you account for those pa;tents 1 schedule for ihc end or the day, oecause If 1 be^an the cay with the::) i: would be ruined For me?" As I pursued :hc meaning of the question, i: became clear that the physician's paradigm of practice would not allow him to admit to me. or hinise:f. :hat he really did not like these patients. He could, however, accept a question ;>n his altitude toward patients «voided as "äuBiüvjs, nrutral. or negative." Active exploration of physician attitude toward panents in my '.raining efforts with family practice resident yielded important insighi* into medical as weil as relationship issues connected to the feelings of the doctors. A mure accurate paradigm for medical praciicc itself would be one lhal also understood the reciprocal nature of the interaction.* ll has been argued thus far that a paradigm that guides professional social work practice, teaching, and research exists. This paradigm has added Kt our understanding and the professionalism of our practice U has also been argued that jigmfiatu advances in our Knowledge pi clients their systems, and the helping process may have prepared ihc way for a shin lo .1 new paradigm, which incorporates more elTcctively new under-standings and practices. 5uch a shift, if it lakes place, ivi'il only be accepted by the field it (he new paradigm provides answers ;o troublesome anom-alies, suggests more productive directions for our research, makes it easier for us to teach new professionals how to practice effectively, and Creoles a closer fit between our theories and model] and the day-to-day realities experienced by pmteviioiials in l he field One Such paradigm is described in the next section and elaborated on in the chapters that follow Others will certainly emerge to compete for the acceptance of (he held. This is a healthy process for the development of any. profession An Interactional Paradigm of Practice f'aeiiuernciional p jradiifin was described by William Schwartz in ar. entry on group work practice published in Tht Socia! Work Lnc,(t,->praui (1977), He described his model asan intcrac t ionist approach. The article in which he fir« described liLs theory was called "The Social Worker in the Croup" (Schwartz, 1961), and was extracted from an unpublished doctoral dis-serration (Schwann, I1MH1). Although Schwanz was widely known .is j group work theorist and the founder of what was later termed the "reciprocal model" (Pappel Sc Kothir.an, I9ö6j. his interest was In developing a theory of social work practice that would describe ihc profession in action in its many different settings and differing modalities of practice (individual, famiiy. group, community). Schwartz drew heavily on Social interact ionist theorists and philosophers (Baldwin. 1911; Dewey. 1922; Foils«. l*)2(i; James, l'J58. Mead. 1934: Parsons, 1937) as weil as social work theorists such as Luide man (1939),, Pray < l!MU), and Keam (I958j. Lawrence Frank Í1Q57). from the held of psychotherapy, was another important infiuencc. In particular. it's interesting to note his roots in what is still termed the junciiimat school 16 • interactional Social Work Practice of M-tia^ wer'-:. Whose Founders, Jessie ul't anc Vi r ji_n iat R< >l:j::st; 11 f tali, 19421 ajnirihoietl many crucial constructs «hicři luve achieved Wide acceptance in practice today Three o: the moat important irjih.de the impact t*f litne on practice beginnings, middles; .md endíngs'r. ihe importance of erripa:ňy in '.he helping process, and the [lowerol clarity of agency function. Ii w is the functional school, physically located at the School of Social Work a: the -'nr.-e-s v- :t Pennsylvania, rtiac first challenged the medical, or d.2gnc«:K._riJrüdigrr.. Taft and Robinsoni drew upon the ideas cf Rank, adhcip.e «ho broke with Freud, to develop some of (lieir central notions of change. These views w-re no: well received in a field cortinaied by S reiirrian jiivchology. In addicon, social work was attempting to enhance iii. professional status by borrowing the paradigm of practice employed bv psychiatr.*. Advocate* of the functional approach found themselves excluder: from the mainstream of the held. Thev were not invited to rjresent at conferences, and die peer review process worked tn Exclndp their publication» from journals; Schwanz turned ;r> the nch literature of the social mtcnictwnists, socuil philosophers, and cnrív %ooal work pioneers in developing lüg own synthesis, which he termed the mteraetionist mode:, (I have changed lite term .'fuv-s. iv.i'i w ntirrnrtiwtrti This places the emphasis on the pmccss rathcrjhaii_on_tlie p*ih>*'• Othws have at limes railed it the "mcdiaiinn" t 'r iinxal" model.) Central to the paradigm was j view uf th-g helping relationship m which a sclf-realiiinjj, energy.produciniii Kent with ■ ei tarn lasksto pcrfôrni and • professional with a specific function in carry out, engage each other .» .merdependent actors Mithin an nr|;.iľ,n system 11*17 .; hie ffKUSed his attention on the w.-vs in widen each pc'\«ť, in the mtem "reverber nes" as all of them ail upon ChciC respective reasons for being there, with (heir lasts changing from moment to moment. The relationship .-. a au ilar, reciprocal nnc, with each part) [«(»rfcei iintl ihcim affecting .aid being affected by i'he'cM wii Starting wnb this paradigm Of practice, one's encPRy is directed toward understanding the client in a moinent-by-mmneni iiitentt-tJon with the worker. A premium is placed on the worker * ability n, understand h« ). hei'tuitex .i pi.-rt(|Mi-.i:e for effective actum Another principle associated with an tntcracwnwl p;ir:idiiť«) Li injc cvniralhyof mcihod. Mcthndiis.thewaji in which ihcliclpin^prijlcwtuinnl piiK his or her function into action. A premium is piat cti mi 4|ltr .ibľ.iiv to describe in *omc detail exactly how our profess in na! rule i> miplé-menrcd. Cnmmunteatibn, reiatioiuhip.arzd pmblem-solvmirsfcilkare'ihe tools wurkeri use :o implement their function. Developing sk.lls withoui harnessing them :o adearscnviol one s function will result in melfrfiivc practice. A worker skilled m (he use of empathy has to kn«w which reelings :r> empathise wich ui pursuit of what purpose. The empathv sk.ll. Devgio>ping a Theory ci Practice • ! 35 39 CQUghtapart frcir. the structure provided by cisrity of purpose and worker function, will not contribute to (he helpingproccss. Finally, understanding [he worker-client interaction as a dynamic system taking place wkftin a 'arger dynamic system (agency, community; society; leads us to 3 holistic approach to theory development anc research. Ali these core ideas are descried and illustrated in the baiar.ee df this book. The Common Elements of a Practice Theory In any effort to develop a unified, cmpiricaJly based practice :henry for a ptofí;«ion.f.íie first seep involves focusing on the core elements that apply to social work practice in any setting, with any population employing any modality of service [individual, family, group, or community work). We have :a observe dcariy what it is that.social workers bring to their work that identifies them m members of a single profession. In past efforts CO identify these unifying elements, we h;ivc focused on common knowledge and values, a unified code of ethics, and a shared interest in the psychological ami social issues lacing clients- While all of these elements con-tribute to the unity of a profession, they do not address commonality of method. 1Vvh.1t we know anil value, our ethical injunctions, and our interest in both Tierson and situation are all important conmbuiors to our activity with clients, hut they are not .Substitutes for a clear definition flT wh.it .s common about what it is we actually do as we put knowledge and values into action. A unified practice theory should provide i*s wuh the tools for recog" ni/mg a »cul worker :ii action, as he or she works i*ith an individual seeking counseling ni a rehabilitation agency, leads a group of patients on .1 psychiatrie ward, helps a lannly m a counseling agency, or organizes tenant* m a housing proi.ru. Although the purposes and processes in each of thcte encounters may be different in many ways, a unified practice theory should help us_perceive.the cimiinonalicicj in the meshiKÍoUigy employed by each practitioner. In addition, if our profession is unique, we should be able 10 observe the unique qualities oFsooul work iftierven-::on as compared to other professions, *n 'he next part of this section. I wjl| provide an illustration of the common eJeincnls of such a theory", loe^sineon the interaction between persons f worker and client} in context «verrime. This discussion is followed by a.section that illustrates how ;his common core is differentiated into the variant elements o! practice. Person in Interaction Many person-related factors may influence :he outcomes of practice. For example, che client's motivation may havea powerful impact. The degree of stress the client experiences or the nature of the problem may prove? io be strong predictors of outcomes. The client's acceptance of a problem and ability to use help may also make a difference. IS • Interactional Social Work Practice ?-rsor.--;^ied factors may influence a worker's interaction with clients. A workers background, education, and ".raining; stress from heavy zuseioacs: or :he nature of the problem {e.g.. sexual abuse) niav take ;i5 toil on worker nWliVatiort. aitiiudcs. and oehaviuts with clients. These person-related fLCi^iSiUeexample^ufcoinmotielcme.-us-ifa practice theory chat may influence;all ■;• ients and workers in their interactions. Startingwith the assumption that workeranci client personal variables inriuence the interaction, the next step is to examine worker skill. To illustrate the theory elaboration process I will use two coreíkilís employed by workers with client* These are the skill defined as sinrifi/mg reU and the emcathic skill called crticuUuing 'Ju cKait'i ieeli*ti& (Shuimar.. l'i7S. 1981. :'i'82;. Clarif-.ing role :s a skill in which the worker explains, in omulc. non-jargon:;ed terms, his or her role m the proceedings. This statement is ;hc worker's attempt to answer the following question from the client {cvei'l if the question tí never directly asked), "How *HI you help me?" The prrphaiunn directness and the restriction nn jargon ;S important hecnuse of the jnfortunate tendency for professionals to use language that obscures rather than clarifies our role (f j. enhance social functioning;, fa-í.ii:.i:c individual growth and development, and strengthen egos) Clarification of one's roc -s an important elerfletttol the crucial contracting work which must rake place if-a framework for p:oduciivc practice is to be developed. Articulating the clients feelings involves the worker hecominjj jq tannin :o the dient * inner feelings and concents that he or she is qitttife to respond directly to indirect cues in their presence." For example, when a mother says her daughter has been going through a tough tunc With the breakup of a marriage, articulating the clients feelings might sound like ihn "Anô ,t has n : ber n M easy urtie lor you either " It iscructal '.hat the chininem tiy the worker be genuine in ih.it the worker must really be irvimj to feel the mother's rx'.in these arc two example» ft! core skills, Which one might rxpi-a to see m the pnu t ice of any social worker, in ir.v setting, with any «diem, working in any mtxkilitv of service, They are examples 11F constant elements ol • •■rial tforfc practice. Thtí actual elaboration of the rule of tin.- social worker, and the kinrb ol"dient lecüngs the worker will cmpjiln/e with, arc all variations oil the dintnitui liicntn Kor example. .1 social workci in a r.innr, . iuotIi -^ igencv might arucuiate a rule that reelected ihe purpose of the agency anil die :amilv counseling modaLiy ol'scrvtce "Hie feeluiga of die eJicnc which arc relevant to family dynamics and laimly čmtitsdiug. might be articulated hv í hi* stsoal wutkei. naiother social worker, working in a community organization agency, ought elaborate .1 ciilFeieni mie fcecjuse he or she contracts with tenants m a housmi; project. The h;ddcn feeLntrs in ti.-M •es.iion.s nugh: relate to tin: icnaiKs' fears of reu-ibut!iin by ;he housing authority One could easily areaie thai these ;v*o skills are also iniportani for anv hrlpine prolesaiouai. tor example. leathers, poychothe-apists-. dmturs. nurses, or physical therapists, I -voulc agree. The difference hetwee« Developing c Theory of Practice • 19